Plastic and reconstructive surgery最新文献

Background: Postmastectomy breast reconstruction can provide breast cancer patients with lasting psychosocial, functional, and body image benefits. Although sociodemographic factors affecting the receipt of breast reconstruction have been well studied, the cultural factors influencing patients' decisions to undergo breast reconstruction remain unclear. There are currently no reviews on cultural factors influencing breast reconstruction decision-making. This scoping review aimed to broadly evaluate the current literature on cultural factors that influence the receipt of breast reconstruction in breast cancer patients who have undergone mastectomies.

Methods: A combination of keywords and subject headings was used to search for articles related to breast reconstruction and decision-making. Databases were searched from inception to November 20, 2023. Screening was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, and quantitative studies examining the receipt of breast reconstruction in breast cancer patients following mastectomy were evaluated for inclusion.

Results: Of the 4520 studies that were screened, 61 were included in the final review. The majority of studies included in the review were retrospective and performed in the United States. Included studies were evaluated for cultural influences on the receipt of breast reconstruction. Six themes emerged across the included studies: race and ethnicity, language and communication barriers, education and literacy, cultural competency, patient perceptions, and family and relationships.

Conclusion: In addition to well-established influences on breast reconstruction such as race and ethnicity, this review broadly identified additional cultural factors that influence patients' decisions to undergo breast reconstruction.

Background: Exorbitism in patients with syndromic craniosynostosis is often managed by Le Fort III (LF3) or monobloc (MB) distraction osteogenesis (DO). This study compared short- and long-term orbital craniometrics after LF3DO/MBDO and related these findings to symptom relief.

Methods: Patients undergoing LF3DO or MBDO from 2000 to 2021 with preoperative and postoperative imaging were included. Postoperative computed tomographic (CT) scans were categorized as early (<1 year) or late (>1 year), and age-matched control CT scans were compared with late postoperative scans. Superoinferior orbital rim position, relative globe position, and orbital volume were analyzed. Symptoms were assessed by a patient-reported outcome analysis.

Results: Thirty-four patients (LF3DO, n = 16; MBDO, n = 18) were matched by age at surgery, sex, syndrome, and age at imaging. Time to late CT scan was 6.2 years (LF3DO) and 7.5 years (MBDO). Between early and late postoperative time points, LF3DO patients experienced no change in inferior rim position. MBDO patients experienced a decrease in inferior orbital rim position of 4.7 mm ( P = 0.005), but superior orbital rim distance remained stable. Comparison of late scans and age-matched controls revealed no difference in inferior or superior orbital rim position in LF3DO patients, but the superior orbital rim distance was longer in MBDO patients ( P = 0.015). Patient-reported outcome response rate was 76% with a median follow-up of 13.7 years. Most (81%) symptomatic patients improved, 19% remained symptomatic, and no patients worsened.

Conclusions: LF3DO and MBDO achieved stable orbital craniometric changes, with improved stability at the inferior orbital rim after LF3DO. Craniometric changes were associated with long-term exorbitism symptom relief.

Clinical question/level of evidence: Therapeutic, III.

Background: Subfascial (SF) pocket breast augmentation (BA) has gained popularity, whereas the transaxillary approach (TAA) offers the benefit of an inconspicuous scar. Previous reports on both techniques involved limited follow-up/samples, and few clinical studies specifically address surgical technique and outcomes following primary and secondary BA. The purpose of this study was to assess outcomes from the SF TAA technique in a large series of patients who underwent primary and secondary BA.

Methods: A retrospective cohort of patients who underwent BA between 1999 and 2024 was identified. The primary outcome was occurrence of incision and implant/pocket complications. Regression logistic analysis evaluated risk factors including age, body mass index, smoking, implant surface/volume, and fat grafting.

Results: The cohort contained 1015 patients (mean age, 28.5 ± 7.3 years), and the average follow-up was 77.6 ± 38.6 months. In primary BA, 212 patients (23.4%) experienced at least 1 complication, most frequently capsular contracture. More complications were seen in secondary BA ( P = 0.016). Multivariate regression identified body mass index less than 18.5 kg/m 2 as a significant risk factor for incision complications, whereas textured surface (OR, 2.70; P < 0.001) and implant volume greater than 350 cc (OR, 2.79; P < 0.001) were risk factors for implant/pocket complications.

Conclusions: Despite extensive research on BA procedures, studies on SF TAA procedures are limited and have not analyzed long-term outcomes following primary/reoperative operations. These results demonstrate that SF TAA is a reliable technique, and the data are compatible with other studies using different BA approaches. Knowledge of the axillary and pectoralis fascia anatomy allows surgeons to safely implement the SF TAA technique and minimize risk.

