Plastic and Reconstructive Surgery Global Open最新文献

Background: Postoperative fluid-related complications, such as hematoma and seroma formation, are common concerns in breast surgery, adversely affecting surgical outcomes and patient recovery. Topical tranexamic acid (TXA) has emerged as a promising intervention to minimize bleeding while reducing systemic adverse effects linked to intravenous administration. However, evidence on the efficacy of topical TXA in breast surgery remains sparse.

Methods: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language databases were searched through April 2024 to identify randomized controlled trials and cohort studies assessing the effects of topical TXA on postoperative outcomes in breast surgery, including hematoma, seroma, infection rates, and drain output/duration.

Results: Six studies, encompassing 823 patients and 1477 breasts, were included. Subgroup meta-analysis demonstrated a statistically significant reduction in hematoma rates in patients who underwent mastectomy (risk ratio [RR] = 0.14; 95% confidence interval [CI], 0.03-0.78; P = 0.02), but not in patients who underwent breast reduction (RR = 0.76; 95% CI, 0.08-7.08; P = 0.24). No significant differences were found in overall hematoma rates (RR = 0.32; 95% CI, 0.08-1.195; P = 0.09), seroma formation (RR = 1.22; 95% CI, 0.99-1.51; P = 0.07), or infection rates (RR = 0.85; 95% CI, 0.46-1.56; P = 0.59).

Conclusions: Topical TXA significantly reduced hematoma rates in patients who underwent mastectomy but showed no significant effect on other outcomes. Larger studies with standardized methodologies are required to fully establish the role of topical TXA in optimizing breast surgery outcomes.

When squamous cell carcinoma necessitates mandibular resection, the resultant defect can be complex. An osteocutaneous fibula free flap is an effective reconstruction option, typically supplied by the peroneal artery for both the fibula and skin flap. In this case report, an anatomical variation was found: the skin paddle was supplied by soleus musculocutaneous perforators of the posterior tibial artery, whereas the fibula was supplied by the peroneal artery. The posterior tibial artery perforator vessels from the skin paddle were anastomosed to the distal end of the peroneal vessels. The peroneal vessels were anastomosed to the left superior thyroid artery and a branch of the internal jugular vein, with confirmation of adequate blood flow via implantable Doppler signal. Septocutaneous perforators from the peroneal artery are absent in 5%-10% of the population; thus, an approach to anomalous vasculature in the setting of fibula free flap harvest that decreases morbidity and multiple operations is valuable.

Subcutaneous indwelling of nonabsorbable threads for tissue fixation and tension reduction is often used in plastic surgery and is applied in breast reduction surgery, umbilicoplasty, and in frontalis muscle lifting for congenital ptosis. However, in a few cases, exposure of the indwelling thread necessitates its removal. Exposure of the indwelling threads mostly occurs due to exposure of the knots. Therefore, we require a novel method to ensure that the knot of the indwelling thread remains unexposed. Hence, we created a stab incision to place the indwelling nonabsorbable threads ligated with moderate tensile force. Furthermore, we attached needles to each end of the ligated thread. The needles penetrated from the stab incision through the depths to separate sites farther away from each other. Finally, we towed and cut the exposed thread from the skin. Thus, the knots on the indwelling thread may be positioned deeper, reducing the risk of exposure to the indwelling thread. Furthermore, the risk of overcorrection is reduced as each end of the indwelling threads penetrates a different site. In addition, this method leaves certain length of the end of the knot under the skin, which improves the visibility of the indwelling thread during revision surgery, facilitates access, and reduces the operative time. Application of this method in subcutaneous indwelling of nonabsorbable threads may reduce complications and time required for revision surgery.

Background: The first class of integrated plastic surgery residency applicants with pass/fail (P/F) step 1 assessments occurred during the 2023-2024 Match cycle. This study analyzes the results of a 2024 postmatch survey to program directors (PDs) regarding the impact of the conversion to P/F step 1 scoring and compares the results to the 2019 survey that attempted to predict how this conversion would influence decision-making when it was initially announced.

