Plastic and Reconstructive Surgery Global Open最新文献

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.

Segmental peripheral nerve injuries, particularly those involving long nerve gaps, pose a significant challenge in reconstructive surgery. Conventional strategies, such as nerve autografts or processed allografts, are often limited by inadequate length or poor regenerative outcomes, especially in traumatized wound beds. Nerve flaps offer the theoretical advantage of enhanced axonal regeneration through improved perfusion and support of Schwann cell viability but are rarely used due to technical complexity and limited donor options. We present a unique case of a free sural nerve flap used to reconstruct a 7-cm segmental defect of the tibial nerve following blast trauma in a 23-year-old man. A composite flap consisting of the sural nerve and lesser saphenous vein was harvested with preservation of the bridging adipofascial tissue to maintain perfusion to the nerve. The lesser saphenous vein was anastomosed to the retrograde peroneal artery distally and ligated proximally, whereas the sural nerve was divided and used as a double-barrel cable graft across the defect. Intraoperative Doppler and SPY angiography confirmed perfusion of the nerve through the preserved adipofascial connections. The patient was recently seen in our clinic at 17 weeks postoperation. He demonstrated undetectable 2-point discrimination in all nerve distributions of his foot but is ambulatory. This case demonstrates the feasibility and potential utility of a free vascularized sural nerve flap for reconstructing extensive peripheral nerve defects, particularly in cases where standard techniques are inadequate.

Background: Postoperative pain and gait disturbance after iliac bone grafting for alveolar clefts significantly impact patients' quality of life. This study investigated the effect of methylene blue on postoperative analgesia and conducted a meta-analysis of its impact on analgesia across various anatomical sites.

Methods: A randomized controlled trial and meta-analysis included 58 patients undergoing autologous iliac bone grafting. Patients were randomized into 2 groups: one receiving a methylene blue-ropivacaine combination and the other receiving ropivacaine alone. Pain scores and gait disturbance duration were measured at 12 hours and at 1, 3, 5, 7, and 14 days postoperatively. A meta-analysis combined results from 6 other studies.

Results: The experimental group showed significantly lower pain scores at 12 hours and at 1, 3, and 5 days. Postoperative gait disturbance duration was also significantly reduced. Meta-analysis confirmed that methylene blue significantly reduced pain at 1 day, 3 days, 1 week, 3 months, and 6 months postoperatively, but not at 1 month.

Conclusions: Methylene blue is a safe and effective approach for postoperative analgesia following iliac bone harvesting, significantly reducing pain and gait disturbance duration without serious side effects.

The pure skin perforator (PSP) flap is a recognized option for hand reconstruction because of its thinness and pliability. Conventional planning involves high-frequency color Doppler ultrasonography to locate perforators, followed by subdermal elevation and distal-to-proximal pedicle dissection. However, access to high-frequency ultrasound remains limited in certain institutions, even in cases requiring extensive PSP flaps. This report presented a technical adaptation for such circumstances. We report on a 70-year-old man with a 12.5 × 10 cm soft-tissue defect from the palmar index metacarpophalangeal joint to the ulnar dorsal hand after traumatic infection, debridement, and index finger amputation. Without high-frequency ultrasound, we designed a 15 × 10 cm PSP flap centered on the superficial branch of the right superficial circumflex iliac artery (SCIA). Intraoperatively, perfusion originated from perforators of the SCIA deep branch rather than the superficial branch. To accommodate this, the proper palmar digital artery (PPDA) of the small finger was divided, and end-to-end anastomoses were performed: proximal PPDA to SCIA deep branch and distal PPDA to SCIA superficial branch. No complications or contractures were observed at the 6-month follow-up. This case demonstrates a practical intraoperative strategy for large dorsal hand reconstruction with SCIA-based PSP flaps when high-resolution imaging is unavailable. Our experience suggests that anatomical variability of SCIA perforators can be managed intraoperatively, and flap design adapted to resource-limited settings warrants further study.

