Plastic and Reconstructive Surgery Global Open最新文献

Background: Breast prosthesis infections are challenging and traditionally managed with prosthesis removal and delayed reconstruction. Single-application negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown promise for salvaging infected implants, though prior studies have been small and heterogeneous. This study analyzes outcomes and compares protocols from four institutions.

Methods: Data were collected on 56 patients (59 breasts) who underwent NPWTi-d salvage for peri-prosthetic infections. Patients with fewer than 3 months of follow-up were excluded. Salvage protocols included explantation, NPWTi-d application, antibiotics, and replantation. Successful salvage was defined as prosthesis retention without further explantation for at least 90 days posttreatment.

Results: Intervention occurred on average 66 days after the index procedure. Methicillin-resistant organisms were cultured in 15% of cases. NPWTi-d was applied for an average of 61 hours with dwell times of 18 minutes every 3 hours, using institution-specific instillates. All patients were discharged with new prostheses (65% expanders, 35% implants) after an average hospital stay of 4 days. At 90-day follow-up, 71% of patients had no further complications, and 85% were successfully salvaged.

Conclusions: This is the largest study to evaluate NPWTi-d for salvaging infected breast prostheses. The high success rate highlights the method's efficacy, safety, and potential for preserving reconstruction. These straightforward protocols can significantly improve patient outcomes and reduce healthcare costs, offering a valuable option for managing prosthesis infections.

Background: Exposure of internal mammary vessels in autologous breast reconstruction often requires removal of a rib cartilage segment, which can lead to breast contour deformity. This study evaluated the use of diced cartilage (DC) to counteract substance loss in the microvascular anastomosis area.

Methods: This retrospective, single-center cohort study included all breast reconstructions in which DC was used from October 2021 to June 2023. Reconstructions using DC were subdivided based on previous breast radiotherapy (DC versus DC with prior breast radiotherapy [DCR]). The control group consisted of an equal number of consecutive reconstructions performed before the use of DC. The effect of DC on breast contour was investigated using magnetic resonance imaging (>6 months postoperative) and photographic documentation (6-month follow-up).

Results: DC was used in 114 of 173 included reconstructions (DC, n = 55; DCR, n = 59; control, n = 59). Magnetic resonance imaging analysis revealed less soft tissue sinking into resection zones in both DC groups (DC 0.2 ± 1.3 mm versus control 6.0 ± 1.6 mm, P = 0.002; DCR 0.4 ± 1.6 mm versus control 6.0 ± 1.6 mm, P < 0.003). Previous irradiation did not affect DC stability. The photographs indicated that there were no deformities after DC use, but deformities occurred in 13.6% of patients in the control group (P < 0.05). Flap failure did not occur in any group.

Conclusions: DC is a safe procedure that prevents contour deformities associated with rib cartilage removal in breast reconstruction, regardless of prior breast irradiation.

Injection cosmetic procedures have shown rapid continuing growth in the last 2 decades. Various substances are injected into the periorbital region for skin quality increase and correction of tear trough deformity, including hyaluronic acid, peptides, collagen, and others. Sometimes patients get accidentally injected with different substances that are not approved for cosmetic treatment in this anatomic area. The author presents a case of a 51-year-old woman, injected with unknown oil solution into the lower eyelid skin by the local dermatologist. Inflammation and induration of the skin of the lower periorbital region have occurred after these injections. The patient was treated conservatively until the acute process stopped, and then surgical correction was performed to correct skin and orbicularis oculi muscle induration changes. Surgical treatment included direct oil cyst excision and removal after injection changed tissues between skin and orbicularis oculi muscle. The patient was observed for scheduled appointments and conservative treatment to prevent unfavorable scar formation and lower eyelid deformity. Although different kinds of oil substances are not approved for skin injections for cosmetic purposes, accidental injections occur and may lead to terrible results. Methods to correct eyelid deformity after oil solution injections are not presented in the literature. In this article, the author presents a case report with the method of correction of induration of soft tissues of the lower eyelids occurring after oil injections. Although cases like this are rare, they require correct surgical solution to provide a good aesthetic result after the treatment.

Background: Vertebral body defects pose a significant challenge in spinal reconstructive surgery. Compression fractures of the vertebral corpus are typically treated with vertebral augmentation procedures. There are significant risks associated with the introduction of foreign material in the spine, including infection and pseudarthrosis. Vascularized bone grafts (VBGs) have become a popular alternative for spinal reconstruction in the last decade thanks to their robust blood supply and autologous nature. VBGs have been described predominantly for the reconstruction of posterior vertebral defects. The objective of this study is to describe a novel procedure for the reconstruction of vertebral corpus defects in the lumbar and distal thoracic spine.

Methods: This is a cadaveric anatomy study. The authors performed the novel surgical technique on an anonymized cadaveric donor in the prone position and recorded the procedure through clinical photography. Consent for the procedure and photography was obtained from the Center for Procedural Innovation.

Results: A 5-cm-long posterior iliac crest VBG (IC-VBG) was successfully harvested on a pedicle of the quadratus lumborum muscle. The VBG was rotated and mobilized anteromedially to the vertebral corpus. In this donor, the IC-VBG could be inset with minimal tension anywhere along the vertebral bodies of the spine from the L5 to the T9 level.

Conclusions: A rotated, anteromedially mobilized IC-VBG represents a novel technique for reconstruction of the anterior vertebral corpus of the lumbar and distal thoracic spine with a lower risk of infection and pseudarthrosis than reconstruction with foreign materials.

