Plastic and reconstructive surgery最新文献

Background: Unilateral facial paralysis is a condition marked by facial asymmetry. Although reconstructive operations, such as masseteric-to-facial nerve transfer combined with static suspension, significantly improve facial symmetry, patient outcomes can vary considerably. This study aimed to explore cerebral reorganization, focusing on rich-club (RC) organization and structural connectivity (SC)-functional connectivity (FC) coupling as potential biomarkers for facial symmetry recovery.

Methods: The authors enrolled 40 patients with severe oral commissure drooping caused by unilateral facial nerve lesions, who underwent masseteric-to-facial nerve transfer combined with static suspension. Using functional magnetic resonance imaging and diffusion tensor imaging, the authors analyzed RC properties, the macroscale SC, and FC. Based on postoperative symmetry levels, patients were categorized into symmetry and asymmetry groups for comparison.

Results: Patients with better facial symmetry demonstrated stronger SC-FC coupling. In addition, greater strength in non-RC nodes, along with stronger feeder and local edges, played a compensatory role in improving facial symmetry. In contrast, patients with facial asymmetry exhibited increasing FC in RC and non-RC nodes, possibly as a maladaptive compensatory mechanism.

Conclusions: The authors' study highlights RC organization and SC-FC coupling as potential biomarkers for assessing and monitoring facial symmetry recovery in facial paralysis patients after surgery. These findings offer valuable insights into the brain's adaptive responses, serving as sensitive indicators of disease symptoms and functional performance.

Background: Predicting postsurgical morphometric changes in breast augmentation remains challenging. A key alteration is the increase in nipple-to-inframammary crease (N-IMC) distance, which affects aesthetics. This study quantifies N-IMC changes after subfascial breast augmentation and develops a predictive model incorporating anatomical and implant-related factors.

Methods: A retrospective analysis of 408 patients undergoing subfascial breast augmentation was conducted. Preoperative and postoperative morphometric measurements, including N-IMC distance, suprasternal notch-to-nipple distance, and breast width, were analyzed. Additional parameters, such as lateral sternal margin thickness and implant size, were assessed using multiple linear regression and stepwise selection. Two implant-to-breast matching ratios were introduced: the implant projection-to-breast width (R ib ratio) and the implant width-to-available breast width ratio.

Results: N-IMC distance increased by 52.98% on average, with variability influenced by patient anatomy suprasternal notch-to-nipple distance change ( P = 0.0019), and implant width-to-available breast width ratio ( P = 0.0482) were significant predictors. The R ib ratio had the highest predictive capacity, explaining 67.85% of lower pole deformation variability.

Conclusions: Implant selection and breast tissue characteristics significantly impact postsurgical morphometry. The R ib ratio offers a standardized metric for implant selection, enhancing preoperative planning and aesthetic outcomes. Its adoption in clinical practice is recommended to improve surgical consistency.

Background: The severity of unilateral cleft lip significantly influences surgical outcomes, yet no standardized system exists to classify cleft severity or assess the impact of presurgical infant orthopedics (PSIO). This study proposes an objective classification system, integrating anthropometric measurements with expert evaluations.

Methods: Deidentified pre-PSIO and post-PSIO photographs of 50 infants with unilateral cleft lip from the Smile Train Express database were analyzed. Three anthropometric parameters-nostril width ratio (NWR), columellar angle (CA), and subnasale lateral displacement (SN)-were measured. An expert panel of orthodontists and surgeons independently rated cleft severity and PSIO outcomes, in a structured 3-stage process. Severity thresholds were established through consensus, and interrater agreement was analyzed using weighted kappa.

Results: Consensus-derived thresholds categorized NWR, CA, and SN into 4 severity levels. Interrater agreement for cleft severity improved across stages, reaching nearly perfect levels in stage 3 (pre-PSIO weighted kappa, 0.91; post-PSIO weighted kappa, 0.93). Although pre-PSIO agreement was similar between surgeons and orthodontists, post-PSIO assessments showed greater variability. PSIO had a disproportionate effect on nasal morphology (CA) compared with maxillary segments (NWR and SN), with severe NWR and SN frequently coexisting with mild CA. The proposed classification system demonstrated substantial reliability, aligning at least 2 parameters within the same severity subclassification.

