Plastic and Reconstructive Surgery Global Open最新文献

Background: Soft tissue defects on the palm side of the thumb can be effectively covered by using the radial midpalmar (RMP) flap, which is usually harvested as a pedicled flap. However, previous anatomical studies on this flap are limited. We analyzed multidetector-row computed tomography angiograms of the radial midpalm of hands to more precisely characterize the 3-dimensional anatomical structure of the perforators in living patients.

Methods: This retrospective cross-sectional study included all eligible patients from 2014 to 2019. All Digital Imaging and Communications in Medicine (DICOM) data were analyzed by the DICOM viewer. RMP area vascularization pattern and cutaneous perforator number, location, origin, internal diameters, and bifurcation-to-dermis lengths were recorded.

Results: In total, 41 perforators were found in 30 patients: 21 patients had 1 perforator, 7 had 2, and 2 had 3 perforators. All were located inside a 23.2-mm diameter circle with an origin on the second metacarpal bone axis approximately 10 mm distally from the Kaplan cardinal line. Their origins were the superficial palmar arch system (61%), palmar arteries of the thumb (24%), and radialis indicis artery (15%). The mean perforator diameter and length were 0.61 and 8.48 mm, respectively.

Conclusions: All patients had at least 1 reliable perforator in the radial midpalm. Our results suggest that plastic surgeons can easily and safely plan the RMP flap design, potentially without preoperative perforator mapping. Guidelines for this flap are proposed.

Background: There has been a delayed, yet steady uptake of robotic-assisted surgery over the past decade within the field of plastic surgery. In an era of rapidly evolving scientific and technological development, there is a need for an update on the current literature for robotic-assisted plastic surgery procedures.

Methods: Searches were conducted across major databases, including MEDLINE, Embase, and Central for published literature from March 2023 to December 2024. Only published articles written in English with full texts were considered for the final narrative synthesis.

Results: Initially, we identified 1200 articles in the database search. Subsequently, 46 articles were included in our final narrative synthesis. Among the selected studies, 4 focused on reconstruction in transoral robotic surgery, 14 on breast surgery, 10 on robotic microsurgery, 5 on abdominal wall reconstruction, 6 on vaginoplasty, and 5 on flap harvest.

Conclusions: The evidence to support the advantage of robotic plastic surgery procedures over traditional methods is relatively weak. However, there have been some advancements, specifically in transoral robotic surgery, robotic mastectomy, and breast reconstruction. Nevertheless, comprehensive exploration and prospective randomized trials are essential across all procedures to define the role of surgical robots in plastic surgery. The impediments to wider adoption include high costs, disruption to operative flow, and the absence of haptic feedback in robotic-assisted procedures within the specialty.

Background: Interphalangeal joint (IPJ) arthrodesis and arthroplasty are mainstay treatments for IPJ arthritis with conflicting evidence about the most efficacious choice. Our study describes case volume and incidence over the last decade (2010-2019).

Methods: The IBM MarketScan database was queried using Current Procedural Terminology codes for IPJ arthrodesis and arthroplasty from January 2010 to December 2019. Volume and incidence were estimated annually and according to sex, age, and US geographical region for 2010 and 2019.

Results: Annual volume and incidence of IPJ arthrodesis increased slightly from 2010 to 2019, though with overlapping confidence intervals for incidence. Arthrodesis tended to be higher in women versus men, especially with increasing age. When considering age, the most substantial increase in rates over increasing age was moving from the 40s to 50s age brackets. Across US regions, arthrodesis was higher in the northeast and midwest in 2010, though other rates rose and regions were similar by 2019. For IPJ arthroplasty, there was a 25%-30% decrease in case volume and incidence over the decade. Incidence was generally higher among women, with a similar jump in incidence from 40s to 50s among women, whereas men showed a more gradual rate increase with age. Regionally, arthroplasty was highest in the northeast and midwest in 2010, though it was similar across regions in 2019.

Conclusions: Although IPJ arthrodesis levels have stayed relatively stable, IPJ arthroplasty showed a general decline over the decade. Incidence of both were higher among women, and despite initial regional differences, rates became more similar by 2019.

Background: The reverse fragility index (RFI) is a measure used to evaluate the neutrality of statistically nonsignificant findings in randomized controlled trials (RCTs). The RFI represents the minimum number of events needed to reverse a statistically nonsignificant result into a significant one. This study applied the RFI to examine the robustness of statistically nonsignificant RCTs in plastic surgery.

