Plastic and Reconstructive Surgery Global Open最新文献

Background: Venous thromboembolism (VTE) poses a major risk after abdominal contouring surgery, impacting morbidity and mortality. Despite various preventative strategies, surgeons are cautious about using enoxaparin for extended postoperative periods. This study aims to determine if a 7-day postoperative course of enoxaparin increases bleeding risks compared with a single dose of intraoperative unfractionated heparin in patients undergoing abdominal contouring surgery.

Methods: A retrospective cohort analysis was performed on patients who underwent abdominoplasty or panniculectomy from August 2017 to October 2023. Patients were split into 2 groups: Group 1 received 5000 units of intraoperative unfractionated heparin in addition to 7 days of postoperative enoxaparin (40 mg daily); group 2 received only the intraoperative heparin dose. Primary outcomes included bleeding events and VTE incidence. Secondary outcomes were seroma, infection, surgical site dehiscence, necrosis, drain duration, and reoperation rates.

Results: The study included 121 patients (111 women, 10 men), with 61 patients in group 1 and 60 in group 2. The average age was 49 ± 12 years, and the average body mass index was 29.8 ± 5 kg/m². No cases of VTE were reported. Postoperative bleeding occurred in 3 patients (4.9%) in group I and 2 patients (3.3%) in group 2, showing no statistically significant difference (P = 0.66). Secondary outcomes also showed no significant differences between the groups.

Conclusions: Our study of 121 patients undergoing either abdominoplasty or panniculectomy demonstrated that administering enoxaparin for 7 days postoperatively is safe and does not increase the risk of bleeding.

Elbow flexion is essential for the functional use of the hand. The reconstructive procedure may also change depending on the location of the sarcoma. The nonresected muscle may alter the function of the elbow. If the proximal part of the triceps muscle remains intact, it is considered functional. Functional muscle transfer is not required in such cases. A 50-year-old patient presented with a soft-tissue defect after a wide resection of a leiomyosarcoma affecting the left elbow. The wide resection resulted in the resection of the distal third of the triceps brachii, exposing the olecranon. We performed reconstruction using a pedicled latissimus dorsi musculocutaneous flap. The flap was transferred to the elbow through a subcutaneous tunnel. Ten months after surgery, the elbow function improved. In our patient, the thoracodorsal nerve was cut to prevent mixed nerve signals. We found that patients with distal muscle defects do not require functional muscle grafting. Pedicled latissimus dorsi musculocutaneous flap transfer is a straightforward and useful procedure for reconstructing the upper arm region.

Background: In this study, the clinical efficacy of a new framework construction technique for costal cartilage rhinoplasty was investigated.

Methods: From January 2020 to February 2022, patients who underwent rhinoplasty in the department of plastic and reconstructive surgery of Zhejiang Provincial People's Hospital were enrolled. The sixth costal cartilage was made into the nasal columellar support graft (strut), the nasal tip graft integrated scaffold, and the septal extension grafts. The strut and septal extension grafts were sutured to construct the framework. Adobe Photoshop 6.0 was used to measure a series of aesthetic indices preoperatively and at 9 months postoperatively, including the nasal length, tip projection, nasofrontal angle, columellar/lobular angle, and nasolabial angle. The visual analog scale score and rhinoplasty outcome evaluation score were used to assess patient satisfaction. A paired t test was used for data analysis, and a P value of less than 0.05 was considered to indicate statistical significance.

Results: A total of 65 patients aged 19-43 years (average age 26.0 y) were enrolled. No short-term complications occurred. All patients were followed up for 9-23 months. There were statistically significant differences in all measurements (P < 0.05), which suggested that the aesthetic defects of the nose were corrected and that no obvious deflection or rotation of the nasal tip occurred. The visual analog scale score and rhinoplasty outcome evaluation score indicated a significant improvement in patient satisfaction (P < 0.05).

Conclusions: This new framework construction technique for costal cartilage rhinoplasty can reduce the risk of framework deflection and nasal tip rotation and provide a satisfactory nasal columellar shape.

Background: More than 65% of patients with end-stage renal disease (ESRD) use arteriovenous fistulas (AVFs) for hemodialysis. The increasing incidence of comorbid ESRD and obesity (body mass index, >35 kg/m²) precludes patients from kidney transplantation, resulting in a need for long-term, durable AVF access. Compared with traditional superficialization techniques for overlying adiposity, liposuction is minimally invasive and well-tolerated, allowing for earlier fistula use with lower complications. We present the detailed surgical technique for superficialization of AVFs using liposuction.

