Plastic and Reconstructive Surgery Global Open最新文献

This case report details the clinical presentation, surgical intervention, and postoperative management of a 36-year-old male renal transplant recipient with grade 4 gynecomastia, classified by the Rohrich scale. The patient had hypertension and was on nifedipine, metoprolol, allopurinol, prednisol, tacrolimus, and mycophenolate. With a body mass index of 31 kg/m² and significant breast hypertrophy 4 months posttransplant, surgical intervention was chosen. The patient underwent bilateral breast tissue excision with free nipple grafting under general anesthesia. Postoperative management included overnight admission, and follow-up showed successful graft take and satisfactory wound healing.

Popliteal pterygium syndrome is a rare congenital disorder characterized by facial, genitourinary, and musculoskeletal anomalies, with popliteal webbing being notably challenging. A 4-year-old boy presented with progressive limping, cleft palate, and genital malformations. He had no follow-up care after an intraoral band excision at 15 days old. The boy underwent surgery for left-sided popliteal webbing, followed by genital and cleft palate repair. A modified jumping man Z-plasty flap was used for the popliteal webbing, followed by splinting. Subsequent follow-ups showed no complications. Enhancing care in resource-constrained settings requires addressing challenges such as delayed interventions due to late follow-up, limited awareness between communities and healthcare professionals, social stigma, and inadequate healthcare understanding. These obstacles hinder timely diagnosis and intervention, underscoring the need for increased awareness and effective early intervention strategies. Early detection and parental counseling are critical in managing popliteal pterygium syndrome. Timely surgical planning, including addressing orofacial and genital deformities and using Z-plasty for webbing release, is essential. Postoperative splinting significantly improves outcomes.

Background: Nasal alar deformity after cosmetic surgery, including nostril sill notching, alar flattening, and a shallow and indistinct alar-facial crease, commonly results from overresection. We developed revision methods for postoperative alar deformity, and applied them from 2016 to 2022 to the revision of 16 cases, consisting of 1 male and 15 female patients, with a median age of 28.5 years.

Methods: Auricular cartilage grafting was used as the main technique to improve alar flattening and notching without risking a poor color match as is seen in composite grafting. Notching was also improved by adding an alar lobule island flap if there was usable excess tissue on the lateral side of the ala. Two cinching sutures were used to define the alar-facial crease.

Results: Median follow-up was 9.25 months (range, 0.5-96 mo). All lobule flaps survived. Cartilage graft infection occurred in 1 case, requiring removal of the graft.

Conclusions: Alar flattening and other deformities often result from too-aggressive nasal cosmetic surgery. These can be corrected using lobule flaps and auricular cartilage grafts, which, unlike composite grafts, do not undergo degeneration with the associated risk of ischemia or discoloration.

Background: Because gynecomastia is one of the most considerable aesthetic procedures for men, we are researching in our article recent management methods for high grades of gynecomastia.

Methods: This prospective study included 45 individuals with gynecomastia, divided into 3 groups: group A (15 individuals) managed by traditional liposuction, group B (15 individuals) managed by vibration amplification of sound energy at resonance (VASER)-assisted lipoplasty, and group C (15 individuals) managed by VASER and J-plasma. Authors used a skin fold caliper for measurement of subareolar disk size and a Cutometer for assessment of skin pliability and firmness. The study was conducted at the Department of Plastic Surgery, Menoufia University Hospital, Egypt, and Reflect Center for Plastic Surgery in Riyadh, Saudi Arabia.

Results: Statistically significant differences were found among the groups in terms of reduction of subareolar disk size (assessed by skinfold caliper), skin redundancy (assessed by Cutometer), the need for a second stage of treatment, and patient satisfaction (by questionnaire).

Conclusions: The combination of VASER and J-plasma is effective for managing grade 2 and 3 gynecomastia, resulting in significant reduction in subareolar disk size, minimal skin redundancy with enhanced skin firmness, reduced need for further procedures, and improved patient satisfaction compared with traditional methods.

Background: The popularity of liposculpture has increased due to the high patient satisfaction rate and low number of complications. However, in Latin America, serious complications have been reported due to various factors. Therefore, our objective was to determine the association of a BMI of 30 kg/m² or more with the development of postoperative complications in patients undergoing liposculpture.

Methods: A retrospective cohort study was performed in patients undergoing liposculpture at the Clinica Nova Quirurgica in Arequipa between 2020 and 2021.

Results: A total of 231 patients were identified. The median age was 35 years, the majority of patients were women (97.4%), and 25.6% of patients had a BMI of 30 kg/m² or more. Postoperative complications developed in 13.4%, the majority being seromas (10.8%), followed by superficial site infections (2.6%), hematomas (1.7%), asymmetry (1.7%), and deep vein thrombosis (0.4%). No other complications were identified. In the multivariable analysis, risk factors for the development of complications were a BMI of 30 kg/m² or more [relative risk (RR) = 3.63; 95% confidence interval (CI), 1.27-10.32; P = 0.016], longer operative time (RR = 1.01; 95% CI, 1.00-1.02; P = 0.001), and greater volume of fat removed (RR = 1.01; 95% CI, 1.01-1.01; P = 0.002).

