Plastic and Reconstructive Surgery Global Open最新文献

This single-case histological study evaluated the safety and tissue effects of dual-depth injections of poly-L-lactic acid (PLLA) and hyaluronic acid (HA)-based skin booster administered into the same anatomical region. A 77-year-old woman received PLLA in the subcutaneous fat layer and HA in the deep dermis/subdermal layer of the right jowl. The untreated left side served as a control. Histological analysis revealed that PLLA induced a localized foreign-body reaction with increased fibroblast activity, dense collagen, and elastic fiber formation in the subcutaneous layer, indicative of extracellular matrix remodeling. HA-treated dermal layers showed mild matrix compaction and low-grade inflammation, consistent with the hydration effects. There was no histological evidence of filler overlap or adverse interaction. Three-dimensional imaging further supported volumetric enhancement and tissue elevation on the treated side. The results demonstrate that when spatially separated by depth, PLLA and HA can exert independent, synergistic effects without compromising safety. This dual-layer approach may offer a novel strategy for targeted skin rejuvenation in clinical practice. In this single-patient case, layer-separated PLLA and HA elicited independent, compartment-specific tissue responses without observed interaction. Findings are descriptive and anecdotal and should not be generalized without larger, controlled studies incorporating quantitative volumetry and histomorphometry.

The thumb is important for hand function; therefore, functional reconstruction after amputation is necessary. Traditional methods, such as wrap-around flap (WAF) and twisted WAF, often involve extensive tissue harvest from the toes. This report introduced a novel approach using a WAF augmented with a superficial palmar branch of the radial artery (SPBRA) flap, which enabled effective reconstruction with reduced donor-site morbidity. A 31-year-old man sustained a traumatic thumb amputation during a cattle-handling accident. Emergency replantation was unfeasible due to severe vascular avulsion. Preoperative computed tomography angiography identified a proximally branching SPBRA, enabling reconstruction using the SPBRA flap-augmented WAF technique. This method allowed effective thumb reconstruction while reducing donor-site complications. The SPBRA flap was harvested 4.9 cm proximal to the radial styloid, enabling primary donor-site closure without additional toe tissue harvest. Although not suitable for all cases, this approach optimizes functional and aesthetic outcomes, offering a less invasive alternative for thumb reconstruction.

Up to 16.6% of facial lacerations involve the eyebrows, and regional scarring often results in hair loss known as cicatricial alopecia (CA). Secondary CA following eyebrow lacerations is often irreversible, resulting in poor aesthetic outcomes and psychological distress. The current gold standard for treating CA is hair transplantation, but this is a painful and invasive procedure. We present 2 cases of patients who experienced eyebrow lacerations, 1 with chronic secondary CA and the other in the setting of acute facial trauma without eyebrow CA. Serial daily topical application of stem cell serum (Calecim) was commenced for both patients. Following 6 months of treatment, the patient with chronic secondary CA experienced regrowth of eyebrow hair, whereas the patient treated earlier retained their eyebrow hair and did not develop secondary CA. We propose stem cell serum as an effective, noninvasive treatment option for patients with chronic secondary CA to aid in hair regrowth. Furthermore, stem cell serum could be considered as an early treatment in acute eyebrow trauma for the prevention of CA development and hair retention.

Background: Cleft lip and/or palate (CL±P) is among the most common congenital craniofacial anomalies, with affected children at high risk of malnutrition due to feeding difficulties. This study aimed to determine the prevalence and factors associated with preoperative malnutrition among patients with nonsyndromic CL±P in Rwanda.

Methods: A multicenter cross-sectional study was conducted over a 1 year period among children younger than 5 years undergoing primary cleft repair. Nutritional status was assessed using the World Health Organization growth standards. Malnutrition was defined as stunting (height-for-age z score ≤ -2) or wasting (weight-for-length z score ≤ -2). The data were analyzed using descriptive statistics, bivariate analysis, and logistic regression.

