Plastic and Reconstructive Surgery Global Open最新文献

Background: Lower eyelid retraction is a common feature of thyroid eye disease (TED). Various spacer materials have been used for surgical correction, but long-term data on donor sclera are missing.

Methods: A retrospective study of all TED patients treated with donor sclera to correct lower eyelid retraction was performed at the Department of Ophthalmology, Haukeland University Hospital, from 1999 to 2023. Data were obtained from hospital records and follow-up examinations. Outcomes were graded as perfect (scleral show of 0 mm), acceptable (0 mm < scleral show ≤ 1 mm), and unacceptable (scleral show >1 mm).

Results: Thirty-five patients (29 women, 6 men) with a median age (range) of 57 (20-79) years and a median time from TED onset to surgery of 72 (12-468) months were included. At first follow-up, 3 (0.03-12) months postoperatively, scleral show improved significantly (P < 0.001) from 2 (1-6) mm preoperatively to 0 (0-4) mm, and margin reflex distance 2 (MRD2) decreased significantly from 7 (6-11) to 5 (4-9) mm. A perfect or acceptable result was achieved in 83% of patients. Estimated graft survival rates were 93.9% at 5 years and 54.2% at 25 years. At final follow-up, 84 (12-275) months postoperatively, a perfect or acceptable outcome was found in 46%. No significant difference (P = 0.808) was observed between the preoperative MRD2 of 7 (6-11) mm and long-term postoperative MRD2 of 7 (5-11) mm.

Conclusions: Correction of lower eyelid retraction with donor sclera in TED patients provides satisfactory short-term outcomes. However, over time, relapse of retraction commonly occurs.

This study evaluated whether echogenic needles improve ultrasound visibility during hyaluronic acid filler injections in the cheek-a high-risk area due to anatomical variability of facial vessels. In a single-patient in vivo setting, 3 types of needles (23G nonechogenic and 23G and 30G echogenic) were tested under ultrasound guidance. Echogenic needles showed better tip and shaft visibility across angles and depths, including dynamic movement. Reviewers noted greater procedural confidence and a reduced need for probe adjustment. These findings suggest that echogenic needles may enhance safety and precision in ultrasound-guided aesthetic procedures.

Background: Dupuytren disease (DD) is a benign fibroproliferative disorder affecting the hand. Although diabetes mellitus is a known risk factor, the underlying mechanisms behind this association remain unclear. This study aimed to examine the relationship between glycemic control and DD in type 1 (T1D) and type 2 diabetes (T2D), and to identify other metabolic risk factors influencing DD risk.

Methods: In this retrospective registry study, data from the Swedish National Diabetes Register and the Skåne Healthcare Register were cross-linked. In total, 96,039 individuals aged 18 years or older with T1D or T2D were included. Sex-stratified, multivariable logistic regression models calculated associations between HbA1c levels and DD risk. Interaction analyses evaluated whether diabetes duration modified the association between HbA1c levels and DD risk.

Results: Longer diabetes duration consistently increased the risk of DD in both T1D and T2D groups. A trend toward increased DD risk with higher HbA1c levels was seen in T1D (P > 0.05). Higher body mass index was inversely associated with DD in men and women with T2D (P < 0.05). No interaction was observed between HbA1c levels and diabetes duration.

Conclusions: Diabetes duration seems to be a strong and independent risk factor for DD in T1D and T2D. Although a trend toward higher DD risk with elevated HbA1c was observed in T1D, no interaction with diabetes duration was found. A higher body mass index was associated with a lower risk of DD in individuals with T2D.

This single-case histological study evaluated the safety and tissue effects of dual-depth injections of poly-L-lactic acid (PLLA) and hyaluronic acid (HA)-based skin booster administered into the same anatomical region. A 77-year-old woman received PLLA in the subcutaneous fat layer and HA in the deep dermis/subdermal layer of the right jowl. The untreated left side served as a control. Histological analysis revealed that PLLA induced a localized foreign-body reaction with increased fibroblast activity, dense collagen, and elastic fiber formation in the subcutaneous layer, indicative of extracellular matrix remodeling. HA-treated dermal layers showed mild matrix compaction and low-grade inflammation, consistent with the hydration effects. There was no histological evidence of filler overlap or adverse interaction. Three-dimensional imaging further supported volumetric enhancement and tissue elevation on the treated side. The results demonstrate that when spatially separated by depth, PLLA and HA can exert independent, synergistic effects without compromising safety. This dual-layer approach may offer a novel strategy for targeted skin rejuvenation in clinical practice. In this single-patient case, layer-separated PLLA and HA elicited independent, compartment-specific tissue responses without observed interaction. Findings are descriptive and anecdotal and should not be generalized without larger, controlled studies incorporating quantitative volumetry and histomorphometry.

The thumb is important for hand function; therefore, functional reconstruction after amputation is necessary. Traditional methods, such as wrap-around flap (WAF) and twisted WAF, often involve extensive tissue harvest from the toes. This report introduced a novel approach using a WAF augmented with a superficial palmar branch of the radial artery (SPBRA) flap, which enabled effective reconstruction with reduced donor-site morbidity. A 31-year-old man sustained a traumatic thumb amputation during a cattle-handling accident. Emergency replantation was unfeasible due to severe vascular avulsion. Preoperative computed tomography angiography identified a proximally branching SPBRA, enabling reconstruction using the SPBRA flap-augmented WAF technique. This method allowed effective thumb reconstruction while reducing donor-site complications. The SPBRA flap was harvested 4.9 cm proximal to the radial styloid, enabling primary donor-site closure without additional toe tissue harvest. Although not suitable for all cases, this approach optimizes functional and aesthetic outcomes, offering a less invasive alternative for thumb reconstruction.