Conclusions: This study introduces a standardized classification system for cleft severity and PSIO outcomes, demonstrating strong interrater reliability. By integrating anthropometric data with expert assessments, it provides a reproducible framework for clinical and research applications. Further refinements, including intraoral measurements and 3-dimensional imaging, may enhance its precision and applicability.

Background: Masseter muscle prominence (MMP) contributes to a widened lower facial shape, considered aesthetically undesirable to some individuals. This study assessed lower facial shaping improvements with onabotulinumtoxinA.

Methods: In a phase 2, randomized, placebo-controlled study, onabotulinumtoxinA (24, 48, 72, or 96 U) or placebo was injected intramuscularly (3 sites per masseter) into subjects with bilaterally symmetric "marked" or "very marked" MMP on the Masseter Muscle Prominence Scale (MMPS). Changes from baseline at day 90 in lower facial width, mandibular facial angle, investigator-rated MMPS response, subject-perceived symptoms, psychosocial impact of lower face appearance, and satisfaction with lower face on the Lower Facial Shape Questionnaire were assessed.

Results: Among 187 subjects (mean age, 35.4 years; 81.8% female; and 79.7% Asian), significant reductions from baseline in lower facial width and mandibular angle were achieved with all onabotulinumtoxinA doses versus placebo at day 90 ( P < 0.001, each parameter), continuing through day 180. At day 90, greater improvements in MMPS grade (all doses) and MMP signs, psychosocial impacts, and satisfaction were observed.

Conclusion: OnabotulinumtoxinA treatment improved lower facial shape in individuals with MMP, producing a more desirable ovoid appearance for at least 6 months, with greater patient satisfaction.

Background: The Temtamy-McKusick classification defines ulnar/postaxial polydactyly with a well-developed accessory digit as type A and cases with a rudimentary pedunculated digit as type B. Surgeons widely agree on type B treatment, but type A cases present more diverse phenotypes and reconstructive challenges. The authors developed an expanded classification based on radiographic morphology that may help guide surgical treatment.

Methods: The multicenter cohort included all type A ulnar polydactyly cases in the Congenital Upper Limb Differences (CoULD) database and additional cases from the Children's Hospital of Philadelphia. Morphologic themes were determined from preoperative radiographs. Clinical relevance was evaluated by discussion and analysis of operative notes to confirm that each subtype carries distinct considerations for reconstruction. Four attending pediatric hand surgeons classified radiographs. Interrater and intrarater reliability were determined by the Cohen κ.

Results: The cohort included 125 type A hands from 84 patients (49% bilateral). Fifteen cases (18%) were syndromic and 37 (44%) reported a family history. Six subtypes emerged from radiographic analysis. Our classification is based on the proximal extent of the skeletal "duplication," comprising A1-hypoplastic, A2-phalangeal, A3-divergent metacarpophalangeal, A4-bifid metacarpal, A5-duplicated metacarpal, and A6-complex types. The authors propose a reconstructive plan for each subtype to aid surgical decision-making. Interrater and intrarater reliability were almost perfect. Raters agreed that all cases were classifiable, achieving 97% initial agreement.

Conclusions: The CoULD Ulnar Polydactyly classification is feasible, comprehensive, and relevant to surgical management. The CoULD Study Group voted to adopt the classification after careful review, reinforcing its potential to frame the care pathway.

Background: In the process of burn wound healing, promoting healing and suppressing wound progression by enhancing blood flow is considered essential. Various agents that increase blood flow are currently being assessed. Batroxobin (DF-521; Defibrase) is a defibrinogenating agent extracted from Bothrops moojeni , used as a thrombin-like serine protease to improve ischemic conditions. However, it remains unclear how this agent affects the burn wound healing process. In this study, the authors conducted analyses to define the effects of batroxobin administration on burn wound healing.

