Plastic and reconstructive surgery最新文献

Background: Esophageal replacement (ER) in pediatric patients is complex, and while gastric or colonic interpositions are common, they carry long-term complications. Supercharged jejunal interposition (JI) offers better function but is technically challenging due to variable vasculature. We describe a protocol using computed tomography angiography (CTA) and 3D reconstruction to optimize surgical planning and vessel selection.

Methods: A retrospective review of patients undergoing supercharged JI for ER was conducted. Preoperative CTA of the chest and neck assessed the internal thoracic arteries/veins (ITA/ITV) and secondary venous options, including cephalic (CV) and external jugular veins (EJV). CTA with 3D segmentation of the superior mesenteric vasculature mapped jejunal branching patterns.

Results: Thirteen patients underwent supercharged JI with CTA-based planning. The median age was 4.9 years (range: 1.5-15.5). Bilateral ITA visualization was achieved in all patients, and all underwent supercharge to the ITA. ITVs were visualized with lower resolution. Ten patients underwent venous anastomosis to the ITV. The CV was used three times due to insufficient ITV size. Of 26 potential vessels, 42% of CVs and 15% of EJVs were insufficient for use. Five patients underwent mesenteric imaging with 3D reconstruction which identified significant vascular variability. Preoperative vessel mapping correlated with intraoperative findings and reduced extensive mesenteric dissection.

Conclusion: Preoperative CTA with 3D vascular modeling facilitates recipient and donor vessel selection, optimizes surgical planning, and may improve operative efficiency and outcomes in pediatric supercharged JI.

Background: Dupuytren contracture is a fibroproliferative disorder that causes progressive flexion deformities of the fingers. Various traditional procedures have distinct benefits and limitations. We developed a novel surgical technique combining selective fasciotomy with local flap interposition to restore extension while preventing pathological reconnection.

Methods: This study adhered to the STROBE guidelines. A retrospective review was conducted on 64 patients (90 fingers; average age, 68.1 years) treated between 2011 and 2024 at two institutions with expertise in hand surgery. Pathological cords were selectively divided through one to three transverse incisions according to the site of contracture. Skin defects were covered with digitolateral or ulnar parametacarpal flaps, which physically interposed between the divided fascial ends. Active extension of the metacarpophalangeal and proximal interphalangeal joints was measured preoperatively and at follow-up visits to assess surgical outcomes and recurrence.

Results: All flaps survived and no major complications, such as hematoma, infection, skin necrosis, or neurovascular injury, were observed. At 6 months postoperatively, 90.7% of metacarpophalangeal joints and 61.7% of proximal interphalangeal joints maintained extension within -5° of full extension. Among the 23 fingers followed for more than 2 years, no apparent tendency toward recurrence was observed.

Conclusions: This technique achieved favorable clinical outcomes with minimal complications. Selective division combined with local flap interposition may effectively reduce the risk of fascial reconnection and early recurrence. Further long-term studies are warranted to confirm the durability of these results and refine the indications for this approach.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, Ⅳ.

Background: While use of buccal fat pad flaps (BFPF) in primary palatoplasty has been shown to improve speech and reduce velopharyngeal insufficiency risk, the risk for obstructive sleep apnea (OSA) remains unknown. We hypothesize that using BFPFs in primary palatoplasty does not confer additional risk for OSA due to its favorable influence on palatal development and velopharyngeal mechanics.

Methods: A retrospective review identified patients who underwent cleft palatoplasty with or without BFPFs from 1995-2016. The primary outcome measure was the rate of OSA diagnosed by pulmonary sleep medicine with prescription for continuous positive airway pressure (CPAP) therapy. Secondary outcomes included need for adenotonsillectomy (T/A), resolution of obstructive sleep symptoms with T/A, and development of OSA after speech surgery.

Results: During primary palatoplasty, 100 patients received BFPF(s), while 110 patients did not. Incidence of OSA with BFPFs was 9.0% (n=9) compared to 8.2% (n=9) without BFPFs (p=0.832), with an adjusted risk difference of 1.3% (±6.6%). Neither the quantity nor location of BFPFs was associated with increased risk for OSA. There was no significant difference in the rate of T/A or the rate of symptom resolution following T/A. One patient with BFPFs and four patients without BFPFs developed OSA after speech surgery. Two patients without BFPFs developed OSA after revision for palatal fistula.

Conclusion: This study demonstrates no statistically meaningful increase in risk for development of OSA when BFPFs are incorporated into primary cleft repair. Given the favorable impact BFPFs have on speech we continue to recommend their use in primary palatoplasty.

Background: Twenty to thirty percent of patients develop velopharyngeal insufficiency (VPI) after cleft palate repair, and quality of life (QoL) may outweigh objective parameters in decision for surgery. We evaluated QoL using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument in post-palatoplasty patients and its impact on decision making for speech surgery.

