Plastic and Reconstructive Surgery Global Open最新文献

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.

Background: Frailty is regarded as a key predictor of adverse surgical outcomes. The 5-item modified frailty index (mFI-5) offers a simplified version of the validated 11-item risk stratification tool. Despite its use across surgical fields, its utility in plastic and reconstructive surgery remains underexplored. The purpose of this study was to evaluate and quantify the predictive value of frailty, as measured by the mFI-5 on postoperative outcomes in adult patients undergoing plastic and reconstructive surgery.

Methods: PubMed, Embase, Web of Science, and Cochrane Library were systematically queried for studies comparing adverse events in frail (mFI-5 ≥ 2) versus nonfrail patients undergoing plastic and reconstructive surgery. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the risk of bias in non-randomized studies-of interventions tool, with evidence quality evaluated using the grading of recommendations, assessment, development and evaluation approach. Outcomes included surgical, medical, and any complications, readmission, reoperation, and mortality. Subgroup analyses were conducted by subject of study, database source, and study sample size.

Results: Twenty-nine studies encompassing 302,641 patients were included. Frailty was significantly associated with increased odds of complications, readmission, reoperation, and mortality. Subgroup analyses by procedure type, database, and sample size consistently confirmed elevated risk across all outcomes, with varying degrees of statistical significance.

Conclusions: Frailty, as measured by the mFI-5, is associated with an increased risk of postoperative complications, hospital readmission, reoperation, and mortality in plastic and reconstructive surgery patients. These findings support the integration of the index in clinical practice and preoperative patient evaluation and decision-making.

Pyogenic granuloma (PG) is an acquired benign vascular lesion commonly affecting the skin and mucous membranes across all age groups. It is often triggered by minor trauma or chronic irritation, with the head and neck region being the most frequently involved (36%). Although PG can resolve spontaneously, surgical intervention is often warranted due to cosmetic concerns, bleeding, or pain. Auricular PG is rare, accounting for approximately 1% of cases, and has been linked to ear piercings. We present the first reported case of auricular PG associated with the use of a nonpiercing ear cuff. Given that ear cuffs are generally considered safe accessories, this case underscores the importance of recognizing such devices as potential triggers. It also highlights the utility of scanning electron microscopy and energy-dispersive x-ray spectroscopy in identifying embedded metals that may contribute to chronic inflammation.

Background: Marjolin ulcers (MUs) are rare, aggressive cutaneous malignancies that arise from previously injured or chronically inflamed skin. MUs have a poorer prognosis than other types of skin malignancies, with higher nodal metastases and recurrence rates. Although surgical resection remains the primary treatment modality, the management and outcomes of patients with metastatic disease are not well characterized. We reviewed literature on treatment strategies for metastatic MUs and report our institutional experience so as to stimulate interest in this difficult-to-treat entity.

Methods: A systematic review on metastatic MUs following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the English-language literature. An institutional case series is reported to capture the experience of a rural African hospital.

Results: Of 180 publications reviewed, 9 studies with 129 patients, with a mean age of 50.3 years, were included in the study. Burn scars were the most common precursor (54%), with squamous cell carcinoma accounting for 97% of cases. Metastases involved the regional lymph nodes, lungs, and liver. Initial treatment included wide local excision or amputation, with or without adjuvant radiotherapy. Survival data were sparse. Our institutional cohort of 11 patients showed similar patterns of metastases.

Conclusions: This review did not identify any effective treatment for metastatic MUs. The current management strategies are largely determined by institutional resource settings, but remain essentially palliative in their approach, highlighting the need for a standardized approach to achieve optimal patient outcomes.

The tibia is the larger and stronger of the 2 bones in the lower leg, acting as the major weight-bearing and load-transferring bone between the knee and the ankle. Its subcutaneous location makes it particularly prone to trauma. When such injuries fail to heal, become infected, or remain exposed, large segmental bone loss can occur, creating significant reconstructive challenges to restore function. We present the case of a 10-year-old boy who sustained a trivial stick injury to his left leg that became infected, resulting in extensive tibial necrosis and exposure. Initial attempts at debridement, cortical drilling, a cross-leg flap, and split-thickness skin grafting at a peripheral hospital were unsuccessful. After referral to our center, thorough debridement of the sequestrum was performed, followed by wound care with Dakin solution for 3 weeks; cultures showed no growth. Reconstruction was achieved by tibializing the ipsilateral fibula with an overlying skin paddle. The fibula stabilized with a biplanar inverted delta frame external fixator, along with additional pins on the overlapping segments. The fixator was removed 6 months postoperatively after radiological confirmation of bony union. At 14 months, the patient can walk short distances unaided and uses crutches for longer distances. He remains in physical therapy for residual stiffness of the knee and ankle joints and to optimize functional recovery. Ipsilateral fibular tibialization remains a dependable limb-salvage option for large tibial defects in children, especially where microsurgical alternatives are limited.