Plastic and Reconstructive Surgery Global Open最新文献

Background: This study provides a detailed examination of facial asymmetry and its relationship with skeletal structure and soft tissues, aiming to better understand the morphological variations of the face.

Methods: The facial characteristics of 615 patients were analyzed using morphometric measurements. To complement this analysis, 189 skulls were examined to establish a concordance between skeletal structure and soft tissues, allowing for a deeper understanding of the observed asymmetry. The data were statistically analyzed to identify patterns of asymmetry.

Results: The measurements revealed a prevalence of the "narrow face" on the right side, characterized by features such as a narrower orbit, a thinner lateronasal area, and a slightly higher and narrower maxillomalar block. Notable exceptions to this pattern were observed, indicating significant individual variations.

Conclusions: Facial asymmetry is a constant feature among individuals and is influenced by complex embryological development processes. Identifying these variations provides new insights for aesthetic procedures, emphasizing the importance of a personalized approach to facial diagnosis.

Background: Our report focuses on a new method for reanimating the facial nerve and reconstructing soft tissue after radical parotidectomy due to malignant parotid tumor infiltration. We found that using the free vastus lateralis functional muscle transfer (FVL-FMT) can be effective.

Methods: FVL-FMT is an immediate single-stage reconstruction technique. It uses 2 branches of the vastus lateralis motor nerve-the descending (type 1) and oblique (type 2) branches-to supply the transferred free functional muscle. The descending branch also acts as a vascularized nerve graft that reconnects the facial nerve and its branches. It was used in a review of patients with stage IVA parotid cancer who underwent radical parotidectomy, with facial function assessed using modified House-Brackmann and Yanagihara facial nerve grading scales.

Results: Seven patients underwent facial nerve reconstruction, 6 with type 1 and 1 with type 2 FVL-FMT. Three patients regained normal ocular function, whereas 4 achieved moderate dysfunction for the lower midface. The modified House-Brackmann scores were III (n = 3, 42.9%), IV (n = 2, 28.6%), and V (n = 2, 28.6%), whereas the Yanagihara system scores ranged from 4 to 30. All patients had minimal synkinesis, and 6 (86%) achieved acceptable symmetrical resting tone. All flaps survived, and ocular complications and feeding problems were absent.

Conclusions: Immediate facial nerve reconstruction can improve the quality of life for patients with facial palsy after surgery. The vastus lateralis functional muscle transfer is a reliable method that restores function and appearance in facial nerve defects.

Background: Breast cancer is a leading cause of mortality among women in sub-Saharan Africa (SSA). As such, optimizing outcomes for treatment and reconstruction is a global health priority. Currently, normative data for interpreting BREAST-Q results are limited to high-income countries. This study seeks to evaluate baseline breast-related quality of life in SSA women without breast cancer and compare it with previously published normative values.

Methods: Women in Ghana, Nigeria, and Ethiopia 18 years of age and older with no history of breast cancer or breast surgery were recruited to complete the BREAST-Q preoperative mastectomy module. Multivariable regression was performed to identify correlations between sociodemographic variables and BREAST-Q scores. Comparisons were made between normative data previously published in high-income countries and within individual SSA populations.

Results: Normative BREAST-Q scores were obtained from a total of 453 women (169 Ghanaian, 210 Nigerian, and 74 Ethiopian) with a mean age of 26 ± 7 years and body mass index of 26 ± 6 kg/m². Scores were as follows: satisfaction with breasts, 64 ± 26; psychosocial well-being, 63 ± 23; sexual well-being, 57 ± 26; and physical well-being, 68 ± 16. Compared with scores published in the United States, SSA women scored higher in breast satisfaction and lower in psychosocial and physical well-being. Significant differences in scores were also found among countries in SSA.

Conclusions: This study establishes normative values for the BREAST-Q mastectomy module in a group of women in SSA without breast cancer and found significant variability globally and among countries within the same region.

Background: Aging affects all the components of the face, and the earlobe stands among them. Elongation of the earlobes necessitates surgical correction to restore the youthful ear shape.

Methods: A comprehensive literature search was conducted across the PubMed, Google Scholar, and Cochrane databases. The quality of the included studies was systematically assessed, and data pertaining to surgical earlobe reduction was extracted.

