Plastic and Reconstructive Surgery Global Open最新文献

Background: Age-related changes in the brow region, such as sagging, asymmetry, and deepening of forehead lines, pose significant cosmetic and functional challenges. Various surgical approaches have been developed over the decades to address these issues. This systematic review compared traditional open techniques versus endoscopic and minimally invasive brow lift techniques in terms of aesthetic outcomes and complication rates.

Methods: A comprehensive search was conducted in PubMed, MEDLINE, the Cochrane Library, Embase, and ClinicalTrials.gov. Studies published during the past 20 years that met our predefined eligibility criteria were included. The quality of randomized controlled trials was assessed using the Cochrane Risk of Bias 2 tool, and nonrandomized studies were evaluated with risk of bias in non-randomized studies of interventions (ROBINS-I). Data on aesthetic outcomes and complications were extracted and compared across studies.

Results: Fifteen studies were included in this review. The evidence suggests that although various open brow lift techniques provide satisfactory elevation, they are generally associated with higher complication rates and less favorable cosmetic results. In contrast, endoscopic and minimally invasive techniques, including the use of Endotine devices and gliding brow lifts, demonstrate comparable or superior aesthetic outcomes with lower complication rates and reduced recovery times. However, heterogeneity in outcome measures and study designs limits the strength of these conclusions.

Conclusions: Endoscopic and minimally invasive brow lift procedures seem to offer cosmetically favorable results with lower complication rates compared with traditional open techniques. Nevertheless, further high-quality, prospective studies are needed to definitively establish the long-term efficacy and safety of these approaches.

Background: Traditional surgical treatment for gynecomastia has multiple complications. Recently, energy-based therapies have gained popularity over conventional surgical treatments, including liposuction using radiofrequency energy, power-assisted liposuction, ultrasound-assisted liposuction, and laser-assisted lipolysis (LAL). This work aims to assess LAL efficacy and glandular tissue treatment using a 1470-nm laser for gynecomastia to correct breast volume, flaccidity, and skin tightening without its removal.

Methods: This prospective, single-blinded randomized controlled trial was conducted on 30 patients enrolled in the National Institute of Laser Enhanced Sciences outpatient clinic who had gynecomastia classified according to the Simon standard. The participants were randomly allocated to 2 groups: group 1 (n = 15) received conventional liposuction (suction-assisted liposuction), and group 2 received LAL (1470-nm diode laser) treatment. Patients were assessed using the BREAST-Q scale.

Results: All patients achieved satisfactory results. The BREAST-Q scores were significantly higher in group 2 compared with group I (P < 0.005). Visual analog scale scores significantly decreased in group 2 (P < 0.001) compared with group 1. Group 2 had significantly improved aesthetic outcomes compared with group 1 (P < 0.001). In group 1, skin retraction and hematoma incidence were significantly greater than in group 2 (P = 0.014, <0.001).

Conclusions: The LAL described is safe and reproducible. It showed a higher BREAST-Q value, a significantly better aesthetic outcome, and fewer postoperative complications.

Sternal wound infections are a serious complication after cardiac surgery and are associated with significant morbidity and mortality. Deep sternal wound infections are characterized by positive mediastinal cultures, clinical signs of mediastinitis, and symptoms such as fever, sternal instability, or purulent drainage. Management includes serial debridement, negative pressure wound therapy, and definitive reconstruction. We present a 70-year-old man with a history of aortic and mitral valve disease, diabetes, chronic kidney disease, and bladder cancer who underwent prosthetic aortic graft reconstruction (Bentall procedure). Postoperatively, he developed mediastinitis requiring multiple washouts and wound vacuum-assisted closure therapy. For reconstruction, a split omental flap pedicled on the right gastroepiploic artery was mobilized, with 1 segment covering the aortic graft and the other the lower sternum. SPY angiography was used to determine the site of division. Sternal closure was performed with wires. Bilateral pectoralis major flaps were advanced medially to complete upper third sternal coverage. This case demonstrates the feasibility of a combined split omental and bilateral pectoralis flap reconstruction for complex deep sternal wound infection, providing layered, vascularized coverage over grafts and bone. This report underscored the viability and utility of a multisegmental omental flap in combination with pectoralis flaps for deep and superficial sternal wounds following cardiothoracic surgery.

Background: Prepectoral implant-based breast reconstruction may enhance aesthetic results and improve functional outcomes. Although currently favored over other approaches, the use of acellular dermal matrices may lead to higher healthcare costs compared with the subpectoral approaches. Prior research on the cost implications often lacks comprehensive analyses of cumulative perioperative medical expenses.

