Plastic and Reconstructive Surgery Global Open最新文献

Lip lift is a versatile procedure to shorten the upper lip and improve the morphology and proportion of the lip. It is commonly performed as part of facial rejuvenation in Western patients, whereas in Asian countries, younger people tend to desire a lip lift because a shorter upper lip is considered more attractive. The lip lift carries a risk of an unfavorable aesthetic outcome when underlying skeletal deformities, such as maxillary protrusion and vertical excess, are not addressed, resulting in an undesirable degree of dental exposure. This article described our experience of integrating orthognathic surgery into subnasal lip lift surgery to harmonize the facial profile, highlighting the methods to achieve an ideal dental show with lip lift. Orthognathic surgery was first performed to correct the skeletal deformity. Subnasal lip lift with bull's horn-type skin excision and orbicularis oris muscle resection was then performed as a staged procedure. The degree of Cupid's bow elevation was determined by the amount of skin excised, and incisor show was determined by the amount of muscle resected. Seventeen patients underwent this combination approach, and the upper lip was successfully shortened with appropriate proportions and dental show. Overall, the aesthetic results were pleasing, with high patient satisfaction. Integrating orthognathic surgery into a lip lift aids in the enhancement of perioral aesthetics. Preexisting skeletal deformities need to be diagnosed before the lip lift and should be corrected when indicated.

Source-grounded artificial intelligence (AI) models have emerged in the public domain and represent a powerful tool for content creation. These models allow users to "ground" the language model in user-input sources and convert text to audio. Although plastic and reconstructive surgery has traditionally relied on textbook sources for trainee education, we demonstrate the potential to migrate information to audio sources. We created podcasts using source-grounded AI technology based on selected chapters of Grabb and Smith's Plastic Surgery. Generated audio was created using NotebookLM and featured a conversation between 2 AI "broadcasters." Surveys were distributed to assess trainee feedback on AI-generated podcasts compared with the source material. Eight source-grounded AI podcasts were created on topics including wound healing, breast reconstruction, lower extremity reconstruction, and aesthetic principles. Generated audio had a mean length of 14.3 ± 0.2 minutes. Generated podcasts had excellent accuracy with no extraneous insertion of information. Weaknesses of AI-generated podcasts included under- or overemphasis on topics that were emphasized in the source. Survey participants (n = 10) on average spent 14.7 ± 4.7 minutes with the podcast and 34.0 ± 13.9 minutes with the book chapter. Participants preferred a mixed-media approach (90%) over text (0%) or audio alone (10%) for learning the specified material. We demonstrate the potential for source-grounded AI models to aid in the creation of audio-based plastic surgery educational content with high accuracy. This technology can translate plastic surgery literature into audible content to diversify the media available to trainees and practitioners.

Background: Postmastectomy radiotherapy (PMRT) in the context of immediate implant-based breast reconstruction (IIBBR) is associated with long-term morbidity. The likelihood of PMRT may influence the type and timing of breast reconstruction chosen in the preoperative setting. This study aimed to validate a machine learning (ML) model for predicting the probability of PMRT recommendations in IIBBR patients, in accordance with the transparent reporting of studies on prediction models for individual prognosis or diagnosis guidelines.

Methods: The study cohort comprised 224 breast cancer patients who underwent mastectomy with IIBBR from January 2021 to December 2022. Data were collected on 12 patient characteristics identified as predictive in our ML model. Preoperative characteristics were recorded from clinical history, physical examination, diagnostic imaging, and pathology reports.

Results: Of the 224 patients, 37% (n = 84) were recommended PMRT. Our ML model demonstrated high predictive performance, with an area under the receiver operating characteristic curve score of 0.80 (0.74-0.86). The variables most predictive of PMRT recommendation included the size of suspicious lymph nodes, the presence of carcinoma in axillary lymph node biopsies, tumor size, and the use of ultrasound as the initial diagnostic modality.

Conclusions: An ML model for predicting PMRT recommendations following IIBBR was validated. This prediction model may be helpful in the preoperative clinical setting to inform the discussion of reconstructive options.

Background: Patients who have undergone abdominoplasty face limited options for microsurgical breast reconstruction, as the deep inferior epigastric perforator flap is often unavailable. This study compared lumbar artery perforator (LAP) and profunda artery perforator (PAP) flaps for microsurgical breast reconstruction in patients with prior abdominoplasty.

