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Discussion: Osseous Maxillary Reconstruction with Immediate Dental Implant Placement: An Optimized Workflow for the Oncologic Patient.
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-03-01 Epub Date: 2025-02-24 DOI: 10.1097/PRS.0000000000011643
Matthew M Hanasono
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引用次数: 0
Pitanguy Ligament Preservation in Structural Precision Rhinoplasty. 结构精密鼻整形术中的皮坦古韧带保留。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-03-01 Epub Date: 2024-07-19 DOI: 10.1097/PRS.0000000000011652
Jeffrey Lisiecki, Michael Chiodo, Matthew Novak, Sebastian Cotofana, Rod J Rohrich

Summary: The Pitanguy ligament is a crucial structure in nasal tip support and in maintaining the integrity of the soft-tissue envelope of the nose. In this cadaveric study, the authors dissected out the Pitanguy ligament on a series of fresh human cadaver specimens to elucidate the structure of the ligament and its fate in open rhinoplasty. The Pitanguy ligament can act as a tethering force to the nasal tip when reshaping the nasal tip. Release of the Pitanguy ligament alleviated downward tension on the nasal tip, and tip shaping to a more appropriate position demonstrated that this ligament was displaced from its ideal position. In patients seeking rhinoplasty, this structure may require release and reconstruction to successfully alter tip position and avoid supratip deformity.

皮坦古韧带是支撑鼻尖和保持鼻软组织包膜完整性的重要结构。在这项尸体研究中,我们在一系列新鲜的人体尸体标本上解剖出了 Pitanguy 韧带,以更好地阐明该韧带的结构及其在开放式鼻整形术中的命运。在重塑鼻尖时,Pitanguy韧带可作为鼻尖的系缚力。释放 Pitanguy 韧带可减轻鼻尖的向下张力,将鼻尖塑形至更合适的位置可证明该韧带已偏离其理想位置。对于寻求鼻整形手术的患者,可能需要松解和重建这一结构,以成功改变鼻尖位置,避免鼻尖上畸形。
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引用次数: 0
Impact of Regional Surgeon Competition on Use, Cost, and Outcomes of Breast Reconstruction in the United States. 地区外科医生竞争对美国乳房再造术的使用、成本和效果的影响。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-03-01 Epub Date: 2024-07-30 DOI: 10.1097/PRS.0000000000011669
Joseph N Fahmy, Jacob S Nasser, Hao Wu, Lu Wang, Kevin C Chung

Background: Breast reconstruction following mastectomy is underused in the United States. Evidence suggests that more competitive hospital markets offer increased access to procedural care across specialties. This study aimed to determine the impact of regional plastic surgeon competition on use, outcomes, and cost of breast reconstruction following mastectomy for breast cancer.

Methods: The authors conducted a retrospective cross-sectional analysis using MarketScan claims data from 2009 to 2020. The Herfindahl-Hirschman Index, a measure of market concentration, was calculated using the sum of squares of the proportion of breast reconstruction cases performed by each surgeon in a metropolitan statistical area. Multivariable logistic regression was used to identify differences in rates, outcomes, and costs of reconstruction by the Herfindahl-Hirschman Index.

Results: Odds of receiving breast reconstruction within 2 years of mastectomy were higher for those in moderately competitive (OR, 1.51 [95% CI, 1.37 to 1.66]; P < 0.001) or competitive (OR, 1.71 [95% CI, 1.58 to 1.86]; P < 0.001) regions compared with noncompetitive regions. Patient out-of-pocket costs decreased when comparing moderately competitive regions with noncompetitive regions (-$67.38 [95% CI, -$88.65 to -$46.11]; P = 0.007), and decreased further when comparing competitive with noncompetitive regions (-$113.06 [95% CI, -$137.00 to -$89.12]; P = 0.02). No linear association between total, surgeon, or facility cost and market competition strata was identified.

Conclusions: Greater competition among surgeons is associated with improved access to reconstructive surgery, but no difference in cost. Application of this evidence may include system-level strategies to bolster care coordination, while targeting drivers of cost, such as hospitals and hospital systems, through policy.

