Plastic and reconstructive surgery最新文献

Background: The stromal vascular fraction (SVF) of adipose tissue has now been widely used in plastic surgeries, clinical trials and therapies. However, the cell composition of SVF undergoes dynamic changes during aging and obesity, which may influence the efficacy of the SVF. This study analyzed the effects of age, harvest site and body mass index on the cell composition of the SVF.

Methods: A study was performed on 162 patients. The age ranged from 13 to 88 years old, with body mass index (BMI) <25kg/m2 or ≥ 25kg/m2. Fat tissue was harvested from the abdominal region, hips, thighs or arms, and the SVF was isolated for flow cytometry.

Results: Our results demonstrated that the declines of adipose derived stem cells (ADSCs) and endothelial cells (ECs) first occurred in donors aged 40-49 years old. Subsequently, the percentages of endothelial progenitor cells (EPCs), preadipocytes, and M2 macrophages started to decrease in donors aged 50-69 years old. Lower percentages of ECs and M2 macrophages were found in donors with higher BMI.

Conclusions: This study demonstrated that the percentages of ADSCs and ECs of SVF, decreased significantly starting from donors over age 40, followed by changes in other cell subpopulations. Furthermore, donors with BMI ≥ 25kg/m2 had lower percentages of ECs and M2 macrophages.

Introduction: Rhinoplasty surgeons often rely on tip grafting in order to add volume in the infratip, mid-tip or supratip areas. The author has developed a novel tip graft, from the repurposed, pliable cephalic margins of the lower lateral cartilage lateral crura. The main purpose of the soft triangle tension graft (STTG) is to control tip tension of the medial crura, buttress the soft triangles and add a small degree of volume to the tip.

Methods: A retrospective review was conducted identifying all patients where the STTG was utilized. Basic demographics, operative reports and complications were recorded.

Results: The STTG was utilized in fifty-eight patients. Fifty-three were female with an average age of 33 years old (range: 22 to 45 years of age) and average follow-up time of 12 months (range: 8 to 24 months). No postoperative complications - including graft malposition, migration, palpability, visibility, infection, alar notching, surgical revisions -were evident on follow up.

Conclusion: The novel STTG focuses on buttressing and controlling tension between the two medial crura and soft triangles rather than simply adding volume to the tip. The soft, pliable nature of the graft enables versatility which can be used even in thin skin patients with a favorable safety profile.

Introduction: Quantitative neuromorphometry analysis of the peripheral nerve is paramount to nerve regeneration research. However, this technique relies upon accurate segmentation and determination of myelin and axonal area. Manual histological analysis methods are time- consuming, and subject to error and bias. We demonstrate and validate a user-friendly method relying on opensource machine-learning software and no coding knowledge.

Materials methods: 19 rat facial nerve segments were fixed, osmicated, embedded in epoxy, sectioned, and stained with toluidine blue. Whole nerve cross-sections were scanned at 20x. Images were pre-processed in ImageJ to measure fascicular area and remove background. Images were imported into Ilastik and the pixel classification module used to segment myelin and axons. A novel CellProfiler pipeline was used with Otsu 2-threshold processing to segment and quantify individual axon and myelin objects from segmentations. Axon counts and g-ratio of nerve samples were acquired manually and using this technique to compare between methods.

Results: Analysis of an entire nerve cross-section can be completed with this method in less than 5 minutes. Bland-Altman plot and intraclass correlation coefficient demonstrated reliability between axon counts performed manually and with this protocol. There was also no statistically significant difference in accuracy in determining g-ratio compared to manual techniques (p<0.05).

Conclusions: The protocol presented here demonstrates a novel and accurate means of segmenting and analyzing histological nerve cross-sections. This method decreases both user time and potential bias. It enables analysis of an entire nerve versus random sampling. Lastly, this protocol utilizes only opensource software freely accessible to researchers.

Background: Temple hollowing is characterized by the reduction of volume in the temporal fossa, which can result in a skeletonized look and contribute to an aged appearance. This study aimed to evaluate the safety and effectiveness of the VYC-20L injectable gel for improvement of temple hollowing.

Methods: Adults with minimal, moderate, or severe temple hollows were randomized 2:1 to receive VYC-20L or no treatment. Participants were followed for 13 months for safety and effectiveness assessments. Treatment effectiveness was assessed by blinded evaluating investigators using the validated Allergan Temple Hollowing Scale (ATHS) and the Global Aesthetic Improvement Scale (GAIS), and by participants using GAIS, FACE-Q scales, and patient satisfaction questionnaires. Adverse events and injection site responses (ISRs) were monitored.

