Plastic and reconstructive surgery最新文献

Background: Macroglossia is a hallmark feature of Beckwith-Wiedemann Syndrome (BWS) and may affect a child's appearance, speech, and feeding. Tongue reduction surgery (TRS) is often recommended to address functional concerns, but its effects on patient-reported speech outcomes remain unclear. This study evaluates self-reported speech outcomes in individuals with BWS.

Methods: Patients with BWS (aged 4-18 years) were prospectively administered the FACE-Q Craniofacial measures (speech distress, breathing, eating and drinking, facial function, speech function). Surveys were Rasch transformed score (0-100, 100=best outcome). Clinical characteristics, BWS Index of Macroglossia (BIG), and Intelligibility in Context Scale (ICS) scores were reviewed.

Results: Thirty-six patients (50% male; mean age 8.6±3.8 years at survey) were included. Most patients had an IC2-LOM genetic diagnosis (n=24, 66.6%). Average BIG score was 1.3±1.1 (range 0-3). Speech therapy was received by 28 patients (77.8%) and 16 (44.4%) underwent TRS at mean age 2.3±2.0 years. FACE-Q scores averaged 84.7±15.0 for speech distress, 84.9±15.0 for breathing, 80.9±15.9 for eating and drinking, 92.0±12.1 for facial function, and 75.8±19.5 for speech function. There was moderate correlation between ICS score and speech function (r=0.697, p=0.001). Patients who received speech therapy at school and clinically had lower speech function (p=0.014). No significant differences were found between surgical and non-surgical patients or by BIG scores (p>0.1).

Conclusions: While overall reported outcomes were favorable, speech function scores were lower, suggesting persistent speech challenges in this population. These findings underscore the multifactorial nature of speech development in BWS and the importance of individualized, longitudinal management to optimize outcomes.

Background: Capsular contracture is a common complication of implant-based breast reconstructive surgery and is especially challenging in the setting of post-mastectomy radiation. The objective of this study was two-fold; first to develop a novel rat model of radiation-induced capsular contracture, and then second, to use this model to evaluate the effect of a RHAMM function-blocking peptide mimetic, NP-110, on capsule fibrosis.

Method: The model consisted of female retired breeder Sprague Dawley rats (7 radiated, 7 controls) that underwent surgery to place a custom 2 cc silicone implant under the right fourth mammary fat pad. The implant, mammary fat pad, and overlying skin were then treated with 26 Gy of targeted ionizing radiation in 7 rats, which resulted in clinically, histologically, and biochemically measurable capsule fibrosis in all irradiated animals compared to non-radiated controls. A second cohort (n=14) received a local injection of NP-110 or scrambled control peptide (100µg/rat), followed by 26 Gy of targeted ionizing radiation.

Results: Clinically, NP-110 treated animals showed decreased post-radiation fibrotic change. A significantly decreased collagen deposition and bundling in the NP-110 group (p <0.001) was demonstrated by Mason's trichrome and Picrosirius red staining and had significantly less aSMA in capsule tissue compared to the scrambled peptide control (p=0.02).

Conclusion: This study demonstrates a novel, orthotopic and replicable animal model for radiation-induced capsular contracture and identifies RHAMM as a potential target for development of preventative therapeutic agents to manage post radiotherapy capsular contracture.

Background: Technical advancements in abdominal flap-based autologous breast reconstruction (ABR) have focussed on minimizing abdominal wall morbidity. However, no consensus exists on the technique that maximises abdominal function, particularly in cases of bilateral ABR. This systematic review critically appraises the literature to assess abdominal wall function following abdominal flap-based ABR.

Methods: A literature search was performed following PRISMA guidelines. Four databases (Embase (via Ovid), Medline (via Ovid), Cochrane Library and PubMed) were searched. The primary outcome was abdominal wall function following abdominal flap-based ABR measured by sit-up performance, manual muscle function testing, isokinetic dynamometry and ultrasound.

Results: 38 studies were included comparing various types of abdominally-based autologous flaps used for breast reconstruction. Sit-up ability was highest in DIEP group (87%) when compared to free TRAM (25%) and pedicled TRAM (12%). Bilateral DIEP had higher combined mean upper rectus and lower rectus abdominis function scores (4.54) compared to bilateral free TRAM (3.87), where 5 represents normal function. Bilateral ABR demonstrated worse abdominal function compared with unilateral ABR in all flap types.

Conclusions: DIEP flaps yield superior abdominal muscle function outcomes compared to TRAM flaps of all types, particularly when performing bilateral ABR. Future research should aim to standardise abdominal function measurement and reporting of intra-operative variables, such as the length of fascial and muscle incisions, the number of abdominal motor nerve branches sacrificed, and the use of abdominal mesh to enable more complete understanding of the impact of abdominal flap-based ABR on abdominal wall function.

Purpose: Surgical scarring has long been hypothesized to contribute to maxillary hypoplasia in patients with cleft lip and palate (CLP), often leading to a need for orthognathic surgery (OGS). This study aimed to identify clinical and surgical factors associated with maxillary hypoplasia in skeletally mature patients with CLP using cephalometric analysis.

Methods: A retrospective review was performed of CLP patients aged ≥16 years with available cone beam CT scans. Cephalometric measurements were obtained using Mimics software. Patient records were reviewed for cleft morphology, number and type of cleft-related surgeries (ages 0-16), surgical timing, demographics, and history of OGS. Linear and logistic regressions were used to evaluate predictors of maxillary hypoplasia and OGS.

