Plastic and reconstructive surgery最新文献

Summary: In patients with large areolae, undefined nipple contours, or herniation of glandular tissue around the areola, achieving an aesthetically pleasing nipple shape that effectively reduces the areolar size, minimizes recurrence, and remains scar-free is important. The authors devised the crown-shape debulking method-a refined single-stage technique based on the previously developed petal pattern method-to enable greater control during areolar reduction and nipple reshaping without visible scars in the frontal areolar area. The petal pattern method, while an excellent technique for nipple-areola contouring, has limitations in areolar reduction and results in visible scars from the front. The crown-shape debulking method is an improved approach to address these issues. The authors used a crown-shaped incision pattern to define new boundaries for the nipple and areola. The crown's triangular "spikes" form the foundation of the new nipple, and the circumference aligns with the target areolar diameter. Excess areolar and subcutaneous tissues are excised; the areola is closed with a purse-string suture; and the remaining incision is completed using simple sutures. This design allows precise adjustments of the nipple and areolar size and shape, with scars concealed along the nipple-areola junction, making them invisible from the front. At the 1-year follow-up, patient satisfaction was high. Minimal complications were observed, demonstrating the reliability of this approach. The crown-shape debulking method is a valuable alternative for natural nipple and areola contouring, avoiding outer areolar and vertical scars associated with traditional and petal pattern techniques, respectively. It is highly versatile, with applications in nipple reduction and contouring and in areolar reshaping. Moreover, it can be effectively combined with breast augmentation or reduction for comprehensive aesthetic results.

Background: Cleft palate anatomy is challenging to appreciate. This study aimed to develop clear and comprehensive 3-dimensional (3D) models of cleft palate anatomy from a surgical perspective for cleft palate repair.

Methods: Cadaver dissections, the Visible Human Project, literature review, and surgical experience were used to obtain consensus on cleft palate anatomy. A computed tomography scan was segmented using 3D Slicer to develop bony anatomy as the foundation for the development of overlying soft-tissue structures. Computer modeling software, ZBrush and Blender, were used to refine the bony model and to develop 3D models of soft-tissue anatomy de novo.

Results: A 3D computer model of a Veau 2 cleft palate was created, complete with a hard palate and skull base foundation. The superior constrictor and buccinator were modeled to represent the oral cavity. The palatopharyngeus and palatoglossus were modeled, with the palatopharyngeus comprising an oral and nasal head enveloping the levator veli palatini within the middle third of the velum before inserting into the posterior hard palate shelf medially. The tensor veli palatini was modeled with 2 insertions: (1) a lateral tendinous nasal component and (2) an oral and medial aponeurosis. A seroglandular/adipose layer, periosteum, blood vessels and mucosa were incorporated.

Conclusions: A realistic and accurate 3D computer model of cleft palate anatomy was developed using 4 methods to obtain consensus. The model represents the clearest representation of cleft palate anatomy relevant to surgeons who perform cleft palate repair.

Background: Adipose-derived stem cell (ADSC)-enhanced fat grafting may improve graft retention and aesthetic outcomes in breast reconstruction, but its safety and efficacy remain uncertain. This systematic review and meta-analysis compared ADSC-enhanced with conventional fat grafting using rigorous methodology and predefined subgroup analyses.

Methods: The authors searched 6 databases for comparative studies published from January of 2000 through November of 2024. Random-effects meta-analyses were used to assess outcomes, with subgroups defined by ADSC preparation method, follow-up duration, and reconstruction indication.

Results: Thirty-one studies (1426 patients: 634 ADSC-enhanced, 792 conventional) met inclusion criteria. ADSC-enhanced grafting significantly improved fat retention (mean difference [MD], 26.8% [95% CI, 18.2 to 35.5]; P < 0.001; moderate-certainty evidence). Ex vivo-expanded ADSCs achieved the greatest improvement (MD, 64.6% [95% CI, 60.5 to 68.7]); stromal vascular fraction methods provided moderate gains (MD, 17.0% [95% CI, 8.6 to 25.4]; P < 0.001; I² = 78%). Complication rates were similar between groups (18.4% versus 17.2%; risk ratio, 1.07 [95% CI, 0.65 to 1.77]; P = 0.78). Among 813 patients with previous breast cancer, recurrence rates did not differ significantly (5.3% versus 3.4%; risk ratio, 1.56 [95% CI, 0.10 to 24.3]; P = 0.75). Patient-reported and aesthetic outcomes generally favored ADSC-enhanced grafting.

