Plastic and Reconstructive Surgery Global Open最新文献

Brachial plexus injuries are among the most challenging clinical scenarios faced by hand surgeons due to the heterogeneity of presentations, the need to reconstruct multiple critical functions, and potentially limited donor options. In this case report, we presented a patient with a medial cord injury of the brachial plexus with a complete lack of grasp. Extrinsic grasp was restored with a double nerve transfer of the extensor carpi radialis brevis to the anterior interosseous nerve, along with the supinator to the flexor digitorum superficialis.

Background: Capsular contracture (CC) is a frequent complication of implant-based breast augmentation and reconstruction, causing deformity, pain, and reoperation, particularly after mastectomy. CC arises from a multifactorial immune and fibrotic response influenced by patient factors, radiation, implant characteristics, and surgical technique. This review summarized recent data on CC epidemiology, prevention, and treatment.

Methods: A narrative review of PubMed and Embase (2020-2024) identified clinical studies on CC after breast augmentation or reconstruction, including trials, cohort studies, case series, and reviews evaluating surgical and adjunctive interventions such as capsulotomy, capsulectomy, and perioperative pharmacological, or material-based strategies.

Results: Chronic peri-implant inflammation, bacterial biofilm, and postoperative radiation were consistently implicated in CC pathogenesis, with higher rates in irradiated mastectomy patients. Preventive measures, including antimicrobial pocket irrigation, implant and mesh selection, and atraumatic "no-touch" techniques, were associated with reduced CC in several reports. Pharmacological adjuncts such as leukotriene inhibitors and glucocorticoids showed promising but heterogeneous results. For established CC, capsulotomy is commonly used for mild to moderate disease, whereas complete or partial capsulectomy remains the standard for severe or recurrent cases, often combined with implant exchange and adjunctive measures to limit recurrence.

Conclusions: CC remains a major cause of morbidity and revisional surgery after implant-based breast procedures. Contemporary evidence supports a multimodal, patient-specific approach that couples meticulous surgical technique with targeted pharmacological and material-based strategies to prevent and treat CC. Robust prospective studies are needed to define optimal protocols and long-term outcomes.

Background: Rhinoplasty, widely known to improve form and function, is growing in popularity for both cosmetic and functional purposes. The preexisting psychosocial state of a patient significantly affects the perceived outcome of aesthetic rhinoplasty, even when surgery is technically successful. Given the elevated rates of distress, depression, social dysfunction, and body dysmorphic disorder among candidates, psychosocial optimization is essential.

Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published from January 2000 to August 2024 examining associations between aesthetic rhinoplasty outcomes and psychological factors were identified through PubMed, Cochrane Library, and Embase. Eligible studies evaluated psychosocial characteristics, preoperative mental health status, and postoperative satisfaction.

Results: Patients with preexisting mental health conditions, including body dysmorphic disorder, anxiety, and depression, consistently reported lower postoperative satisfaction despite technically successful results. Patient-reported outcome measures demonstrated that psychological readiness, social context, and expectation setting significantly influenced perceived outcomes. Individuals with diminished psychosocial functioning were more likely to experience reduced postoperative satisfaction, underscoring the interplay between psychological pathology and subjective assessment of surgical success.

Conclusions: Evaluating patient motivations, expectations, and psychosocial readiness allows physicians to better predict satisfaction and improve expectation management. Incorporating a thorough preoperative mental health assessment can help identify modifiable psychosocial factors and optimize outcomes for patients pursuing aesthetic rhinoplasty.

Background: Successful microsurgical autologous breast reconstruction (MABR) requires significant resources. The co-surgery model, involving 2 experienced surgeons, aims to improve outcomes. This study evaluated the financial and patient benefits of implementing a co-surgery model in MABR at an academic center.

Methods: A retrospective study was conducted on MABR procedures (2021-2023) at an academic cancer center. Encounters were categorized by the co-surgery modifier (-62) or single-surgeon. Financial data (expected versus actual payments, time to payment) and patient outcomes (complications, flap compromise) were collected. Statistical analysis used the Pearson χ² test and independent samples t test.

Results: Of 393 encounters, 193 were single-surgeon, and 200 were co-surgery. Single-surgeon cases had more accurate payments (88.5% versus 76.4%, P < 0.001) and faster payment times (82.5 versus 103.9 d, P = 0.02). Co-surgery cases were underpaid by $86,748 during 3 years, with single-surgeon cases receiving $1200 more per patient. First-pass payment rates were higher for single surgeons (48.2% versus 39.5%, P = 0.04). Patient outcomes showed no significant differences in overall complications, donor-site complications, flap compromise, or flap loss, though the co-surgery group had higher infection rates (9.3% versus 0%, P < 0.01) and breast wounds (14% versus 1.3%, P < 0.01). Operative time and length of stay were comparable.