Results: Of 116 infants, the median age was 6.5 months (interquartile range: 3-10 mo), and 64% were male. The overall prevalence of malnutrition was 47% (95% confidence interval: 38-56). Stunting was observed in 41% (19% moderate, 22% severe) and wasting in 9% of the patients. Malnutrition was significantly associated with older infant age (P = 0.0099), lack of postnatal nutrition education (P = 0.0232), nonbreastfeeding at the time of surgery (P = 0.0088), early introduction of complementary feeding (P = 0.0034), cow's milk consumption (P < 0.001), and having both cleft lip and palate (P = 0.0101). On multivariate analysis, the consumption of cow's milk (P = 0.001) and cleft type (palate or lip and palate) (P = 0.028) remained significant factors.

Conclusions: Nearly half of the cleft patients operated on were malnourished preoperatively. Strengthening preoperative nutritional support is essential to reduce this burden.

Advanced primary lymphedema is challenging to treat and imposes physical and psychosociological burdens on patients. Currently, vascularized lymph node transfer and modified Charles procedures are recommended for late-stage patients due to the limited functional superficial lymphatics required for conventional lymphovenous bypass. However, the reconstruction involves radical resection of tissue and changes in lymphatic flow, resulting in prolonged recovery time, high complication rates, and emotional and economic burdens on the patients. The authors proposed a novel alternative for treating stage II primary lymphedema using a duo-plane lymphovenous bypass. The innovation involves anastomosing the collecting lymphatics in the deeper subcutaneous tissue to superficial venules. The technique benefits from accessing functional lymphatics with preserved architecture, a larger vessel diameter, and a well-defined anatomical location to optimize drainage and prevent venous backflow using the Venturi effect. The duo-plane lymphovenous bypass procedure warrants significant volume reduction, faster recovery, and minimal scarring, thus providing a less-invasive treatment option for patients with advanced primary lymphedema.

Toxic shock syndrome (TSS) is a severe postoperative infection characterized by rapidly progressing systemic symptoms, although local findings are typically unremarkable. Therefore, understanding its pathogenesis and ensuring early diagnosis are critical. To date, only 5 cases of TSS caused by methicillin-resistant Staphylococcus aureus have been reported in the context of breast reconstruction. We report a case of total mastectomy for breast cancer where a tissue expander was used. On postoperative day 12, the patient had hypotension, high fever, decreased consciousness, renal dysfunction, and gastrointestinal symptoms, indicating significant systemic deterioration. However, local findings at the surgical site were minimal, demonstrating a marked discrepancy between systemic manifestations and local signs. The patient was diagnosed with methicillin-resistant S. aureus-induced TSS, and the primary treatment strategy involved the complete removal of the capsule and the administration of intravenous antibiotics.

Background: Subcutaneous lasers represent a paradigmatic change in aesthetic procedures and have increased the demand for effective and minimally invasive treatments for fat compaction and skin sagging, revolutionizing face and body contouring techniques. Selective photothermolysis induced by the 1210-nm lasers can modulate fat without inducing damage to the surrounding tissues.

Methods: This pilot study evaluated a minimally invasive technique using a subcutaneous 1210-nm laser for face and body contouring using a 3-dimensional imaging technique.

Results: This study evaluated 5 facial and 10 abdominal body contouring cases using the minimally invasive lipolifting technique in a single session. Patients, predominantly woman (80%) with a mean age of 36 years, were assessed before procedure and at least 90 days after procedure. Facial treatments demonstrated average volume reductions of 2.06 mm³ in the cheek, 3.02 mm³ in the jowl, and 1.42 mm³ in the jawline regions. Among body contouring patients, most were classified as overweight and exhibited an average waist circumference reduction of 3.81 cm (SD = 1.86 cm). All patients rated their aesthetic outcomes as "very much improved" on the Global Aesthetic Improvement Scale throughout the follow-up period.

Conclusions: The 1210-nm laser technique proved to be safe and effective in enhancing facial and body contours through adipose tissue compaction. Additionally, it reduced skin laxity by inducing a regenerative response, promoting the differentiation of adipose-derived mesenchymal cells into fibroblasts, and stimulating collagen production.

