Plastic and Reconstructive Surgery Global Open最新文献

Abdominal wall reconstruction in women of childbearing age represents a complex and rarely reported clinical challenge. Various reconstructive techniques, including mesh repair and autologous tissue flaps, have been described, but no consensus has been established regarding optimal management. We present the fifth documented case of successful pregnancy and delivery following autologous abdominal wall reconstruction. A 35-year-old woman with a desmoid tumor underwent surgical removal, resulting in an 11 × 13 cm abdominal wall defect. Reconstruction was performed using a pedicled fascia lata flap based on perforators from the lateral circumflex femoral artery. The patient was advised to defer pregnancy for 1 year postoperatively. Twenty-eight months after reconstruction, she underwent cesarean delivery through a vertical incision to avoid the reconstructed area. No complications, such as abdominal wall hernia or bulging, were observed during the perinatal period or at 3 years and 2 months postoperatively. This case demonstrated that large abdominal wall defects can be safely reconstructed with vascularized tissue, yielding favorable perinatal outcomes during subsequent pregnancy. Our experience underscores the potential of vascularized fascial flaps as a durable and physiologically integrated option for abdominal wall reconstruction in women who desire future pregnancies. Further case accumulation is warranted to establish evidence-based guidelines for surgical and perinatal management.

Background: Hyaluronic acid (HA) filler injections have been associated with the rare but vision-threatening complication of retinal artery embolism. Clinical management of this condition remains challenging due to the lack of high-level evidence. Randomized controlled trials are neither ethically justifiable nor practically feasible, and current treatment recommendations are derived almost exclusively from individual case reports and small case series.

Methods: The aim of this article is to offer evidence-informed recommendations for the management of central retinal artery occlusion following HA filler injections. These recommendations are intended for both aesthetic practitioners and in-hospital specialists and are structured as stepwise treatment algorithms, based on published reviews and expert opinions as well as the clinical experience of the authors.

Results: Algorithms are provided and organized into 2 sequential tiers: outpatient management and in-hospital management.

Conclusions: These guidelines are not intended to be complete or exhaustive but may prove informative for aesthetic physicians and in-hospital specialists who are responsible for treating patients with HA filler-induced central retinal artery occlusion. They should be regarded as a basis for treatment and discussion by clinicians, providing clear guidance under conditions of uncertainty.

Background: Revision breast reconstruction is often necessary to address complications, reduce asymmetry, or improve the aesthetic result. Our previously described use of poly-4-hydroxybutyrate (P4HB) has shown promise in primary reconstruction; limited data exist on its use in revision surgery. This study presented a single-institution case series evaluating indications and outcomes of revision breast reconstruction using a P4HB-wrapped implant.

Methods: We retrospectively reviewed patients who underwent breast reconstruction revision with a P4HB-wrapped implant at our institution from September 2022 to May 2025. Data were collected through chart review.

Results: Thirty-four patients (51 breasts) underwent revision surgery using a P4HB-wrapped implant. Most patients (85%) had 2-stage reconstructions. Most primary reconstructions (76%) occurred at our institution, with 96% continuity among reconstructive surgeons. Median (interquartile range) time from initial reconstruction to revision was 344 (609) days. The most common indication was radiation-associated breast asymmetry (35%). At a median (interquartile range) follow-up of 501 (410) days, 91% (31 of 34) of patients maintained stable breast symmetry. Complications occurred in 5.9% (3 of 51) of breasts: 1 implant exposure requiring explantation (1.96%) and 2 cases of persistent malposition (3.92%) despite P4HB use.

Conclusions: The P4HB-wrapped implants achieved consistent soft-tissue support and maintained symmetry during the observed follow-up period, and for the limited number of patients studied, radiation-associated capsular contracture or shape changes were not observed during the study period. These findings support P4HB as a valuable adjunct in complex revisions, particularly in patients with prior radiation or significant asymmetry. Ongoing follow-up is needed to assess the long-term durability and aesthetic outcomes of this approach.

