Plastic and Reconstructive Surgery Global Open最新文献

In rib reshaping, it is known that the waist plays a role in defining the structure and harmony of the body. There are techniques as part of the costal remodeling that allow for achieving a narrower and more defined waist and generate a harmonious transition from the waist to the hip in the body of the patients. Waist remodeling without incision, with ultrasound-guided monocortical fracture (RibXcar), is a noninvasive technique that does not leave scars and helps sculpt the desired shape of the waist. The technique was applied to 220 patients who voluntarily consented under informed consent. Sociodemographic data were collected from an initial evaluation. Likewise, waist measurements were taken from patients preoperatively and 6 months after the intervention. RibXcar is safe; no serious complications were evidenced, and minor complications due to pain were adequately treated. As for the results, it was found that body measurements of the waist before the operation and 6 months after evidenced a reduction of between 6 and 11 cm less in the diameter of the waist after the application of the technique. RibXcar is an innovative, safe, and aesthetically pleasing technique without scarring or serious complications.

This case report presents a novel approach for vulvovaginal reconstruction using a modified pedicled anterolateral thigh (ALT) flap. The patient was a 62-year-old woman with a history of vulvar squamous cell carcinoma and radiation therapy, after which the cancer recurred. Total vulvectomy was performed with preservation of the urethra and vaginal introitus. The resulting defect was reconstructed using a boomerang-shaped ALT flap measuring 16 × 7 cm. The flap was harvested via intramuscular dissection and transposed into the vulvar defect through a subcutaneous tunnel. The excess skin was de-epithelialized and used to fill the defect around the urethra. Six months postoperatively, the patient had recovered successfully with satisfactory cosmetic and functional results. The advantages of the ALT flap include its versatility, long vascular pedicle, and the ability to harvest it from a nonirradiated area. The modified technique used a boomerang-shaped design and careful placement of the perforators. This technique eliminates the disadvantages associated with fenestrated and split ALT flaps, provides well-vascularized tissue, restores function, minimizes donor-site morbidity, and achieves a natural-looking aesthetic result. The modified pedicled ALT flap is a safe and effective method for vulvovaginal reconstruction, particularly in patients with a history of radiation therapy or large, complex vulvar defects.

Retrobulbar hemorrhage can increase intraorbital pressure, thereby elevating intraocular pressure (IOP), inducing ischemia, and/or threatening the optic nerve. Emergent decompression is needed to preserve visual function. Multiple decompression methods that are favored by different clinical departments have been reported. Here, we report 2 emergency room cases of retrobulbar hemorrhage that were treated first with lateral canthotomy and inferior cantholysis (LC/IC) under local anesthesia followed an hour later by wide orbital septum release under general anesthesia. LC/IC permits the quickest possible decompression after injury, thus temporarily reducing IOP. Orbital septum release consolidates the decompression by permitting hematoma drainage and identification and hemostasis of the bleeding point. In our cases, IOP dropped from 55 and 52 mm Hg to 14 mm Hg in both cases, and corrected visual acuity improved from light perception/counting fingers to 20/20. Notably, LC/IC was only conducted 7 and 4 hours postinjury. This counters the commonly held view that decompression should occur within 2 hours of injury to achieve visual recovery. Thus, even though LC/IC followed by orbital septum release requires 2 surgical steps, it can result in excellent visual outcomes after retrobulbar hemorrhage.

Bioresorbable plating systems have been more recently developed as an alternative to metal osteofixation systems and can be used for craniosynostosis operations. To date, the bioresorbable materials used for osteofixation have been used clinically with excellent safety outcomes and good patient outcomes without major plate-induced complications. In this report, we present 2 cases in which bioresorbable materials failed to degrade following operations for craniosynostosis in a chronic manner mandating removal and revision. We also provide a review of the existing literature regarding bioresorbable fixation and evidence of failure to degrade. Based on the clinical courses and pathological findings, it is likely that material factors, combined with the metabolic resorptive capacity and the patient host immune system, contributed to the failure of resorption. Treatment with the removal of implant debris has proven to be effective in other reports, and both patients ultimately progressed with acceptable clinical outcomes. Evaluating rare complications associated with these systems will help provide evidence to inform future product development and refinement. As the field of craniofacial surgery continues to evolve, the use of new materials and technologies promises to enhance patient outcomes, reduce complications, and expand the scope of surgical interventions.

Background: Tranexamic acid (TXA) is an antifibrinolytic agent with promising benefits in facial rejuvenation surgery. The best way to administer this medication for therapeutic value is currently unknown. This study compared outcomes for facelift patients given TXA intravenously versus locally in tumescent solution.

Methods: Sixty rhytidectomy patients were randomized to receive 1 g of TXA intravenously or 150 mg of TXA in facial tumescent. Blood loss and surgeon-assigned bleeding rate were recorded intraoperatively for each side of the face. On postoperative day 7, patients assessed surgical satisfaction and bruising and swelling levels, and the surgeon graded ecchymosis and edema. Time to drain removal and complication incidence were also documented.

