Plastic and reconstructive surgery最新文献

Background: Conventional liposuction techniques involve visible incisions and scars. Newer methods offer less invasive options with improved patient satisfaction and fewer complications. Use of tranexamic acid (TXA) in tumescent solution has shown promise in reducing bleeding and bruising, enhancing postoperative outcomes. The purpose of this study was to describe TXA's effects in edema, ecchymosis, and pain in patients undergoing arm liposuction.

Methods: A comparative contralateral randomized clinical trial was conducted at a single specialized plastic surgery institution in Bogotá, Colombia, from May of 2022 to February of 2024. The study involved adult patients aged 18 to 60 years undergoing arm liposuction, either alone or in combination with other procedures. Patients received TXA in 1 arm, and placebo in the contralateral arm, with random assignment and blinding for both patients and surgeons.

Results: The authors' study included 78 patients, resulting in 156 arms undergoing arm liposuction with either TXA or placebo. Most patients were female (78.2%), with a mean age of 37.6 years and a mean body mass index of 24.7 kg/m². Pain scores and ecchymosis were significantly lower in the TXA arm compared with the placebo arm on the first day after the procedure. No differences in arm circumference measurements were found between groups along the different time points. The overall complication rate was 8.97%. Adding TXA to tumescent solution for arm liposuction significantly reduces pain and bruising, improving patient recovery. Our randomized trial confirms TXA's safety and effectiveness, highlighting its potential as a valuable tool in body contouring procedures and postoperative care.

Background: Efficient and objective tools for self-assessment of microsurgical skills are needed to ensure high-quality microsurgical training and optimized use of surgeons' time and resources. In addition, the successful clinical integration of microsurgical robots in operating rooms will critically depend on effective training and evaluation strategies for microsurgeons, necessitating the development, usability testing, and validation of such assessment tools for both conventional and robotically assisted microsurgery.

Methods: Two deep convolutional neural network-based computer algorithms were developed to enable automated tracking of conventional and robotic microsurgical instruments. To train these models, supervised and semisupervised learning was applied to 84 microsurgical training videos, and the results were statistically analyzed using t tests, ANOVA, linear regression, and correlation analyses.

Results: Computer algorithms that automatically track conventional and robotic microinstruments in recorded microsurgical training videos were developed. The total trajectory length showed a positive correlation with procedure time and Structured Assessment of Microsurgical Skill scores, reflecting operative efficiency and flow. Both procedure time and total trajectory length of robot-assisted procedures were significantly longer among experienced microsurgeons compared with the conventional approach, but not among microsurgical beginners. The mean deviation intensity, quantifying hand tremor throughout microsurgical performances, was significantly lower with the robot-assisted compared with the conventional microsurgical approach across all experience levels.

Conclusions: The proposed computer algorithms address critical gaps in objective microsurgical skill assessment, enabling accessible, efficient, and quantitative self-evaluation, and allow for direct comparison of robot-assisted and conventional microsurgical performances.

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.