Background: Surgery is the most energy-intensive healthcare practice contributing to climate change. Nail bed injuries are among the most frequently encountered types of hand injuries seen in emergency rooms; however, their environmental impact has yet to be elucidated. This study assessed the carbon footprint associated with nail bed injury treatment and proposed alternatives, where feasible, to mitigate its impact.

Methods: This retrospective study analyzed patients undergoing NBI treatment from August 2022 to August 2023 at the Royal Free Hospital. The carbon footprint was calculated perioperatively using process mapping. Emissions were quantified based on patient travel, imaging, energy consumption, consumables used, waste disposal, and product transportation. A survey was shared with members of the hand trauma clinic to identify the items used during the procedure.

Results: Out of 1569 patients, 449 met the inclusion criteria. Overall pathway emissions were equal to 1333.22 kg carbon dioxide equivalents (CO₂e) annually, or 2.97 kg CO₂e per patient. The preoperative phase contributed the most to emissions (52.7%), primarily from x-ray procedures and patient travel. Hazardous infectious waste accounted for most intraoperative emissions. Survey results revealed that several items in disposable surgical packs were routinely unused, suggesting potential for waste reduction. Minimizing the products included in the surgical packages could save approximately 13.44 kg CO₂e across included patients or 46.95 kg CO₂e annually.

Conclusions: By promoting same-day imaging, optimizing surgical packs, and enhancing surgeon education on sustainability, healthcare institutions can reduce carbon emissions, aligning with the National Health Service's net-zero goals. Small, targeted changes in common procedures can achieve significant environmental and economic benefits.

Background: The surgical removal of permanent facial fillers is often complicated by chronic inflammation, tissue distortion, and the risk of facial nerve injury. This pilot case series highlighted the use of intraoperative nerve monitoring (IONM) to enhance the safety and precision of filler removal procedures.

Methods: This single-center pilot case series included patients who underwent permanent facial filler removal using IONM to localize and protect the facial nerve branches.

Results: Four female patients (mean age 53 y; range: 48-56 y) underwent surgical removal of permanent facial fillers, with concurrent face lifting and intraoperative facial nerve monitoring. Indications included recurrent infection in 2 (50.0%) patients, chronic inflammation in 1 (25.0%) patient, and facial asymmetry in 1 (25.0%) patient. No patients had preoperative facial nerve deficits. The mean operative time was 4.5 hours, and filler removal was successful in all cases. Facial nerve function was preserved in all patients without any transient or permanent dysfunction. Two patients (50.0%) received adjunctive fat grafting (mean volume 20 mL; range: 16-25 mL). Minor complications occurred in 2 (50.0%) patients and resolved spontaneously in both. All patients (100%) reported improved facial contour and resolution of symptoms. Follow-up ranged from 5 to 12 months, with no recurrence of nodules, inflammation, or occurrence of any nerve dysfunction.

Conclusions: This pilot case series showed that surgical removal of permanent facial fillers with IONM proved safe and effective, yielding full nerve preservation, high patient satisfaction, and no major complications. However, this approach needs further study to prove its efficacy, safety, and cost-effectiveness.

Background: Repair of the alveolar cleft is essential for both functional and aesthetic reasons, particularly in syndromic individuals with inherited deformities. The aim of this work was to compare the outcomes of nanocrystalline hydroxyapatite and autogenous bone grafts in alveolar cleft grafting.

Methods: A total of 36 patients with alveolar clefts were enrolled in the study. The patients were randomly divided into 2 groups: group A, in which an autogenous iliac bone graft was used to fill the alveolar defect, and group B, in which nanocrystalline hydroxyapatite was used to fill the alveolar defect. All patients were evaluated with cone beam computed tomography at 6 months postoperatively.

Results: The main findings of the present study were that there were no significant differences in the baseline or perioperative data between the 2 groups. Group A had a significantly longer duration of surgery (100 ± 21.21 versus 61.38 ± 26.05 min; P = 0.02). Both groups had comparable postoperative success scores.

Conclusions: Nanocrystalline hydroxyapatite, an alloplastic substitute, is a good graft material for alveolar cleft repair, reducing the risk of donor site morbidity, causing less pain, and resulting in shorter operative time and hospital stay.