Results: At Month 3, 80.4% of the treatment group vs 13.5% of the untreated control group achieved a ≥1-grade improvement in both temples on the ATHS (P < 0.0001). The ATHS responder rate remained high throughout Month 13. The GAIS responder rates at Month 3 (responses of Improved or Much improved) were high in the treatment group, as assessed by the blinded evaluating investigator (83.8%) and participants (92.9%). Furthermore, satisfaction with Facial Appearance and Temples on the FACE-Q questionnaires increased significantly from baseline (both P < 0.0001). Adverse events and ISRs were mostly mild and consistent with the known safety profile of fillers.

Conclusions: VYC-20L treatment showed favorable safety and effectiveness results in restoring temple volume, with significant aesthetic improvement and high participant satisfaction. Treatment effects lasted for over a year.

Summary: Thighplasty is a widely performed body contouring procedure, utilizing various surgical techniques for thigh lifting, including medial scar positioning, vertical and horizontal procedures, and liposuction. Despite its popularity, thighplasty is associated with high complication rates and suboptimal postoperative outcomes.This article presents a novel technique: the J medial thighplasty combined with helium plasma radiofrequency technology (HPRF) to address moderate skin and soft-tissue laxity and ptosis in the inner thighs. Between 2020 and 2023, 21 patients underwent this combined procedure. The surgical approach involved selective liposuction in targeted areas, skin resection, and preservation of deep tissue layers, coupled with the application of HPRF in the lower third of the medial thigh.Results demonstrated significant reductions in thigh laxity, correction of skin overhang, and fat reduction, yielding improved functional and aesthetic outcomes in the lower thigh region. By strategically avoiding lymphatic vessels in superficial areas, the risk of secondary lymphedema was minimized. Patient satisfaction was notably high, with both patients and surgeons reporting favorable results.In conclusion, the J medial thighplasty combined with HPRF offers an effective and straightforward method for enhancing the lower thigh area with minimal complications. This innovative technique provides a promising solution for patients seeking improved thigh contouring while ensuring high levels of patient satisfaction.

Background: The benefits and cost-effectiveness of functional septorhinoplasty have been previously demonstrated. However, reimbursement for functional septorhinoplasty by health insurance companies remains inconsistent. The purpose of this study is to define the current state of insurance coverage for functional septorhinoplasty.

Methods: A cross-sectional analysis of insurance reimbursement for functional septorhinoplasty in the United States was designed. The top three insurance companies per state based on market share data maintained by the Kaiser Family Foundation were included. Established medical policies were gathered from insurance company websites and phone interviews, and descriptive statistics were performed. Primary outcomes included the level of and criteria for coverage.

Results: This study included 67 insurance companies representing 88% of the United States market share. Most insurance companies offered coverage with preauthorization for rhinoplasty (61%) and septoplasty (55%). However, some companies determined coverage on a case-by-case basis (rhinoplasty 25% and septoplasty 22%), while others had no defined policy for coverage (rhinoplasty 14% and septoplasty 23%). The most common criteria for coverage of rhinoplasty included nasal deformity secondary to trauma (98%), congenital anomaly (88%), and other disease (85%). The most common criteria for coverage of septoplasty included nasal obstruction (49%), septal deviation (46%), and recurrent sinusitis (40%).

Conclusions: Functional septorhinoplasty offers significant improvement in nasal breathing and quality of life, yet disparate insurance coverage criteria limit patient access to care. Patient-reported outcome measures data will be essential to define an evidence-based list of standardized criteria for insurance coverage of functional septorhinoplasty moving forward.

Background: Abdominoplasty may be considered a procedure performed after a patient has already lost weight, but many surgeons have clinically observed that patients continue to lose weight in the postoperative period. This study sought to quantify continued weight loss after abdominoplasty procedures.

Methods: A retrospective chart review was conducted on all abdominoplasty cases performed by the senior author between 2018 and 2022. Patient demographics, surgical information, and postoperative weights were all obtained. Independent samples t-tests were used for comparisons between groups.

Results: One-hundred eighty-eight patients were included with an average age of 42.5 years and follow-up of 26.5 months. Average preoperative weight and BMI were 167.8 lbs and 27.7, respectively. Average weight loss and percentage of body weight following surgery was -5.77 lbs (-3.15%) at 3 months, -5.28 lbs (-2.77%) at 6 months, -4.02 lbs (-2.17%) at 12 months, -4.18 lbs (-2.23%) at 2 years, -4.16 lbs (-2.20%) at 3 years, and -9.8 lbs (-5.29%) at 5 years. No patient who lost weight required revision surgery for additional skin removal.

