Plastic and Reconstructive Surgery Global Open最新文献

Background: Skull computed tomography (CT) segmentation is the cornerstone of computer-assisted craniomaxillofacial surgery. Clinical routine threshold-based segmentation is time-consuming and yields suboptimal results in critical anatomical regions. This study evaluated the performance of an artificial intelligence (AI)-enabled automatic segmentation of skull CT scans and investigated clinical factors affecting its performance.

Methods: The segmentation outcomes of 44 preoperative skull CT scans from a surgery database by AI-enabled and clinical routine methods were evaluated using quantitative metrics and qualitative assessment. The impact of occlusal contact, metallic artifact, bone involvement, slice increment, and pixel size of the CT scan was analyzed.

Results: The mean Dice coefficient (DICE) of AI-enabled segmentation of the upper skull was 92.19% ± 2.59%, comparable to the clinical routine segmentation at 91.72% ± 3.77% (P = 0.228). The mean DICE of AI-enabled segmentation of the mandible was 94.81% ± 3.24%, outperforming clinical routine segmentation at 91.77% ± 5.21% (P < 0.001). AI yielded superior segmentation at the anterior maxillary wall and the temporomandibular joint. The presence of occlusal contact adversely affected AI segmentation of the mandible. Smaller slice increments and pixel sizes were associated with improved AI accuracy, whereas metallic artifacts and bone involvement had no significant effect.

Conclusions: AI yielded comparable accuracy to the clinical routine method for skull CT segmentation, with better performance in critical anatomical regions and elimination of metallic artifacts. This study served as an external validation cohort to support future application of this AI-enabled segmentation model in the workflow of computer-assisted craniomaxillofacial surgery.

Computer-aided design/manufacturing with a free fibula flap has improved mandibular reconstruction, yet the adoption of patient-specific mandibular plates remains limited by cost and regulatory barriers. Premade mini-plates (MPs) are inexpensive and widely available but lack contouring capacity, making positional accuracy essential. We developed an innovative computer-aided design/manufacturing guide system incorporating a dental reference cap and synchronized screw-hole guides to bridge the gap between virtual planning and surgical execution. The dental reference cap anchors the guides to residual teeth, enhancing stability without requiring extensive bone contact and reducing tumor spillage risk. Synchronized screw holes repurpose temporary fixation points as reference sites for positioning guides on both the mandible and fibula. This enables the fibular segments to be assembled into a single reconstruction block before transfer, minimizing drilling, preserving periosteal vascularity, and achieving precise alignment with the mandibular defect. A 42-year-old man with right lower alveolar squamous cell carcinoma underwent mandibular reconstruction using this system. Postoperatively, he tolerated a full diet with stable occlusion, and functional outcomes remained favorable at 15 months. Quantitative analysis demonstrated a mean deviation of 1.94 mm, a root mean square of 3.27 mm, and 73.9% of vertices within ±2 mm. Key mandibular landmarks were reproduced with submillimeter accuracy. By integrating a dental reference cap and synchronized screw-hole guides, this system achieves accuracy comparable to patient-specific mandibular plates while retaining the cost-effectiveness and accessibility of MPs, offering a practical and reproducible solution for mandibular reconstruction.

Tessier 0, or midline facial clefts, is one of the most common presentations among craniofacial clefts; however, there may be a diverse severity in presentations. This report applies established methods in bilateral lip repair to an incomplete Tessier 0 presentation. The report reviews literature available on midline facial clefts and contrasts the proposed application with a single straight-line repair. Tessier 0 clefts are rare, with an estimated incidence ranging from 1.4 to 4.9 per 100,000 live births. About 80 cases have been described in the literature; however, these may be underreported. Standard bilateral cheilorhinoplasty techniques previously described may be used for these relatively rare cases. The application of established methods for bilateral cleft lip/nose primary care may be performed for variants of rare facial clefting.

