Plastic and Reconstructive Surgery Global Open最新文献

The tibia is the larger and stronger of the 2 bones in the lower leg, acting as the major weight-bearing and load-transferring bone between the knee and the ankle. Its subcutaneous location makes it particularly prone to trauma. When such injuries fail to heal, become infected, or remain exposed, large segmental bone loss can occur, creating significant reconstructive challenges to restore function. We present the case of a 10-year-old boy who sustained a trivial stick injury to his left leg that became infected, resulting in extensive tibial necrosis and exposure. Initial attempts at debridement, cortical drilling, a cross-leg flap, and split-thickness skin grafting at a peripheral hospital were unsuccessful. After referral to our center, thorough debridement of the sequestrum was performed, followed by wound care with Dakin solution for 3 weeks; cultures showed no growth. Reconstruction was achieved by tibializing the ipsilateral fibula with an overlying skin paddle. The fibula stabilized with a biplanar inverted delta frame external fixator, along with additional pins on the overlapping segments. The fixator was removed 6 months postoperatively after radiological confirmation of bony union. At 14 months, the patient can walk short distances unaided and uses crutches for longer distances. He remains in physical therapy for residual stiffness of the knee and ankle joints and to optimize functional recovery. Ipsilateral fibular tibialization remains a dependable limb-salvage option for large tibial defects in children, especially where microsurgical alternatives are limited.

Porous polyethylene implants are widely used in rhinoplasty but are associated with complications, including infection, extrusion, and framework destruction. Managing such complications is challenging, often requiring staged reconstruction. Autologous costal cartilage remains the gold standard for structural support due to its durability and biocompatibility. We reported 2 cases of severe nasal deformity following the use of porous polyethylene implants. Both patients underwent single-stage removal of the implants with immediate septal framework reconstruction using autologous costal cartilage harvested from the eighth rib. Fixation was achieved with a triple transosseous suture through a single bony tunnel in the nasal spine. Outcomes were assessed clinically and with validated patient-reported outcome measures, including the FACE-Q and Rhinoplasty Outcome Evaluation. Patient 1 (34 years old) was followed up for 12 months; patient 2 (36 years old) was followed up for 6 months. Both remained infection-free after surgery. FACE-Q scores improved from an average of 2.4 preoperatively to 4.0 postoperatively. Rhinoplasty Outcome Evaluation scores improved from 7 out of 24 to 20 out of 24 in patient 1 and from 9 out of 24 to 21 out of 24 in patient 2. No graft resorption, structural compromise, or revision procedures were observed. Aesthetic outcomes were stable, and functional breathing improved in both cases. Single-stage autologous costal cartilage reconstruction after implant failure is safe and effective, even in cases with active infection. This approach restores both function and aesthetics without staged procedures or revision surgery.

Background: The opioid epidemic remains an issue in the United States. Multiple studies have demonstrated that prescription opiates are overprescribed following surgery, with evidence showing that more than 50% are not used. The opioid epidemic has led to the development of enhanced recovery after surgery protocols, with an emphasis on multimodal analgesia (MMA) as an alternative. The aim of this pilot study was to evaluate the feasibility of a newly implemented MMA protocol in primary breast augmentation.

Methods: A protocol including preoperative, intraoperative, and postoperative components was implemented by 4 plastic surgeons at the University of Nebraska Medical Center. Thirty-five female patients were included. Protocol failure was defined as the use of opioids after discharge, and postoperative pain was assessed twice using the Brief Pain Inventory form.

Results: The median age and body mass index for patients were 37 years and 22.2 kg/m², respectively. All patients received subpectoral implants, with silicone being the most common implant (91.4%). The majority of patients received full-profile implants (57.1%). Of the 35 patients enrolled, the protocol failed in 2 (5.7%) patients. There was a significant negative correlation between patient age and the average pain score reported on postoperative day 1 (r = -0.35, P = 0.04). There was no significant difference in pain scores demonstrated between different implant profiles (P = 0.84).

Conclusions: MMA for outpatient breast augmentation was successful and may be an effective alternative to opioids. Younger patients reported higher average pain scores postoperatively and may be more likely to require opioids.