Results: Thirteen articles that closely matched the study objectives were included in this systematic review. We regrouped these techniques into 3 categories: those involving inferior margin excision of the earlobe, those involving anterior earlobe resection, and the third group comprising other methods. To aid in clinical decision-making, we created an algorithm to guide the choice of the procedure.

Conclusions: Proper management of earlobe ptosis and pseudoptosis enhances facial harmony. By outlining the available techniques and providing a treatment algorithm, we emphasize the importance of incorporating earlobe reduction into comprehensive facial rejuvenation strategies.

Background: We analyzed patient outcomes after deep inferior epigastric perforator (DIEP) flap reconstruction using a national database to assess readmission, mortality, morbidity, and length of stay (LOS).

Methods: This retrospective cohort study utilized the 2017-2020 Nationwide Readmissions Database. Patients had an International Classification of Diseases, Tenth Revision procedure code for DIEP flap reconstruction from January to November each year. The primary outcome was the 30-day readmission rate, with secondary outcomes including in-hospital and 30-day mortality, reasons for admission and readmission, and complication rates. Multivariate regression adjusted for confounders.

Results: A total of 32,019 DIEP flap reconstructions were identified, with a median patient age of 51 years. The most common indication was breast reconstruction after mastectomy. In-hospital, 30-day, and calendar-year mortality rates were all under 1% (95% confidence interval [CI]: 1.29-3.99). The 30-day readmission rate was 5.8% (95% CI: 5.4%-6.3%), with infection being the leading cause of readmission (2.0%), a previously unreported finding. Other causes included wound dehiscence (0.19%), pulmonary embolism (0.19%), sepsis (0.18%), and hematoma (0.18%). Reoperation rates were 7% during the index hospitalization and 11% during readmission. The average LOS was 3.7 days (95% CI: 3.65-3.82), consistent with current literature.

Conclusions: This study provides valuable insights into DIEP flap reconstruction outcomes, revealing a 2.0% infection readmission rate. It shows a higher overall readmission rate (7% versus 5.6%) and a lower dehiscence rate (0.2% versus 2.8%) compared with previous data. These findings, derived from the largest nationally representative readmission database in the United States, also demonstrate comparable reoperation rates and LOS.

Background: The use of nonnarcotic analgesics, such as ketorolac, has been shown to reduce postoperative pain and opioid consumption. This double-blinded randomized trial is designed to assess the efficacy of intraoperative ketorolac in reducing postoperative narcotic use in outpatient breast reconstruction and reduction procedures.

Methods: This study is a prospective double-blinded randomized controlled trial. Adult patients, 18-64 years of age, undergoing breast surgery were randomized to receive 15 mg of ketorolac, 30 mg of ketorolac, or a placebo dose of saline. Patients' opioid requirements in the postoperative anesthesia care unit and postoperative opioid utilization and pain scores were collected through a daily survey. Postoperative hematomas were assessed before discharge and at subsequent follow-up visits for a period of 14 days.

Results: Of the 63 patients included in the study, 31 patients underwent delayed reconstruction following mastectomy and 35 patients underwent breast reduction surgery. Patients who received 30 mg of ketorolac had the fastest pain resolution (P < 0.05). The rate of opioid discontinuance was the fastest overall in patients who received 15 mg of ketorolac (rate = -0.072) when compared with the 30-mg ketorolac group (rate = -0.071) and the placebo group (rate = -0.065). Total opioid usage in the postoperative anesthesia care unit was not statistically different across the 3 groups. Only 1 patient developed a hematoma in the 15-mg ketorolac group.

Conclusions: This study demonstrates that a single dose of intraoperative ketorolac was associated with reduced opioid usage and postoperative pain. However, due to the study size, the difference in hematoma rate was not statistically significant.

The increasing necessity for solo surgery in plastic and reconstructive microsurgery is driven by contemporary challenges such as a growing and aging population, a shortage of qualified assistants, and the ongoing recovery efforts from COVID-19. Historically limited to remote or exceptional circumstances, solo surgery is now more frequently performed due to these evolving factors. Technological advancements, including robotics, play a crucial role in facilitating this transition and supporting the trend toward self-sufficiency in surgical practice. This article presents practical strategies for executing solo surgery based on our team's experience and a review of current literature. Key considerations discussed include patient positioning and optimizing surgical workflows. By presenting these recommendations and techniques, derived from both practical experience and literature, we highlight that plastic surgeons and microsurgeons can maintain consistently high standards of surgical care, even when operating independently.