Methods: A systematic literature search of the 10 highest impact journals covering plastic and reconstructive surgery topics was conducted to identify RCTs published between January 2000 and March 2023. The Fisher exact test was used to calculate the RFI for each primary outcome. Bivariate analysis was performed to investigate the association of trial characteristics with the RFI.

Results: Forty RCTs that yielded 65 primary outcomes were included in the analysis with a median sample size of 76 participants (interquartile range [IQR], 49-129) and a median of 10 events (IQR, 3-22). The median RFI was 4 (IQR, 3-5), indicating that statistical significance would have been achieved if 4 participants had a change in event status. The median RFQ was 0.053 (IQR, 0.038-0.08). Most studies (21 of 40) did not perform statistical power analysis. Twelve of 40 RCTs did not report or clearly indicate loss to follow-up.

Conclusions: The findings of RCTs in the plastic surgery literature demonstrate fragility as the preservation of nonsignificant results rested on a small number of events. The RFI is a useful measure to complement the P value and examine the neutrality of null clinical trials.

Background: Facial aging involves multifactorial changes affecting the bone, superficial musculoaponeurotic system, fat pads, and skin, primarily manifesting as the downward displacement of these structures. The transtemporal endoscopic deep plane face lift (TEDPF) suggests a vertical lifting method, targeting these issues without a preauricular incision.

Methods: A retrospective study was conducted on 140 patients (133 women and 7 men) 33-67 years of age who underwent TEDPF from February 2020 to March 2023. Of these, 42 patients also received a neck lift. The surgical technique involved endoscopic dissection and vertical lifting and fixation of the superficial musculoaponeurotic system layer using specific suture points. An objective photographic analysis was performed by measuring preoperative and postoperative lower eyelid lengths to assess aesthetic outcomes.

Results: The follow-up period ranged from 18 to 36 months. Temporary frontal neuropraxia occurred in 5 patients, resolving within 3 weeks to 3 months. Revision surgery was required for 6 patients due to excess preauricular skin or temporal skin accumulation malar dimpling. Significant improvements were observed, especially in periorbital, nasolabial, and jowl areas, enhancing eye shape and reducing the need for lower blepharoplasty. Objective photographic analysis showed a significant reduction in lower eyelid length postoperatively, with a mean percentage reduction of 22.45% in eyelid length (P < 0.05).

Conclusions: TEDPF achieves effective vertical lifting for facial rejuvenation, minimizes scarring, and reduces surgery time. It provides notable aesthetic improvements with manageable complications, suitable for patients prone to keloids or seeking less invasive options.

In the evolving landscape of ambulatory surgery, wide-awake local anesthesia no tourniquet (WALANT) surgery has emerged as a preferred approach due to its efficacy, cost-effectiveness, and patient satisfaction. This paradigm shift places the patient at the center of intraoperative communication, requiring a significant change in the dialogue within the operating room (OR). Traditional conversations, which often exclude the unconscious patient, must evolve to accommodate and prioritize the psychological comfort of the conscious patient. This article examines the impact of language, tone, and conversation content on the patient experience during WALANT. We propose a communication framework that emphasizes empathy, reassurance, and patient inclusion to reduce anxiety and increase patient compliance. By analyzing common OR dialogues and their potential impact on awake patients, we identify specific phrases and words that may exacerbate patient stress or discomfort. Alternatives are suggested to foster a more positive and inclusive environment. Our recommendations are based on extensive clinical experience and supported by relevant literature, highlighting the critical role of mindful communication in improving clinical outcomes and patient satisfaction in WALANT.

Background: Given the growing demand for gender-affirming surgery (GAS) in recent years, it is essential to explore the public perceptions of GAS. Understanding the public's opinions and attitudes toward GAS will provide valuable insights for shaping educational initiatives to enhance public knowledge and awareness.

Methods: This cross-sectional study used the Prolific Academic platform to distribute an online survey among adult participants residing in the United States in August 2023.

Results: Of 1005 completed survey responses, 50% of respondents were 41 years of age or older, 51% were women, and 73% were White. A total of 18% identified as part of the LGBTQIA+ community, and most (37%) resided in the southern United States. The majority of participants (78%) did not personally know anyone who underwent GAS, and 74% believed that plastic surgeons mainly perform GAS. Only 22% felt healthcare professionals were well qualified to provide gender-affirming care. Media's effect on GAS acceptance was assessed to be mostly negative (33%) or very negative (12%). About 33% favored both public and private health insurance coverage for GAS, whereas 35% opposed insurance coverage. Most respondents strongly agreed (32% and 34%) or agreed (33% and 37%) that GAS aligns with gender identity and improves mental health. Regarding minimum age, most partakers (43%) supported 18 years, whereas 38% endorsed 21 years.