Results: Mean blood loss was 25.86 mL for intravenous (IV) TXA patients versus 30.00 mL for local patients (P = 0.23) on side 1. On side 2, average blood loss was 30.00 mL in the IV group and 35.54 mL in the local group (P = 0.51). The median bruising and swelling rating was 2 for IV patients and 3 for local patients (P = 0.14). The groups had equivalent median blood loss scores, satisfaction ratings, ecchymosis and edema ratings, and complication rates. Mean days to drain removal were lower in the IV TXA group (1.16 versus 2.04 d, P = 0.04). The local TXA group had significantly more variation in patient satisfaction (P = 0.04) and time to drain removal (P < 0.001).

Conclusions: IV administration of TXA may have a slight advantage over local infiltration as it decreases days to drain removal and yields more precise outcomes for patient satisfaction and time to drain removal.

Effective management of complications from hyaluronic acid (HA) fillers is crucial in aesthetic medicine. This article examined the role of hyaluronidase in addressing adverse effects associated with HA fillers, such as nodules, vascular occlusions, and excessive volume. It highlights the enzyme's ability to degrade HA, thereby resolving issues that may arise from filler treatments. The discussion includes practical aspects of using hyaluronidase, such as recommended dosing, injection techniques, and potential risks. The benefits of hyaluronidase, including its rapid action in dissolving problematic fillers and its role in improving patient outcomes, are explored. The article also addresses limitations and safety considerations to provide a comprehensive understanding of hyaluronidase in the context of filler complications. By offering insights into the application and effectiveness of hyaluronidase, this article aimed to enhance practitioners' ability to manage HA filler-related issues effectively and ensure optimal results in aesthetic procedures.

[This corrects the article DOI: 10.1097/GOX.0000000000006024.].

Background: This Delphi study aimed to develop the Observer Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0 for measurements of scar quality in patients with all types of scars. The POSAS 3.0 Patient Scale has been developed using an extensive qualitative study, which has been published separately.

Methods: An online, 3-round Delphi study was performed with 124 international scar experts from 23 countries spanning 7 continents. Panelists rated their (dis)agreement with proposals regarding the wording and relevance of scar characteristics on a 5-point scale ("strongly disagree" to "strongly agree"), and provided arguments for their decisions. Consensus was reached if ≥67% of the panelists agreed or strongly agreed to a proposal.

Results: Consensus was reached on the inclusion of 9 items. Two versions of the Observer Scale of the POSAS 3.0 have been developed, 1 generic version including 7 items, and 1 linear scar version, containing the same 7 items and 2 additional scar-specific items.

Conclusions: This is the first study using the Delphi process to develop an instrument for the assessment of scars. Panelists from all over the world reached a consensus on the content of 2 versions of the Observer Scale, the generic version and the linear scar version. By involving the potential end-user community of the new POSAS version in its development, we expect the developed instrument to have high content validity. For a comprehensive scar assessment, the Observer Scale should be used in combination with the Patient Scales of the POSAS 3.0.

Background: Thumb function is integral to hand movement and overall hand function. Impairment, often caused by carpometacarpal (CMC) arthritis, reduces the quality of life. Here, we explored a novel approach using a mixture of the stromal vascular fraction, adipose-derived stem cells, and platelet-rich plasma to treat symptomatic trapeziometacarpal osteoarthritis.

Methods: Retrospective data from 30 hands of 19 patients classified as Eaton and Littler stages 1-4 were analyzed. Platelet-rich plasma and fat were collected under sterile conditions, followed by centrifugation, stem cell extraction, and injection of the mixture into the thumb CMC joint under x-ray guidance. The measurement parameters included the visual analog scale pain score, grip strength, pinch strength, and Thumb Disability Examination (TDX) score. Statistical analysis was performed using paired t tests to evaluate the outcomes across the entire group, individual stages, and early/late stages.

Results: We examined 30 hands of 19 patients with trapeziometacarpal osteoarthritis. Pain reduction was significant at 6 and 24 months for all stages, particularly stages 2 and 3. Substantial pain reduction was also observed at the early and late stages. The TDX score decreased significantly in all groups after 6 and 24 months. Hand function notably improved with significant gains in tip-to-tip pinch strength at 24 months and palmar pinch strength at 6 and 24 months. No complications were observed.

Conclusions: The intra-articular injection of autologous conditioned plasma/stromal vascular fraction in patients with thumb CMC arthritis, in all stages, helps to improve pain symptoms and postpone potential resection arthroplasty with minimal surgical intervention and risks.

Background: Unilateral cleft lip and palates present unique anatomy at the palato-velar-vomerine junction. This region can be the widest and most challenging part of the cleft, where functional fistulas may occur. In 2017, an approach concentrating on the nasal part was implemented, which rendered the repair of this transition zone less challenging. This study detailed this surgical modification, which allows easy and effective palate repair and thereby reduces fistula rates.

Methods: This study included 71 patients with unilateral cleft lip and palates who underwent 1-stage palatal repair using the same technique at the age of less than 1 year between 2017 and 2019 and were followed up until 2022. The surgical technique involved the incorporation of the unconnected vomer at the palato-velar-vomerine junction. Anatomical and speech assessments were performed during the annual follow-up period.

Results: None of the patients developed fistulas. The rate of hypernasality was 11.9%.

Conclusions: This study described a reliable technique to reduce fistula formation at the palato/velar junction during unilateral cleft lip and palate repair.