Methods: A 26-item survey evaluating PDs' perspectives on applicant characteristics and the application process following P/F step 1 scoring was distributed March 2024. Data were analyzed using summary tables, marginal homogeneity tests, and Mann-Whitney U tests.

Results: Thirty-seven plastic surgery PDs completed the survey (response rate = 46.3%). The top 3 most important metrics for determining applicant interview invitations after step 1 P/F conversion were participation in an away rotation, letters of recommendation, and involvement in research, while ultimately match rank list order emphasized quality of the applicant's interview. A total of 68.1% of PDs agree that it was more difficult to differentiate applicants without a numerical step 1 score. A total of 51.5% of PDs reported using step 2 clinical knowledge scores to screen applicants. PDs' opinions on factors influencing the 2023-2024 Match cycle did not significantly change from predictions studied in 2019.

Conclusions: Program directors felt that in the 2023-2024 cycle, it was more difficult to differentiate between applicants, leading to increased emphasis on other characteristics such as away rotations, letters of recommendation, step 2 clinical knowledge scores, and research. There was no difference from what was predicted.

Abdominoplasty is a common aesthetic procedure, and ischemic complications are rare, particularly in nonsmokers. We present 2 cases of ischemic complications in nonsmoking patients treated with fremanezumab, a biologic medication for severe migraines. A 55-year-old woman underwent lipoabdominoplasty on December 18, 2023. At the 16-day postoperative follow-up, demarcated necrosis was observed beneath the wound tape, and secondary direct closure was performed 6 weeks later. She had been using fremanezumab for 4 years. A 47-year-old woman underwent abdominoplasty on April 23, 2024, with moderate dissection and liposuction to the flanks. Signs of abdominal flap ischemia were evident in the operating room, and treatment for the Raynaud phenomenon was initiated immediately. The ischemia demarcated over 2 weeks, and secondary direct closure was performed 3 weeks postoperatively. She had been using fremanezumab for two months. Calcitonin gene-related peptide antagonists are potent medications for severe migraine with few contraindications. Fremanezumab may affect peripheral circulation, potentially increasing the risk of surgical complications.

Successful rhinoplasty relies on a deep understanding of nasal anatomy and precise nasal tip control for lasting functional and aesthetic outcomes. Structural grafts, like septal extension grafts, are instrumental in maintaining tip position and projection with minimal long-term changes. This article details a systematic technique to harvest septal cartilage that maximizes graft material and allows for effective septal deviation correction.

Pyogenic flexor tenosynovitis (PFT), also known as septic or suppurative flexor tenosynovitis, is a closed-space infection of the hand's flexor tendon sheath that necessitates timely diagnosis and treatment. The treatment consists of antibiotic therapy often combined with prompt surgical treatment. The most common surgical approach is the closed irrigation technique, which involves inserting a 16-gauge angiocatheter in the proximal aspect of the flexor tendon sheath, leaving the distal end of the Brunner incision open during the irrigation process. However, this method has its own challenges, such as catheter bending and kinking, thereby obstructing the fluid irrigation process and prolonging the operative duration. Instead, we propose the use of a rigid plastic facial fat grafting cannula, which is coupled to a 50-mL syringe with 0.9% saline solution. The cannula is placed at the level of the A1 pulley, and irrigation is easily performed. This simplifies this process by maintaining adequate fluid outflow through the flexor tendon sheath.

Background: Over the past 2 decades, vertical scar reduction mammaplasty techniques have been gaining more acceptance. However, many surgeons are still hesitant to use it routinely because of the uncertainty of the effectiveness of vertical scar techniques in managing lower pole skin excess. We aimed to test its efficacy by using objective anthropometric measurements to evaluate long-term breast shape and lower pole stability.

Methods: The study population included 40 of 129 consecutive women with short-scar reduction mammaplasty followed up for at least 1 year. Breasts were measured preoperatively, perioperatively, and at least 1 year postoperatively. All women also completed the BREAST-Q questionnaire at their most recent visit.