Methods: Using cross-sectional methodology, patients ages 3-18 with history of cleft palate repair and their parents were recruited to complete the VELO. Hypernasality, a common manifestation of VPI, was determined by speech pathologist (SLP) documentation. Additional management of hypernasality included nasendoscopy and/or surgery. Clinical and demographic variables were extracted from medical records and summarized using descriptive statistics. Bivariate tests compared VELO scores, decision for additional management, and other variables of interest.

Results: Four patients and 66 parents completed the VELO instrument, representing seventy patients (52.9% female, mean age 8.2 years) with a median VELO score of 82.7 (IQR 20.0). Almost half (48.6%) of patients had hypernasality. Clinically evident hypernasality was associated with lower VELO scores (p=0.05). Patients with hypernasality who pursued additional management had lower VELO scores (median=62.5, IQR=13.0) than those with hypernasality who were offered but did not pursue additional management (median=83.7, IQR=11.3) (p=0.02). Patients with hypernasality who were offered but did not pursue additional management had similar VELO scores as those without hypernasality (median=86.5, IQR=18.6) (p=0.75).

Conclusions: Patients may not pursue additional management for hypernasality if QoL is unaffected, regardless of clinical assessment. Recurrent administration of the VELO instrument and clinical evaluation together can identify functionally limiting hypernasality that merits surgery.

Background: Costochondral graft (CCG) are the preferred treatment for Kaban-Pruzansky type IIB/III hemifacial microsomia (HFM) in children. However, debate persists regarding whether the periosteum and perichondrium should be preserved during surgery. This retrospective clinical study evaluated the role of periosteal and perichondral preservation in CCG transplantation.

Methods: Twenty-one consecutive patients with HFM who underwent CCG transplantation for mandibular ramus reconstruction were included. Based on whether the periosteum and perichondrium were preserved, patients were categorized into the periosteum-preserved (PP) group (n = 12) and the periosteum-stripped (PS) group (n = 9). Demographic data, surgical details, treatment outcomes, and postoperative complications were recorded. Three-dimensional computed tomography scans obtained immediately postoperatively and at 18-24-month follow-up were analyzed to assess osteogenesis.

Results: In the PP group, graft length increased by 3.39 mm, volume expanded by 223.25 mm³, and ramus height increased by 3.94 mm. Conversely, the PS group showed a graft length increase of only 0.44 mm, a volume decrease of 76.05 mm³, and a ramus height reduction of 0.93 mm. These differences were statistically significant (p ≤ 0.05). The PP group demonstrated improved mandibular symmetry, with an increased ramus height ratio and stable hemimandibular volume ratio. Conversely, the PS group exhibited reductions in both metrics. Notably, the incidence of pseudarthrosis formation was significantly higher in the PP group (p ≤ 0.05).

Conclusion: Preservation of the periosteum and perichondrium during CCG implantation enhances postoperative bone fusion, remodeling, and growth in patients with HFM.

Background: As the U.S. grows more diverse, equitable representation in medicine is vital for addressing health disparities and improving outcomes. This study evaluates demographic trends among plastic surgery trainees and compares them to peer specialties.

Methods: Applicant and trainee demographics in plastic surgery from 2017-2023 were obtained from AAMC's ERAS Statistics and GME Track databases. Trends were compared to orthopedic surgery, otolaryngology, general surgery, internal medicine, and family medicine. Analyses included chi-square tests, two-proportion z-tests, and linear regression.

Results: Female applicants to plastic surgery increased from 32.3% in 2017 to 48.3% in 2023 (2.7% annual growth, p<0.0001) with a slower associated rise in female residents (42.0% to 50.9%, 1.5% annual growth, p=0.0001). Comparable growth rates were seen in otolaryngology and general sugery, however plastic surgery surpassed orthopedic surgery, family medicine, and internal medicine in the rate of increase in female applicants and residents (p<0.05). Black applicants to plastic surgery remained stable (5.3% to 6.7%, p=0.22), while Black residents increased (2.4% to 3.8%, p=0.001), with similar trends across all specialties. The proportion of Hispanic applicants rose significantly (8.0% to 13.5%, p<0.0001), yet Hispanic residents declined (6.1% to 4.0%, p=0.06). Similar patterns were observed in both surgical and nonsurgical specialties, though the magnitude of increase in applications into plastic surgery was higher (p<0.02, all comparisons).

Conclusions: Gender parity has been achieved among plastic surgery residents, reflecting successful diversity efforts. However, underrepresentation of Black and Hispanic residents persists despite increased applicant interest. These disparities, mirrored in peer fields, highlight enduring structural barriers.

Background: Abdominal donor site complications remain significant concerns in Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. In this study, we pair computed tomography (CT) morphometric analysis of the abdominal wall with machine learning approaches to identify features of the abdomen that signal increased risk for donor site complications.