Conclusions: This study sheds light on the public perceptions of GAS. These insights underscore the need for targeted educational efforts to increase awareness, rectify misconceptions, and promote a deeper understanding of GAS within society.

Background: Plastic surgery aims to enhance patients' positive features and improve perceived flaws without seeking complete transformation. The body is a living organism, not a sculptural object to be reshaped at will. Aesthetic standards are influenced by subjective factors, including technology and social media's effect on self-perception and beauty ideals. Understanding body perception requires consideration of personal views, mirror reflections, and external perspectives.

Methods: We analyzed data from more than 4000 patients to obtain objective insights into contemporary aesthetic preferences. We examined the influence of globalization on beauty standards, the relationship between physical activity and desired body definitions, and regional preferences for specific body shapes. In addition, we assessed how patients' aesthetic preferences are shaped more by the surgical centers they choose than by their nationality.

Results: Our findings indicate that globalization has diversified perceptions of beauty, highlighting personal and cultural differences. We noted a significant correlation between patients' aesthetic preferences and the surgical center, reflecting the impact of medical tourism and social media on shaping beauty ideals.

Conclusions: As patient opportunities expand, the remote management of complex procedures necessitates skilled surgeons to ensure safe and effective care. Our experience provides valuable data on current patient preferences, essential for adapting practices in the evolving landscape of plastic surgery.

Background: Breast reconstruction with the deep inferior epigastric perforator (DIEP) free flap has become the gold standard for autologous breast reconstruction. Flap take-back to the operating room (OR) is an uncommon but difficult situation, requiring prompt and accessible resources. We conducted a literature review and independent expert review to inform evidence-based perioperative algorithms in the event of DIEP flap compromise.

Methods: A review of the literature was conducted, including MEDLINE, Embase, Google Scholar, and Cochrane Controlled Register of Trials. Publications examining free flap re-exploration in breast reconstruction were used to inform evidence-based clinical algorithms. The algorithms then underwent expert review and revisions from 6 international experts in microsurgery.

Results: Three evidence-based management algorithms were created. The first algorithm outlines perioperative management strategies to optimize patient care and prompt return to the OR. Nonconstricting flap inset after take-back, salvage medical strategies and postoperative management following flap failure were additionally included. Algorithms 2 (venous congestion) and 3 (vascular thrombosis) provide specific intraoperative strategies surrounding mechanical decompression, pedicle exposure, assessment and extraction of thrombosis, identification and use of alternative recipient vessels, and the usage of intraoperative thrombolytics.

Conclusions: A coherent and stepwise approach to DIEP flap compromise in breast reconstruction was developed. These expert-reviewed algorithms provide an approachable and evidence-based structure to support return to the OR and serve as readily available resources.

The free fibula flap is a common technique for mandibular bone defects. However, its limited skin paddle is disadvantageous in cases with significant soft-tissue defects. A free fibula dual-skin paddle flap is used for medium-sized soft-tissue defects. Just as the anterolateral thigh flap can be extended through linking vessels, so the peroneal skin flap can be extended to the adjacent proximal area through linking vessels. This has led to the development of the free fibula banana-shaped flap. From 2021 to 2023, 8 patients, with an average age of 68.1 years, underwent head and neck reconstructive surgery using the free fibula banana-shaped flap at the Saitama Cancer Center in Japan. Their primary disease, defect sites, flaps, bone size, and postoperative complications were analyzed retrospectively. The blood flow of the flap was examined using intraoperative indocyanine green imaging. All 8 patients had successful operations with only 1 partial necrosis of the flap tip. Four patients had buccal mucosa cancers, 3 had osteoradionecrosis of the jaw, and 1 had lower gingival cancer. The flap size averaged 25.0 ± 3.0 cm (long axis) and 4.1 ± 0.4 cm (short axis), with a transplanted bone length of 8.4 ± 1.9 cm. The number of perforators was 1-3 in the distal to the central area. All flaps' microcirculation was confirmed with intraoperative indocyanine green imaging; the average time was 3 minutes 59 seconds. Postoperative complications included 1 surgical site infection and 1 minor salivary leak. The free fibula banana-shaped flap is a good option for head and neck reconstructive surgery in medium-sized soft-tissue defects with mandibular bone defects.