Methods: A retrospective chart review was conducted on all patients who underwent microsurgical breast reconstruction between January 2011 and May 2023. Data analyzed included demographics, comorbidities, reconstruction type, complications, and patient-reported outcomes measured by BREAST-Q surveys. Statistical analysis used the Pearson χ² test and independent samples t test.

Results: A total of 264 patients underwent microsurgical breast reconstruction, with 39 having a history of abdominoplasty. Patients with prior abdominoplasty were older (54.4 ± 7.8 versus 50.5 ± 9.1 y, P = 0.012) and had a significantly higher body mass index (28.8 ± 4.4 versus 25.3 ± 4.2 kg/m², P < 0.001). Hypertension (30.8% versus 15.6%, P = 0.023) and diabetes (12.8% versus 4.0%, P = 0.024) were also more common in the abdominoplasty group. Among abdominoplasty patients, LAP flaps were more often undergone (66.7% versus 26.2%, P < 0.001). LAP flap recipients reported significantly higher BREAST-Q scores compared with PAP flap patients (all P < 0.001).

Conclusions: The LAP flap emerges as a superior option for microsurgical breast reconstruction in patients with prior abdominoplasty, providing higher patient satisfaction compared with PAP flaps. This study highlights the necessity of personalized, adaptable surgical approaches in microsurgical breast reconstruction, emphasizing patient-specific anatomical and historical considerations to optimize outcomes.

Background: Patient-reported outcome measures (PROMs) have become an integral part of outcome evaluation in reconstructive microsurgery. This study explored the usage of PROMs in microsurgical oncological head and neck reconstruction across surgical specialties and geographic regions.

Methods: A systematic literature search was conducted in Embase, MEDLINE, and Web of Science to identify studies reporting on adult patients undergoing oncological head and neck free flap reconstruction. Data extracted included PROM tools used, study demographics, surgical disciplines involved, procedural details, and outcomes.

Results: Of 5015 screened studies, 354 (n = 30,369 patients) met the inclusion criteria. A total of 94 PROM tools were identified. The most frequently used were the University of Washington Quality of Life Questionnaire (34.75%), nonvalidated tools (25.99%), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Head and Neck Module 35 (22.32%). Donor site-specific PROMs were infrequently used (22%), though more frequently used when plastic and reconstructive surgeons were involved (31.11% versus 15.53%, P = 0.019). PROM selection varied significantly by specialty and geographic location, and only 20% of studies were interdisciplinary.

Conclusions: Substantial heterogeneity exists in the use of PROMs in head and neck reconstruction, with variations driven by specialty and region. This lack of standardization hinders meaningful cross-study comparisons and the development of robust quality benchmarks. A unified, validated PROM framework is urgently needed to support international evidence-based practice. Future efforts should prioritize interdisciplinary collaboration and incorporate donor-site evaluation to comprehensively assess outcomes in oncological head and neck reconstruction.

Background: Delivery of immediate breast reconstruction (IBR) was severely restricted during the coronavirus disease 2019 (COVID-19) pandemic, with irreversible consequences for breast cancer survivors. This study aimed to determine the pandemic's effect on the provision of IBR services, quality of care delivered, and reconstructive outcomes.

Methods: For this multi-institutional, retrospective cohort study, data were obtained from all IBR cases during the study periods defined as "pre-COVID-19" (October 1, 2018, to March 14, 2020) and "COVID-19" (March 15, 2020, to October 31, 2021). Patient demographics, reconstructive strategy types, and oncological and surgical characteristics were analyzed. Safety and quality outcomes, including readmission, infection, seroma, mastectomy flap necrosis, and wait times were recorded.

Results: A cohort of 525 patients was included in this study. Patient and tumor characteristics were similar between the 2 study periods. There was a significantly lower odds of undergoing a single-stage alloplastic surgery (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.17-0.94, P = 0.0365) or autologous immediate reconstruction with a deep inferior epigastric perforator (DIEP) flap (OR = 0.42, 95% CI = 0.21-0.85, P = 0.015) during the COVID-19 era, with a reciprocal 53% higher odds of 2-stage alloplastic surgery (OR = 1.53, 95% CI = 1.03-2.27, P = 0.0359) during that time. Median wait time from first-stage to second-stage reconstruction was significantly shorter during COVID-19 (P = 0.0017). There were no differences in safety outcomes between the periods.

Conclusions: Reconstructive strategies differed during the COVID-19 era of resource limitations with more 2-stage alloplastic procedures and fewer single-stage alloplastic and autologous immediate DIEP flap procedures.