Conclusions: Patients with a BMI of 30 kg/m² or more undergoing liposculpture have a ~3.5-fold higher risk of developing postsurgical complications compared with patients without obesity. Other risk factors were longer operative time and greater volume of fat removed. Adequate patient selection is crucial to obtain optimal results.

Background: Genital surgery is often considered the final step in surgical gender-affirming treatment. Metoidioplasty is a variant where the enlarged clitoris is lengthened and straightened. The technique has several advantages but is not without complications. We evaluated the surgical outcomes after metoidioplasty from our national center from 2007 to 2020.

Methods: All patients who had undergone the metoidioplasty procedure at Oslo University Hospital from January 1, 2007, to December 31, 2020, were identified by the Local Quality Register of Gender Incongruence. Demographic, clinical, and surgical variables were recorded. Statistical analysis was carried out with SPSS.

Results: A total of 84 patients were identified. The median age at the time of surgery was 27.5 years. Of 84 patients, 48 (57.1%) experienced some kind of complication after the surgery, with an average of 1.7 complications. Complications related to the urethroplasty were the most common, with strictures occurring in 19 (22.6%) patients and urethral fistulas occurring in 11 (13.1%) patients. Forty-one patients (48.8%) needed 1 or more secondary procedures. After the management of strictures and fistulas, a secondary testis implant correction was the most frequent revision procedure performed in 38.1% (32) of patients. With increasing body mass index, the risk of complications and of undergoing secondary procedures also increased significantly (P = 0.045 and 0.019, respectively).

Conclusions: Metoidioplasty is an operation with a relatively high complication rate, mainly related to urethroplasty. There is an urgent need for future research with a focus on quality of life and long-term follow-up.

Blindness from hyaluronic acid filler injections is an uncommon but devastating complication. We present a case of blindness related to a "skin booster." It is often assumed that skin boosters have no risk of visual problems, and this case underlines the need to understand products' rheology and chemistry. Given the lack of agreed consensus in bedside and secondary care management, it is important to report and describe all cases of vision loss caused by fillers, including assessment and management, to allow understanding of what may give rise to better outcomes.

Background: Traumatic brain injury (TBI) is underreported in craniofacial trauma patients, and the long-term morbidity of TBI associated with craniofacial trauma is poorly defined. Current literature is limited in scope to TBI identification in the immediate posttrauma time frame.

Methods: A retrospective, cohort analysis of adult facial fracture patients presenting from February 2022 to February 2023 was performed. Data were collected for demographics, mechanism of injury, fracture pattern, Glasgow Coma Score, admission status, operative intervention, and concomitant injuries. Rivermead Post Concussion Symptoms Questionnaire surveys were given for evaluation of TBI symptoms at most recent follow-up. Statistical significance was accepted when the P value was less than 0.05.

Results: Of 232 facial fracture patients, 82 (35%) completed the Rivermead Post Concussion Symptoms Questionnaire. The mean age was 49.8 years, and mean follow-up time was 11.6 months (range, 2-22 mo). The rate of all patients with TBI symptoms at follow-up was 32.9%. Mechanism of injury, presence of multiple fractures, Glasgow Coma Score less than 15, concomitant injuries, and admission status were not significant predictors of TBI. Fractures requiring operative intervention had higher rates of TBI compared with nonoperative fractures (47.1% versus 22.9%, P = 0.02). Operative intervention was the only significant predictor of TBI symptoms at the time of follow-up (odds ratio: 6.268; 95% confidence interval: 1.322-29.744; P = 0.021) by multivariable logistic regression.

Conclusions: Craniofacial trauma is associated with persistent TBI symptoms. Surgeons treating this trauma population should screen for TBI to facilitate disease identification and specialty referral.

Background: The advent of artificial intelligence (AI) in microsurgery has tremendous potential in plastic and reconstructive surgery, with possibilities to elevate surgical precision, planning, and patient outcomes. This systematic review seeks to summarize available studies on the implementation of AI in microsurgery and classify these into subdomains where AI can revolutionize our field.

Methods: Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a meticulous search strategy was used across multiple databases. The inclusion criteria encompassed articles that explicitly discussed AI's integration in microsurgical practices. Our aim was to analyze and classify these studies across subdomains for future development.

Results: The search yielded 2377 articles, with 571 abstracts eligible for screening. After shortlisting and reviewing 86 full-text articles, 29 studies met inclusion criteria. Detailed analysis led to the classification of 6 subdomains within AI applications in microsurgery, including information and knowledge delivery, microsurgical skills training, preoperative planning, intraoperative navigational aids and automated surgical tool control, flap monitoring, and postoperative predictive analytics for patient outcomes. Each subtheme showcased the multifaceted impact of AI on enhancing microsurgical procedures, from preoperative planning to postoperative recovery.

Conclusions: The integration of AI into microsurgery signals a new dawn of surgical innovation, albeit with the caution warranted by its nascent stage and application diversity. The authors present a systematic review and 6 clear subdomains across which AI will likely play a role within microsurgery. Continuous research, ethical diligence, and cross-disciplinary cooperation is necessary for its successful integration within our specialty.