Plastic and reconstructive surgery最新文献

Background: Various nasolabial flap types, including 2-stage and single-stage flaps, have been advocated for alar reconstruction. When to choose which method remains unclear. In this study, the performance of nasolabial flap variations was analyzed and compared with other reconstructive options.

Methods: Consecutive alar reconstructions performed over a 10-year period (2012 through 2022) were studied retrospectively. Patient charts were reviewed for defect size, reconstructive technique, cartilage grafts, surgical complications, and secondary procedures. Patients were followed up clinically at 3, 6, and 12 months. Aesthetic outcomes were evaluated using standard digital photographs.

Results: A total of 148 alar reconstructions were performed in 84 women and 64 men (mean age, 69 years). The average defect diameter was 1.6 cm (range, 0.5 through 4.5 cm). A total of 110 reconstructions (74%) were performed with nasolabial flaps (90 single-stage and 20 2-stage), including 68 nasolabial cheek flaps, 32 nasolabial island flaps, and 10 nasolabial transposition flaps. A total of 38 reconstructions (26%) were performed using other flaps ( n = 20), skin-fat grafts ( n = 14), or direct closure ( n = 4). Alar rim grafts (95 primary and 5 secondary) were used in 100 patients. Complications occurred in 43 patients (29%), including hematoma, delayed wound healing, flap necrosis, vestibular stenosis, and alar crease obliteration. Planned secondary procedures were performed in 20 nasolabial island flaps and 12 paramedian forehead flaps. Unplanned secondary procedures were performed in 40 single-stage (44%) and two 2-stage (10%) nasolabial flaps. None of the other single-stage flaps or skin-fat grafts were revised.

Conclusions: Single-stage nasolabial flaps produce aesthetically pleasing results and compare favorably to other techniques. However, unplanned secondary surgery is frequent.

Background: Direct-to-implant (DTI) reconstruction offers several advantages over the 2-stage implant-based breast reconstruction approach. However, the outcomes of prepectoral reconstruction are debated. Many previous studies contained confounders, making their conclusions less definitive. This study offers the first matched cohort analysis comparing DTI with 2-stage reconstruction in the prepectoral plane.

Methods: Patients treated with postmastectomy implant-based breast reconstruction from 2018 through 2021 were retrospectively reviewed. Patients were propensity score matched by body mass index, smoking status, history of hypertension, mastectomy type, chemotherapy, radiotherapy, acellular dermal matrix use, and coverage type. Outcomes assessed included surgical site occurrences (SSOs), capsular contracture, and explantation of either expander or implant.

Results: A total of 433 breasts were identified, and 154 breasts were matched (77 DTI; 77 2-stage). Two-stage prepectoral reconstruction was associated with greater rates of seromas (2-stage, 18.2%; DTI, 5.2% [ P < 0.05]) and overall SSOs (2-stage, 45.5%; DTI, 24.7% [ P < 0.05]). This approach was also an independent predictor on multivariate regression (adjusted odds ratio, 5.69, 4.86 [ P < 0.05]). There were no differences between the groups regarding final implant size, capsular contraction (grades 3 or 4), or implant or expander loss ( P > 0.05). There were also no significant differences in secondary reconstruction or failures of secondary reconstructions after explantation between the groups, with a mean follow-up of 22 months.

Conclusions: Prepectoral 2-stage and DTI reconstruction have similar risk profiles; however, DTI may be more beneficial in the correctly identified patient. Prepectoral 2-stage reconstruction is associated with higher rates of seromas and SSOs compared with DTI reconstruction. Secondary reconstruction after explantation can readily achieve long-term success in both prepectoral 2-stage and DTI reconstruction.

Background: Historically, cosmetic surgery has been primarily used by White patients. However, in recent decades, the population in the United States has become increasingly diversified. It is unknown how these national demographic changes have affected the racial and ethnic distribution of those using cosmetic surgical services. This study seeks to quantify the changes in the demographics of these patients.

Methods: The National Surgical Quality Improvement Project database from 2010 to 2023 was queried using CPT codes to generate a data set inclusive of 5 common cosmetic surgery procedures. National demographic information was obtained from the U.S. Census Bureau to assess trends in population demographics. A logistic regression analysis was used to identify changes over time.

