Plastic and reconstructive surgery最新文献

Background: Buffalo hump is fibrolipodystrophy in the posterior part of neck. Although established surgical treatments, such as lipectomy and liposuction, are available, they each have notable limitations. Lipectomy often leads to significant scarring, trauma, and prolonged recovery. Traditional liposuction encounters challenges such as high suction resistance and potential complications. The objective of this study is to introduce a novel technique-dissector-assisted liposuction-as a potential solution to address these limitations.

Methods: A case series study was conducted. The fibrous tissue was first dissected using a specialized dissector to reduce the resistance in the subcutaneous and deep fascia layers. The fibers within the buffalo hump were also carefully dissected. Once the resistance in the buffalo hump area was significantly reduced, a 3.5-mm harvesting cannula with a cutting edge was used to perform liposuction. A 5-point Likert scale was used to assess outcomes preoperatively and 6 months postoperatively.

Results: A total of 57 patients underwent dissector-assisted liposuction for buffalo hump treatment without complications. The average volume of the buffalo hump was 328.72 mL. Immediate improvements in appearance were observed in all patients. Six months after surgery, with the exception of scarring (which showed a median Likert scale value of 0 in both the preoperative and postoperative periods), the Likert scale value for the other 4 parameters showed a significant increase ( P < 0.05).

Conclusions: Dissector-assisted liposuction offers several advantages, including the predissecting of fibrous tissue, reduction of fibrous tissue volume, and decreased resistance during liposuction, making it a promising approach for treating buffalo hump.

Background: Transverse facial cleft is a rare congenital craniofacial anomaly that significantly impacts both aesthetic appearance and functional integrity of the oral commissure. Current surgical techniques demonstrate suboptimal efficacy in restoring commissural morphology and facial symmetry. To further optimize surgical outcomes, we enhanced the conventional approach by incorporating anatomical reconstruction of the modiolus and orbicularis oris, and evaluated its long-term aesthetic outcomes in the symmetry of commissure compared with conventional methods.

Methods: This single-center cohort study retrospectively analyzed 20 patients who underwent unilateral transverse facial cleft repair between May 2015 and October 2023. The cohort comprised two groups: (1) conventional repair group (n=9) and (2) priority modiolus reconstruction group (n=11). Objective anthropometric measurements were obtained at preoperative, immediate postoperative, and long-term follow-up stages. Subjective evaluations were performed using Face-Q and Visual Analog Scale (VAS) questionnaires.

Results: Immediate postoperative assessment revealed significant improvement in the lower cheilion spread angle (ΔLCSA) in the modiolus reconstruction group compared to controls (8.22 ± 5.43 vs. 3.67 ± 2.99, p = 0.045). Long-term follow-up demonstrated significant differences in four key perioral measurements: ΔUCSA (10.04 ± 6.83 vs. 4.56 ± 1.78, p = 0.046), ΔLCSA (9.47 ± 5.19 vs. 3.94 ± 2.78, p = 0.014), ΔLs-Ch (9.75 ± 5.91 vs. 3.82 ± 1.95, p = 0.004) and Δl-Ch (10.59 ± 5.41 vs. 3.89 ± 3.32, p = 0.006), indicating enhanced commissural symmetry, particularly during mouth-opening. Professional evaluation using VAS for commissural symmetry were also significantly higher in the reconstruction group at long-term follow-up (7.78 ± 0.75 vs. 8.45 ± 0.58, p = 0.042).

Conclusions: In patients with unilateral transverse facial cleft, priority modiolus reconstruction is associated with superior static and dynamic symmetry of commissure compared with conventional repair, with maintained long-term outcomes.

Background: Pierre Robin Sequence (PRS) is defined by micrognathia, glossoptosis, and upper airway obstruction. Although neonatal management is well established, surgical indications and protocols beyond this period remain variable due to the absence of standardized guidelines. This review evaluates published treatment algorithms for mandibular distraction osteogenesis (MDO), identifies common decision-making criteria, and proposes a unifying algorithm informed by existing literature. We hypothesize that MDO is preferred following failed conservative management of feeding and airway function.

Methods: A literature search was conducted following PRISMA guidelines. Inclusion criteria required studies to describe treatment algorithms, decision-making criteria, or institutional protocols for MDO. Of 275 studies identified, 23 met inclusion criteria.