The demand for aesthetic surgery continues to increase, and it is therefore essential to ensure that the next generation of plastic surgeons are adequately trained. We propose a safe method in aesthetic training in abdominoplasty and facelift, utilizing free deep inferior epigastric perforator (DIEP) flap and parotidectomy for training aesthetic procedures. The trainees' focus differed between the 2 procedures. In the DIEP cases, the trainees' focus was the preoperative marking of the abdomen; elevation of the abdominoplasty flap; rectus plication; and quilting of the abdominoplasty flap to the rectus sheath and umbiloplasty. In the parotidectomy cases, the focus was skin flap elevation using the classic face lift incision; superficial musculoaponeurotic system flap elevation; superficial musculoaponeurotic system; and skin redraping. A questionnaire was given to all involved trainees for evaluation after the training exercises in aesthetic surgery, this included how they felt about performing aesthetic procedures afterwards, their level of knowledge, and their confidence in performing abdominoplasty and rhytidectomy. The results of the trainee questionnaires were positive; competence and level of confidence were high. There were minor complications including wound healing problems but no revisions. This training procedure can be safely applied during plastic surgery training under safe conditions.

Background: Obesity is widely recognized as a significant risk factor for postoperative complications of breast reconstruction. Despite extensive research, there remains a lack of consensus regarding the specific complications and outcomes experienced by patients with obesity who undergo deep inferior epigastric perforator (DIEP) flap reconstruction. To provide a clearer understanding of the challenges faced by patients with obesity, we present a single-center outcome analysis of individuals who underwent DIEP flap reconstruction.

Methods: A cohort of 194 patients who underwent at least 1 DIEP flap was retrospectively analyzed at the University of Nebraska Medical Center utilizing electronic medical records. Patients who underwent DIEP flap breast reconstruction were organized into 5 categories using World Health Organization weight status by body mass index (BMI) obtained from the day of surgery. Surgical complications within 120 days and postsurgical complication-related procedural interventions were also evaluated and compared. Comparisons of variables of interest between weight groups were assessed using Mantel-Haenszel chi-square tests or Spearman correlations.

Results: Increases in patient weight category were associated with increased length of operation (P = 0.003), increased rates of breast fat necrosis (P = 0.04), breast wound dehiscence (P = 0.01), abdominal wound dehiscence (P = 0.02), numbers of abdominal complications (P = 0.001), and rates of requiring an intervention (P = 0.03).

Conclusions: The findings imply that higher BMI values may lead to a higher likelihood of postoperative complications and the need for intervention. It is crucial for patients with obesity to be aware of the elevated risk associated with rising BMI values.

Artificial intelligence (AI) scribe applications in the healthcare community are in the early adoption phase and offer unprecedented efficiency for medical documentation. They typically use an application programming interface with a large language model (LLM), for example, generative pretrained transformer 4. They use automatic speech recognition on the physician-patient interaction, generating a full medical note for the encounter, together with a draft follow-up e-mail for the patient and, often, recommendations, all within seconds or minutes. This provides physicians with increased cognitive freedom during medical encounters due to less time needed interfacing with electronic medical records. However, careful proofreading of the AI-generated language by the physician signing the note is essential. Insidious and potentially significant errors of omission, fabrication, or substitution may occur. The neural network algorithms of LLMs have unpredictable sensitivity to user input and inherent variability in their output. LLMs are unconstrained by established medical knowledge or rules. As they gain increasing levels of access to large corpora of medical records, the explosion of discovered knowledge comes with large potential risks, including to patient privacy, and potential bias in algorithms. Medical AI developers should use robust regulatory oversights, adhere to ethical guidelines, correct bias in algorithms, and improve detection and correction of deviations from the intended output.

Facial thread lifts, known for being minimally invasive with quick results, can sometimes lead to dimpling. A case report of a 35-year-old Asian man who developed a pleasing unilateral dimple after a thread lift highlights the potential for intentional dimple creation through this method. With surgical dimple creation in demand, as dimples symbolize good luck in Chinese culture and beauty in Arabic traditions, thread lifts may offer a less invasive alternative for those seeking dimples without surgery. The patient in the case report was satisfied and chose not to reduce the dimple, though further studies are needed to ensure safety and improve patient satisfaction.

Background: Explantation often alleviates symptoms in women with breast implant illness. However, persistent complaints in some cases may be linked to persistent silicone-induced inflammation from residual silicone particles. Positron emission tomography (PET) imaging could potentially detect this inflammation. This case series describes the PET findings in women with ongoing symptoms after explantation.

Methods: A retrospective review was performed of cases from the silicone outpatient clinic at the Amsterdam University Medical Centers, the Netherlands. All women underwent PET imaging due to persistent systemic symptoms after explantation (n = 17) or replacement (n = 1).

Results: Before PET imaging, silicone deposits were demonstrated in all 18 cases using ultrasound or magnetic resonance imaging. PET imaging revealed varying fluorodeoxyglucose avidity in axillary, parasternal, mediastinal, cervical, or supraclavicular lymph nodes and extranodal sites in all patients, up to 11 years after explantation. The median implantation time was 17 years, the average number of implant sets was 2, and the median time from explantation to PET was 2 years. In cases where biopsy was performed, silicone lymphadenitis with characteristic foreign body reaction was confirmed. The PET findings suggest that silicone residues can provoke inflammation even years after explantation. However, not all women with silicone residues may exhibit fluorodeoxyglucose-positive PET scans, indicating variability in susceptibility to silicone-induced inflammation.

Conclusions: PET imaging may be a useful diagnostic tool for detecting silicone-induced inflammation in patients with persistent complaints after explantation. However, given inherent limitations, further research is warranted to fully assess its potential diagnostic utility in breast implant illness.