Results: The proportion of cosmetic surgery procedures used by non-White patients increased by 10% each year on average ( P < 0.001). This increase was found to be significantly greater than their relative growth in the population by an average of 8% annually ( P < 0.001). The proportion of White patients undergoing cosmetic surgery procedures declined by 19.9%. For White patients, this decline occurred at a rate 7% greater than their relative population ( P < 0.001).

Conclusions: Recent trends in the cosmetic surgery patient population have shown a rise in minority patients undergoing surgery that surpasses their relative increase in the national population. As the cosmetic surgery population is becoming more diverse, it is becoming increasingly important for surgeons to be cognizant of cultural and socioeconomic factors that may impact surgical decision-making, patient satisfaction, and surgical outcomes.

Background: The nipple-areola complex (NAC) is essential for breast aesthetics and self-image. However, large-scale studies on patient satisfaction after NAC reconstruction in implant-based breast reconstruction are limited, especially those accounting for confounders. This study aimed to evaluate the long-term impact of NAC reconstruction on patient-reported outcomes using the BREAST-Q, hypothesizing that NAC reconstruction would yield better patient-reported outcomes than no reconstruction.

Methods: A single-center retrospective analysis of patients who underwent skin-sparing mastectomy with 2-stage alloplastic reconstruction between 2015 and 2021 was performed. NAC reconstruction methods included local flaps and tattoos. Patients were excluded if they had nipple-sparing mastectomy, autologous reconstruction, adjuvant radiation, direct-to-implant or unilateral reconstruction, or incomplete BREAST-Q data. BREAST-Q was assessed preoperatively and 2 years after implant exchange.

Results: Overall, 372 patients were included in the study, with 210 not undergoing NAC reconstruction and 162 undergoing NAC reconstruction within 2 years of implant exchange. Preoperatively, no significant difference existed between cohorts for all BREAST-Q domains. Postoperatively, patients undergoing NAC reconstruction reported significantly higher scores across all BREAST-Q domains, with clinically meaningful improvements in Sexual Well-Being and Satisfaction with Breasts. Analysis of the change in BREAST-Q scores from preoperatively to 2 years postoperatively revealed significant improvements in Sexual Well-Being (+6 points; P = 0.006) and Satisfaction with Breasts (+9 points; P = 0.003) among patients who underwent NAC reconstruction compared with patients who did not undergo NAC reconstruction.

Conclusions: NAC reconstruction enhances patient satisfaction after implant-based breast reconstruction. Providers should discuss these benefits with appropriate patients, emphasizing the potential impact on breast satisfaction and sexual well-being.

Background: Split-thickness skin grafts are an effective therapy for treating large skin wounds; however, patients may experience chronic pain and dysesthesia from poor regeneration of sensory nerves into the harvest site. Endogenous and exogenous electrical fields are known to direct axon regeneration and support epithelial wound healing. This study aimed to demonstrate the efficacy of a novel therapeutic electrical stimulation protocol, asymmetric charge-balanced (ACB) waveforms, to aid in peripheral nerve regeneration and wound healing.

Methods: Split-thickness skin harvests were collected from 4 Thy1-GFP rats, with each rat receiving 2 harvests. After this, rats received electrical stimulation on 1 of their wounds for 5 days using ACB waveforms. After the animals were killed, the harvest sites were collected, and fluorescence levels were quantified using ImageJ software. Split-thickness skin harvests were collected from 4 Long-Evans rats that were stimulated for 5 days using ACB waveforms. Equivalent wound resistance was characterized to quantify the rate of wound healing.

Results: Increased peripheral nerve regeneration was observed in the split-thickness skin harvest sites of the stimulated group compared with the control group. Impedance measurements showed significantly increased impedance in wounds that underwent stimulation compared with sham controls, suggesting accelerated wound healing in the stimulated group.

Conclusion: The authors' work suggests a potential noninvasive strategy, translatable to humans, for enhancing healing of split-thickness skin harvest sites that could minimize associated morbidity.