Despite the clinical importance of perforator flaps in the field of flap surgery, ambiguity still surrounds the terminology and definition. This study aimed to resolve this ambiguity through a logical analysis of perforator flaps. In this study, we present a new classification system for skin flaps with various tissue compositions based on the vascular plexus we have previously clarified and examine whether perforator flaps constitute an independent category from the perspective of tissue composition. Through anatomical and physiological analyses, we identified 7 distinct skin flap types: full-thickness, split-thickness, thin (including the super-thin and pure skin subtypes), dermis, adipofascial, protective adipofascial, and lubricant adipofascial flaps. All perforator flaps except for the pure skin perforator flap do not exhibit tissue compositions exclusive to their type and, therefore, cannot be considered a distinct category based solely on tissue structure. We discussed the need for rethinking the classification not only in terms of the surgical technique, but also based on objective anatomical features such as tissue composition and vascular connectivity. By focusing on these criteria, this new classification system further clarifies and homogenizes the terminology and conceptual framework of skin flap surgery.

Empty nose syndrome (ENS) is a debilitating, iatrogenic condition caused by a previous inferior turbinectomy; the symptoms of which include subjective feelings of suffocation despite an objectively patent nasal passage. The definitive treatment for ENS is to replace the missing tissue through surgery. The implantation material and the implantation site are important considerations when it comes to ENS surgery. Here, we present a case of ENS treated with inferior turbinate augmentation using homologous costal cartilage. This novel surgical technique creates a submucosal pocket at the site of the inferior turbinate remnant and implants the homologous costal cartilage therein, thus augmenting the inferior turbinate remnant instead of creating a new turbinate. Our case reported a favorable outcome with no obvious complications. This is a rare case report of an ENS treated with inferior turbinate augmentation by using homologous costal cartilage and offers more insight into ENS surgery.

Background: There are several reports on field cleft surgery procedures, but none from a public health institution and a mission hospital. The experiences are highlighted to chronicle the methodology, scope, and outcomes of field surgery in these facilities.

Methods: A retrospective review of 122 patients using data uploaded on the Smile Train Express database and the authors' personal records of field surgery was conducted from August 2010 to January 2020.

Results: Ten outreaches (medical/surgical missions) were undertaken, and 122 patients were operated on. The ages ranged from 1 week to 55 years, with a male-to-female ratio of 1:0.8. The procedures ranged from lip revision to combined cheilo-palatoplasty. There were 95 unilateral lip and 14 bilateral lip repairs, 4 atypical cleft repairs, and 9 palatoplasties. One patient had a combined cheilo-palatoplasty. The commonest techniques performed were the Mohler modification of the Millard template for unilateral cheiloplasty, the Mulliken technique for bilateral cheiloplasty, and intravelar veloplasty for palatoplasty. Initially, no palatoplasty was done. The combination surgery was done in the ninth year. Adult cheiloplasty was done under local anesthesia, and conscious sedation was used for children. All palate repairs were done with total intravenous anesthesia using orotracheal intubation. Monitoring was done using pulse oximetry. There were no mortalities or blood transfusions. Complications included desaturation in 2 patients, requiring conversion to general anesthesia, postoperative bleeding (controlled by pressure), partial dehiscence, and palatal fistula formation (25%). Follow-up was up to 3 years.

Conclusions: Field cleft surgery, including combined cheilo-palatoplasty with careful planning, proper patient selection, and careful surgery, is safe in Nigeria.

Background: The treatment of bilateral cleft lip (BCL) depends on many factors, and the complexity of the repair can be reflected in the resulting complications. The severity of the cleft, along with the orthopedic and surgical treatment, requires coordinated treatment under a proven algorithm to achieve an aesthetically harmonious lip while avoiding complications. This study aimed to design and apply a clear approach to measuring severity and applying a technique that leads to optimal outcomes in BCL repairs.

Methods: This study included patients from Operation Smile Ecuador and Guatemala. It consisted of 2 parts: (1) the retrospective part, which studied the clinical histories of patients with BCL from January 2021 to December 2022, correlating photographs, measurements, treatment protocol, surgical technique, and patient evolution; and (2) the prospective part, in which the algorithm was applied to patients treated from January 2023 to December 2024.