It is well known that osteotomy of the premaxilla is an effective surgical procedure for the correction of a displaced premaxilla in patients with bilateral cleft lip and palate. In cases with a posteriorly displaced premaxilla, it is not easy to move the premaxilla forward because of scarring of the palatal mucosal attachment, narrowing of the adjacent maxillary segments, and the stable fixation of this bone segment after its movement. This fixation is also important in cases without secondary bone grafting. We propose a new method that combines osteotomy and a method such as bone distraction for cases with significant premaxilla displacement that are difficult to repair by osteotomy alone. A conventional orthodontic palatal expander was used as the distractor. The anterior arms were bent at the posterior part of the lingual side of the anterior teeth, and a resin base was attached to the arm parts. The posterior arms were bent and waxed onto the bands of both first molars. Supportive stainless steel wire arms, which are attached to the rest of the deciduous molars, stabilize the distractor. After the osteotomy of the premaxilla, distraction was performed at a rate of 1.0 mm per day, starting the day after surgery. Because the premaxilla of patients with bilateral cleft lip and palate has undergone multiple surgical interventions, the soft tissue is not mobile, making it impossible to guide the premaxilla to an ideal position in a single stage. However, this procedure, using this semirigid distractor, makes it possible to move the osteotomized premaxilla to the planned position with firm stability.

Liposuction has become a highly common procedure performed by plastic surgeons since its advent in 1979. However, it is not without risk. The authors report their experience with breakage and retention of the tip of a liposuction infiltration cannula. They also discuss the interventions they implemented to prevent recurrence of such complications.

Most soft tissue hand tumors are benign, but excision may be performed to confirm diagnosis, relieve pain, or improve function. This report describes a 16-year-old male patient with a growing, intermittently painful dorsal hand mass that was excised for diagnostic purposes and possible pain relief, which was subsequently identified as a juvenile xanthogranuloma. As a result of these pathological findings, our patient underwent specialist evaluation, and no further lesions or systemic involvement were identified. He was followed up postoperatively for 3 months without complications. Juvenile xanthogranulomas are rare and most often present in infants and young children as a solitary yellowish or cutaneous nodule or papule. They may also present as multiple skin nodules, less commonly as a deep subcutaneous mass, or even more rarely as a systemic, potentially fatal process. They often arise in the skin of the face, head, neck, and trunk but are a rare finding in the hand, reported only on a case-by-case basis. Even though juvenile xanthogranulomas are benign, their identification should not be dismissed and requires further consideration. Although our patient was fortunate to have a solitary hand lesion that was excised with clear margins and without systemic involvement, it remains imperative that the operating surgeon is aware of, and sends appropriate referrals for work-up of, the associations that may be seen in these cases.

Background: The training of plastic surgery residents is constantly evolving. This study explored whether different artificial intelligence (AI) systems highlight the same key aspects of residency training as experts in the field.

Methods: Six modern AI systems (ChatGPT 3.5, ChatGPT 4o, Claude 3.5, Gemini 1.5 Pro, Llama 3.1 70B, and OpenAI o1) were tested on various aspects of residency training. Their responses were evaluated for accuracy, quality, and comprehensiveness both by the AI systems and by field experts.

Results: All AI systems delivered accurate and comprehensive responses. OpenAI o1 and ChatGPT 4o consistently ranked highest, nearly achieving excellent scores in all categories. Although some systems addressed certain aspects more superficially, all identified most of the key elements and provided a solid overview of important topics in residency training.

Conclusions: OpenAI o1 and ChatGPT 4o stood out for their accuracy and depth, emphasizing the potential of AI in medical education. AI may offer new opportunities for personalized and efficient surgical training.

Background: Telemedicine has rapidly evolved in the field of plastic and reconstructive surgery, particularly since the COVID-19 pandemic, offering new opportunities for patient care, especially in wound management, pediatric consultations, and postoperative follow-ups. Despite its growing use, questions remain regarding user satisfaction and technological limitations. This study aims to systematically evaluate the satisfaction and usability of telemedicine among patients and providers in plastic surgery and to present a single-center experience with telehealth during the early months of the COVID-19 pandemic.

Methods: A systematic review was conducted across PubMed, Cochrane, Scopus, and Google Scholar databases for articles published between January 2017 and April 2025. Inclusion criteria focused on studies addressing satisfaction with telemedicine in plastic surgery. Additionally, a prospective survey was conducted of 63 patients, mean age of 59.6 ± 23.86, at our center using a modified Telehealth Usability Questionnaire between May and August 2020. Statistical analyses included descriptive statistics and comparative tests.

Results: Twenty-one studies were included, spanning burns, pediatric, aesthetic, and reconstructive surgery. Overall, telemedicine demonstrated high patient satisfaction (72%-98%), provider satisfaction (74%-97%), and diagnostic reliability (up to 94.4%). In our local cohort, 77.8% completed their scheduled virtual appointments, and usefulness received the highest satisfaction score (mean 6.68 of 7). No significant differences were observed by age or sex.

Conclusions: Telemedicine is a highly satisfactory and feasible adjunct to traditional plastic surgery care, especially for follow-ups and wound care. Continued technological improvements and standardized protocols are essential for broader adoption.