[This corrects the article DOI: 10.1097/GOX.0000000000007415.].

Facial aging in Asian patients involves a flatter skeletal structure, reduced ligamentous anchoring, and soft-tissue laxity. This structured injection strategy, herein referred to as the L-V approach (lifting and V-shaped contouring), uses 3 hyaluronic acid fillers with distinct rheological properties. It combines deep supraperiosteal injections for foundational support, targeted ligament and fascia injections for facial lifting, and superficial volumization to smooth grooves and wrinkles. This layered, biomechanically informed approach restores facial projection, enhances contour definition, and maintains natural dynamics-offering a safe and effective rejuvenation technique tailored to Asian facial morphology.

Background: This prospective, randomized, controlled, open-label, multicenter clinical trial evaluated the efficacy and safety of air-based cold atmospheric plasma jet (CAPJ) therapy for chronic venous leg ulcers (VLUs) compared with standard of care (SOC).

Methods: Sixty adult patients with nonhealing VLUs were randomized to receive either CAPJ therapy twice weekly for 10 weeks or SOC. The primary outcome was the percentage reduction in wound area at weeks 4, 9, and 17. Secondary outcomes included granulation tissue formation, microbial burden (qualitative and quantitative), pain (visual analog scale), aesthetic satisfaction, and adverse events. Analyses were performed on an intention-to-treat basis.

Results: Both groups demonstrated progressive reductions in wound area over time. Although the CAPJ group exhibited a greater mean reduction (-72.9% versus -56.7% at week 17), the difference was not statistically significant (P = 0.30). Complete healing was achieved in 42.9% of CAPJ patients compared with 30.4% in the SOC group (P = 0.361). CAPJ produced significant immediate decreases in microbial burden at weeks 0 and 4 (P < 0.05). Pain scores improved similarly in both groups, and aesthetic satisfaction was high without significant intergroup differences. No serious adverse events were attributed to the device; transient pain-related sensations were the most frequent treatment-related effects.

Conclusions: Although not statistically superior to SOC, air CAPJ therapy resulted in clinically meaningful wound area reduction, rapid antimicrobial effects, and high patient acceptability without increased adverse events. These findings support further investigation of CAPJ as a safe, noninvasive therapy for chronic VLU management.

Background: Lymphaticovenous anastomosis (LVA) is a crucial surgical method for treating lymphedema by reconstructing lymphatic pathways. The success and efficacy of LVA rely on accurate preoperative localization of functional lymphatic vessels. This study investigated the use of percutaneous lymphatic contrast-enhanced ultrasound (PL-CEUS) to identify and localize these vessels in patients with the International Society of Lymphology stages 2-3 before LVA.

Methods: This retrospective cohort study included 234 patients with 256 limbs affected by International Society of Lymphology stage 2-3 lymphedema. Preoperatively, a contrast agent was injected intradermally, and functional lymphatic vessels were dynamically visualized and localized by ultrasound. Using surgical findings as the gold standard, the localization accuracy of PL-CEUS was calculated. The diameter and depth of the lymphatic vessels from the body surface were analyzed. Short-term postoperative efficacy was evaluated by comparing changes in limb circumference within 1 week postoperatively.

Results: PL-CEUS visualized lymphatic vessels in 218 of 256 limbs (85.2%), identifying 468 vessels. The mean inner diameters were 0.52 ± 0.26 mm (stage 2) and 0.59 ± 0.35 mm (stage 3), with mean depths of 8.61 ± 3.40 and 11.03 ± 4.38 mm, respectively. Surgical verification showed localization accuracies of 96.04% (stage 2) and 93.64% (stage 3). Postoperative limb circumference measurements within 1 week revealed a significant reduction, with a mean reduction rate of 3.73% ± 3.55%.

Conclusions: PL-CEUS accurately localizes superficial functional lymphatic vessels and may serve as an alternative or complementary method to indocyanine green lymphography for preoperative lymphatic mapping in LVA.