Background: Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) procedures can mitigate the incidence of neuroma; however, neuromas may still form. Interval soft tissue changes at the site of these nerve constructs may pose a diagnostic challenge. This review examined existing literature on ultrasound (US) and magnetic resonance imaging (MRI) characteristics of TMR and RPNI to aid in their identification.

Methods: A literature review was conducted using the PubMed, Embase, Cochrane, and Web of Science databases following the preferred reporting items for systematic reviews and meta-analyses 2020 protocol to examine studies describing imaging characteristics of TMR and RPNI in humans. Studies were screened by 2 authors. Studies that described imaging characteristics of TMR and RPNI were included.

Results: The review yielded 623 articles. Ten articles were identified for full-text review, and 4 met the inclusion criteria. One article described the US appearance of TMR. Two articles described the US characteristics of RPNI. One article described the appearance of RPNI on MRI. A total of 44 patients, 70 RPNIs, and 6 TMRs were included.

Conclusions: The characterization of TMR and RPNI on US and MRI is limited, particularly regarding upper extremity TMR and RPNI. TMR and RPNI demonstrate consistent core features on US and MRI. When monitoring patients for pain postamputation, plastic surgeons should be aware of the expected changes to the nerve and surrounding soft tissues after TMR and RPNI to aid in clinical judgment of new soft tissue lesions identified on imaging after amputation.

Background: Occipital neuralgia (ON) is a debilitating craniofacial pain disorder characterized by paroxysmal pain in the distribution of the greater, lesser, or third occipital nerves. Despite a growing array of interventions, clinical decision-making remains highly variable, with no standardized algorithm to guide diagnostic evaluation, procedural selection, or treatment escalation. Our objective was to synthesize the existing literature on ON management.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered with PROSPERO (International Prospective Register of Systematic Reviews). PubMed, Embase, and Scopus were searched from 2000 to 2025. Studies were assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews), SANRA (Scale for the Assessment of Narrative Review Articles), and AGREE II (Appraisal of Guidelines for Research and Evaluation) tools. A narrative synthesis was performed, and studies with decision frameworks were compared against our clinical approach.

Results: Fourteen studies met the inclusion criteria, including 7 systematic reviews and 7 narrative reviews or guidelines. Most included diagnostic nerve blocks, decompression, neurectomy, and peripheral nerve stimulation; however, only a minority proposed structured algorithms. Our proposed framework integrates botulinum toxin stratification, nerve block response, imaging, and intraoperative findings to guide decompression versus neurectomy. A secondary escalation pathway addresses early versus late surgical failure and neuromodulation treatments.

Conclusions: This review highlighted the need for unified, evidence-informed decision-making in ON. Our clinical approach offered a structured, patient-specific framework to guide diagnosis, treatment, and escalation, addressing key gaps in current practice.

Background: Nasolabial folds (NLFs) significantly impact facial aesthetics. A novel filler combining cross-linked sodium hyaluronate with poly-L-lactic acid-b-polyethylene glycol microspheres (PLLA-b-PEG/HA) has shown potential. This study evaluated the efficacy and safety of the PLLA-b-PEG/HA filler for NLF correction with an innovative ligament-targeted injection technique.

Methods: This retrospective study was reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Thirteen participants presenting with mild to severe bilateral NLFs (WSRS scores 2-4), were examined between December 2022 and February 2023. Treatment involved injections of PLLA-b-PEG/HA at the temporal, preauricular, zygomatic, and mandibular ligaments. Efficacy was assessed via the WSRS, Global Aesthetic Improvement Scale, FACE-Q satisfaction with cheeks scale, and participants' satisfaction during a 12-month follow-up period.

Results: At the 12 months, a statistically significant improvement was observed in the mean WSRS score, which decreased from 3.00 ± 0.71 to 1.85 ± 0.90 (P < 0.05), with a response rate of 84.62%. The improvement was sustained through the 12-month period. Significant enhancements were also noted in both the FACE-Q and Global Aesthetic Improvement Scale scores at each posttreatment follow-up visit, with participants reporting high levels of satisfaction. The PLLA-b-PEG/HA filler demonstrated an acceptable safety profile, with only 1 case of transient mild erythema and edema reported.