Results: Airway management strategies prioritized non-invasive approaches, including prone/lateral positioning, supplemental oxygen, positive airway pressure, and nasopharyngeal airway (NPA) use. Polysomnography (PSG) was utilized in 12 studies to guide decision-making, with an Apnea-Hypopnea Index (AHI) > 20 frequently cited as the threshold for surgical escalation. 16 studies favored MDO over tongue-lip adhesion (TLA) due to its lower risk of long-term tracheostomy and feeding impairment, though three studies preferred TLA, and four did not specify a preferred approach. The earliest reported MDO occurred at 11 days; however, the mean age across studies was 100 days, indicating most interventions occurred in early infancy beyond the neonatal period (<28 days).

Conclusions: Algorithm-based airway management in PRS emphasizes early PSG assessment, conservative trialing, and MDO as the preferred surgical intervention. Further studies should refine predictive criteria for MDO success and optimize management strategies beyond the neonatal period.

Background: Autologous Fat Transfer (AFT) has emerged as a promising technique for total breast reconstruction post-mastectomy, particularly in patients unsuitable for other reconstruction methods. Evaluating its efficacy, safety, and impact on quality of life is essential.

Objective: To assess the efficacy and safety outcomes of AFT as total breast reconstruction in women post-mastectomy, based on 12-month follow-up data from the BREAST-II trial.

Methods: This multicentre, nonrandomised clinical trial included women aged ≥18 years with a history of or planned mastectomy across eight Dutch hospitals. Participants underwent multiple AFT sessions combined with external expansion using the EVE-bra device, with a maximum of five sessions over 12 months. Primary outcome was quality of life measured by BREAST-Q and BODY-Q questionnaires. Secondary outcomes included safety (serious adverse events [SAEs]), operating time, hospital stay, and number of sessions.

Results: A total of 229 women were included. At 12 months post-AFT, significant improvements were observed in psychosocial well-being (+5.72 ±16.79), sexual well-being (+8.05 ±19.61), physical well-being of the chest (+5.97 ±20.44), and chest satisfaction (+17.22 ±27.27) (all p<0.001). BODY-Q scores showed significant increases in satisfaction with abdomen, back, body, hips/outer thighs, inner thighs, and scars (all p<0.001). Among 805 AFT sessions, 52 (S)AEs occurred (6.46% complication rate). Hospital stays were less than one day per session.

Conclusions: AFT is an effective and safe total breast reconstruction technique post-mastectomy, significantly improving quality of life with low complication rates. These findings support AFT as a valuable addition to breast reconstruction options.

Trial registration: AFT: Introduction of a Full Breast Reconstructive Method (BREAST-II).

Clinicaltrialsgov id: NCT04261829.

Study details aft: Introduction of a Full Breast Reconstructive Method | ClinicalTrials.gov.

Background: The effect of aesthetic osseous genioplasty on upper airway volume remains unclear, particularly the relative contributions of horizontal and vertical chin changes.

Methods: We retrospectively analyzed volumetric airway changes in 70 patients who underwent osseous genioplasty, using pre- and postoperative craniofacial CT scans (140 total). Image segmentation was performed to approximate volumes of the nasopharynx, oropharynx, hypopharynx, and total pharynx. Horizontal chin projection change was defined as the difference in anterior-posterior (AP) position of the osteotomized chin segment, and vertical change as lengthening or shortening based on inferior-superior movement of the pogonion, both measured between pre- and postoperative scans. Univariable and multivariable linear regressions were then performed to assess associations with airway volume change.

Results: Vertical chin lengthening was independently associated with oropharyngeal (β = 664.4 mm³, p = 0.015) and total airway volume (β = 917.6 mm³, p = 0.011) change, confirmed in univariable models (oropharynx: β = 728.0 mm³, p = 0.0047). Horizontal projection showed no significant associations across any airway region. Across the entire cohort, patients experienced net reductions in airway volume postoperatively, most notably in the oropharynx (-1270 mm³, p = 0.048) and total airway (-2801 mm³, p = 0.0016), particularly in cases with vertical chin shortening. Controls demonstrated minimal change. These findings suggest that vertical lengthening may increase airway patency, while vertical reduction may contribute to narrowing.

Conclusion: Vertical movement of the osteotomized chin segment, both lengthening and shortening, was identified as a significant factor associated with postoperative airway change after genioplasty. This highlights the relevance of vertical repositioning in surgical planning and provides a basis for future studies on the functional effects of aesthetic genioplasty on the airway.

