Plastic and Reconstructive Surgery Global Open最新文献

Globally, cleft surgical protocols have nuanced differences between centers, yet the goals of cleft lip and palate (CLP) repair are similar. These protocols all aim to achieve optimal aesthetic appearance and speech outcomes while limiting significant complications such as velopharyngeal insufficiency and midface hypoplasia. Variability in complication rates following primary CLP repair has been well documented within the literature. A series of systematic reviews investigate the impact of factors on surgical outcomes, all demonstrating an inability to comment on the ideal technique and timing to optimize outcomes. This article presents a summary of the current state of the literature on surgical outcomes following CLP repair. Studies were limited by small samples sizes; standardized measurement tools; study design; and lack of diversity in cleft phenotype, severity, and patient population. These limitations highlight the need for further research with more representative populations globally, standardized measurement tools, and a global consortium of cleft surgeons to make recommendations based on improved data. As the need for training in cleft surgery expands across the globe, evidence-based algorithms are essential to optimize outcomes and limit costly complications.

Background: Patients with darker skin tend to experience an increased prevalence of adverse surgical scarring and poorer treatment response in comparison to White patients. Ethnic and racial factors play a role in overall surgical scar outcomes because they predispose darker-skinned individuals to sequelae such as scar hypertrophy, keloid formation, and an overall negative psychosocial impact. This systematic review will summarize existing literature on surgical scar outcomes and management in minority patients and will highlight gaps in the medical literature.

Methods: The search was conducted using PubMed, Embase, Scopus, and Cochrane Library to identify relevant articles. All articles went through title and abstract screening, followed by full-text review.

Results: Of 1235 articles, 40 met eligibility criteria. Following the full-text review, 10 articles were included. In 5 of the 10 studies, patients were characterized as having Fitzpatrick skin types II-V. Five studies utilized laser techniques, and the remaining 3 studies utilized silicone sheet, topical silicone, and surgery. The Vancouver Scar Scale was the most utilized assessment tool. The two studies that evaluated fractional CO₂ laser interventions using the Vancouver Scar Scale showed improvement in scar outcomes and overall patient satisfaction.

Conclusions: Laser interventions were the most utilized and show promise for improving scar management outcomes in ethnic patients, though there is little work highlighting treatment decision-making in scar management. This review emphasizes the need for increased research focused on scar management interventions and comprehensive protocols to address scar management in plastic surgery for patients with darker skin.

Computer vision has emerged as a useful technology that may prove capable of facilitating remote clinical examinations in hand surgery. This study's primary aim is to evaluate the efficacy of computer vision for assessing peripheral motor function and range of motion of the hand for future clinic and telemedicine purposes. Five healthy volunteer subjects (10 hands total) were filmed performing three static hand examinations ("peace sign," "hitchhiker thumb," and "OK sign") as well as apposition. Videos were processed using the proprietary H.AI.ND program based on the MediaPipe API (Google, v0.9.2.1), generating temporal and spatial data for joint angle analysis. The median joint angles determined for each test were compared with their manually derived counterparts to assess accuracy and reliability. The measurements were compared at a population level using Wilcoxon signed rank tests and at the individual video level using interclass correlation analyses. The artificial intelligence-generated angle outputs demonstrated a high level of reliability when compared with manually determined measurements for the 3 clinical positions included in this study. Assessment of compound appositional movement also demonstrated high reliability with time-dependent multijoint evaluation. Goniometric analysis through computer vision applications may provide an easy and reliable alternative for hand evaluation in the normal population for both static and dynamic function. Further study is warranted to evaluate this program's potential role for diagnostic assessment in the diseased population before and after surgical investigation.