Results: In the retrospective part, the results of 22 patients were correlated with the case-treatment protocol analysis, as well as the incidence of complications. Using these results, the 3-line algorithm was developed and applied to 21 patients in the prospective portion. Complications were decreased in this cohort, demonstrating the applicability and viability of the algorithm.

Conclusions: In cases of BCL, the severity of the cleft is a factor of sine qua non importance, influencing not only the planning of the treatment protocol, but also the prevention of complications. The results of this study showed that the 3-line algorithm reduces complications and improves the function and aesthetic result for patients.

Background: Postoperative eyebrow position change after double-eyelid surgery can affect aesthetic outcomes, but its mechanism remains unclear. This study aimed to investigate the influence of preoperative eyebrow elevation and other factors using the buried-suture technique to reduce confounding from tissue manipulation.

Methods: This retrospective study analyzed patients who underwent buried-suture double-eyelid surgery performed by the senior author. Eyebrow height was measured pre- and postoperatively using standardized photographs, and changes were compared between groups stratified by preoperative eyebrow elevation. Subgroup analyses were also performed based on crease height, fixation method, sex, and laterality.

Results: A total of 108 patients (216 eyelids) were included. The average rate of eyebrow position change across all patients was 4.8%. Patients with marked preoperative eyebrow elevation exhibited more pronounced postoperative eyebrow descent, and all such eyelids showed a downward shift. Subgroup analyses by crease height, fixation method, sex, and laterality revealed no significant differences in eyebrow-position change.

Conclusions: Preoperative eyebrow elevation is a strong predictor of postoperative descent. This factor should be considered during surgical planning and patient counseling to improve accuracy in outcome prediction after double-eyelid surgery.

Conventional imaging cannot capture the spatial relationship between soft tissue and vasculature in patients with cleft lip. Here, a novel technique integrating micro-computed tomography imaging with voxel-based 3-dimensional reconstruction was developed using the Bioxel Nodes plugin in Blender. High-resolution modeling of both vasculature and surrounding soft tissue with adjustable transparency was achieved by segmenting computed tomography data based on intensity thresholds. This method allows intuitive visualization of the superior labial artery, columellar branches, and lateral nasal arteries. Notably, a spatial correlation was observed between these vessels and embryonic fusion zones of facial prominences, suggesting a potential link to cleft lip pathogenesis. Compared with traditional modeling methods, the current workflow offers improved anatomical clarity, enhanced interactivity, and lower technical barriers. In this study, Blender-based voxel rendering was applied for simultaneous reconstruction of blood vessels and transparent soft tissue in the perioral and perinasal region. This technique may assist in flap design, injection planning, and intraoperative vascular preservation, and thus provides a valuable tool for craniofacial surgery and education.

Background: Total reconstruction of the alar nasal subunit, often following traumatic or oncological amputation, presents a significant reconstructive challenge. This study compares the nasolabial flap (NLF) and the paramedian forehead flap (PFF) for their aesthetic and functional outcomes in this specific context.

Methods: A prospective, monocentric study included 28 patients who underwent total alar subunit reconstruction between 2017 and 2024. Patients were allocated to 2 groups based on the reconstructive technique: folded PFF or NLF. Postoperative assessment included patient satisfaction surveys and the Nasal Aesthetic and Functional Evaluation Questionnaire score to evaluate functional and aesthetic outcomes.

Results: Reconstruction with the PFF provided superior aesthetic outcomes compared with the NLF, with a mean Nasal Aesthetic and Functional Evaluation Questionnaire aesthetic score of 30 out of 35 versus 21.6 out of 35 (P = 0.01). No significant difference was found in functional scores. The PFF, however, required a significantly higher number of operative stages (mean 3.6 versus 1.4, P < 0.001). This procedural complexity influenced patient choice, with those prioritizing a limited number of procedures opting more frequently for the NLF. The surgical decision was guided by pre- and postoperative photographic analysis in 71% of cases.

Conclusions: For total alar subunit reconstruction, the PFF offers superior aesthetic results at the cost of greater procedural complexity compared with the NLF. This study underscores the necessity of an individualized, patient-centered approach, balancing aesthetic goals against the surgical burden through shared decision-making.