Conclusions: ADSC-enhanced fat grafting increases graft retention without raising complication or recurrence risk. Ex vivo-expanded ADSCs offer the greatest benefit, with stromal vascular fraction yielding moderate improvement. Standardized protocols and long-term safety data are needed to optimize clinical use.

Background: This study evaluates the presurgical lip, alveolus, and nose approximation (PLANA) technique as a novel alternative to nasoalveolar molding (NAM). The study hypothesizes that PLANA can achieve comparable nasolabial outcomes to NAM while addressing its limitations, particularly by reducing the burden of care.

Methods: A retrospective review was conducted on 50 patients with nonsyndromic unilateral or bilateral cleft lip and palate (CLP) treated with either NAM ( n = 28, including 2 treatment discontinuations) or PLANA ( n = 22). The overall physical burden of care was assessed in the full cohort. A subset of 25 patients with complete unilateral cleft lip and palate (PLANA, n = 12; NAM, n = 13) was further analyzed to assess changes in nasolabial anthropometric ratios between the cleft and noncleft side using standardized two-dimensional photographs taken before and after treatment.

Results: The physical burden of care was significantly lower in the PLANA group, with 61.2% fewer total office visits (5.2 versus 13.4; P < 0.001). The PLANA group also showed a 72.19% reduction in transient reversible side effects, such as oral, nasal, and cheek irritations (18.18% [ n = 4] versus 65.38% [ n = 17]; P < 0.001). PLANA achieved a significantly greater improvement in the columellar length ratio (0.53 versus 0.37; P = 0.026), whereas NAM demonstrated a greater increase in the nostril height ratio (0.29 versus 0.39; P = 0.04). No significant differences were observed in nostril width and alar base width ratios, or columellar deviation angle between the groups.

Conclusion: These findings suggest that PLANA significantly reduces the burden of care for patients with cleft lip and palate and may offer comparable nasolabial outcomes to NAM.

Background: One of the goals of the Plastic Surgery Foundation (PSF) is to initiate a pathway by which researchers can develop national extramurally funded grants. This study was performed to investigate the effectiveness of seed PSF grants in helping researchers obtain grant funding through the National Institutes of Health (NIH).

Methods: The NIH RePORTER database was queried with the names of all American Society of Plastic Surgeons members. PSF pilot grants and research fellowships were defined as PSF seed funding. To obtain information on the PSF grants, all grants that were funded from 2003 through 2023 were manually extracted from the website. Principal investigators who had both PSF and NIH grants were identified and analyzed further.

Results: A total of 427 unique individuals earned a PSF grant and 54 unique individuals earned an NIH grant related to plastic surgery. Of those who attained PSF grant funding, 25 (5.9%) attained both PSF and NIH grants; these individuals were awarded 53 NIH grants and 56 PSF grants. Only 11 (2.6%) PSF grant recipients received a PSF grant before attaining NIH grant funding. Of the 49 PSF research fellowship recipients, only 2 (4.1%) later received an NIH grant.

Conclusions: The PSF provides the most seed grant funding in plastic surgery outside of the NIH. However, transition from PSF seed grants to NIH funding remains low. Additional work to understand PSF grant conversion to other important sources of funding, including Department of Defense, Veterans Administration, and Foundation grants, is needed.

Background: The breast meridian is a central axis in breast surgery design, essential for procedures such as breast reduction and mastopexy. Traditional methods of marking the breast meridian rely on subjective surgeon perspectives, often leading to postoperative asymmetry and inconsistent outcomes. This study introduces a simple and objective formula-the "rule of 11%"-for estimating the ideal breast meridian using measurable preoperative indices.

Methods: Data of chest wall width and underbust circumference of 50 patients were collected and analyzed. The ideal nipple position was calculated as 6:4 from the chest wall width and compared with the underbust circumference. Statistical analyses were conducted to evaluate the correlation between the 2 indices and validate the formula.

Results: The mean chest wall width and underbust circumference were 30.21 cm and 82.05 cm, respectively. The ideal nipple position, calculated as 6:4 from the chest wall width, closely corresponded to 11% of the underbust circumference, with a mean ratio of 0.111 (11.06%). A strong positive correlation was observed between chest wall width and underbust circumference. Clinical application of the formula in four patients demonstrated accurate postoperative nipple positioning and high patient satisfaction.

Conclusions: The rule of 11% provides a reproducible and objective guideline for designing the breast meridian. This bottom-up approach minimizes subjectivity, improves symmetry, and ensures stable and predictable outcomes. This formula is particularly beneficial for novice surgeons and enhances patient satisfaction by aligning with aesthetically ideal nipple positions.