Plastic and Reconstructive Surgery Global Open最新文献

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.

Background: Relative motion flexion orthoses (RMFOs) are a type of early mobilization based on the "quadriga effect." Currently, there are few published clinical outcome data and no documented treatment protocols. This study aimed to standardize our a rehabilitation protocol for early mobilization with relative motion for flexor tendon injuries within a 9-week program.

Methods: A prospective study was conducted from April 2023 to June 2024, which included all patients who had undergone relative motion orthoses and rehabilitation for flexor digitorum profundus repair in zone I or II. The exclusion criteria were as follows: age younger than 18 years, more than 3 injured fingers, and lack of adherence, associated fracture, and surgical repair for more than 10 days. Final measurements at weeks 8 and 12 included total active motion; Strickland and Glogovac formula; Quick Disability of the Arm, Shoulder, and Hand questionnaire; grip strength (Jamar); and pain.

Results: Ten patients underwent the RMFO protocol between April 2023 and June 2024, with at least 3 months of follow-up. Two patients were excluded from the study; the remaining patients (8) showed improvements in range of motion; Disabilities of the Arm, Shoulder, and Hand; Jamar; and visual analog scale scores. No complications such as proximal interphalangeal joint contracture, tenolysis, or rupture were reported. All patients returned to work by week 10.

Conclusions: In this small prospective case report of RMFOs, we continue to increase the number of patients in the literature, and our results are compared with those of previous studies. In addition, we present our step-by-step approach to a 9-week program.

The deep inferior epigastric perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Because abdominal tissue is limited to a single use, metachronous contralateral breast cancer reconstruction frequently necessitates an alternative donor site, raising concerns about symmetry and additional scarring. We propose using a hemi-DIEP flap for the initial reconstruction while preserving the unused contralateral hemi-flap subcutaneously in the abdominal region for future use. The patient is a 69-year-old woman diagnosed with invasive ductal carcinoma of the right breast. The patient underwent a nipple-sparing mastectomy with sentinel lymph node biopsy, followed by immediate breast reconstruction using a hemi-DIEP flap. The unused hemi-DIEP flap was denuded and stored subcutaneously in the lower abdominal region. The abdominal donor site healed with only mild midline thickening, without bulging or cosmetic deformity, resulting in an appearance comparable to a standard DIEP flap harvest. For high-risk patients with contralateral breast cancer, this approach provides a promising autologous breast reconstruction alternative that reduces donor-site morbidity while ensuring optimal symmetry and tissue quality.

Background: Hand therapy is essential after flexor and extensor tendon repairs, but adherence varies, raising concerns about outcomes for patients lost to follow-up (LTFU). Previous studies identified predictors of patients being LTFU, but the functional status of these patients remains unclear. This study used the QuickDASH and Patient-Rated Wrist and Hand Evaluation (PRWHE) scores to assess whether patients LTFU achieve comparable outcomes earlier than those who complete therapy.

Methods: We conducted a retrospective chart review for 268 patients who underwent tendon repair at our institution between January 01, 2014, and December 2, 2024. PRWHE scores, QuickDASH scores, and the number of sessions attended were collected from patients' final hand therapy appointment records. Patients were grouped by adherence: therapy completers versus patients LTFU. Functional scores at discharge or last visit were compared. Statistical analysis was performed using R.

Results: The LTFU rate was 38%. Median PRWHE change was significantly lower in patients LTFU (27.5) versus completers (50), with significant differences in functional (P = 0.01257) and pain subscores (P = 0.0409). Final PRWHE scores were also significantly higher (worse) among patients LTFU (mean = 42.82) than completers (mean = 24.47), despite similar baseline PRWHE scores (67.41 versus 69.89; P > 0.05). Overall PRWHE improvement was lower for patients LTFU (30.02) versus completers (46.9) (P < 0.05). QuickDASH scores showed no significant difference (P = 0.7473). Kendall rank correlation showed weak, nonsignificant associations between follow-up visits and changes in QuickDASH (P = 0.509) and PRWHE (P = 0.812). Receiver operating characteristic analysis showed modest area under the curve for PRWHE (0.53) and QuickDASH (0.5747), suggesting limited predictive value of visit count.

Conclusions: Although visit count did not strongly predict functional improvement, worse PRWHE scores in LTFU patients suggest that early dropout may compromise recovery. Efforts should focus on addressing barriers to adherence.

Complex ventral hernias remain challenging due to large fascial defects and loss of domain. The posterior flap hernioplasty is a simplified modification of posterior component separation that enables wide preperitoneal mesh placement without extensive dissection or adjunctive techniques. In this retrospective series, 7 patients with midline hernias greater than 10 cm underwent repair using this approach. The mean operative time was 107 minutes, the mean blood loss was 137 mL, and the median hospital stay was 1 day. Postoperative pain averaged 3 ± 1.1, with no systemic complications. One hematoma (14%) and 1 recurrence (14%) occurred at a median follow-up of 6 months. This technique provides a safe, reproducible, and resource-efficient alternative for large midline hernias, achieving tension-free closure and rapid recovery. Further comparative studies are required to validate long-term outcomes and cost-effectiveness.