Clinical relevance statement: This study shows that pulsed asymmetric biphasic electrical fields regenerate peripheral nerves and accelerate wound healing in split-thickness skin graft donor sites, offering a promising approach to reduce chronic pain, hyperesthesia, and pruritus, while restoring normal sensation to patients.

Background: The authors evaluated whether baseline patient-reported outcome measures (PROMs) are associated with initial treatment choice of hand therapy (HT) or corticosteroid injection. The authors hypothesized that patients with worse baseline PROMs would choose corticosteroid injection.

Methods: The authors have an ongoing prospective study of patients aged 35 to 85 years with thumb carpometacarpal osteoarthritis. The authors track initial treatments and PROMs, including visual analog scale (VA)/numerical rating scale (NRS) subscales, brief Michigan Hand Outcomes Questionnaire, and Patient-Reported Outcomes Measurement Information System Pain Interference and Global Health modules. Global Mental Health, Global Physical Health, and EuroQol were calculated. The authors retrospectively identified patients from 2019 to 2022 who initially chose HT or corticosteroid injection. The authors performed pairwise comparisons of independent variables between HT and corticosteroid injection groups, and then exploratory bivariate logistic regression (LR) analyses for independent variables. The authors then performed more stringent multivariable LR analyses.

Results: We included 156 patients with 191 thumbs (average age, 61 ± 9 years; 77% female). A total of 158 thumbs received initial HT, and 33 received corticosteroid injection. For exploratory bivariate LR analyses, baseline and activity-related VA/NRS pain and brief Michigan Hand Outcomes Questionnaire scores were worse for patients pursuing corticosteroid injection. Each multivariable LR model demonstrated higher VA/NRS activity-related pain levels and was still independently associated with increased odds of choosing corticosteroid injection.

Conclusions: Adjusting for covariates, baseline activity-related pain was associated with increased odds for choosing corticosteroid injection. Other baseline Patient-Reported Outcomes Measurement Information System/demographics were not associated with initial treatments. Our findings can inform providers, patients, and investigators considering HT and corticosteroid injection, and their potential comparative outcomes, for initiating nonoperative thumb carpometacarpal osteoarthritis care.

Summary: Extracorporeal septoplasty was proposed for correcting the severely deviated nasal septum caused by insufficient outcomes of the conventional septoplasty techniques. This technique is superior in terms of accessibility and visibility of the nasal septum. However, it imposes a risk of creating a saddle nose deformity by disrupting the keystone area. The authors aimed to prevent this deformity by developing a new modified extracorporeal septoplasty technique called the "shark-tooth technique." This technique is based on the retention of a small triangular segment of the cartilaginous septum on the bony septum, resembling a shark tooth. By functioning as a mark, the shark tooth ensures precise repositioning of the septum. It was thought that, consequently, the septal height would be preserved, thereby maintaining the dorsal profile.

Background: Fat grafting has become one of the most widely used methods for gluteal augmentation, yet concerns remain regarding its safety and complication profile. This study aims to update and synthesize complication rates associated with gluteal fat grafting, with a particular focus on procedural factors.

Methods: A systematic search through PubMed, Embase, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original clinical studies reporting complications following autologous fat grafting for gluteal augmentation were included.

Results: A total of 38 studies comprising 22,151 patients were included. The pooled incidence of minor complications was 3.58% (95% CI, 1.75% to 5.99%), with seromas occurring in 2.03% and contour irregularities in 2.29% of cases. Pulmonary embolism had a pooled incidence of 0.04%. Ultrasound-guided fat grafting was associated with lower rates of both major (0.02% versus 0.08%) and minor (2.82% versus 3.70%) complications. Subcutaneous-only injection planes demonstrated the lowest complication rates compared with intramuscular or combined approaches. The use of lipoaspirate additives and drains did not consistently lower complication rates and was sometimes associated with increased adverse outcomes.

Conclusions: Fat grafting is generally safe when performed using evidence-based techniques. Subcutaneous-only injection and ultrasound guidance are associated with improved outcomes and may enhance procedural safety. Continued research with prospective, standardized studies is necessary to refine procedural strategies and minimize complication risks.