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Tibialization of Fibula for Large Segment Tibia Loss Following Chronic Osteomyelitis. 腓骨固定治疗慢性骨髓炎后大段胫骨丢失。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007440
Abraham G Negussie, Metasebia W Abebe, Tesfaye B Meles

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.

胫骨是小腿的两块骨头中较大、较强的一块,是膝关节和踝关节之间的主要承重和负荷转移骨。它的皮下位置使它特别容易受到创伤。当这些损伤无法愈合、感染或暴露时,可能会发生大面积的骨节段丢失,给恢复功能带来重大的重建挑战。我们提出的情况下,一个10岁的男孩谁持续轻微棍棒损伤他的左腿成为感染,导致广泛的胫骨坏死和暴露。最初在周边医院尝试清创、皮质钻孔、交叉腿瓣和裂厚皮肤移植均未成功。转介至本中心后,对残肢进行彻底清创,并用Dakin液护理伤口3周;培养没有显示出生长。重建是通过将同侧腓骨用覆盖的皮肤板固定来实现的。用双平面倒三角框架外固定架固定腓骨,并在重叠节段上附加钉。术后放射学证实骨愈合后6个月取出固定架。14个月时,患者可以独立行走短距离,长距离时使用拐杖。他仍在接受膝关节和踝关节残余僵硬的物理治疗,以优化功能恢复。同侧腓骨胫骨固定仍然是儿童大胫骨缺损的可靠的保肢选择,特别是在显微手术选择有限的情况下。
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引用次数: 0
Single-stage Septal Framework Reconstruction After Alloplastic Implant Failure Using Autologous Costal Cartilage. 同种异体肋软骨植入失败后单期鼻中隔框架重建。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007475
Georgy A Aganesov, Valentin I Sharobaro, Yulia A Kopylova

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.

多孔聚乙烯假体广泛应用于鼻整形术,但其并发症包括感染、挤压和框架破坏。处理这些并发症是具有挑战性的,通常需要分阶段重建。由于其耐久性和生物相容性,自体肋软骨仍然是结构支持的金标准。我们报告了2例使用多孔聚乙烯假体后的严重鼻畸形。两例患者均采用从第8根肋骨取下的自体肋软骨,一期取出植入物并立即重建鼻中隔框架。通过鼻棘单骨隧道采用三联经骨缝合固定。临床评估结果和经过验证的患者报告的结果测量,包括FACE-Q和鼻整形结果评估。患者1(34岁)随访12个月;患者2(36岁)随访6个月。手术后两人都没有感染。FACE-Q评分从术前平均2.4分提高到术后平均4.0分。在患者1中,鼻整形预后评估评分从24分中的7分提高到20分,在患者2中从24分中的9分提高到21分。未观察到移植物吸收、结构损害或翻修手术。美学结果稳定,两例患者的呼吸功能均有改善。单期自体肋软骨植入失败后重建是安全有效的,即使在活动性感染的情况下也是如此。这种方法可以恢复功能和美观,而不需要分阶段的手术或翻修手术。
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引用次数: 0
Pilot Study: Evaluation of the Feasibility of a Multimodal Analgesia Protocol for Primary Breast Augmentation Patients. 初步研究:评价原发性隆胸患者多模式镇痛方案的可行性。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007470
Courtney J Doherty, Nathaniel A Teitler, Kaeli K Samson, Bria R Meyer, Shannon L Wong, Heidi H Hon

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.