Melasma poses considerable challenges in dermatologic management, particularly due to variable treatment responses and frequent recurrence following conventional interventions. We describe ethosome photothermal therapy (ETHOSOMEPTT, N-Finders Co., Ltd, Korea), an innovative 5-layer nanosystem that integrates transdermal delivery technology with targeted laser energy. The platform incorporates ethosomes, phospholipid vesicles containing ethanol, with plasmonic gold and platinum nanoparticles to provide dual therapeutic mechanisms: enhanced drug penetration and controlled hyperthermia. Upon activation by specific laser wavelengths, this system generates localized heat while facilitating the delivery of active ingredients to deeper tissue layers relative to conventional topical treatments. A clinical example demonstrates its utility: a 42-year-old woman with persistent malar melasma spanning 6 years, who had undergone treatment with hydroquinone, oral tranexamic acid, and neodymium-doped yttrium aluminum garnet laser with insufficient improvement, demonstrated a 68% reduction in Modified Melasma Area and Severity Index after 12 treatment sessions. Treatment was well tolerated, with transient erythema as the primary side effect. The mechanism underlying ethosome photothermal therapy encompasses ethanol-mediated enhancement of stratum corneum permeability, targeted delivery via plasmonic nanoparticles, and controlled thermal effects on tissue structure. This methodology represents a potential advancement in melasma management, particularly for cases demonstrating limited response to conventional therapies.

One of the most important and challenging decisions in reduction mammaplasty and mastopexy is the choice of incision. Although an existing algorithm considers the sternal notch-nipple distance, patient age, and skin quality to guide selection, it remains incomplete. The superior breast border-inframammary fold distance provides a more accurate assessment of the actual amount of skin and tissue. By analyzing this measurement-along with its components and the patient's skin quality-we can determine the optimal incision type using the mathematics of distances and breast geometry. In brief, a superior breast border-inframammary fold distance of up to approximately 32 cm is generally suitable for a vertical scar mammaplasty.

Background: Analyzing characteristics of national leaders in surgery can provide insight into the factors that contribute to their success.

Methods: The names of the 2024 executive board and past presidents were collected from national surgical subspecialty organizations. A cross-sectional analysis of training and leadership backgrounds was conducted from information gathered online. Logistic regression was used to analyze predictors for executive positions.

Results: A total of 871 leaders from 48 organizations were characterized, including 66 plastic surgeons. Most (84.5%) leaders completed a subspecialty-specific fellowship and had a mean of 3.6 institutional positions. The number of chief/chair positions (odds ratio [95% confidence interval] = 1.55 [1.31-1.84]) and editor positions (1.11 [1.02-1.23]) were associated with increased odds of being a national vice president/president, whereas completing multiple fellowships was associated with decreased odds (odds ratio [95% confidence interval] = 0.56 [0.35-0.88]). Plastic surgery leaders had higher rates of no fellowship training (22.7% versus 5.5%) and a lower average number of industry positions (0.1 versus 0.4) compared with those in other fields. Compared with presidents in other specialties, plastic surgery presidents had lower rates of subspecialty-specific fellowship training (72.2% versus 84.9%).

Conclusions: Experience leading at the institutional level is correlated with national surgical leadership. Our findings may help guide young plastic surgeons hoping to become involved at the national level.

Preoperative markings are essential in breast reduction surgery, yet conventional hand-drawn methods may be prone to inaccuracies, particularly in patients with large or ptotic breasts. This study aimed to introduce and evaluate a standardized preoperative drawing method using temporary tattoos based on 3-dimensional (3D) breast modeling. Three-dimensional breast models were created using Blender 3D software, incorporating various base diameters and nipple-areola complex widths. The models were flattened into 2D templates and transferred to skin using temporary tattoos. A 5-step standardized drawing protocol was designed and applied to the simulated model. Ratios between breast base circumference and nipple-areola complex diameter were analyzed to guide excision planning. The 2D templates preserved key proportional relationships derived from 3D analysis. The use of temporary tattoos reduced variability in markings caused by tissue elasticity and human error. Tattoos remained intact for several days, enabling surgeons to perform and verify markings ahead of surgery without disruption to daily activities. Temporary tattoos based on 3D modeling offer a reproducible, patient-friendly, and easy guide for preoperative planning in breast reduction surgery. This method may enhance surgical precision and improve aesthetic outcomes.