Methods: Full-thickness burn wounds were created on the dorsal skin of C57BL/6 mice by applying a 90°C, 5-mm-diameter soldering iron for 10 seconds. Immediately after wounding, batroxobin (30 batroxobin units/kg per mouse) was administered intraperitoneally daily. As a vehicle control, the same volume of saline was administered. The authors analyzed wound area, histologic findings, blood flow, growth factor and chemokine synthesis, and factor expression related to ischemia-reperfusion.

Results: The authors found that the systemic administration of batroxobin prevented burn wound progression, which was accompanied by decreased expression of tumor necrosis factor-α and NOX2 and reduced synthesis of hypoxia-inducible factor-1α. In addition, this agent promoted wound healing by enhancing blood flow, increasing S100A4 + fibroblast accumulation, and stimulating the production of growth factors (basic fibroblast growth factor, epidermal growth factor, and placental growth factor).

Conclusions: These results indicate that the systemic administration of batroxobin prevented burn wound progression and accelerated the healing process by enhancing blood flow.

Clinical relevance statement: The authors demonstrated that the treatment of batroxobin accelerated angiogenesis and S100A4-positive fibroblast accumulation, accompanied by increased local basic fibroblast growth factor production. In addition, batroxobin was found to reduce burn wound progression.

Background: Advanced mandibular osteoradionecrosis (ORN) often requires segmental resection and reconstruction. Although ORN has distinct clinical and radiographic features, detecting occult cancer preoperatively remains challenging. The goal of this study was to determine the incidence and risk factors of occult cancer in patients undergoing surgery for advanced mandibular ORN.

Methods: Medical records of mandibular ORN patients who underwent compound or composite segmental mandibulectomy with flap reconstruction between 2010 and 2022 were reviewed. Data on demographics, ORN presentation, and surgical details were collected. The primary outcome was the incidence of occult cancer in resected specimens, and secondary outcomes included associated risk factors, cancer characteristics, and survival outcomes. Univariable and multivariable logistic regression analyses were used to identify factors associated with occult cancer. Overall survival (OS) and disease-specific survival (DSS) were assessed using Kaplan-Meier analysis.

Results: Among 267 patients included in the study, 24 (9.0%) were found to have occult cancer. Multivariable analysis revealed that bleeding (OR, 4.76; 95% CI, 1.30 to 17.42; P = 0.018), surgery within 6 months of diagnosis (OR, 5.51; 95% CI, 2.02 to 14.99; P = 0.001), and disease extension greater than 4 cm (OR, 6.33; 95% CI, 2.30 to 17.46; P < 0.001) were significant risk factors. Occult cancer was associated with lower 5-year DSS and OS compared with pure ORN (DSS, 50.2% versus 81.3%; OS, 47.4% versus 77.5%; P < 0.001).

Conclusions: Occult cancer was present in a notable proportion of advanced ORN cases. Clinical bleeding, early surgery, and extensive disease were significant risk factors, underscoring the need for diagnostic vigilance and guiding preoperative counseling.

Background: Nasolabial folds (NLFs) are a common cosmetic concern. Hyaluronic acid (HA)-based fillers are increasingly popular for minimally invasive facial wrinkle and fold correction. This study aimed to evaluate the efficacy and safety of a new monophasic HA filler, Curea, for NLF correction compared with the widely used Juvéderm.

Methods: A 24-week, prospective, single-center, double-blind, randomized, split-face, noninferiority controlled trial was conducted. Seventy-four participants with moderate to severe NLFs were enrolled and treated with Curea on one side of the face and Juvéderm on the other. Evaluation included NLF improvement as determined using the Wrinkle Severity Rating Scale, participant satisfaction, and adverse events.

Results: At 24 weeks, Curea significantly improved Wrinkle Severity Rating Scale scores from 3.16 ± 0.84 at baseline to 2.59 ± 0.87 at week 24 ( P < 0.001). Curea demonstrated efficacy for NLF correction within the predefined noninferiority margin compared with Juvéderm. The safety profiles and participant satisfaction for Curea were similar to those for Juvéderm. Only mild, transient local reactions were observed, and participants were satisfied with the clinical improvement of both fillers throughout the 24-week follow-up.

Conclusion: Curea is comparable to Juvéderm in NLF correction and safety profiles, and its efficacy lasts up to 24 weeks.