Plastic and Reconstructive Surgery Global Open最新文献

Background: Penile inversion vaginoplasty (PIV) entails considerable soft-tissue dissection to the perineal region and involves complex tissue rearrangement. This study examines the role of an enhanced recovery after surgery (ERAS) pathway after PIV in reducing opioid use and controlling postoperative pain.

Methods: A retrospective study of 50 transfemale patients who underwent PIV at a single institution from June 2021 to January 2023 was completed. The study compared 2 groups of patients who were given different postoperative pain management regimens: group A received standard postoperative analgesics and group B received ERAS. Variables such as postoperative pain scores on the numeric pain rating scale (0-10), use of opioid medication, length of hospital stay, and patient comorbidities were recorded and compared across the 2 groups.

Results: The average hospital stay length was 4.92 (±0.85) days. Group A had a slightly longer average stay compared with group B. The average pain level in both groups was 4.25 (SD ±1.51). Group A exhibited a slightly higher average pain level of 4.31 (±1.53), whereas group B exhibited 4.16 (SD±1.51) (P = 0.77). Although pain levels did not significantly vary between the 2 groups, there was a statistically significant decrease in the amount of opioid medication used in group B with a P value of 0.009.

Conclusions: ERAS protocol is effective in decreasing opioid usage in the immediate postoperative setting after PIV.

Nerve transfers play a crucial role in the management of nerve injuries. I present a case where a young weightlifter had a devastating high median nerve injury resulting in absent thumb flexor pollicis longus function and absent flexor digitorum superficialis (FDS) and flexor digitorum profundus function of the index finger. An extensor carpi radialis brevis branch of the radial nerve was transferred to the anterior interosseous nerve (AIN), and the distal AIN was then mobilized and reflected from distal to proximal to supply a second nerve transfer to an FDS-index branch of the median nerve. In this configuration, the AIN served as both the target motor nerve for the first transfer and the donor nerve for the second transfer. The use of the AIN in this manner had the effect of minimizing donor morbidity (only 1 functioning donor nerve sacrificed) while also delivering an additional donor nerve to a target in an anatomically distinct area, avoiding sacrifice of additional donors or use of nerve grafts. The patient had full recovery of flexor pollicis longus function and flexor digitorum profundus index function at 10 months, as well as full recovery of FDS function of the index finger at 1.5 years postoperatively.

Background: Lipedema is a disease typically affecting women with a symmetrical, painful fat distribution disorder, which is hypothesized to be caused by impaired adipogenesis, inflammation, and extracellular matrix remodeling, leading to fibrosis and the development of edema in lipedema subcutaneous adipose tissue. The pathogenesis and molecular processes leading to lipedema have not yet been clarified.

Methods: A whole transcriptome analysis of subcutaneous tissue of lipedema stages I (n = 12), II (n = 9), and III (n = 8) compared with hypertrophied subcutaneous tissue (n = 4) was performed. Further data about hormonal substitution and body morphology were collected. The study is registered at ClinicalTrials.gov (NCT05861583).

Results: We identified several differentially expressed genes involved in mechanisms leading to the development of lipedema. Some genes, such as PRKG2, MEDAG, CSF1R, BICC1, ERBB4, and ACP5, are involved in adipogenesis, regulating the development of mature adipocytes from mesenchymal stem cells. Other genes, such as MAFB, C1Q, C2, CD68, CD209, CD163, CD84, BCAT1, and TREM2, are predicted to be involved in lipid accumulation, hypertrophy, and the inflammation process. Further genes such as SHTN1, SCN7A, and SCL12A2 are predicted to be involved in the regulation and transmission of pain.

Conclusions: In summary, the pathogenesis and development of lipedema might be caused by alterations in adipogenesis, inflammation, and extracellular matrix remodeling, leading to fibrosis and the formation of edema resulting in this painful disease. These processes differ from hypertrophied adipose tissue and may therefore play a main role in the formation of lipedema.

Background: Management of esophageal cancer is complex. Esophagectomy is associated with risk of significant complications. In this case series, we share the experience of our multidisciplinary team of thoracic surgeons and otolaryngologists in managing complications arising in the surgical treatment of esophageal cancer with the assistance of regional tissue transfer in the form of the pectoralis major flap.

Methods: We present a case series highlighting 3 patients who underwent esophagectomy who experienced significant anastomotic or conduit complications which were managed with a pectoralis muscle flap.

Results: Complications included tracheoesophageal fistula, refractory stenosis, and gastric conduit necrosis. Using a pectoralis major muscle flap with both myocutaneous and myofascial transfers was key to successful management. In the first patient, esophageal stent erosion after posterior tracheal wall dissection resulted in a tracheoesophageal fistula reconstructed through interposition of a myofascial flap. In the second patient, a tubed myocutaneous flap was interposed between the remnant gastric conduit and cervical esophagus to manage a posttreatment stenosis following resection of the stenosed segment. Finally, a myofascial flap was utilized to bolster a colonic interposition flap after initial necrosis of a gastric conduit that necessitated the creation of a temporary pharyngocutaneous fistula and subsequent colon interposition.