Up to 16.6% of facial lacerations involve the eyebrows, and regional scarring often results in hair loss known as cicatricial alopecia (CA). Secondary CA following eyebrow lacerations is often irreversible, resulting in poor aesthetic outcomes and psychological distress. The current gold standard for treating CA is hair transplantation, but this is a painful and invasive procedure. We present 2 cases of patients who experienced eyebrow lacerations, 1 with chronic secondary CA and the other in the setting of acute facial trauma without eyebrow CA. Serial daily topical application of stem cell serum (Calecim) was commenced for both patients. Following 6 months of treatment, the patient with chronic secondary CA experienced regrowth of eyebrow hair, whereas the patient treated earlier retained their eyebrow hair and did not develop secondary CA. We propose stem cell serum as an effective, noninvasive treatment option for patients with chronic secondary CA to aid in hair regrowth. Furthermore, stem cell serum could be considered as an early treatment in acute eyebrow trauma for the prevention of CA development and hair retention.

Background: Cleft lip and/or palate (CL±P) is among the most common congenital craniofacial anomalies, with affected children at high risk of malnutrition due to feeding difficulties. This study aimed to determine the prevalence and factors associated with preoperative malnutrition among patients with nonsyndromic CL±P in Rwanda.

Methods: A multicenter cross-sectional study was conducted over a 1 year period among children younger than 5 years undergoing primary cleft repair. Nutritional status was assessed using the World Health Organization growth standards. Malnutrition was defined as stunting (height-for-age z score ≤ -2) or wasting (weight-for-length z score ≤ -2). The data were analyzed using descriptive statistics, bivariate analysis, and logistic regression.

Results: Of 116 infants, the median age was 6.5 months (interquartile range: 3-10 mo), and 64% were male. The overall prevalence of malnutrition was 47% (95% confidence interval: 38-56). Stunting was observed in 41% (19% moderate, 22% severe) and wasting in 9% of the patients. Malnutrition was significantly associated with older infant age (P = 0.0099), lack of postnatal nutrition education (P = 0.0232), nonbreastfeeding at the time of surgery (P = 0.0088), early introduction of complementary feeding (P = 0.0034), cow's milk consumption (P < 0.001), and having both cleft lip and palate (P = 0.0101). On multivariate analysis, the consumption of cow's milk (P = 0.001) and cleft type (palate or lip and palate) (P = 0.028) remained significant factors.

Conclusions: Nearly half of the cleft patients operated on were malnourished preoperatively. Strengthening preoperative nutritional support is essential to reduce this burden.

Advanced primary lymphedema is challenging to treat and imposes physical and psychosociological burdens on patients. Currently, vascularized lymph node transfer and modified Charles procedures are recommended for late-stage patients due to the limited functional superficial lymphatics required for conventional lymphovenous bypass. However, the reconstruction involves radical resection of tissue and changes in lymphatic flow, resulting in prolonged recovery time, high complication rates, and emotional and economic burdens on the patients. The authors proposed a novel alternative for treating stage II primary lymphedema using a duo-plane lymphovenous bypass. The innovation involves anastomosing the collecting lymphatics in the deeper subcutaneous tissue to superficial venules. The technique benefits from accessing functional lymphatics with preserved architecture, a larger vessel diameter, and a well-defined anatomical location to optimize drainage and prevent venous backflow using the Venturi effect. The duo-plane lymphovenous bypass procedure warrants significant volume reduction, faster recovery, and minimal scarring, thus providing a less-invasive treatment option for patients with advanced primary lymphedema.

Toxic shock syndrome (TSS) is a severe postoperative infection characterized by rapidly progressing systemic symptoms, although local findings are typically unremarkable. Therefore, understanding its pathogenesis and ensuring early diagnosis are critical. To date, only 5 cases of TSS caused by methicillin-resistant Staphylococcus aureus have been reported in the context of breast reconstruction. We report a case of total mastectomy for breast cancer where a tissue expander was used. On postoperative day 12, the patient had hypotension, high fever, decreased consciousness, renal dysfunction, and gastrointestinal symptoms, indicating significant systemic deterioration. However, local findings at the surgical site were minimal, demonstrating a marked discrepancy between systemic manifestations and local signs. The patient was diagnosed with methicillin-resistant S. aureus-induced TSS, and the primary treatment strategy involved the complete removal of the capsule and the administration of intravenous antibiotics.

Background: Subcutaneous lasers represent a paradigmatic change in aesthetic procedures and have increased the demand for effective and minimally invasive treatments for fat compaction and skin sagging, revolutionizing face and body contouring techniques. Selective photothermolysis induced by the 1210-nm lasers can modulate fat without inducing damage to the surrounding tissues.

Methods: This pilot study evaluated a minimally invasive technique using a subcutaneous 1210-nm laser for face and body contouring using a 3-dimensional imaging technique.

Results: This study evaluated 5 facial and 10 abdominal body contouring cases using the minimally invasive lipolifting technique in a single session. Patients, predominantly woman (80%) with a mean age of 36 years, were assessed before procedure and at least 90 days after procedure. Facial treatments demonstrated average volume reductions of 2.06 mm³ in the cheek, 3.02 mm³ in the jowl, and 1.42 mm³ in the jawline regions. Among body contouring patients, most were classified as overweight and exhibited an average waist circumference reduction of 3.81 cm (SD = 1.86 cm). All patients rated their aesthetic outcomes as "very much improved" on the Global Aesthetic Improvement Scale throughout the follow-up period.

Conclusions: The 1210-nm laser technique proved to be safe and effective in enhancing facial and body contours through adipose tissue compaction. Additionally, it reduced skin laxity by inducing a regenerative response, promoting the differentiation of adipose-derived mesenchymal cells into fibroblasts, and stimulating collagen production.