背景:在美国,乳房切除术后的乳房再造术使用率很低。有证据表明,竞争更激烈的医院市场能增加各专科获得手术治疗的机会。本研究旨在确定地区整形外科医生竞争对乳腺癌乳房切除术后乳房再造的使用、结果和成本的影响:我们利用 2009 年至 2020 年的 Marketscan 索赔数据进行了一项回顾性横截面分析。赫芬达尔-赫希曼指数(Herfindahl-Hirschman Index,HHI)是衡量市场集中度的指标,它是用大都会统计区(MSA)中每位外科医生所做乳房重建病例比例的平方和来计算的。采用多变量逻辑回归来确定不同 HHI 下重建率、结果和成本的差异:结果:乳房切除术后两年内接受乳房再造的几率在中等竞争水平的医院更高(OR:1.51 [95% CI:1.37 至 1.66];P结论:外科医生之间的竞争越激烈,乳房再造的几率就越高:外科医生之间的竞争越激烈,接受整形手术的机会就越多,但成本却没有差异。这一证据的应用可能包括系统层面的策略,以加强医疗协调,同时通过政策针对成本的驱动因素,如医院和医院系统。
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引用次数: 0
Nasal Tip Deprojection in Rhinoplasty. 鼻整形术中的鼻尖凹陷。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-03-01 Epub Date: 2024-08-23 DOI: 10.1097/PRS.0000000000011697
Shaishav Datta, Buğra Tugertimur, Steven A Hanna, Paige Goote, Matthew Morris, David Mattos, Richard G Reish

Background: Rhinoplasty is one of the most commonly performed facial operations in the United States, and many major and minor nasal tip support structures affect tip projection. Overprojection may result from anatomical factors or occur iatrogenically during primary rhinoplasty. Achieving reliable, reproducible, and stable results is the aim of nasal tip deprojection rhinoplasty. The authors' technique is designed to decrease nasal tip deprojection in patients with an overly projected nasal tip.

Methods: A retrospective chart review of 2003 rhinoplasty cases in the senior author's (R.G.R.) practice was conducted for the period between July of 2014 and June of 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases with nasal tip deprojection, with a minimum of 12 months of follow-up. Outcomes of interest included the rate of operative revisions and the rate of postoperative infection.

Results: A total of 447 patients met the inclusion criteria. The mean age of our study group was 32.1 years, with 409 female patients, and 291 cases were primary rhinoplasties. The mean follow-up period was 22.4 months. Eight patients (1.8%) required empiric antibiotics postoperatively, and 17 patients (3.8%) required operative revision.

Conclusions: The authors' case series demonstrates that combining resection of the medial crura with lateral crural steal and a columellar strut graft allows the surgeon to achieve considerable nasal tip deprojection. The comprehensive patient follow-up (mean, 22.4 months) further supports the reliability of the authors' technique.

Clinical question/level of evidence: Therapeutic, IV.

背景介绍鼻整形手术是美国最常见的面部手术之一。影响鼻尖投影的主要和次要鼻尖支撑结构有很多。鼻尖过度突出可能是解剖学因素造成的,也可能是在初级鼻整形术中人为造成的。实现可靠、可重现和稳定的效果是鼻尖注射隆鼻术的目标。该技术旨在减少鼻尖过度突出患者的鼻尖下垂:方法:2014 年 7 月至 2022 年 6 月期间,对资深作者所在诊所的 2,003 例鼻部整形手术进行了回顾性病历审查。纳入标准为鼻尖下垂的美容性或功能性鼻整形病例,随访至少 12 个月。研究结果包括手术翻修率和术后感染率:结果:447 名患者符合纳入标准。研究对象的平均年龄为 32.1 岁,其中女性 409 人。291例为初次鼻整形手术。平均随访时间为 22.4 个月。8名患者(1.8%)术后需要使用经验性抗生素,17名患者(3.8%)需要进行手术翻修:我们的病例系列表明,将内侧嵴切除与外侧嵴窃取和结肠支柱移植相结合,可以实现相当程度的鼻尖下移。对患者平均 22.4 个月的全面随访进一步证明了我们技术的可靠性。
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引用次数: 0
Bone Formation in Unilateral Cleft Lip and Palate Patients after Early Secondary Gingivoalveoloplasty and Bone Graft: Long-Term Study. 单侧唇腭裂患者早期二次龈瓣成形术和植骨后的骨形成:长期研究。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-03-01 Epub Date: 2024-08-20 DOI: 10.1097/PRS.0000000000011684
Luca Autelitano, Daniele Hamaui, Valeria M A Battista, Federico Biglioli, Maria C Meazzini

