Plastic and Reconstructive Surgery Global Open最新文献

There is limited literature describing the management of breast deformities secondary to neurofibromatosis-1. We report the management of breast asymmetry and distortion secondary to neurofibromatosis of the chest wall and spine. A 24-year-old woman presented with breast asymmetry as a result of scoliosis, chest wall asymmetry, and soft-tissue distortion secondary to neurofibromatosis-1. The right breast displayed loss of projection, effacement of the inframammary fold, and caudal displacement. Ptotic tissue on the right hemithorax immediately caudal to the breast was folded superiorly in the retromammary region, thereby lifting the breast upward, increasing projection via auto-augmentation, and simultaneously intensifying the inframammary fold. Slight overcorrection was accomplished intraoperatively in anticipation of potential relapse. No postoperative complications were encountered. At 10-month follow-up, the patient continued to show a satisfactory outcome with improved symmetry and was very pleased with the outcome.

Phyllodes tumors are rare fibroepithelial breast neoplasms that occasionally present as giant masses, requiring radical excision and complex reconstruction. We report the case of a 21-year-old woman who presented with a progressively enlarging right breast mass for more than 18 months, which had recently ulcerated and become symptomatic. Imaging showed a heterogeneous mass occupying the entire breast, with no distant metastases but axillary nodal enlargement. She underwent a radical mastectomy and sentinel lymph node biopsy. The specimen measured 22 × 17.5 × 14.5 cm and weighed 2440.5 g. Immediate reconstruction was performed using a conjoined abdominal free flap: a deep inferior epigastric artery perforator flap based on the left deep inferior epigastric vessels and a superficial inferior epigastric artery flap based on the right superficial system. Microvascular anastomoses were performed to the internal mammary and lateral thoracic branch pedicles. The final histology report confirmed a borderline phyllodes tumor with negative margins and no nodal involvement. Postoperative recovery was uneventful, and the patient was discharged on day 5. During follow-up, there was no evidence of recurrence, and the breast mound showed reasonable shape and projection. This case highlighted the value of conjoined abdominal free flaps as a reliable single-stage solution for immediate reconstruction following resection of giant phyllodes tumors, offering adequate soft tissue coverage and volume with low donor-site morbidity.

Extensor digitorum brevis manus is an accessory muscle anomaly found on the dorsum of the hand. This variation in the fourth compartment may lead to preoperative misdiagnosis. In this study, we report the case of a 25-year-old man who presented with bilateral dorsal hand masses associated with pain during hand movement. History, examination, and imaging have led to a diagnosis of extensor digitorum brevis manus. Surgical excision was offered to the patient to relieve his symptoms, with an uneventful postoperative course.

This case report aims to increase awareness about foreign body (FB) impaction in the pediatric palate. The significance of this clinical entity lies in the fact that it is frequently misdiagnosed as a palatal fistula or mass. Patients are therefore subjected to a variety of unnecessary investigations, for example, computed tomography scans and x-rays. In this case report, a 13-month-old boy was referred for a newly developed oronasal fistula. Clinical evaluation, however, correctly identified a FB impacted in the palatal vault. The FB (button cap) was successfully removed under general anesthesia with adequate airway control. No complications were observed. The diagnosis of FB impaction in the pediatric palate can be simple: The usual scenario is of a child less than 4 years of age, who is otherwise healthy, presenting with a sudden-onset palatal mass or fistula. Typically history of palatal pathology is lacking, and the patient has no associated feeding difficulty, nasal regurgitation, speech, or airway symptoms. Thus, we believe a palatal FB impaction should be included in the differentials whenever a patient of this age group presents with a sudden-onset palatal fistula or mass without history of the disorder and no associated relevant symptoms. Specifically, an isolated hard palate cleft or fistula that spares the velum in the absence of nasal regurgitation or feeding difficulties is suggestive.

The fibula free flap (FFF) is one of the most widely used methods for head and neck bony reconstruction, yet pedicle ossification-though rare-can lead to complications. Although historically considered benign, ossification may cause vascular compromise, a phenomenon previously unreported. We present a unique case of consecutive FFF failures due to pedicle ossification-induced thrombosis. A 56-year-old man underwent FFF reconstruction following mandibulectomy for T4N0M0 squamous cell carcinoma. Despite adjuvant chemoradiotherapy, the first flap necrosed months later, with imaging revealing extensive pedicle ossification and thrombosis. A contralateral FFF was performed but similarly failed due to recurrent ossification and arterial thrombosis, confirmed histopathologically. This case challenged the assumption that pedicle ossification is benign and highlighted its potential for catastrophic flap loss. A literature review indicates that ossification rates vary (4.4%-21%), with meticulous periosteal dissection significantly reducing risk. Clinical presentation often includes trismus, submandibular induration, and pain, but complete necrosis had not been previously documented. This report underscored the need for technical modifications in high-risk cases, consideration of alternative flaps (eg, scapular), and systematic evaluation of late flap failure to exclude ossification-related thrombosis. Surgeons must recognize this underreported complication to optimize reconstructive outcomes.

Background: There is currently no widely accepted treatment protocol for pilonidal disease. Although surgery is often the first line of treatment, it is associated with a high recurrence rate. Noninvasive approaches to treating pilonidal disease, such as light-based epilation, have shown promise in small studies. Systematic reviews on this subject have been limited by small sample sizes, lack of comparative groups, and substantial heterogeneity. The purpose of this systematic review and meta-analysis was to address these limitations and evaluate the effectiveness of light-based epilation as an adjunct to surgery in the treatment of pilonidal disease.

Methods: A PubMed search was performed of all studies that evaluated the rate of pilonidal disease recurrence when light-based epilation was used. Only English-language comparative studies with more than 10 subjects and a follow-up longer than 6 months were included. Data from all studies were compiled, and a systematic review and meta-analysis were conducted to evaluate the effectiveness of light-based epilation in reducing pilonidal disease recurrence.

Results: Eleven comparative studies comprising 804 patients were included, including 3 randomized controlled trials, 4 prospective studies, and 4 retrospective studies. Light-based epilation used as an adjunct to surgery was found to significantly reduce pilonidal disease recurrence compared with surgery alone (P = 0.02). No statistically significant differences were observed when light-based epilation alone was compared with conventional treatment (P = 0.9) or surgery alone (P = 0.5).

Conclusions: This study demonstrated that light-based epilation as an adjunct to surgery results in significantly lower pilonidal recurrence rates than surgery alone.

[This retracts the article DOI: 10.1097/GOX.0000000000007200.].