Conclusions: Multidisciplinary care and collaboration are integral components for optimization of patient outcomes. In this case series, otolaryngology and thoracic surgery utilized multiple tools within their armamentarium to manage complications associated with the surgical management of esophageal cancer.

Purpose: Both governmental and nongovernmental training programs are expanding efforts to train the next generation of plastic surgeons who will work in low- and middle-income countries (LMICs). Sufficient training is dependent on acquiring the appropriate skillset for these contexts. Few studies have characterized the spectrum of practice of plastic surgeons in LMICs and their relative disparity.

Methods: We performed a retrospective review on all patients who received plastic surgery at a single institution in rural western Kenya from 2021 to 2023. Data such as diagnoses, procedures, and home village/town of residence were collected. Patient home location was geomapped using an open-access distance matrix application programming interface to estimate travel time based on terrain and road quality, assuming patient access to a private vehicle and ideal traveling conditions. Descriptive statistics were performed.

Results: A total of 296 patients received surgery. Common procedures included treatment of cleft lip/palate (CLP), burn reconstruction, and reconstruction for benign tumors of the head and neck. The average distance to treatment was 159.2 minutes. Increased travel time was not associated with time to CLP repair (P > 0.05). Increased travel time was associated with delayed treatment for burns (P = 0.005), maxillofacial trauma (P = 0.032), and hand trauma (P = 0.016).

Conclusions: Training programs for plastic surgeons in LMICs should ensure competency in CLP, flaps, burn reconstruction, and head and neck reconstruction. Our novel use of an application programming interface indicates that international partnerships have been more successful in decreasing treatment delays for CLP patients, but not other reconstructive procedure patients. Expanded commitment from international partners to address these reconstructive burdens in LMICs is warranted.

The number of spinal reconstruction cases is growing, as are the accompanying complications. Wound complications after spinal reconstruction can be fatal and can affect up to 19% of patients undergoing major spine surgery. The discipline of spinoplastic surgery is characterized by the use of vascularized bone grafts to reconstruct spinal defects, which provide better results compared with nonvascularized and allogenic equivalents, owing to their superior blood supply. We present a 49-year-old man with spinal defect in the C3-C7 region treated with spinoplastic reconstruction. A 5 × 6 cm occipital VBG was designed with a centrally located muscular pedicle and successfully inset into the osseous defect. Radiographs taken 15 months postoperatively demonstrated overall excellent bony fusion, and the patient made an appropriate clinical recovery. In difficult spine procedures, the use of this occipital vascularized bone graft may lead to higher fusion rates without the need for free tissue transfer or allograft placement, which may not be available at all surgical centers around the world.

Background: Abdominal periumbilical hernias are prevalent within the adult population. When symptomatic, quality of life may be affected. This case series of 10 patients evaluates the short-term outcomes of using the T-Line mesh in periumbilical hernia repair.

Methods: A retrospective review of adult patients with symptomatic periumbilical abdominal hernia treated with open repair with T-Line mesh was performed at a tertiary referral center. Ten patients with an average age of 51 years were offered surgical treatment. Measures of postoperative outcomes included readmission within the 30-day postoperative period; recurrence; surgical site infection; development of seroma and hematoma; and the presence of pain, numbness, or bloating. Descriptive statistics were computed in Microsoft Excel.

Results: All 10 patients reported improvement in symptoms. All repairs were elective and classified as clean (100%). Hernias included 40% primary umbilical, 50% ventral, and 10% incisional. The average defect size was 10 cm², with a range from 1 to 25 cm². The T-Line mesh was placed in a sublay manner, with an average mesh size of 36 cm². No patients were readmitted in the 30-day postoperative period. There were no occurrences of surgical site infection or hernia recurrence. No hospital readmissions and no follow-up visits with hernia recurrence were noted at 3 months.

Conclusions: We present a case series of 10 patients presenting with symptomatic periumbilical hernias who underwent repair with the T-Line hernia mesh without short-term surgical occurrences. Long-term studies are required to accurately reflect safety and efficacy.

Background: Cleft repair remains a contentious issue in craniofacial surgery, especially regarding the optimal timing and techniques. This study aims to present our institutions' current protocol for cleft lip and palate repair, including alveolar bone grafting (ABG).

Methods: A total of 17 patients (20 clefts) treated with the latest protocol from 2016 to 2023 were evaluated. Demographic and clinical data were obtained from electronic charts. The protocol includes lip repair at 3 months, soft palate repair at 1 year, and hard palate closure with concurrent ABG at 2 years.

Results: Mean graft height and thickness scores were 2.3 and 2.2, respectively. Three clefts showed scores marginally below the threshold for thickness, potentially requiring regrafting. Malocclusion was minimal with no significant crossbites or velopharyngeal insufficiency.

Conclusions: Our modified protocol, emphasizing early hard palate closure with ABG, yields satisfactory outcomes in terms of graft height and thickness. Although long-term follow-up is warranted, our approach seems safe and efficient, potentially improving outcomes compared with traditional methods.