Background: The aim of this study was to conduct a comparative analysis, using computed tomographic scans, of ossification patterns in unilateral cleft lip and palate patients who underwent early secondary gingivoalveoloplasty (esGAP) versus those who underwent traditional alveolar bone grafting harvested from the iliac crest (IC).

Methods: Computed tomographic scans of 22 consecutively treated patients with esGAP were compared with those of 21 patients treated with bone grafting from the IC. Inclusion criteria were nonsyndromic unilateral cleft lip and palate patients in permanent dentition. Two parameters were considered: the alveolar thickness, measured at 3 levels, and the nasoalveolar height. All measurements were normalized and ratios of the affected versus nonaffected sides were provided as in addition to the statistical comparison between the 2 groups' ossification outcomes.

Results: In the esGAP sample, nasoalveolar height was categorized as ideal and good in 86.36% and in 13.64% of the cases, and no mediocre or insufficient ossification was detected; whereas in the bone grafting sample, 38.10% had ideal and good ossification, 14.29% had mediocre ossification, and 9.52% had insufficient ossification. As regards the alveolar thickness, when we consider the average of 3 levels, the esGAP sample was ideal and good in 57.57% and in 30.30% of the cases; for the IC sample, the alveolar thickness was ideal and good 41.27% and in 25.40% of the cases, respectively. The analysis detected a statistically significant difference in the ossification outcomes in the 2 samples.

Conclusion: The esGAP yields superior ossification grades in comparison to IC bone grafting.

Clinical relevance statement: In unilateral cleft lip and palate patients, esGAP seems to allow for a higher grade of ossification compared to IC bone grafting.

Clinical question/level of evidence: Therapeutic, III.

研究背景本研究的目的是通过 CT 扫描,对接受早期继发性牙槽骨成形术(esGAP)和传统的髂嵴牙槽骨移植术(IC)的单侧唇腭裂(UCLP)患者的骨化模式进行比较分析。方法:对连续接受 esGAP 治疗的 22 名患者的 CT 扫描结果与接受髂嵴牙槽骨移植术(IC)的 21 名患者的 CT 扫描结果进行比较。纳入标准为恒牙期非综合征 UCLP 患者。研究考虑了两个参数:在三个水平测量的牙槽厚度和鼻牙槽高度。所有测量值均已归一化,并提供了患侧与非患侧的比率以及两组骨化结果的统计比较:在 esGAP 样本中,86.36% 的病例和 13.64% 的病例的鼻齿槽高度被归类为理想和良好,没有发现骨化平庸或不足的情况;而在植骨样本中,38.10% 的病例骨化理想和良好,14.29% 的病例骨化平庸,9.52% 的病例骨化不足。至于牙槽骨厚度,当我们考虑三个水平的平均值时,esGAP样本中分别有57.57%和30.30%的病例达到了理想和良好的厚度,而IC样本中分别有41.27%和25.40%的病例达到了理想和良好的厚度。分析发现,两种样本的骨化结果在统计学上存在显著差异:结论:与 IC 骨移植相比,EsGAP 的骨化等级更高。
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引用次数: 0
Impact of Lymphedema Duration on Lymphatic Vessel Quality and Outcomes After Supermicrosurgical Lymphaticovenous Anastomosis.
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-02-28 DOI: 10.1097/PRS.0000000000012061
George Taliat, Yu-Che Ou, Yu-Ming Wang, Chad Chang, Shao-Chun Wu, Wei-Che Lin, Peng-Chen Chien, Ching-Hua Hsieh, Johnson Chia-Shen Yang