背景:阿片类药物的流行在美国仍然是一个问题。多项研究表明,手术后处方阿片类药物被过量使用,有证据表明超过50%的人没有使用。阿片类药物的流行导致了加强手术后恢复方案的发展,重点是多模态镇痛(MMA)作为一种替代方案。本初步研究的目的是评估一种新实施的MMA方案在原发性隆胸术中的可行性。方法:内布拉斯加大学医学中心的4名整形外科医生实施了一项包括术前、术中和术后组成部分的方案。纳入35例女性患者。方案失败定义为出院后使用阿片类药物,术后疼痛使用简短疼痛量表评估两次。结果:患者的中位年龄为37岁,体质量指数为22.2 kg/m2。所有患者均接受胸下植入,硅胶是最常见的植入物(91.4%)。大多数患者接受全侧位种植体(57.1%)。在纳入的35例患者中,2例(5.7%)患者失败。患者年龄与术后第1天的平均疼痛评分呈显著负相关(r = -0.35, P = 0.04)。不同种植体的疼痛评分差异无统计学意义(P = 0.84)。结论:MMA用于门诊隆胸是成功的,可能是阿片类药物的有效替代。年轻患者术后平均疼痛评分较高,可能更需要阿片类药物。
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引用次数: 0
The Future of Residency Application Screening: How Artificial Intelligence Can Create a Fairer and Smarter System. 居住申请筛选的未来:人工智能如何创造一个更公平、更智能的系统。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007472
Malke Asaad
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引用次数: 0
The Dunning-Kruger Effect in Plastic Surgery: A Cognitive Framework for Understanding Surgical Overconfidence. 整形手术中的邓宁-克鲁格效应:理解手术过度自信的认知框架。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007484
Lázaro Cárdenas-Camarena
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引用次数: 0
A Technique for Repositioning the Posteriorly Displaced Premaxilla Following Prior Repair of Complete Bilateral Cleft Lip. 双侧完全性唇裂修复术后上颌骨后移位的复位技术。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007467
Yuki Arimura, Seiji Iida, Aiko Hyodo, Ayaka Mikami, Satoru Hayano, Fumiko Takemoto, Hiroshi Kamioka

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.

上颌前牙截骨术是矫正双侧唇腭裂患者上颌前牙移位的有效手术方法。对于前颌后移位的病例,由于腭粘膜附着体的瘢痕形成、邻近上颌段的变窄以及该骨段移动后的稳定固定,导致前颌不容易向前移动。这种固定在没有二次植骨的情况下也很重要。对于单纯截骨难以修复的上颌骨前移位病例,我们提出了一种将截骨术和骨牵引术相结合的新方法。使用常规正畸腭扩张器作为牵张器。在前牙舌侧的后部弯曲前臂,并在臂部附着树脂基架。后臂弯曲,在两颗第一磨牙的牙带上打蜡。支撑的不锈钢丝臂附着在乳牙的其余部分,稳定牵张器。上颌骨前截骨后,从术后第一天开始,以每天1.0 mm的速度进行牵张。由于双侧唇腭裂患者的前颌骨经过多次手术干预,软组织不能动,无法在单期将前颌骨引导到理想位置。然而,使用这种半刚性牵张器,可以将截骨的上颌骨移动到计划位置,并保持稳定。
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引用次数: 0
Retention of Broken Cannula Tip Following Liposuction-assisted Debulking of Lower Limb Flap: Rare Case Report. 吸脂辅助下肢皮瓣减积术后断管尖端保留:罕见病例报告。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007471
Christelle Guillon, O-Wern Low, Vigneswaran Nallathamby

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.

自1979年问世以来,吸脂术已经成为整形外科医生非常普遍的手术。然而,这并非没有风险。作者报告了他们的经验,破裂和保留尖端的吸脂浸润插管。他们还讨论了他们为防止此类并发症复发而实施的干预措施。
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引用次数: 0
A Case of Juvenile Xanthogranuloma of the Hand in an Adolescent. 青少年手部黄色肉芽肿1例。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-06 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007497
Carly A Askinas, Horacio M Maluf, David A Kulber, Stuart H Kuschner

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.

