Plastic and Reconstructive Surgery Global Open最新文献

Background: Imaging studies have become indispensable tools in the perforator flap surgeon's armamentarium, significantly enhancing operative outcomes and reducing complications. We conducted the first bibliometric analysis on imaging studies for flap reconstruction to characterize any emerging trends and assess the methodological quality of the field.

Methods: The 100 most-cited articles in imaging studies for flap reconstruction were identified on Web of Science, across all available journals and years (1950-2024). Study details, including the citation count, main subject, outcome measures, imaging type, and evidence level, were extracted.

Results: The most-cited articles involved 21,619 patients and amassed a total of 9689 citations. Citations per article ranged from 41 to 302. The evidence base relied heavily on level 3 (n = 37) and level 4 (n = 34) studies, reflecting the prevalence of retrospective cohorts and case series. Only 1 study was a randomized trial achieving level 1 evidence. Validated patient-reported outcome measures were reported in only 1 study. Imaging outcomes were the most explored, followed by flap anatomy and comparisons of imaging modality, with cost-effectiveness being the least investigated. Imaging was most frequently used for preoperative flap planning (n = 62), with fewer studies using intraoperative (n = 27) and postoperative (n = 19) imaging for perfusion assessment and complication detection. Computed tomography angiography, Doppler ultrasound, and indocyanine green ICG angiography were the most frequently used imaging modalities.

Conclusions: The most influential studies lacked randomization and were conducted by single-center efforts. Promoting global collaboration and incorporating patient-reported outcome measures into high-quality research can advance a more patient-centered, holistic evaluation of reconstructive success.

Acral lentiginous melanoma (ALM) is a rare but aggressive subtype of melanoma that can be easily missed. It may also be underresected during the first surgical excision, mandating additional surgery. An 81-year-old man presented with a pigmented lesion on the dorsum of the hand. Initial dermatologic treatment with cryotherapy failed, prompting an excisional biopsy, which revealed malignant ALM with a Breslow depth of 2.2 mm, with positive peripheral margins for ALM in situ. The patient underwent a second wide local excision and axillary sentinel lymph node biopsy. The nodes were negative for tumor. However, invasive ALM was found at the margins of the resected specimen. This necessitated a third wide local excision, incorporating the previous graft and surrounding tissues. Final pathology after the third resection confirmed negative margins. This case highlighted the locally aggressive nature of ALM, its potential for multifocal subclinical spread, and the need for thorough pathological and surgical strategies. The concept of multifocal invasion and field effect warrants attention in surgical planning.

Background: This study aimed to present maxillary bone grafts as a favorable option for the reconstruction of traumatic orbital floor (TOF) defects.

Methods: The senior author's preferred surgical technique using a transconjunctival incision is described. Patients undergoing TOF repair using maxillary bone grafts versus titanium mesh were then assessed retrospectively, with a focus on the size of the TOF defect, operative time, and complications.

Results: A total of 389 patients presented with 426 TOF defects to a single surgeon between 2006 and 2021. Maxillary bone grafts were used to repair the orbital floor fracture in 304 patients (332 fractures), whereas the remaining 85 patients (94 fractures) were repaired using titanium mesh. There were no significant differences in age or sex. Orbital defect size was slightly higher in the titanium mesh group (bone graft group: mean 1.58 cm², range 0.29-2.91 cm²; titanium mesh group: mean 1.74 cm², range 0.38-2.98 cm²). There were fewer complications observed when using the autogenous bone graft substrate (10%) versus titanium mesh (18%). No major donor-site complications were documented in the bone graft group. Operative time was marginally higher in the bone graft group than in the titanium mesh group (35.9 versus 29.2 min).

Conclusions: This study serves as the largest clinical series to date examining indications, surgical technique, safety, and efficacy of maxillary bone grafts in TOF repairs. Maxillary bone grafts represent a viable option to be considered in the armamentarium of the craniofacial surgeon for the treatment of TOFs.

Background: BCCT.core software has been validated for breast-conserving therapy. This study examined the use of the BCCT.core software as an objective tool to evaluate aesthetic outcomes following bilateral nipple-sparing mastectomy and implant-based breast reconstruction.

Methods: A retrospective review of standardized anterior photographs from 123 patients who underwent bilateral nipple-sparing, implant-based breast reconstruction was performed. The BCCT.core software assigned an outcome class (excellent = 1, good = 2, fair = 3, and poor = 4). Seven symmetry and contour parameters were extracted: 4 linear measures (breast retraction assessment, lower breast contour, upward nipple retraction, and breast compliance evaluation), and 3 area-based measures (breast contour difference, breast area difference, and breast overlap difference).

Results: All 7 objective parameters demonstrated statistically significant differences across the 4 BCCT.core classes (analysis of variance, P < 0.001 for each). Linear parameters showed narrower confidence intervals and a lower coefficient of variation, suggesting superior discriminatory power and reproducibility.

Conclusions: The linear parameters (breast retraction assessment, lower breast contour, upward nipple retraction, and breast compliance evaluation) demonstrated consistent correlations with the BCCT.core aesthetic outcome classes and superior reproducibility compared with area-based indices. These findings validate the BCCT.core software for reconstruction and support its clinical use in standardizing the benchmarking of reconstructive results.