Results: Among 106 patients, 47.2% had bilateral CLP and 49.1% underwent OGS. The average number of cleft-related surgeries was 4.28. BCLP patients demonstrated significantly reduced maxillary width compared to UCLP (-2.87 mm, p = 0.001). Increasing total number of surgeries was significantly associated with decreased SNA, ANB, and facial convexity angles (p < 0.001). Surgeries performed between ages 0-5 were significantly associated with decreased SNA, facial convexity angle, and alveolar length (p < 0.02). Linear regression showed that each surgery beyond three predicted a 1.94° reduction in SNA, 0.81° reduction in ANB, and 2.82° reduction in facial convexity angle. Surgical burden was not predictive of OGS.

Conclusions: Greater number of cleft-related surgeries, particularly in early childhood, correlates directly with maxillary growth restriction. These findings highlight the importance of optimizing surgical timing and minimizing additional interventions when feasible.

In surgical research, statistical sophistication is too often mistaken for scientific rigor. Across a growing body of plastic surgery literature, adjusted odds ratios, hazard ratios, and regression coef- ficients are frequently presented without the crude event rates or absolute measures of effect that give findings clinical meaning. We describe this phenomenon as "runic statistics": results that are statistically valid yet clinically opaque. Through examples drawn from contemporary plastic surgery studies, we highlight three recurrent interpretive flaws: reliance on statistical significance without consideration of clinical relevance, reporting of relative measures without baseline risks or absolute differences, and conflation of association with causation. We further demonstrate how case-mix imbalances can create apparent contradictions in results (Simpson's paradox), and how identical odds ratios can translate into very different clinical implications depending on the base- line risk. To address these challenges, we propose a thirteen-step reporting framework designed to promote transparency, interpretability, and clinical applicability. Key elements include explicit definition of the estimand, presentation of both crude and adjusted data, translation of relative effects into absolute risks and patient-facing numbers, assessment of minimal clinically important differences, careful handling of confounding, and restraint in the use of causal language. By an- choring statistical reporting in clinical realities, surgical research can remain both methodologically rigorous and directly relevant to patient care. Our goal is not to simplify science, but to ensure that its communication is clear, transparent, and ultimately useful at the bedside.

Background: Reconstruction of mandibular symphysis defects using deep circumflex iliac artery (DCIA) flap remains challenging due to the unique morphology and high technical requirements. Virtual surgical planning (VSP) and template-guided workflows may improve accuracy and efficiency.

Methods: This retrospective study evaluated clinical outcomes of patients with mandibular symphysis defects applied with DCIA flap. The primary outcome was morphological accuracy of actual post-operative model (APM) relative to virtual preoperative model (VPM), including deviations in superimposition, graft length, intercondylar (ICL) and intergonial (IGL) length, coronal (CMA), axial (AMA) and sagittal (SMA) mandibular angles. The secondary outcome was perioperative complication rates and functional outcomes.

Results: Thirty-one patients were included between 2018 and 2023 (18 with double-segment and 13 with triple-segment bone graft). All cases utilized VSP and Resection & Cutting-Osteotomy-Trimming (Re-COT) template system. Baseline and peri-operative parameters were comparable between groups. Double-segment procedures took significantly less time than triple-segment procedures (P=0.028). Superimposition deviations of neo-mandible and bone graft were negligible between the groups (P=0.357 and 0.242, respectively). The linear deviations were all similar between the two groups: bone graft length (P=0.224), ICL (P=0.722) and IGL (P=0.488). Left-side CMA deviation was significantly lower in double-segment group compared with triple-segment group (1.35 (0.68, 1.78) vs. 1.80 (1.50, 2.20), P=0.015). Rest of the angular deviations, including right-side CMA, AMA and SMA in both sides, all showed comparable results (P>0.05).

Conclusions: DCIA flap reconstruction guided by VSP and Re-COT template system is a reliable method for restoring symphyseal mandibular defects, ensuring high anatomical accuracy and procedural efficiency.

This study introduces a novel application of 3D printing technology to improve the precision of nasal osteotomy for crooked nose correction. A customized 3D-printed surgical guide was applied in ten patients, enabling highly accurate osteotomies with a mean deviation of 0.48 mm from the planned path. Patient-reported outcomes also improved significantly on the Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) questionnaire. This early feasibility report highlights the potential of 3D-printed guides to enhance surgical predictability, reduce complications, and support consistent results even for less experienced surgeons.

Summary: Alzheimer disease is a multifactorial neurodegenerative disorder characterized by amyloid-beta plaques, tau tangles, and neuroinflammation, with emerging evidence highlighting a potential role for brain lymphatic dysfunction. Lymphovenous anastomosis (LVA), a microsurgical technique traditionally used in lymphedema management, offers a novel solution to enhance brain metabolite clearance by bypassing impaired lymphatic pathways and enhancing glymphatic outflow. By connecting lymphatic vessels to veins, LVA compensates for aging-related declines in lymphatic/glymphatic flow, with preliminary studies supporting this theory. This review evaluates the feasibility of LVA, emphasizing key anatomical targets such as cervical lymphatic vessels, while proposing robust patient selection criteria. It also aims to address the controversies in outcome measures including advanced imaging, biomarker analysis, and cognitive assessments. Although early findings are promising, further research is essential to optimize surgical protocols, clarify biological mechanisms, and ensure safety. LVA represents a novel therapeutic strategy that may complement existing treatments, offering new hope for addressing the inevitable outcome of Alzheimer disease.