We introduce and evaluate a novel L-shaped perforator free flap from the thenar eminence for total nasal ala reconstruction, addressing both the inner and outer linings in complex nasal reconstruction cases. A 74-year-old man with a history of basal cell carcinoma and multiple failed local flap reconstructions underwent nasal ala reconstruction using the L-shaped thenar flap. The flap, based on the superficial branch of the radial artery, was designed to create a 3-dimensional nasal structure, and its viability was ensured using intraoperative Doppler monitoring. The L-shaped thenar flap successfully reconstructed the nasal ala, maintaining the shape and function of the nostril. The robust vascularization and the ability to incorporate structural cartilage minimized the risk of flap failure. The donor site morbidity was minimal, and the aesthetic outcome was satisfactory, with the flap providing adequate tissue for both the internal and external nasal linings. The L-shaped thenar flap is a viable and effective option for complex nasal ala reconstruction, offering reliable vascularization, sufficient tissue for comprehensive reconstruction, and minimal donor site complications. This technique provides a promising alternative for challenging nasal reconstructions, eliminating the need for separate cutaneous islands and allowing for the potential inclusion of a structural cartilage layer.

Fractures at the base of the proximal phalanx of the thumb pose significant challenges including joint stability, precise reduction, and functional recovery. These injuries can lead to chronic pain, limited mobility, and impaired hand function if not effectively treated, underscoring the need for innovative management techniques. Despite the prevalence and complexity of these fractures, the literature offers limited guidance on effective, minimally invasive treatment options. The Suzuki frame, a versatile external fixator initially designed for proximal interphalangeal joint fractures, has shown promise in managing these fractures; however, it remains underexplored for fractures at the base of the thumb's proximal phalanx. This report aims to bridge this gap by presenting a case and literature review on the efficacy of the Suzuki frame in managing these complex thumb fractures. By highlighting this technique's unique advantages, this article provides evidence to support the Suzuki frame as a viable, minimally invasive alternative for treating these challenging injuries.

Background: Research is an increasingly substantial criterion for competitive applicants entering the plastic and reconstructive surgery (PRS) match. Presenting at conferences provides valuable networking opportunities, especially for students from schools without home-integrated PRS programs (no home program [NHP]). We sought to characterize the demographics and outcomes of student presenters at national PRS conferences.

Methods: Student presenters were obtained from annual meeting programs of 3 national PRS conferences from 2013 to 2022. Data were collected on demographics, presentation frequency, presenters' home and/or research institutions, and match outcomes using Doximity, residency webpages, and LinkedIn. The Pearson χ² test, unpaired t test, and the Pearson correlation coefficient were performed.

Results: Overall, 745 students delivered 1133 presentations with an approximate 13-fold increase during 10 years. Approximately 61% matriculated into an integrated PRS residency program. NHP presenters comprised 20%, with a 58% match rate, compared with 62% for students who had a home program (HP) (P = 0.41). Among NHP students, 53% researched externally at HP institutions, yielding a 70% match rate, compared with 44% for NHP students researching within their NHP institutions (P = 0.005). Delivering 1 presentation corresponded to a 50% match rate, compared with 76% for multiple presentations (P < 0.0001).

Conclusions: Presenting multiple times at national conferences is associated with a greater PRS match rate. NHP students have a higher likelihood of matching when collaborating with a separate HP institution. Rising volumes of student presentations at PRS conferences suggest that engaging in research, perhaps due to the importance of networking at conferences, may be integral to matching.

Facial synkinesis manifests as involuntary muscle movements alongside volitional facial actions and is typically managed with a combination of neuromuscular retraining, botulinum toxin injections, and in some cases, selective neurectomy. Some patients with synkinesis describe persistent neck tightness or pain at the level of the mandibular angle and horizontally towards the midline, similar to the anatomic course of the posterior belly of digastric (PBD) and stylohyoid muscles. There are limited studies exploring the involvement of the PBD and stylohyoid muscles in facial synkinesis and the use of chemodenervation as treatment. Herein, we present 2 patients with facial synkinesis and ipsilateral neck tightness and pain who underwent novel surgical treatment in the form of the standard selective neurectomy procedure along with a myectomy of the PBD and stylohyoid muscles. Following completion of the standard steps of selective neurectomy, the PBD and stylohyoid muscles were carefully dissected and separated from the surrounding structures. Both muscles were divided using bipolar electrocautery. Both patients reported improvement of neck pain and tightness immediately after the intervention and at the 6.5-month follow-up visit. These preliminary results show promise in aiding a subset of patients with synkinesis-related neck pain and tightness.

Background: In plastic surgery, breast surgery patients are among the most susceptible to postoperative pain. Amidst the opioid epidemic, healthcare goals seek to optimize nonopioid multimodal pain control by including regional analgesia. The erector spinae plane block (ESPB) is among several regional blocks used in breast surgery. Although the paravertebral block has previously served as the gold standard, new research focused on ESPB may shift standards.