Background: Inferior lymphatic vessel (LV) quality was thought to be associated with prolonged lymphedema duration (LD), which can lead to unfavorable lymphaticovenous anastomosis (LVA) outcomes. However, increasing evidence supports the use of LVA in the treatment of advanced lymphedema. Hence, this study aimed to determine the impact of LD on LV quality and outcomes after LVA in patients with secondary lower limb lymphedema.

Patients and methods: A total of 189 patients who underwent supermicrosurgical LVA were retrospectively reviewed and enrolled. The study group (LD>3.6 years) and the control group (LD≤3.6 years) consisted of 94 and 95 patients, respectively. Patients with previous LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters and volume changes were recorded and the parameters except LD were matched using propensity-score-matching. The primary endpoint was volume change at 6 and 12 months after LVA.

Results: Before matching, the study group had significantly higher ratios of indocyanine green-enhanced, lymph flow-positive, and Normal+Ectatic LVs (p=0.016, 0.035, and 0.002, respectively) than the control group. After all parameters except LD were matched, 64 patients were included in each group, with higher median LD in the study group (7.8 vs. 1.1 years, p<0.001) than the control group. However, no significant intergroup differences were found in postoperative percentage volume reduction at the 6- and 12-month follow-up (p=0.813 and 0.627, respectively).

Conclusion: Contrary to common beliefs, longer LD did not negatively affect LV quality and outcomes after LVA. Therefore, LVA remains a viable treatment option for patients with long-standing lymphedema.

{"title":"Impact of Lymphedema Duration on Lymphatic Vessel Quality and Outcomes After Supermicrosurgical Lymphaticovenous Anastomosis.","authors":"George Taliat, Yu-Che Ou, Yu-Ming Wang, Chad Chang, Shao-Chun Wu, Wei-Che Lin, Peng-Chen Chien, Ching-Hua Hsieh, Johnson Chia-Shen Yang","doi":"10.1097/PRS.0000000000012061","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012061","url":null,"abstract":"<p><strong>Background: </strong>Inferior lymphatic vessel (LV) quality was thought to be associated with prolonged lymphedema duration (LD), which can lead to unfavorable lymphaticovenous anastomosis (LVA) outcomes. However, increasing evidence supports the use of LVA in the treatment of advanced lymphedema. Hence, this study aimed to determine the impact of LD on LV quality and outcomes after LVA in patients with secondary lower limb lymphedema.</p><p><strong>Patients and methods: </strong>A total of 189 patients who underwent supermicrosurgical LVA were retrospectively reviewed and enrolled. The study group (LD>3.6 years) and the control group (LD≤3.6 years) consisted of 94 and 95 patients, respectively. Patients with previous LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters and volume changes were recorded and the parameters except LD were matched using propensity-score-matching. The primary endpoint was volume change at 6 and 12 months after LVA.</p><p><strong>Results: </strong>Before matching, the study group had significantly higher ratios of indocyanine green-enhanced, lymph flow-positive, and Normal+Ectatic LVs (p=0.016, 0.035, and 0.002, respectively) than the control group. After all parameters except LD were matched, 64 patients were included in each group, with higher median LD in the study group (7.8 vs. 1.1 years, p<0.001) than the control group. However, no significant intergroup differences were found in postoperative percentage volume reduction at the 6- and 12-month follow-up (p=0.813 and 0.627, respectively).</p><p><strong>Conclusion: </strong>Contrary to common beliefs, longer LD did not negatively affect LV quality and outcomes after LVA. Therefore, LVA remains a viable treatment option for patients with long-standing lymphedema.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Study of Inflammatory and Fibrotic Reactions Induced by Silicone Implants with Different Hardness.
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-02-28 DOI: 10.1097/PRS.0000000000012055
Da Woon Lee, Si-Hyong Jang, Hyun Kim, Taek Kyun Kim, Je Yeon Byeon, Hwan Jun Choi

Background: Silicone nasal implants have been widely used in rhinoplasty. However, research on the correlation between implant hardness and the development of fibrosis and inflammation is lacking. This study investigated how the hardness of silicone implants influences fibrosis and inflammation through an experimental investigation.