Methods: Fourteen patients with well-matured but difficult-access fistulas due to adiposity were selected. Preoperative ultrasound mapped depth of fistulas. Tumescent liposuction was completed in a cross-hatched manner. Intraoperative ultrasound confirmed cannula positioning and measured fistula depth. A palpable thrill remained throughout superficialization. Cannulation began 4 weeks postoperatively.

Results: Mean access depth preoperatively was 10.8 mm (8-15 mm), immediately postoperative was 7 mm (6-9 mm), and at 4 weeks was 5.3 mm (4-8 mm). The average usable access length was 12.7 cm (10-15 cm) after surgery. Thirteen fistulas were successfully accessed after liposuction superficialization. All patients were discharged home the same day. There were no postoperative infections or hemorrhage.

Conclusions: Early experience with liposuction for superficialization of deep hemodialysis access is promising. This innovative solution has the possibility to improve outcomes and quality of life for patients living with ESRD and obesity. Our experience shows that this is a safe and effective technique to increase patient eligibility, enable successful and early cannulation, and decrease recovery time.

Current breast augmentation options face limitations and potential associated complications. Implant-based augmentation introduces risks such as capsular contracture and malpositioning, whereas fat grafting poses issues such as induration and infections, necessitating revisions. Tissue engineering, integrating 3-dimensional (3D) printing and biomaterials science, aims to overcome these challenges. However, the clinical translation of these advancements remains challenging, with many approaches falling short in demonstrating the necessary volume regeneration. A 28-year-old yoga instructor with a disinterest in traditional options sought an alternative solution. Custom-made biocompatible thermoplastic copolyester implants were proposed, approved, and implemented. Our approach utilized artificial intelligence, magnetic resonance imaging, computer-aided design, and lattice structure engineering for customizing the implant design. Three-dimensional printing and plasma technology surface treatment created implants of 300 and 315 cm³ volumes, weighting around 33 g with biomimetic properties. Implants were placed in the subglandular plane; an 8-month follow-up revealed well-maintained implants without complications, except for a conservatively managed hematoma, and excellent cosmetic outcomes. Magnetic resonance imaging analysis revealed revascularization and new tissue formation within the implant, demonstrating tissue integration without complications. The study addresses biomechanical issues and foreign body reactions that cause capsular contracture in breast augmentation and proposes a novel 3D-printed implant with ultralight weight, tissue integrative porous structure, and biomimetic environments for scaffold-guided tissue regeneration. In conclusion, the presented solution shows promise in overcoming current breast augmentation limitations, demonstrating safety, biocompatibility, and patient satisfaction. Further adoption and long-term studies with larger cohorts are needed to validate its clinical effectiveness and feasibility.

Open-window thoracostomy is an effective treatment for refractory postpneumonectomy empyema. However, it can leave large thoracic dead space, and bronchopleural fistulas (BPF) are a common major complication. These problems can be treated with myocutaneous flap transfer or negative-pressure wound therapy (NPWT). However, treatment is often difficult and prolonged. Here, we report 2 cases of free anterolateral thigh flap transfer followed immediately by NPWT combined with Penrose drains. Both patients, including 1 with BPF, had favorable postoperative courses and were discharged 28 and 14 days after reconstruction. Dead space infection and BPF recurrence were not observed after discharge. Following free flap transfer with NPWT combined with Penrose drains may efficiently eliminate dead space and accelerate wound healing in a large three-dimensional space.

Background: Statistically nonsignificant randomized clinical trial (RCT) results are challenging to interpret, as they are unable to prove the absence of a difference between treatment groups. Bayesian analysis offers an alternative statistical framework capable of providing a comprehensive understanding of nonsignificant results.

Methods: This cross-sectional study conducted a post hoc Bayesian analysis of statistically nonsignificant outcomes from RCTs published in Plastic and Reconstructive Surgery from 2013 to 2022. Bayes factors representing the probability of the absence of a difference, or the null hypothesis of no difference, were calculated and examined. P values and Bayes factors of these outcomes were also compared with assessment of their association.

Results: In 73 studies with 176 statistically nonsignificant outcomes, 160 (91%) indicated evidence for the absence of a difference (Bayes factor > 1). For 110 (63%) of these, the Bayes factor was between 1 and 3, indicating weak evidence for the absence of a difference; 16 (9.1%) results supported the presence of a difference (Bayes factor < 1). A greater P value was independently associated with a larger Bayes factor (β = 2.6, P <0.001).

Conclusions: Nearly two-thirds of nonsignificant RCT outcomes provided only weak evidence supporting the absence of a difference. This uncertainty poses challenges for clinical decision-making and highlights the inefficiency in resource utilization. Integrating Bayesian statistics into future trial design and analysis could overcome these challenges, enhancing result interpretability and guiding medical practice and research.