Methods: This retrospective cohort study analyzed data from women who underwent unilateral or bilateral mastectomy followed by immediate implant-based reconstruction at a single academic center between July 2017 and June 2022. We used financial data to examine billing charges from the index surgery and the downstream costs of patient care up to 6 months postoperation. Regression analyses assessed total index surgery costs, downstream costs, and cumulative costs while adjusting for variables such as age, body mass index, and racial demographics.

Results: The study analyzed data from 86 prepectoral and 99 subpectoral reconstruction patients. Subpectoral reconstructions had significantly lower index surgery costs, including a 30.5% decrease in costs compared with prepectoral reconstruction (P < 0.001). Although downstream costs up to 6 months postsurgery did not significantly differ, cumulative costs were 29.2% lower in subpectoral cases (P < 0.001). The increased use of acellular dermal matrix in prepectoral procedures contributed to higher costs.

Conclusions: Prepectoral implant-based reconstruction is associated with significantly higher surgical and cumulative costs compared with subpectoral reconstruction. These results provide critical cost-related insights as prepectoral techniques gain traction. Addressing these cost variables could facilitate broader implementation of prepectoral procedures, leveraging their potential patient-centered benefits.

With the rising popularity of hyaluronic acid (HA) fillers for cosmetic purposes, complications such as delayed-onset edema and nodules have become more frequent. These adverse reactions may be challenging to treat and often require multiple therapeutic strategies. We report 3 cases of women who developed late-onset edema and firm nodules following HA filler procedures. Conventional treatments, including corticosteroids, antibiotics, and hyaluronidase, were insufficient. Oral methotrexate at 15 mg per week was introduced, resulting in complete resolution in all cases within approximately 30 days. Low-dose methotrexate proved to be effective in managing persistent nodules and edema secondary to HA fillers. Methotrexate may represent a promising treatment option for delayed inflammatory responses following HA filler injections. Further prospective studies are needed to validate its safety and efficacy in this context.

Background: Effective perioperative analgesia and control of postoperative nausea and vomiting (PONV) are key determinants of recovery after otoplasty for prominent ear deformity, yet comparative evidence for current techniques is limited.

Methods: A PROSPERO-registered systematic review (CRD42024586119) was performed in September 2024 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Google Scholar, Web of Science, and the Cochrane Library were searched (1989-2020) for English-language randomized or prospective studies reporting pain outcomes after otoplasty. Nine studies (6 randomized controlled trials and 3 cohort studies; 370 patients) met eligibility criteria. Two reviewers extracted pain scores, opioid use, PONV, and complications; risk of bias was assessed using RoB 2 and methodological index for non-randomized studies.

Results: Regional nerve block provided superior analgesia versus local infiltration anesthesia with a mean pain score at 6 hours of 0.25 versus 2.34 (P < 0.001) and opioid requirements of 14% versus 24%. Propofol anesthesia and transdermal hyoscine patches reduced PONV to 16% versus 48% with placebo. Reported adverse events were infrequent (<5%) and transient (eg, Horner syndrome, mild bradycardia, hoarseness). Overall methodological quality was moderate, and heterogeneity precluded meta-analysis.

Conclusions: Regional nerve block is the most effective strategy for perioperative pain control in otoplasty, halving opioid use and improving early pain scores. Adjunctive propofol and hyoscine further reduce PONV, with no serious or lasting complications. Standardized multimodal protocols and high-quality trials-especially in pediatric and awake procedures-are required to strengthen evidence and broaden applicability.

The pectoralis major flap is a reliable option in head, neck, and chest wall reconstruction; however, postoperative myospasm is a source of significant morbidity. The pathophysiological mechanism remains unclear, with proposed causes including incomplete nerve division or anatomical variation. We present 2 cases of patients who developed symptomatic myospasm following pectoralis major flap reconstruction, despite division of the medial and lateral pectoral nerves during the primary procedure. In both cases, aberrant motor nerves were identified intraoperatively running alongside the thoracoacromial pedicle. Stimulation of these nerves reproduced patient symptoms, and targeted neurectomy led to symptom resolution or significant improvement. These findings suggested that alternative motor innervation may underlie persistent myospasm in some patients. This was the first report to document the direct intraoperative identification and treatment of aberrant innervation as a contributing factor. Further anatomical studies are warranted to explore the prevalence, origin, and clinical significance of this variation.

