Plastic and Reconstructive Surgery Global Open最新文献

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that often necessitates extensive surgery when medical treatment fails, particularly in advanced stages. Traditional surgical approaches, including flaps and skin grafts, are effective for tissue coverage but can lead to vascular complications and recurrence of HS. This study introduces a novel technique, the apple-peeling procedure, combined with negative pressure wound therapy at -50 mm Hg for 5 days postoperatively. This approach demonstrated improved operative efficiency and a low complication rate. Over a 3-year follow-up, there were no signs of HS recurrence, and the patient exhibited satisfactory functional and cosmetic outcomes. This technique may offer a promising alternative for treating HS, reducing the need for additional donor sites and mitigating the risks associated with conventional methods.

Gigantomastia is an exceedingly rare condition characterized by extraordinary growth of breasts during pregnancy, and its underlying etiology remains elusive. Although surgical intervention is the primary treatment modality, there have been emerging prospects for utilizing adjunctive medical therapies, such as bromocriptine, to address this challenging condition. Herein, we report the case of a 26-year-old woman who experienced abrupt and asymmetric bilateral breast enlargement commencing in the second month of her pregnancy. Remarkably, this enlargement persisted for an extended duration of 3 years. Despite the absence of prior medical therapy involving bromocriptine or other interventions, the patient ultimately underwent a simple mastectomy coupled with nipple-areola complex reconstruction. Although bromocriptine treatment holds potential benefits, its availability may vary in different healthcare settings. Therefore, the consideration of surgical management as an alternative approach becomes crucial, particularly when bromocriptine is not accessible or proves ineffective. This approach ensures the appropriate management of gestational gigantomastia, with the choice of treatment tailored to the individual patient's needs and resource availability.

Background: The increasing demand for noninvasive gluteal augmentation using hyaluronic acid (HA) gel highlights the need for research into its safety and effectiveness. This study aimed to assess the safety and satisfaction levels of patients and physicians regarding HA body filler for buttock enhancement. It also explores variations in outcomes across different injection sites and among different practitioners.

Methods: This retrospective, observational, descriptive multicenter study analyzed the outcomes of using a body HA filler (HYAcorp MLF2) for buttock augmentation across 4 Italian centers, with a 6-month follow-up period. Patients' and physicians' satisfaction levels were measured immediately postprocedure, and adverse events were monitored throughout the study period.

Results: Thirty-five subjects received injections, with an average volume of 85.1 ± 42.2 mL per subject injected. Throughout follow-up, 94% of patients and 100% of physicians rated the improvement as "very good" or "good." Adverse events were generally mild-to-moderate, typically resolving within 2-7 days. The most frequently recorded adverse effects were swelling, pain, and redness. No significant differences were observed among injectors (P > 0.05).

Conclusions: HYAcorp MLF2 is safe and effective for buttock augmentation, demonstrated by high satisfaction rates and manageable, mild-to-moderate adverse events, with no significant variation based on practitioner experience or clinic site.

Background: Breast implant surfaces are categorized as smooth or textured. Compared with smooth implants, textured surface implants have a higher risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) but may have a lower risk of capsular contracture (CC). This study aimed to quantify whether survey respondents would be willing to accept a higher risk of BIA-ALCL in exchange for the potential reported benefits of textured breast implants.

Methods: We fielded a threshold technique survey to 405 respondents from 4 cohorts: (1) patients with breast cancer who were considering but did not receive reconstruction with implants, (2) patients with breast cancer who had received reconstruction with implants, (3) persons considering breast augmentation with implants, and (4) patients who had received breast augmentation with implants.

Results: The average maximum increase in the risk of BIA-ALCL that the survey respondents were willing to accept in exchange for textured implants-with both a teardrop-shaped option and a 10% reduction in the risk of CC-were as follows: 0.83% for patients who were considering breast reconstruction, 0.61% for patients who had received breast reconstruction, 0.85% for persons considering breast augmentation, and 0.60% for patients who had received breast augmentation.

Conclusions: We found respondents generally were willing to accept the higher risk of BIA-ALCL associated with textured implants to gain the potential benefit of reduced risk of CC and the option of the teardrop-shaped implant. Patient perspectives and preferences are integral, and continued assessment of patient perspectives can help inform regulatory and care paradigms.

Background: The objective of this study was to propose a novel classification for lateral polydactyly of the foot that integrates both visual appearance and radiographic findings and to delineate surgical techniques and their outcomes based on this classification.

Methods: This study enrolled 148 feet from 126 patients who underwent initial surgery at our hospital between January 2009 and July 2021. The new classification system was derived from visual appearance according to the Hirase classification and radiological bifurcation level (D: distal or middle phalanx, P: proximal phalanx, and M: metatarsal). Incidence rates, surgical procedures, and surgical outcomes were compared across each type.

Results: Morphologically, 25 cases were classified as type A, 43 cases as type B1, and 80 cases as type B2. The branching level was categorized as D in 81 feet, P in 41 feet, and M in 26 feet, with 68 feet (46%) classified as B2-D type. Excision of the sixth toes was performed in all type A cases, whereas the majority of type B cases required excision of the fifth toes. Revision procedures were conducted on 8 feet. Three patients with type A-P classification developed painful hammer toe deformities as a late sequela that necessitated extensor tenolysis and metatarsophalangeal joint contracture release during their school-age years.