Methods: Three types of nasal silicone implants with varying hardness levels were implanted bilaterally on the backs of 15 Wistar rats. Ten weeks post-implantation, clinical aspects, such as differences in immune reactions and formation of peri-implant capsules were analyzed. The intra-tissue response of the host was assessed by qRT-PCR using 11 markers. Specific markers were investigated by immunohistochemical (IHC) staining. Pathological grading was performed to investigate inflammation and fibrosis in the peri-implant tissues. Quantification and statistical analysis of these parameters were conducted to derive scores for intergroup comparisons.

Results: Histological analysis of the 45 capsules obtained revealed lower levels of fibrosis and acute inflammation in the group with lower hardness. This result was confirmed by IHC staining. Hematoxylin and eosin staining showed that the capsule thickness was less in the low-hardness group. Additionally, inflammation resolved quickly in the low-hardness group, and mature fibrotic tissue was observed.

Conclusions: When silicone implants are stably positioned within the body, less-rigid implants exhibit lower inflammatory or fibrotic responses. This is directly related to the adverse effects associated with capsule formation. These findings contribute to our understanding of the behavior of heterotopic materials in the nasal dorsum and their effects on the skin and soft tissue envelope.

{"title":"Comparative Study of Inflammatory and Fibrotic Reactions Induced by Silicone Implants with Different Hardness.","authors":"Da Woon Lee, Si-Hyong Jang, Hyun Kim, Taek Kyun Kim, Je Yeon Byeon, Hwan Jun Choi","doi":"10.1097/PRS.0000000000012055","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012055","url":null,"abstract":"<p><strong>Background: </strong>Silicone nasal implants have been widely used in rhinoplasty. However, research on the correlation between implant hardness and the development of fibrosis and inflammation is lacking. This study investigated how the hardness of silicone implants influences fibrosis and inflammation through an experimental investigation.</p><p><strong>Methods: </strong>Three types of nasal silicone implants with varying hardness levels were implanted bilaterally on the backs of 15 Wistar rats. Ten weeks post-implantation, clinical aspects, such as differences in immune reactions and formation of peri-implant capsules were analyzed. The intra-tissue response of the host was assessed by qRT-PCR using 11 markers. Specific markers were investigated by immunohistochemical (IHC) staining. Pathological grading was performed to investigate inflammation and fibrosis in the peri-implant tissues. Quantification and statistical analysis of these parameters were conducted to derive scores for intergroup comparisons.</p><p><strong>Results: </strong>Histological analysis of the 45 capsules obtained revealed lower levels of fibrosis and acute inflammation in the group with lower hardness. This result was confirmed by IHC staining. Hematoxylin and eosin staining showed that the capsule thickness was less in the low-hardness group. Additionally, inflammation resolved quickly in the low-hardness group, and mature fibrotic tissue was observed.</p><p><strong>Conclusions: </strong>When silicone implants are stably positioned within the body, less-rigid implants exhibit lower inflammatory or fibrotic responses. This is directly related to the adverse effects associated with capsule formation. These findings contribute to our understanding of the behavior of heterotopic materials in the nasal dorsum and their effects on the skin and soft tissue envelope.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the editor: Single-Center, Long-Term Experience with Mentor Contour Profile Gel Implants: What Can We Learn after 21 Years of Follow-Up?
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-02-28 DOI: 10.1097/PRS.0000000000012060
Alvise Montanari, Vincenzo Vindigni, Franco Bassetto
{"title":"Letter to the editor: Single-Center, Long-Term Experience with Mentor Contour Profile Gel Implants: What Can We Learn after 21 Years of Follow-Up?","authors":"Alvise Montanari, Vincenzo Vindigni, Franco Bassetto","doi":"10.1097/PRS.0000000000012060","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012060","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The influence of Pitanguy ligament on the supra tip break point in open rhinoplasty.
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-02-28 DOI: 10.1097/PRS.0000000000012056
Hakan Şirinoglu, Emre Güvercin, Burak Ergün Tatar, Hakan Gence