Conclusion: Patients undergoing abdominoplasty experienced maintenance of surgical weight reduction and continued weight loss up to 5 years postoperatively. Those with higher BMIs had significantly greater weight loss that increased at later time intervals.

Introduction: Laser resurfacing provides a minimally invasive method for addressing facial/neck skin rejuvenation neglected by modern surgical approaches. Despite its popularity, there is a paucity of outcome data. Herein, we present patient reported outcomes (PROs) to assess the effectiveness of a single surgeon's approach to skin rejuvenation.

Methods: Adult patients undergoing first-time facial laser resurfacing (with broadband light and hybrid Er:YAG/thulium laser or hybrid thulium fractional laser alone) between March 2023 - February 2024, performed by the senior author (GG) and laser specialist (Registered Nurse: RN (LS)), were prospectively analyzed. Patient demographics, laser technique/settings, prophylactic medication, and post-procedure management were collected. PROs were assessed during early and late recovery periods, using 10 FACE-Q surveys related to appearance, health-related quality of life (HRQOL), and adverse effects. A paired student's t-test compared pre- and post-treatment responses.

Results: A total of 71 (69 female, two male) patients were identified. The mean age was 56 years [40-78]. Most (>50%) patients experienced tightness, swelling, tenderness, discomfort, and burning in the early recovery period, that dissipated over time. Post-procedure facial (p < 0.001) and skin (p < 0.001) appearance scores improved significantly, whereas that of facial lines insignificantly improved (p = 0.053). Overall, most patients were satisfied with the treatment outcome and their decision to undergo laser resurfacing.

Conclusion: Patients were highly satisfied with both the decision to undergo the procedure and the outcome, particularly in facial appearance and HRQOL. They experienced minimal adverse effects in the early recovery period that dissipated over time.

Summary: This novel hybrid single-double-single barrel (1-2-1) design for fibula free flap reconstruction addresses the unique challenges presented by Brown Class III mandibular defects, which involve long-span defects at both bodies of the mandible and the chin. The importance of this design lies in its ability to overcome the limitations of traditional approaches in terms of mandible height and pedicle length, while optimizing both functional and esthetic outcomes.The technique utilizes a combination of single-double-single barrel fibula segments to achieve ideal esthetics and support for dental prosthesis across different areas of the mandible. At the chin, a double barrel design provides proper chin and lower lip projection and supports dental prosthesis at the alveolus, while single barrel segments are used for the mandibular bodies to allow adequate restorative space for dental rehabilitation and save the pedicle length.Favorable outcomes were demonstrated in terms of flap survival, dental implant osseointegration, bony healing, facial aesthetics, and occlusal rehabilitation. By addressing both functional and aesthetic requirements, this technique represents an important advancement in mandibular reconstruction for complex Brown Class III defects. The approach showcases the potential of computer-assisted surgery and innovative flap designs to improve patient outcomes in challenging reconstructive scenarios.

Background: Ideal methods for double eyelid crease creation in Asian upper eyelids remain controversial due to the complexity of Asian upper eyelid anatomies. Key confusions include the underestimation of tarsal height and the septum/aponeurosis fusion point height (FPH), which may underlie the unnaturally high creases in many classic double eyelid procedures.

Methods: A total of 1272 patients had tarsal heights measured. Among 386 patients with orbital septa opened, FPHs and other anatomic findings were also documented. Based on the anatomical findings, a novel method for double eyelid crease formation was designed. This method involves preserving the pretarsal fibrofatty tissue and using horizontal mattress sutures to connect the orbicularis oculi muscle (OOM), through the pretarsal fibrofatty tissue and levator aponeurosis, to the pretarsal membrane (MAP method) as the linkage mechanism.

Results: Tarsal height levels were higher than reported in many previous studies. In the supine position, all FPHs were higher than the tarsi. Eyelid creases using the MAP method are created below the superior tarsal edges at varying heights, accommodating individual patient requests while achieving well-formed creases and improved eyelid mechanics. The recovery was brief, and the results were long-lasting with a minimal failure rate.

Conclusions: Tarsal heights and FPHs are not as low as previously thought, which could explain why many 'classic' surgeries encounter various issues. Our proposed MAP method for Asian double eyelid blepharoplasty allows conservative crease-height-adjustability with results that are dynamic, natural, and durable.