Results: The mean sternal notch-to-nipple and upper breast-to-nipple distances decreased postoperatively by 22% and 43%, respectively, and remained stable over a mean time of 110.1 ± 65.58 weeks. The nipple-to-inframammary fold distance, which was intraoperatively shortened by an average of 63%, elongated back to 88% of its preoperative measurements. No correlation was detected between the long-term changes across all 3 measurements, the amount of tissue removed or the satisfaction reported by patients. Mean BREAST-Q satisfaction rates in all parameters evaluated were 75.79-98.12.

Conclusions: The 12% improvement in the nipple-to-inframammary fold measurement implies that the short-scar technique might properly address the horizontal dimension of the hypertrophic-ptotic breast but falls short in addressing its vertical dimension. The search for a modification that mirrors the advantages of the vertical scar technique in terms of shape and projection, while guaranteeing a steady lower pole, remains ongoing.

Background: Most patients undergoing breast surgery with free nipple grafts lose nipple erection (NE) function. This study aimed to evaluate the effect of nerve preservation and reconstruction with targeted nipple-areola complex reinnervation (TNR) on NE following gender-affirming mastectomy with free nipple grafting.

Methods: Patients undergoing gender-affirming mastectomy with free nipple grafts were prospectively enrolled. Subjects who underwent TNR were compared with controls who did not undergo TNR. Postoperative patient-reported NE function was scored using a 4-point Likert scale. Objective NE evaluation consisted of the change in areola circumference and nipple height following cold application using a thermal device and 3-dimensional imaging.

Results: Twenty patients (11 subjects and 9 controls) with comparable age, body mass index, and mastectomy weight were included. At an average follow-up of 16.8 (±7.0) months, significantly more subjects reported NE than controls (72.8% versus 38.9%, P = 0.03), with a higher median NE score (3 [range 1-4] versus 1 [range 1-2], P = 0.0005). Following cold application, subjects had a greater mean reduction in areola circumference (-4.16 ± 3.3 versus -1.67 ± 1.9 mm, P = 0.02) and a greater mean increase in nipple height (+0.86 ± 0.8 versus +0.37±0.3 mm, P = 0.04) compared with controls. Improved patient-reported NE function correlated with better cold detection thresholds (P = 0.01).

Conclusions: TNR was associated with improved patient-reported and objective NE following gender-affirming mastectomy. Improved NE correlated with improved cold detection, suggesting the role of both sensory and autonomic innervation in mediating NE.

Background: Ventral hernia repair (VHR) is a common procedure performed on a comorbid patient population at risk for complications, necessitating effective preoperative risk assessment. Previous research suggests that frailty better predicts adverse outcomes compared with historical risk proxies including age. We examined the association between frailty as measured by the 5-factor modified frailty index and postoperative complications following VHR as reported in the National Surgical Quality Improvement Program database.

Methods: A retrospective review of the National Surgical Quality Improvement Program database from 2015 to 2020 was performed for patients who underwent VHR with the component separation technique. Descriptive analyses were performed on demographics, comorbidities, American Society of Anesthesiologists class, and the modified frailty index score. Multivariable regression was conducted for frailty, age, other comorbidities, and hernia characteristics to determine the relationship to all-cause and surgical site complications, complication severity, complications with Clavien-Dindo score above 3, length of stay, readmission, and reoperation. All analyses were performed using R software. A P value less than 0.05 was considered statistically significant.

Results: A total of 14,575 patients were identified. Frailty was a significant predictor of all-cause complications, readmission, reoperation, and increasing length of stay. Increased age was a significant predictor for length of stay and severe systemic complications. Smoking status and American Society of Anesthesiologists class of 4 were associated with all outcomes. Body mass index predicted surgical site complications and reoperation.

Conclusions: Frailty can predict many postoperative complications of VHR with component separation technique and is an important element of risk prediction for potential surgical candidates.