Background: Traditional neck rejuvenation-liposuction, platysmaplasty, and skin redraping-overlooks intrinsic mandibular-cervical asymmetry,digastric insertions, platysmal discontinuity, submandibular gland descent, and age-related hyoid retrodisplacement. These influence submental contour and require a tridimensional, anatomy-based correction.

Methods: A retrospective study of 177 patients (99 women, 78 men; mean age 59 y, range 26-78 y) undergoing isolated neck rejuvenation (2003-2024) assessed outcomes of the 3D neck lift, which has been used since 2018 in Knize stage II-III and stage IV cases. The technique combines a triangular platysma myectomy forming a stabilizing neo-floor, partial digastric resection, and subplatysmal fat control, with platelet-rich plasma (PRP) (stages III-IV) or bipolar radiofrequency (stage IV). Results were evaluated by complications, morphology, and satisfaction.

Results: Mandibular asymmetry (broad on the left side) was present in 92% of patients. Stage distribution was: I, 28%; II, 35%; III, 21%; and IV, 16%. Chin implants were added in 10%, PRP in 31%, and radiofrequency in 6%. Complications were minimal, consisting of 2 transient marginal mandibular pareses (<6 wk) and 10 seromas, only 3 of which occurred since 2020; all resolved after a single aspiration. Excellent or good cervicomental angle definition was achieved in 98% of cases, with 96% of patients satisfied or very satisfied.

Conclusions: The 3D neck lift offers a personalized, single-incision solution to submental rejuvenation, integrating natural asymmetry, triangular platysma resection, and fibrotic stabilization to restore a stable cervicomental angle with low morbidity. Adjuncts such as PRP or radiofrequency enhance advanced cases but are nonessential. This method provides a reliable, scar-sparing alternative for isolated neck rejuvenation.

Background: Managing complex wounds with exposed bone, tendons, metalware, or irradiated tissue is challenging. NovoSorb Biodegradable Temporizing Matrix (BTM) offers an alternative by promoting vascularization and neodermis formation. This review assessed the effectiveness of BTM in managing complex wounds, including those with vascular compromise (eg, periosteal stripping or denuded paratenon) or exposure to radiotherapy.

Methods: A systematic search of Embase, Ovid, Scopus, and PubMed was conducted. Inclusion criteria included wounds involving exposed bone, tendons, or radiotherapy exposure. Data were analyzed for clinical outcomes, demographic variables, and complications.

Results: A total of 208 patients across 34 studies were analyzed. The overall complication rate was 27.9%. Wounds with combined bone and tendon exposure and periosteal stripping or denuded paratenon had significantly higher complication rates than those with only exposed bone and tendon (57.1% versus 35.3%, P = 0.006). Denuded tendons only had significantly higher complication rates compared with intact tendons (38.9% versus 18.6%, P = 0.044). Across all wounds, the presence of periosteal stripping and/or denuded paratenon was linked to significantly more complications (40.0% versus 21.8%, P = 0.005). Chronic wounds were independently associated with a 4-fold increase in complication risk (P = 0.013). Upper extremity wounds had significantly lower complication rates than lower extremity wounds (odds ratio 0.295, P = 0.008). Increasing age was independently associated with poorer outcomes (odds ratio 1.015 per year, P = 0.039).

Conclusions: BTM is a valuable addition to the reconstructive armamentarium. However, complication rates in complex wounds are high, so careful clinical judgment is essential for their implementation.

Functional deficits in severe carpal tunnel syndrome arise from a combination of persistent diminished sensation and thenar muscle paralysis, leading to the disruption of thumb kinematics. Decompression alone does not address thenar atrophy. To restore thumb function, tendon transfers from donors, such as the palmaris longus, have been described. However, palmaris longus abductorplasty has disadvantages, including extensive dissection and large wounds, which increase the risk of higher morbidity, scarring, increased pain, and delayed rehabilitation. We introduce a minimally invasive endoscopic technique of tendon harvest for thenar abductorplasty to minimize morbidity. This technique can be used with a simultaneous endoscopic carpal tunnel decompression. The average surgical time was 47 minutes for combined endoscopic carpal tunnel decompression and tendon transfer procedures. The final outcomes at 6 months showed a pinch strength of 1-3.5 kgF, or 74.8% of the contralateral side. The introduction of the endoscopic technique for tendon transfer heralds a new direction in minimally invasive surgery.