Conclusions: These preliminary findings suggest that the PLLA-b-PEG/HA filler, combined with a ligament-targeted injection technique, shows promising efficacy and a favorable safety profile for NLF correction over 12 months.

Background: A causal association between breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and macrotextured breast implants has been established. In response, global surveillance of implant-based breast reconstruction safety has intensified. We investigated the frequency of BIA-ALCL in patients receiving gel-filled breast implants and tissue expanders approved in Japan.

Methods: We reviewed adverse event reports submitted to the Pharmaceuticals and Medical Devices Agency between April 1, 2013, and March 31, 2024, and examined safety measures implemented by marketing authorization holders and the Ministry of Health, Labour and Welfare.

Results: A total of 736 adverse events were reported in patients with gel-filled breast implants, whereas 296 were reported in those with tissue expanders. Following the global recall of Allergan's Biocell products, adverse event reports rose markedly between FY2019 and FY2022. In Japan, 2 confirmed cases of BIA-ALCL were reported in FY2021 and FY2023, and 8 suspected cases were reported between FY2020 and FY2023. Allergan voluntarily recalled its Biocell products due to their risk of BIA-ALCL and issued a field safety notice with risk information and recommendations. The Ministry of Health, Labour and Welfare issued public notices referencing academic society guidelines and updated the package insert precautions for gel-filled breast implants.

Conclusions: Fewer BIA-ALCL cases have been reported in Japan than in the United States and Europe, likely due to early, coordinated safety measures.

Background: The inframammary fold (IMF) is a crucial anatomical structure that influences breast aesthetics after reconstruction. However, mastectomy often compromises the IMF, necessitating effective reconstruction techniques. Current approaches vary, and no consensus exists regarding the optimal method.

Methods: A scoping review was conducted using PubMed and Embase. Twenty-five eligible studies describing IMF reconstruction were included. Surgical techniques were categorized into open (direct and indirect access), closed, and other approaches. Data were analyzed for techniques, outcomes, and complications.

Results: Open approaches offered superior visualization and precise IMF anchoring but required larger incisions and carried higher complication risks. Direct access typically used de-epithelialized dermal flaps following the IMF incision, whereas indirect access relied on existing scars to anchor the capsular, superficial fascia, dermis, or combinations thereof. Closed techniques reduced invasiveness but limited visualization, complicating fixation. One study evaluated liposuction to enhance skin-fascia adherence, demonstrating its potential benefit. Suture methods varied widely, with some studies describing barbed sutures; however, skin-fascia adherence seemed more important than suture choice for durable IMF reconstruction. Recurrence of IMF displacement was common across all techniques.

Conclusions: No single IMF reconstruction technique has been established as superior. The predominance of implant-based reports and the absence of comparative or prospective studies limit definitive conclusions. Future prospective research should compare long-term outcomes across technique categories and investigate adjunctive strategies, such as liposuction, for enhancing IMF stability.

Plastic surgery residency applicants face a high-stakes, emotionally charged decision-how to rank the programs at which they have interviewed. Although programs evaluate applicants using structured interview processes, application metrics, and faculty consensus, applicants' program assessments are often subjective, inconsistent, and influenced by emotion, perceived (and sometimes misplaced) prestige, or recency bias. Despite the personal and professional consequences of an ill-informed rank list, there is no standardized framework to help applicants objectively compare programs. We propose the Residency Applicant Numeric Key (RANK) tool to standardize program evaluation for plastic surgery residency applicants. RANK uses a head-to-head scoring approach that prompts applicants to rate each program across 10 domains, including case volume, surgical autonomy, county and community hospital exposure, case diversity, program culture, global surgery, research, location, and other applicant-specific factors. Each domain is scored on a 1-5 scale. Domain scores are summed to generate an overall score, enabling direct numerical comparison and organized ranking across programs. The RANK tool provides a consistent structure to support objective, side-by-side evaluation while preserving room for individualized priorities through domain selection and weighting.