Methods: A comprehensive PubMed review was performed in September 2023 to identify articles related to ESPB use in breast surgery. Non-English and unavailable articles were excluded. Data extracted included publication year, techniques, and outcomes.

Results: Sixty-eight publications were included, of which 31 were randomized control trials (45.6%). Most were published between 2021 and 2023 (n = 40, 58.8%). Most articles that evaluated pain and opioid use suggested that ESPB performed better than nonblocked groups (n = 26, 38.2% of total articles and n = 4, 5.88% of total articles) and performed similarly to other blocks. However, articles that evaluated the pectoral nerve block suggested it outperformed ESPB in these aspects (n = 6 articles, 8.82%). ESPB was shown to be a safe and procedurally short block to perform, effective in the hands of novice providers.

Conclusions: ESPB offers reliable outcomes, improving pain control and decreasing opioid consumption. In turn, this can decrease healthcare costs and patient morbidity.

Background: Rectourethral fistulae are complex pathologies with significant morbidity that warrant multidisciplinary care. Although gracilis muscle interposition for fistula repair has been reported, specific indications and techniques for this mode of reconstruction remain unclear.

Methods: A retrospective quasi-experimental study was previously conducted to assess outcomes of rectourethral fistula management before and after the implementation of a multidisciplinary treatment algorithm. Patients with complex rectourethral fistulae and repair with gracilis muscle flap interposition were further investigated. Plastic surgery involvement for gracilis muscle interposition was indicated for (1) radiated rectourethral fistulae less than 3 cm and (2) nonradiated rectourethral fistulae more than 2 cm. Our preferred technique for gracilis muscle flap harvest, transposition, and inset is described in detail. Primary outcomes included healing of rectourethral fistulae and secondary reversal of urinary or fecal diversions.

Results: Twenty-three patients with complex rectourethral fistulae underwent gracilis muscle flap interposition between 2001 and 2022 before (n = 12) and after (n = 11) algorithmic implementation. The frequency of definitive rectourethral fistula healing improved in the postalgorithm group by 33%. There was no significant difference in fistula healing time or the rate of urinary or fecal diversions after algorithm implementation. The technique of gracilis muscle flap interposition is also described.

Conclusions: The gracilis muscle interposition flap is a valuable reconstructive option for complex rectourethral fistula repair. Implementation of a multidisciplinary treatment algorithm including plastic surgery involvement and refinement of the operative approach was associated with improved frequency of definitive healing of rectourethral fistulae.

Background: Wassel type IV is a common radial polydactyly anomaly characterized by duplication of the proximal phalanges at the metacarpophalangeal joint (MPJ). The primary goal of reconstructive surgery is to achieve a fully functional thumb with appropriate mobility, dimensions, and stable MPJ. This study aimed to compare the outcomes of MPJ reconstruction using either K-wire or non-K-wire fixation for Wassel type IV polydactyly.

Methods: The study included 78 thumbs from 77 patients with Wassel Type IV polydactyly between April 2011 and December 2022. In addition to standard excision of duplicates, MPJ collateral ligament repair, and thenar muscle reattachment using a periosteal sleeve flap, the study analyzed the application of tendon transfer, soft-tissue augmentation, and K-wire fixation. Outcomes were evaluated using Tada score classification, MPJ deviation angle, and range of motion. Complications were also documented.

Results: There was no significant difference in surgical outcomes based on Tada classification between the K-wire and non-K-wire fixation groups. Favorable outcomes were achieved in 76.3% and 84.2% of the K-wire and non-K-wire fixation groups, respectively. Although there was a significantly higher tissue augmentation rate in the K-wire fixation group, there were no significant differences in preoperative and postoperative MPJ angles between the 2 groups. Complications associated with K-wire fixation included pin tract infection (10.2%), migration (10.2%), and maceration (5.1%).

Conclusions: Both K-wire and non-K-wire fixation approaches for Wassel type IV polydactyly yielded favorable subjective and objective outcomes. However, complications associated with K-wire fixation should be considered when determining the surgical approach.