Plastic and Reconstructive Surgery Global Open最新文献

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.

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.

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.

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.

Background: Hand flexor tendon injuries can be treated with primary repair by direct tenorrhaphy or, when this option is not feasible, with secondary repair by reconstruction with tendon grafts. Commonly used autologous grafts include palmaris longus and plantaris; however, these may be congenitally absent or unavailable. Fascia lata (FL) is widely used for ligament and tendon reconstruction in other anatomical regions, but its use in hand surgery is rarely reported.

Methods: A narrative review of the literature was conducted using the PubMed and Scopus databases to identify clinical and experimental studies on the use of FL grafts in tendon reconstruction. Relevant case reports and series were analyzed to summarize indications, techniques, and outcomes. A representative clinical case is also presented to illustrate the use of FL in a 2-staged flexor tendon reconstruction.

Results: FL has demonstrated favorable biomechanical and histological properties across multiple sites including shoulder, knee, Achilles tendon, and upper limb, with satisfactory long-term outcomes. Only a few reports have described its use in hand flexor tendon reconstruction, generally noting good motion recovery and low donor-site morbidity. The reported case illustrates a successful 2-stage reconstruction of a flexor digitorum profundus tendon using a rolled FL graft in a 20-year-old patient.

Conclusions: FL represents a reliable and versatile autologous graft option when conventional donor tendons are unavailable. Further biomechanical and clinical research is needed to establish its long-term performance and optimal applications in hand surgery.

Capsular contracture (CC) is a common complication following breast augmentation. Acellular dermal matrix (ADM) is increasingly used to reduce and treat CC in breast augmentation. However, rare cases of ADM-associated CC can occur. In this case report, we describe a 63-year-old breast augmentation patient who developed significant recurrent CC following subglandular augmentation, capsulectomies, and ADM-assisted revisions. Despite ADM coverage, the patient developed Baker grade 3 CC. Histologic and immunohistochemical analyses were performed on capsular tissue adjacent to visible ADM (study ADM) and on capsule without ADM contact (study capsule), and the results were compared with benign controls. Study ADM demonstrated histologic evidence of ADM resorption and increased fibrotic density. Study capsule exhibited the greatest capsule thickness. Immunohistochemistry revealed significantly elevated macrophages (CD68+, P < 0.0001), pro-inflammatory M1 macrophages (iNOS+, P < 0.05), and T cells (CD3+, P < 0.01) in both study ADM and study capsule compared with controls. Comparison of study ADM to study capsule revealed a higher macrophage burden near ADM (CD68+ P < 0.001, iNOS+ P = 0.6), whereas T cells (CD3+, CD4+, P < 0.05) were reduced. This case illustrates that ADM may paradoxically trigger an inflammatory reaction, resulting in ADM-associated CC despite its intended protective role. The observed immune dysregulation suggests that ADM resorption, in contrast to incorporation, may be a driver of capsule pathology. These findings underscore the need for further research into patient-specific immune responses to ADM and their implications for CC risk.

Transoral robotic surgery (TORS) has revolutionized head and neck cancer treatment by offering minimally invasive access to challenging anatomical regions. The first TORS procedure was performed in 2003, using the da Vinci Surgical System to remove a vallecular cyst, demonstrating its feasibility in otolaryngology. In 2005, Hockstein et al advanced robotic applications for pharyngeal and laryngeal regions, making TORS a viable alternative to more invasive approaches, such as mandibulotomy for tumor resection. Initially used for small tumors, TORS has expanded to include larger tumors requiring free flap reconstruction for extensive oropharyngeal defects. Robotic surgery also continues to grow in other head and neck procedures, with increasing reports of robotic thyroidectomy and skull base procedures. As robotic techniques expand, challenges for reconstructive surgeons accustomed to open techniques may arise. It is imperative that plastic surgeons embrace new technology and innovate accordingly. This case series explored a novel, minimally invasive approach to transoral free flap inset and pedicle positioning using a nerve- and vessel-sparing mini-pharyngotomy. Four patients underwent robotic-assisted resection and free flap reconstruction, avoiding traditional mandibulotomy and lateral pharyngotomy, thus preserving critical structures such as the hypoglossal and lingual nerves. This method may reduce surgical morbidity, optimize pedicle transfer, and improve functional outcomes. All patients had successful reconstructions with no flap loss or fistulas, and follow-up ranged from 9 to 70 months. These findings suggest that robotic-assisted free flap inset with a mini-pharyngotomy is a safe, effective, and patient-centric alternative to conventional approaches in head and neck reconstruction.