Methods: Morphometric analysis of the abdominal wall was conducted on pre-operative abdominal CT scans from 107 patients who underwent DIEP flap breast reconstruction by a single surgeon (TMM). Standard statistical approaches were used to correlate these anatomic measurements to adverse donor site outcomes. Multilayer perceptron (MLP) classifier machine learning algorithms based on morphometric data, BMI, or both were used to generate prediction models for donor site outcomes.

Results: BMI correlated with features of the abdominal wall including abdominal wall protrusion, subcutaneous and visceral fat volumes, rectus abdominis width and abdominal wall thickness. Using quartile analysis, abdominal bulge correlated with BMI and inter-ASIS distance. Incision dehiscence correlated with abdominal wall protrusion, rectus abdominus width, visceral fat, and mean rectus abdominis density. Using MLP approaches, prediction models for bulge based on CT morphometric measurements outperformed those based on BMI alone whereas these models performed similarly in predicting donor site dehiscence. Abdominal wall protrusion was the most influential variable in both models.

Conclusions: Our study is the first to couple comprehensive morphometric analysis with machine learning approaches to delineate anatomic risk factors for abdominal donor site outcomes. Our multi-feature donor site outcome prediction models may be more informative than BMI in pre-operative risk assessment.

Background: With the rise in medically assisted weight loss, procedures like panniculectomy are increasingly common. The surgical impact of glucagon-like peptide-1 (GLP-1) receptor agonists remains unclear, particularly compared to bariatric surgery.

Objectives: To compare panniculectomy outcomes and perioperative lab values in patients with prior GLP-1 use versus bariatric surgery.

Methods: TriNetX Global Research Network was queried to identify patients who underwent panniculectomy following either GLP-1 use or bariatric surgery. Cohorts were formed using codes such as CPT and ICD-10 and perioperative laboratory values were compared between groups, including hemoglobin A1c (HgA1c), body mass index (BMI), low-density lipoprotein (LDL), triglycerides, and albumin. Propensity score matching for age, sex, race, HbA1c, BMI, and triglyceride levels was performed to stabilize baseline metabolic profiles and allow balanced comparison of postoperative outcomes, including cellulitis, hematoma, seroma, hemorrhage, wound dehiscence, surgical site infection, and abscess formation.

Results: Data from 177,467,699 patients across 150 healthcare organizations (2020-2025) were analyzed. Among all patients who underwent panniculectomy (n=24,645), 6,060 had preoperative GLP-1 use and 4,142 had prior bariatric surgery. GLP-1 users exhibited higher perioperative triglycerides, HbA1c, BMI, and LDL (all p < 0.05). Multivariable regression demonstrated lower odds of cellulitis (OR 0.62, 95% CI 0.47-0.83, p=0.0015), seroma (OR 0.77, 95% CI 0.59-0.89, p=0.026), and hemorrhage (OR 0.51, 95% CI 0.30-0.89, p=0.016) in the GLP-1 cohort.

Conclusion: Despite initial concerns, preoperative patients who achieve weight loss via GLP-1 receptor agonists, as opposed to bariatric surgery, may experience fewer postoperative complications following panniculectomy.

Background: YY001 (Retoxin ®), the first global recombinant botulinum toxin type A (rBoNT/A) tested in humans, contains a pure 150-kDa core neurotoxin identical to natural BoNT/A (nBoNT/A). This study aimed to evaluate the safety and preliminary efficacy of YY001 in humans for moderate-to-severe glabellar lines.

Methods: Preclinical assessments comprised homology modeling, biochemical and pharmacological evaluation, and multispecies toxicology. In this phase I multicenter double-blind, randomized, dose-ranging, vehicle- and active- controlled trial, participants (n=50) with moderate-to-severe glabellar lines were randomized 1:1:1:1:1 to receive intramuscular injection of YY001 at 10, 20 and 30 U, Botox ® at 20 U, or vehicle. The primary endpoint encompassed the incidence of adverse events (AEs), serious AEs, injection site reactions and clinically significant laboratory changes within 28 days post-injection, with exploratory follow-up to 168 days.

Results: The YY001's structure and biological activities are highly consistent with those of nBoNT/A. In this trial, no drug-related AEs were observed in the tested 10-30 U of YY001. At day 28, the response rate by investigator's live assessment was 60% for 10 U of YY001, 80% for 20 U of YY001, 90% for 30 U of YY001, 70% for 20 U of Botox ®, and 0% for the vehicle, while the proportion of subjects with none or mild glabellar lines at maximum frown was 80%, 90%, 100%, 80%, and 0%, respectively.

Conclusions: The first rBoNT/A (YY001) in human study demonstrated a favorable safety and tolerability profile (dose-independent) at doses of 10, 20 and 30 U in Chinese subjects with moderate-to-severe glabellar lines. It also showed dose-dependent efficacy benefit.Trial Registration: ChinaDrugTrials.org.cn identifier: CTR20221419.