Background: The supratip break point is paramount in nasal aesthetics. "Polly beak deformity" denotes a swollen supratip, posing aesthetic concerns. The Pitanguy ligament facilitates tissue attachment and aids in the control of fibrosis. This study investigated the impact of Pitanguy ligament repair on the supratip depth.

Patients: This retrospective study conducted between May 2019 and July 2023 included 120 patients. Divided into three groups, each comprising 40 patients: Group I (No Touch Group): The Pitanguy ligament remained untouched. Group II (Excision Group): The Pitanguy ligament was excised. Group III (Repair Group): The Pitanguy ligament was sutured to the highest point of the caudal septum. Patient photographs were taken at the 3rd and 12th months post-operation. Supratip area depth was measured using Adobe Photoshop software. Changes in the supratip breakpoint depth at 3 and 12 months, along with a comparison of the 12-month supratip depths among the groups, were conducted.

Results: The study included 120 patients (96 females and 24 males. Group II exhibited statistically significant differences when comparing the changes between 3 and 12 months postoperatively (p<0.05). By the 12th month, the depth of the repair group (Group III) significantly exceeded that of the other groups (p<0.05).

Conclusion: This study demonstrates that performing Pitanguy repair in open rhinoplasty techniques significantly enhances supratip depth and prevents pollybeak deformities.

{"title":"The influence of Pitanguy ligament on the supra tip break point in open rhinoplasty.","authors":"Hakan Şirinoglu, Emre Güvercin, Burak Ergün Tatar, Hakan Gence","doi":"10.1097/PRS.0000000000012056","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012056","url":null,"abstract":"<p><strong>Background: </strong>The supratip break point is paramount in nasal aesthetics. \"Polly beak deformity\" denotes a swollen supratip, posing aesthetic concerns. The Pitanguy ligament facilitates tissue attachment and aids in the control of fibrosis. This study investigated the impact of Pitanguy ligament repair on the supratip depth.</p><p><strong>Patients: </strong>This retrospective study conducted between May 2019 and July 2023 included 120 patients. Divided into three groups, each comprising 40 patients: Group I (No Touch Group): The Pitanguy ligament remained untouched. Group II (Excision Group): The Pitanguy ligament was excised. Group III (Repair Group): The Pitanguy ligament was sutured to the highest point of the caudal septum. Patient photographs were taken at the 3rd and 12th months post-operation. Supratip area depth was measured using Adobe Photoshop software. Changes in the supratip breakpoint depth at 3 and 12 months, along with a comparison of the 12-month supratip depths among the groups, were conducted.</p><p><strong>Results: </strong>The study included 120 patients (96 females and 24 males. Group II exhibited statistically significant differences when comparing the changes between 3 and 12 months postoperatively (p<0.05). By the 12th month, the depth of the repair group (Group III) significantly exceeded that of the other groups (p<0.05).</p><p><strong>Conclusion: </strong>This study demonstrates that performing Pitanguy repair in open rhinoplasty techniques significantly enhances supratip depth and prevents pollybeak deformities.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postoperative and Long-Term Patient-Reported Outcomes of Type A Ulnar Polydactyly.
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2025-02-24 DOI: 10.1097/PRS.0000000000012052
Holly Cordray, Apurva S Shah, Eliza Buttrick, Benjamin Chang, Kevin J Little, Tamara Al-Muhtaseb, Shaun D Mendenhall

Introduction: Type A ulnar/postaxial polydactyly describes a well-developed supernumerary small finger, which may have self-image and functional sequelae even after reconstructive surgery. We aimed to characterize postoperative outcomes and substantiate the CoULD Ulnar Polydactyly (CUP) Classification's clinical relevance.