Targeted muscle reinnervation (TMR) represents a significant advancement in treating symptomatic stump neuromas. Unlike traditional passive procedures, TMR redirects axonal growth from sensory nerves to motor endplates, which may help prevent neuroma recurrence. This study detailed the surgical steps involved in applying TMR to the lumbrical muscles, supported by graphic, photographic, and video illustrations, aiming to ensure reproducibility.

Background: The pedicled transverse rectus abdominis myocutaneous (pTRAM) flap has long been a cornerstone in breast reconstruction. Despite the increasing adoption of muscle-sparing options such as the deep inferior epigasetric perforator flap, the pTRAM remains relevant, particularly in resource-limited settings or in patients unsuitable for microsurgery. This systematic review aimed to evaluate its current indications, outcomes, and clinical utility.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search of PubMed was conducted using the terms "pedicled TRAM flap" and "breast reconstruction," covering studies published from 2014 to 2024. A total of 43 articles, including original studies and case reports, met the inclusion criteria. Additionally, 2 clinical cases from our institution were presented to illustrate contemporary applications.

Results: The pTRAM flap offers several advantages: shorter operative times, independence from microvascular techniques, and versatility in complex reconstructive scenarios. It is especially suitable for patients with prior radiation therapy, vessel-depleted fields, or contraindications to free flap surgery. Although donor-site complications such as abdominal bulging and hernias remain concerns, outcomes have improved with mesh reinforcement and vascular delay techniques. Across included studies, aesthetic outcomes and patient satisfaction were high, and major complications were uncommon.

Conclusions: The pTRAM flap remains a reliable and accessible choice for breast reconstruction, particularly in patients or settings where microsurgery is not feasible. Although deep inferior epigasetric perforator flaps provide superior muscle preservation, the pTRAM combines speed, safety, and predictable results, maintaining a significant role in modern reconstructive practice. Mastery of this technique facilitates the transition to advanced microsurgical procedures.

Current experience with robotic-assisted axillary lymph node dissection (R-ALND) is limited. Axillary lymph node dissection is essential for patients with pathological N2-3 disease, but conventional open surgery carries a risk of injury to the intercostobrachial nerve, leading to sensory deficits, pain, and reduced quality of life. R-ALND may enhance precision through minimally invasive techniques, potentially reducing complications. Patients with breast cancer who underwent R-ALND at our institution between March 2024 and March 2025 were enrolled and analyzed. The procedure used the da Vinci system, following a systematic "bottom-up, back-to-front" sequence for axillary dissection, with emphasis on preserving the intercostobrachial nerve and blood vessels. The clinical characteristics, surgical outcomes, complications, and recurrence of R-ALND were analyzed. The mean operative time was 48.16 ± 9.65 minutes, with a median blood loss of 3.00 (2.00, 5.00) mL. A median of 18.00 (13.00, 22.00) lymph nodes were dissected, of which a median of 1.00 (1.00, 4.00) was metastatic. During a mean follow-up period of 8.70 ± 3.24 months, no cases of hemorrhage, infection, seroma, lymphorrhagia, upper limb lymphedema, or recurrence occurred. R-ALND is a safe and precise technique for axillary lymph node dissection, significantly reducing perioperative complications. Its technical advantages include 3-dimensional visualization and enhanced instrument maneuverability, although further validation of long-term survival benefits is required.

Lipomas are commonly identified as benign neoplasms in humans, primarily located in the head, neck, and upper limb areas. Their rare appearance in hands and digits makes such cases particularly intriguing to those in the field. We present a case of a middle-aged Saudi female patient who presented with a large lipoma at the middle phalanx of the right ring finger, with numbness distal to the lipoma, emphasizing the uncommon nature of this occurrence and the significance of surgical intervention.

Background: Integrated plastic surgery residency remains highly competitive, with a 2025 match rate of 55.8%. This study aimed to update the previously identified inflection points to assess their ongoing relevance.

Methods: The National Resident Matching Program database from 2023 to 2025 was queried, and data on objective resident selection criteria were collected. Criteria were categorized into subgroups, and stepwise comparisons were performed to determine inflection points.

Results: Compared with the national average, the chances of matching into integrated plastic surgery residency were significantly reduced with less than 5 contiguous ranks (up to -46.5%), less than 15 publications (up to -28.3%), Step 2 Clinical Knowledge scores less than 240 (up to -59%), and less than 5 volunteer experiences (-4.1%). Conversely, more than 15 publications, a USMLE Step 2 score of greater than 240, more than 5 research and volunteer experiences, Alpha Omega Alpha membership, and being a US MD senior were all associated with higher chances of matching, compared with the national average. Between 2023 and 2025, the inflection point went up for the number of publications (15 versus 25) and research experience (5 versus 10). On the other hand, the number of contiguous ranks (15), USMLE Step 2 score (250), and volunteer experiences (10) remained the same over the same period.

Conclusions: Updated benchmarks confirm upward shifts in some of the inflection points, reflecting increased competitiveness during the study period. Importantly, applicants should prioritize these metrics strategically, supplemented by qualitative factors such as letters of recommendation to optimize their chances of matching.