Amid the global trend toward smooth implants' use, implant stability has become a progressively significant concern for augmentation mammaplasty. During the dual-plane augmentation via the inframammary fold (IMF) approach, IMF fixation suture-suturing the Scarpa's fascia to the deep fascia-is routinely adopted by surgeons to minimize inferior implant displacement. However, this approach of maintaining implant stability demonstrates inconsistent reliability, particularly with smooth implants. Excluding suboptimal technical factors, the fundamental cause of implant malposition lies in inadequate inferior or lateral support structure. Based on pectoralis major's anatomical foundation and the access characteristics of the IMF incision, the authors introduce an innovative technical refinement-the modified bi-muscular flap (BMF) technique. The procedure involves an L-shaped muscle release that preserves the lateral long-head origins of the muscle, creating an inferior support structure for the implant. A preliminary outcome compared with the dual-plane technique using fixation suture suggests that this new technique may represent a promising alternative for reducing smooth implant malposition and improving long-term stability.

Introduction: Autologous breast reconstruction (ABR) following postmastectomy radiotherapy (PMRT) is often delayed several months due to adverse effects of radiation on outcomes. The optimal time between PMRT and ABR remains uncertain. We sought to analyze how the timing of ABR following PMRT affects postoperative outcomes.

Methods: A retrospective analysis was performed on adult female patients who underwent ABR. Cases were analyzed on a per-flap basis and were stratified into PMRT and non-PMRT groups. The PMRT group was further stratified into cohorts based on the time from completion of PMRT to ABR defined as: 0-3 months, 3-6 months, 6-12 months, and 12+ months. Primary outcomes included flap failure or necrosis and immediate reoperation. All other complications were secondary outcomes. Group differences were assessed using Chi-squared, Fischer's exact, Kruskal-Wallis and Wilcoxon rank sum tests. A logistic mixed-effects model was conducted to identify variables associated with postoperative complications.

Results: 514 flaps among 339 patients were included. 37.2% of the flaps were performed following PMRT: 5 within 0-3 months, 72 within 3-6 months, 71 within 6-12 months, and 43 within 12+ months. There were no statistically significant differences in reoperations, flap thrombosis, flap failure, infection, wound dehiscence, or operative time when comparing cases with or without PMRT and no statistically significant differences when comparing cases at the various time intervals.

Conclusion: No statistically significant differences in postoperative complications were observed across PMRT timing intervals. These findings do not support a strong association between the interval from radiotherapy to ABR and complication rates.

Clinical question/level of evidence: Therapeutic, IV.

Background: Developmental and behavioral issues are frequently reported in patients with metopic synostosis. The effect of pre-operative severity and surgical timing on these outcomes remains debated and inconclusive. This study aims to describe neurocognitive profiles in patients with metopic synostosis and evaluate associations with pre-operative severity and surgical timing.

Methods: A retrospective study was conducted on patients with non-syndromic metopic synostosis who underwent fronto-orbital advancement (FOA) at Sophia Children's Hospital. Patients were born between 2006-2018 and had a minimum 6-year follow-up. Data from psychological/psychiatric diagnostic assessments were collected, including WPPSI and WISC. Pre-operative severity was determined using CranioRate.

Results: A total of 228 patients with non-syndromic metopic synostosis who underwent FOA (median age 10 months, IQR 8-12) were included. Among these, 48.2% had reported parental concerns regarding their child's developmental and behavioral functioning. In total, 99 patients underwent psychological/psychiatric assessment, of which 73 patients underwent assessment at our center at the mean age of 7.8 years. Among referred patients, full scale IQ (FSIQ) (mean 95.5, p 0.012) and processing speed index (mean 94.3, p 0.002) were significantly lower compared to normative means. No significant association was found between FSIQ and pre-operative severity or surgical timing. Among all patients who underwent assessment, 43 were diagnosed with attention deficit/hyperactivity disorder and 13 were diagnosed with autism spectrum disorder, representing 18.9% and 5.7% of the total cohort respectively.

Conclusion: In this single-center cohort, cognitive and behavioral outcomes in children with metopic synostosis are not associated with pre-operative severity or surgical timing. However, parental concerns are common, and the increased prevalence of behavioral problems in this population highlights the importance of long-term neurodevelopmental monitoring.