Clinical question/level of evidence: Therapeutic, III.

Background: This study investigated the effects of combining an auricular composite graft with rib cartilage-based rhinoplasty to correct contracted noses in Asian patients with a history of multiple previous operations.

Methods: A total of 43 patients were included in the retrospective analysis of secondary rhinoplasty procedures. The surgical approach involved short-nose correction, using rib cartilage for septal extension grafts and chondrocutaneous composite grafts harvested from the conchal part of the ear for internal nasal lining reconstruction. The authors' assessment encompassed clinical outcomes, the occurrence of complications; and the use of 3-dimensional photography for nasal measurements at the preoperative, 3-month, and 1-year postoperative stages.

Results: With regard to graft survival, 12 patients (27.9%) showed greater than 80% graft engraftment, 29 patients (67.4%) showed 50% to 80% graft engraftment, and 2 patients (4.6%) showed 20% to 50% graft engraftment. Two of these patients required wound irrigation for infection control and additional repair and were finally discharged without significant nasal deformity. At 3 months postoperatively, 3-dimensional anthropometry showed significant differences in nasal dorsum length (4.46 ± 1.79 mm), nasal height (1.25 ± 1.25 mm), nasal tip projection (4.06 ± 1.76 mm), and columellar-labial angle (22.75 ± 14.19 degrees). No significant relapse of nasal parameters was noted 1 year postoperatively.

Conclusions: Auricular composite graft combined with rib cartilage-based rhinoplasty enables the comprehensive restoration of nasal structures, addressing the inner, intermediate, and outer layers. This approach can serve as an effective and sustainable option for correcting contracted noses in Asian patients who have undergone multiple operations.

Clinical question/level of evidence: Therapeutic, IV.

Background: The authors investigated the timing of and indications for the Tajima reverse-U incision for correcting secondary unilateral cleft nasal deformities.

Methods: Nonsyndromic patients with secondary cleft lip and nasal deformity who received Tajima reverse-U incision rhinoplasty were grouped by age (4 to 13 years, n = 56; 13 to 18 years, n = 22; older than 18 years, n = 18) and severity of deformity (mild deformity, n = 7; moderate deformity = 22; severity deformity = 67) during 5-year follow-up. FACE-Q assessment and nasal symmetry measurements were used in this study.

Results: Ninety-six patients completed the FACE-Q assessment for the nose and nostril. The results showed higher satisfaction with nostril appearance 1 week after surgery (85.95 ± 13.01) compared with before surgery (79.72 ± 11.89), maintained at the 5-year follow-up (82.61 ± 14.06). Significant differences were observed in 5 nasal parameters (nasal height ratio, one-fourth media part of nostril height ratio, nasal sill height ratio, columellar angle, and inner nostril height-to-width ratio [cleft]) at 1 week postoperatively, and the corrected outcome of the Tajima technique was maintained 5 years after surgery in the 4- to 13-year age group. The same statistically significant changes were found in nasal sill height ratio in the mild deformity group and nostril width ratio, one-fourth media part of nostril height ratio, columellar angle, and inner nostril height-to-width ratio (cleft) in the moderate deformity group.

Conclusion: The Tajima procedure was beneficial for preadolescent children and children with mild to moderate unilateral cleft nasal deformities.

Clinical question/level of evidence: Therapeutic, IV.

Background: Primary lymphedema is characterized by lymphatic dysplasia in which one variant is Milroy disease. The association with congenital chylothorax is even rarer, with poor outcome. This is the first report to use peripheral lymphovenous anastomosis (LVA) and lymph node-to-vein anastomosis (LNVA) for the management of such condition.

Methods: A retrospective chart review of patients with Milroy disease with complication of chylothorax between 2019 until 2023 was performed. Clinical assessment and radiologic investigations were reviewed.

Results: Six patients with a mean age of 12 ± 3.9 years and disease duration of 10.5 ± 2.8 years were reviewed. Three had International Society of Lymphology stage 3 disease, and the others had stage 2 (late) disease. All had bilateral lower extremity lymphedema and chylothorax with history of chest tube drainage. After LVA and LNVA, significant reduction in extremity volume ( P = 0.028) along with nearly complete resolution of chylothorax were noted during the long-term follow-up (32 ± 17.9 months).

Conclusions: Milroy disease complicated with chylothorax remains challenging. This is the first report using peripheral bypass (LVA and LNVA), which resulted in improvement of both lower extremity lymphedema and chylothorax. The utility of this approach represents a promising modality in the management of this devastating condition.

Clinical question/level of evidence: Therapeutic, IV.