大多数手部软组织肿瘤是良性的,但切除可用于确诊、缓解疼痛或改善功能。这篇报告描述了一个16岁的男性患者,他的手背有一个不断增长的、间歇性疼痛的肿块,为了诊断和可能的疼痛缓解,我们切除了这个肿块,随后确诊为幼年性黄色肉芽肿。由于这些病理发现,我们的患者接受了专家评估,没有发现进一步的病变或全身累及。术后随访3个月,无并发症发生。幼年黄色肉芽肿是罕见的,最常见于婴幼儿,表现为孤立的黄色或皮肤结节或丘疹。它们也可能表现为多个皮肤结节,较少见为深皮下肿块,甚至更罕见为全身性的、可能致命的疾病。它们通常出现在面部、头部、颈部和躯干的皮肤上,但很少出现在手部,仅根据具体情况报道。即使幼年黄色肉芽肿是良性的,也不应忽视其鉴别,需要进一步考虑。虽然我们的病人很幸运,切除了一个孤立的手部病变,边缘清晰,没有全身受累,但手术外科医生仍然有必要意识到这些病例中可能出现的关联,并提供适当的转诊检查。
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引用次数: 0
Comparative Analysis of Artificial Intelligence Responses to Questions on Plastic Surgery Education: An Exploratory Study. 人工智能对整形外科教育问题回答的比较分析:探索性研究。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-04 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007458
Elisabeth Eschenbacher, Raymund E Horch, Fabian Necker, Andreas Arkudas

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.

背景:整形外科住院医师的培训是不断发展的。本研究探讨了不同的人工智能(AI)系统是否与该领域的专家一样强调住院医师培训的关键方面。方法:对六个现代AI系统(ChatGPT 3.5、ChatGPT 40、Claude 3.5、Gemini 1.5 Pro、Llama 3.1 70B和OpenAI 01)进行住院医师培训各方面的测试。人工智能系统和现场专家对他们的回答进行了准确性、质量和全面性的评估。结果:所有人工智能系统都提供了准确和全面的响应。OpenAI 01和ChatGPT 40一直排名最高,几乎在所有类别中都取得了优异的成绩。虽然有些系统对某些方面的处理比较肤浅,但所有系统都确定了大多数关键要素,并对住院医师培训中的重要主题提供了坚实的概述。结论:OpenAI 01和ChatGPT 40以其准确性和深度脱颖而出,强调了AI在医学教育中的潜力。人工智能可能为个性化和高效的外科培训提供新的机会。
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引用次数: 0
Telemedicine in Plastic Surgery: Satisfaction, Safety, and the Need for Ethical and Regulatory Frameworks. 整形外科中的远程医疗:满意度、安全性以及对伦理和监管框架的需求。
IF 1.8 Q3 SURGERY Pub Date : 2026-02-04 eCollection Date: 2026-02-01 DOI: 10.1097/GOX.0000000000007446
Daniel Hilewitz, Oriana Haran, Dana Brin, Yoav Barnea, Moshe Lachiani, Gon Shoham, Rafael Y Brzezinski, Inna Solodeev, Eyal Gur, Orel Govrin-Yehudain

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.

背景:远程医疗在整形和重建手术领域迅速发展,特别是自2019冠状病毒病大流行以来,为患者护理提供了新的机会,特别是在伤口管理、儿科会诊和术后随访方面。尽管它的使用越来越多,但关于用户满意度和技术限制的问题仍然存在。本研究旨在系统评估整形外科患者和提供者对远程医疗的满意度和可用性,并在COVID-19大流行的最初几个月提供单中心远程医疗体验。方法:对PubMed、Cochrane、Scopus和谷歌Scholar数据库中2017年1月至2025年4月间发表的文章进行系统评价。纳入标准侧重于整形手术中远程医疗满意度的研究。此外,于2020年5月至8月对63例平均年龄59.6±23.86岁的患者进行前瞻性调查,采用修改后的远程医疗可用性问卷。统计分析包括描述性统计和比较检验。结果:纳入21项研究,涵盖烧伤、儿科、美容和重建手术。总体而言,远程医疗显示出较高的患者满意度(72%-98%)、提供者满意度(74%-97%)和诊断可靠性(高达94.4%)。在我们的本地队列中,77.8%的人完成了他们预定的虚拟预约,有效性获得了最高的满意度得分(平均6.68分)。没有观察到年龄或性别的显著差异。结论:远程医疗是传统整形外科护理的一种非常满意和可行的辅助手段,特别是在随访和伤口护理方面。持续的技术改进和标准化协议对于更广泛的采用至关重要。
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引用次数: 0
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