Conclusions: The co-surgery model in MABR enhances surgical efficiency but complicates billing, resulting in underpayment and delayed reimbursement. Streamlining reimbursement could foster co-surgery adoption, benefiting patient outcomes and efficiency.

Dermoid cysts are congenital lesions formed by the entrapment of ectodermal tissues along embryological closure lines. These cysts do not have direct etiologic causes and are not seen as typical in any race. Diagnostic evaluation typically includes ultrasound and computed tomography imaging to assess for complications. The mainstay treatment is surgical excision, which sometimes leads to unwanted scarring. We herein present a case of a glabellar dermoid cyst successfully treated using surgical suction.

This article described the fabrication and clinical application of a simple relative motion extension orthosis constructed using readily accessible materials such as a wooden tongue depressor, an aluminum strip, and a cohesive bandage. Initially developed to facilitate early active mobilization following extensor tendon repairs, the relative motion extension orthosis is applied by positioning the metacarpophalangeal joint of the injured finger 15-20 degrees more extended relative to the adjacent fingers. The proposed orthosis, produced with low-cost and easily obtainable materials, is considered an effective and practical option for implementing early active mobilization protocols, particularly in settings with limited resources.

Injectable fillers, such as hyaluronic acid (HA)-based fillers and calcium hydroxylapatite (CaHA) collagen stimulators, have been used to replenish lost volume by physically filling gaps or stimulating collagen synthesis. A commercially available hybrid filler combining HA and CaHA in a new gel-form collagen stimulator has yet to be extensively studied in an Asian population. This was a case series of patients attending 2 centers in Hong Kong between August 2023 and February 2024 to document the safety of HA-CaHA in Asian patients. Outcomes included patients' overall satisfaction with the treatment experience, based on the Global Aesthetic Improvement Scale assessment and treatment-emergent adverse events reported after treatment at the 3- and 6-month follow-ups. Twenty-five Chinese patients (22 female; age range [median]: 25-63 [37] y) received 2-3 syringes of HA-CaHA with a mean total volume of 2.8 mL (range: 2.5-3.75 mL). Immediately after treatment and at the 1- and 3-month follow-ups, 60% (15 of 25) of patients reported "very much improved," 32% (8 of 25) reported "much improved," 8% (2 of 25) reported "improved," and 0% reported "unchanged" or "worse" throughout the 6 months. Treatment-emergent adverse events immediately after treatment included bruising (n = 3, 12%), edema (n = 8, 32%), erythema (n = 1, 4%), tenderness (n = 3, 12%), and skin induration (n = 4, 16%). A hybrid filler combining HA and CaHA represents a promising advance in facial rejuvenation, offering immediate volumizing effects, longer-lasting results, and few adverse events.

Bullous pemphigoid (BP) is a rare but devastating autoimmune dermatologic condition and can be triggered by infection, trauma, radiation, or surgery, all conditions routinely encountered by reconstructive surgeons. Chronic wounds secondary to BP are difficult to manage with local wound care and can necessitate soft tissue coverage, yet there remains a paucity of literature surrounding the evaluation and management of autoimmune skin conditions as they relate to the reconstructive surgeon. A 57-year-old man presented with a chronic left heel wound secondary to BP, and despite medical therapies, continued to have worsening ulcerations. He underwent debridement of the wound followed by free anterolateral thigh flap reconstruction. On postoperative day 3, he developed erythema and blistering of the distal edge skin flap. The dangle protocol was halted, and dermatology was consulted, who recommended 0.05% clobetasol cream applied to the areas of erythema. By the day of discharge on postoperative day 16, the flap remained stable in appearance, and erythema had significantly improved. Literature surrounding the management of chronic wounds in patients with pemphigoid diseases remains scarce. This case report added to the literature on the evaluation and management of wounds in these patients. The ideal treatment of chronic wounds secondary to BP necessitates the involvement of a multidisciplinary team, stabilization of the dermatologic disease preoperatively, aggressive resection of diseased tissue, and adequate wound bed preparation. Following this, the preferred method of reconstruction should take into consideration the pathophysiologic mechanism of the disease, followed by close postoperative monitoring and early intervention for postoperative skin changes.