Background: Lower eyelid retraction is a common feature of thyroid eye disease (TED). Various spacer materials have been used for surgical correction, but long-term data on donor sclera are missing.

Methods: A retrospective study of all TED patients treated with donor sclera to correct lower eyelid retraction was performed at the Department of Ophthalmology, Haukeland University Hospital, from 1999 to 2023. Data were obtained from hospital records and follow-up examinations. Outcomes were graded as perfect (scleral show of 0 mm), acceptable (0 mm < scleral show ≤ 1 mm), and unacceptable (scleral show >1 mm).

Results: Thirty-five patients (29 women, 6 men) with a median age (range) of 57 (20-79) years and a median time from TED onset to surgery of 72 (12-468) months were included. At first follow-up, 3 (0.03-12) months postoperatively, scleral show improved significantly (P < 0.001) from 2 (1-6) mm preoperatively to 0 (0-4) mm, and margin reflex distance 2 (MRD2) decreased significantly from 7 (6-11) to 5 (4-9) mm. A perfect or acceptable result was achieved in 83% of patients. Estimated graft survival rates were 93.9% at 5 years and 54.2% at 25 years. At final follow-up, 84 (12-275) months postoperatively, a perfect or acceptable outcome was found in 46%. No significant difference (P = 0.808) was observed between the preoperative MRD2 of 7 (6-11) mm and long-term postoperative MRD2 of 7 (5-11) mm.

Conclusions: Correction of lower eyelid retraction with donor sclera in TED patients provides satisfactory short-term outcomes. However, over time, relapse of retraction commonly occurs.

This study evaluated whether echogenic needles improve ultrasound visibility during hyaluronic acid filler injections in the cheek-a high-risk area due to anatomical variability of facial vessels. In a single-patient in vivo setting, 3 types of needles (23G nonechogenic and 23G and 30G echogenic) were tested under ultrasound guidance. Echogenic needles showed better tip and shaft visibility across angles and depths, including dynamic movement. Reviewers noted greater procedural confidence and a reduced need for probe adjustment. These findings suggest that echogenic needles may enhance safety and precision in ultrasound-guided aesthetic procedures.

Background: Dupuytren disease (DD) is a benign fibroproliferative disorder affecting the hand. Although diabetes mellitus is a known risk factor, the underlying mechanisms behind this association remain unclear. This study aimed to examine the relationship between glycemic control and DD in type 1 (T1D) and type 2 diabetes (T2D), and to identify other metabolic risk factors influencing DD risk.

Methods: In this retrospective registry study, data from the Swedish National Diabetes Register and the Skåne Healthcare Register were cross-linked. In total, 96,039 individuals aged 18 years or older with T1D or T2D were included. Sex-stratified, multivariable logistic regression models calculated associations between HbA1c levels and DD risk. Interaction analyses evaluated whether diabetes duration modified the association between HbA1c levels and DD risk.

Results: Longer diabetes duration consistently increased the risk of DD in both T1D and T2D groups. A trend toward increased DD risk with higher HbA1c levels was seen in T1D (P > 0.05). Higher body mass index was inversely associated with DD in men and women with T2D (P < 0.05). No interaction was observed between HbA1c levels and diabetes duration.

Conclusions: Diabetes duration seems to be a strong and independent risk factor for DD in T1D and T2D. Although a trend toward higher DD risk with elevated HbA1c was observed in T1D, no interaction with diabetes duration was found. A higher body mass index was associated with a lower risk of DD in individuals with T2D.