Methods: All cases at two major pediatric hospitals from 2012-2022 were reviewed. Surgeons classified preoperative radiographs using the CUP Classification. Complication rates were compared using Chi-square/Fisher's exact tests. Patient-reported outcomes included the Patient and Observer Scar Assessment Scale, Australian Hand Difference Register aesthetics scale, and PROMIS; descriptive analyses considered minimum clinically important differences (MCIDs).

Results: Sixty-four hands in 42 patients underwent surgery (mean age 15.1 ± 12.2 months). Operative techniques aligned with the CUP reconstructive pathway. Late complications varied significantly by CUP subtype (P < .001), occurring most commonly in A3-Divergent Metacarpophalangeal and A5-Duplicated Metacarpal cases. Differences centered on functional complications, including subjective functional concerns, flexion contractures, and limited flexion (each P ≤ .02). Nineteen patients/caregivers completed questionnaires on average 5.9 years postoperatively. Most agreed that surgery improved their hands' appearance (median 5/5) and endorsed happiness with their hands' appearance (median 4/5). Approximately half nonetheless felt that their hands could look better. Patients/caregivers reported good scar quality. Regarding function, mean PROMIS Upper Extremity scores fell more than a MCID below pediatric norms, especially for older children/adolescents (ages 8-18 years). Self-reported PROMIS Peer Relationships were within normal limits.

Conclusions: Most patients were pleased with postoperative results, but many reported room for aesthetic and functional improvement. This study corroborated the CUP Classification's clinical relevance.

{"title":"Postoperative and Long-Term Patient-Reported Outcomes of Type A Ulnar Polydactyly.","authors":"Holly Cordray, Apurva S Shah, Eliza Buttrick, Benjamin Chang, Kevin J Little, Tamara Al-Muhtaseb, Shaun D Mendenhall","doi":"10.1097/PRS.0000000000012052","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012052","url":null,"abstract":"<p><strong>Introduction: </strong>Type A ulnar/postaxial polydactyly describes a well-developed supernumerary small finger, which may have self-image and functional sequelae even after reconstructive surgery. We aimed to characterize postoperative outcomes and substantiate the CoULD Ulnar Polydactyly (CUP) Classification's clinical relevance.</p><p><strong>Methods: </strong>All cases at two major pediatric hospitals from 2012-2022 were reviewed. Surgeons classified preoperative radiographs using the CUP Classification. Complication rates were compared using Chi-square/Fisher's exact tests. Patient-reported outcomes included the Patient and Observer Scar Assessment Scale, Australian Hand Difference Register aesthetics scale, and PROMIS; descriptive analyses considered minimum clinically important differences (MCIDs).</p><p><strong>Results: </strong>Sixty-four hands in 42 patients underwent surgery (mean age 15.1 ± 12.2 months). Operative techniques aligned with the CUP reconstructive pathway. Late complications varied significantly by CUP subtype (P < .001), occurring most commonly in A3-Divergent Metacarpophalangeal and A5-Duplicated Metacarpal cases. Differences centered on functional complications, including subjective functional concerns, flexion contractures, and limited flexion (each P ≤ .02). Nineteen patients/caregivers completed questionnaires on average 5.9 years postoperatively. Most agreed that surgery improved their hands' appearance (median 5/5) and endorsed happiness with their hands' appearance (median 4/5). Approximately half nonetheless felt that their hands could look better. Patients/caregivers reported good scar quality. Regarding function, mean PROMIS Upper Extremity scores fell more than a MCID below pediatric norms, especially for older children/adolescents (ages 8-18 years). Self-reported PROMIS Peer Relationships were within normal limits.</p><p><strong>Conclusions: </strong>Most patients were pleased with postoperative results, but many reported room for aesthetic and functional improvement. This study corroborated the CUP Classification's clinical relevance.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Plastic and reconstructive surgery
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