Bilateral autologous breast reconstruction requires microsurgery on both sides, increasing operative time and surgeon workload compared with unilateral reconstruction. This study examines the efficacy of a simultaneous microsurgical approach for bilateral breast reconstruction in reducing operative time and burden. A total of 22 patients who underwent bilateral breast reconstruction with deep inferior epigastric artery perforator flaps at the University of Toyama Hospital from March 2020 to December 2023 were included. These comprised 2 groups of patients who underwent either conventional sequential reconstruction or simultaneous reconstruction. In the conventional group, 1 flap was transected, and vascular anastomosis was completed before proceeding to the second flap. Abdominal closure was started after the transection of the second flap. In the simultaneous group, both flaps were transected at approximately the same time, and 2 surgeons performed the microsurgery simultaneously using separate microscopes. Abdominal closure began after both flaps were transected. Our results showed significantly shorter operative time (538 versus 657 min, P = 0.04) and ischemia time (92 versus 177 min, P = 0.006) in the simultaneous group than the conventional group, respectively. No postoperative complications requiring reoperation occurred in the simultaneous group. In the conventional group, there was 1 case of flap loss due to postoperative infection. This study demonstrates that the bilateral simultaneous approach reduced operative and ischemia times while maintaining safety. Despite requiring 2 skilled microsurgeons, this approach offered an efficient and reliable solution for bilateral reconstruction.

Background: Pathological scars, particularly hypertrophic and keloid types, often pose significant cosmetic and functional challenges. Although fractional CO₂ lasers and pulsed dye lasers have individually shown promise in scar treatment, their combined efficacy remains underexplored.

Methods: Following preferred reporting items for systematic reviews and meta-analyses guidelines and registered in PROSPERO (CRD42024619973), a comprehensive search across 6 databases identified studies involving patients treated with combined fractional CO₂ laser and pulsed dye laser for scars of various etiologies. Inclusion criteria focused on clinical outcomes such as scar thickness, vascularity, pliability, and pigmentation, assessed via validated tools such as the Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Observer Scar Assessment Scale. Nine studies, involving a total of 247 patients, were included. Meta-analyses were performed using a random-effects model.

Results: The combination therapy significantly improved scar appearance across multiple scales. The pooled mean differences were -18.09 for the Patient and Observer Scar Assessment Scale, -19.44 for the Observer Scar Assessment Scale, and -3.80 for the Vancouver Scar Scale, all of which were statistically significant (P < 0.0001). Improvements were consistent across pigmentation, vascularity, texture, and patient satisfaction, with minimal adverse effects reported. Heterogeneity was high, but it did not impact the direction of the findings.

Conclusions: Combining fractional CO₂ and pulsed dye lasers offers superior outcomes in scar remodeling compared with monotherapy, improving both functional and aesthetic aspects with a favorable safety profile. Future studies should focus on standardizing treatment protocols and exploring long-term outcomes to optimize clinical use.

Background: The Keller Funnel facilitates breast implant placement while minimizing contamination and capsular contracture risk. Antiseptic agents are commonly used as lubricants, but they may carry adverse effects. This study evaluated outcomes of funnel-assisted insertion lubricated with hyaluronic acid compared with manual insertion.

Methods: A retrospective cohort study was conducted on 200 patients undergoing primary breast augmentation (2022-2024). Data were collected from the records of 100 patients who received manual implant insertion and 100 patients who underwent implant placement using the funnel technique. Demographics, surgical variables, scar size, insertion time, complications, and patient satisfaction (BODY-Q) were analyzed. Statistical significance was set at a P value of less than 0.05.

Results: Mean patient age was 25.3 years, body mass index was 21.8 kg/m², and implant volume was 330 mL. Scar size was smaller in the funnel group (32 versus 37 mm, P = 0.025). Insertion time was shorter (5.9 versus 57.6 s, P = 0.001). Complications occurred in 1% of funnel cases versus 8% of manual cases (odds ratio: 0.11; 95% confidence interval: 0.01-0.94; P = 0.04). Satisfaction improved significantly postoperatively in both groups (preoperative 54.3 versus 92.6 at 6 mo, P < 0.001) with no between-group difference (P = 0.712).

Conclusions: Funnel insertion with hyaluronic acid reduced scar size, insertion time, and complication risk compared with manual insertion, while achieving high and comparable satisfaction. This technique offers a safe "no-touch" alternative that may lower contamination and capsular contracture risk. Prospective studies are needed to validate long-term efficacy and to compare hyaluronic acid with antiseptic additives.