Conclusions: The classification system based on the combination of visual appearance and radiological branching level was both straightforward and beneficial for surgical planning and for predicting surgical outcomes and late sequelae.

Giant congenital melanocytic nevi are large pigmented premalignant lesions present at birth that have an associated risk of malignant transformation. Full-thickness excision of these lesions would be required to eliminate this risk. However, giant nevi can leave behind large defects that can be challenging to reconstruct. We present the case of a pediatric patient with a lesion occupying the entirety of the back, or around 18% total body surface area, and in whom Integra and meshed skin grafts were successfully used. This represents the largest defect size in the literature resulting from a giant nevus that has been treated by this method. Full take of the skin grafts was observed 26 days from the excision of the lesion with satisfactory functional outcomes.

Background: The deep inferior epigastric perforator (DIEP) flap is universally considered the gold standard technique for breast reconstruction (BR), though it cannot always be proposed to patients with insufficient donor-site volume. We explore the efficacy of autologous fat transfer (AFT) of the Holm abdomen zone IV in the retropectoral plane during DIEP flap reconstruction (lipo-DIEP flap), to enhance the volume provided by the abdominal donor site in patients with low body mass index (BMI).

Methods: We prospectively enrolled patients with BMI less than 25 kg/m² and candidates for lipo-DIEP flap BR (group A) comparing them with a control group (group B) undergoing traditional DIEP flap BR with the same characteristics of the first group (BMI < 25 kg/m²). Patients belonging to group A underwent magnetic resonance imaging preoperatively and 6 months after the BR, evaluating the adipose tissue volume retained in the retropectoral space.

Results: A total of 40 breasts were included in the study. The 2 groups were homogeneous regarding the collected variables, except for mean delayed AFT sessions (0.25 versus 0.95; P= 0.00094). The average volume of retropectoral AFT was 116.25 mL (SD 31.36). Six months after the procedure, the mean retropectoral fat volume calculated through magnetic resonance imaging was 48.64 mL (SD 14.15), whereas the mean graft integration rate was 45.98% (range, 30.7%-64.2%).

Conclusions: The lipo-DIEP flap is a valuable technique for patients with insufficient donor-site volume. Immediate retropectoral fat grafting from the Holm zone IV has proven to be safe in terms of complications, reducing the need for further AFT sessions.

Conjoined twins, although rare, present unique challenges in surgical management, particularly regarding skin closure after separation. This case report details the successful separation of pygopagus conjoined twins using a rectangular skin flap technique. The twins, joined at the lumbar and sacral regions, underwent meticulous preoperative planning and collaborative effort from multiple medical teams. The surgery involved raising fasciocutaneous rectangular flaps over the buttocks, spine separation, rectal division, and reconstruction of pelvic floor muscles. The primary skin closure was achieved successfully. This case highlights the superior gluteal-based rectangular flap technique in such a separation and the importance of multidisciplinary approaches in improving outcomes for complex surgeries.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) affects 29%-68% of patients undergoing anticancer treatments within the first month. Traditional cryotherapy methods, such as frozen gloves, can pose risks. This study evaluates the cool-water electric circulation seat (CECS), which maintains a constant 15°C, as a safer alternative.

Methods: In this prospective study, 21 healthy Japanese adults underwent 2.5 hours of hand cooling at 15°C, reflecting the standard duration of taxane anticancer drug administration. Microcirculation was evaluated using videocapillaroscopy before and after cooling.

Results: Results showed significant reductions in blood vessel area and altered red blood cell movement postcooling. Finger temperature and vascular area decreased significantly (P < 0.001), and red blood cell movement changed significantly, with most cells shifting from slow (52.4%) or fast (47.6%) movement before cooling to slow (23.8%) or immobile (76.2%) afterward (P < 0.001). Thirty minutes postcooling, 38.1% of participants reported temporary redness, and 28.6% reported pain, both resolving by the next day.

Conclusions: The CECS effectively provides secure cooling, offering a promising approach for CIPN prevention without frostbite risk. These findings highlight the potential advantages of CECS in sustained cooling therapy for CIPN prevention.

Background: Recurrent burn contractures on the volar aspect of the hand present a formidable challenge, especially in the pediatric patient. We used Integra followed by staged full-thickness skin grafting for recurrent bilateral volar hand burn contracture in a toddler. We reviewed the literature to appraise the utility of full-thickness skin graft (FTSG) combined with Integra used for volar hand contractures.

Methods: A systematic review of the world's literature was conducted identifying publications on the application of Integra and skin substitutes for palmar hand contractures and wounds, to include burn injuries. We describe a case of a pediatric patient with recurrent bilateral burn flexion contracture of the palm and digits treated with scar excision and application of Integra, followed by staged application of FTSG.

Results: We identified 92 publications pertaining to volar hand defects or contractures managed with skin grafts, skin substitutes, and/or flaps. Ten articles referred to the use of Integra on volar hand wounds or contractures, and only 2 articles used FTSG instead of split-thickness skin graft in combination with Integra. Our systematic review of volar burn injuries of the hand and fingers demonstrated that the use of Integra combined with FTSG for postburn flexion contracture of the hand has not been previously reported.

Conclusions: This case report suggests that application of FTSG instead of split-thickness skin graft to vascularized Integra offers protective value against recurrent burn contracture of the palmar hand, but more studies are needed to support our hypothesis.