Plastic and Reconstructive Surgery Global Open最新文献

Background: Postbariatric abdominoplasty carries an increased risk of perioperative bleeding due to extensive dissection and tissue fragility. Tranexamic acid (TXA) effectively reduces blood loss in several surgical fields, but evidence in postbariatric body-contouring surgery remains limited.

Methods: A single-center, retrospective pilot study of 200 postbariatric abdominoplasty patients was conducted. One hundred patients received perioperative TXA (intravenous and local), and 100 historical controls did not. Outcomes measured included hemoglobin drop, 24-hour drain output, complications, and hospital stay.

Results: TXA use significantly reduced hemoglobin drop (1.6 ± 0.5 versus 3.1 ± 0.7 g/dL; P < 0.001), drain output (82 versus 154 mL; P < 0.01), and hospital stay (3.0 ± 0.4 versus 4.3 ± 0.6 d; P < 0.001). No thromboembolic events occurred.

Conclusions: TXA is associated with reduced blood loss and shorter hospitalization in postbariatric abdominoplasty, without increased thromboembolic risk. TXA should be considered as part of perioperative management for this population.

Background: Cleft lip and/or palate are among the most common congenital anomalies, often accompanied by systemic comorbidities. In rural regions such as Appalachia, barriers to healthcare access may delay comprehensive diagnosis and multidisciplinary care.

Methods: A retrospective review of 83 patients with cleft anomalies treated between 2017 and 2021 at a rural academic hospital in West Virginia was conducted. Demographics, cleft type, functional impairments, comorbidities, and syndromic associations were analyzed. χ² tests were used to assess associations.

Results: Forty-one out of 83 patients were female, and the most common defect was an isolated cleft palate (n = 44). Isolated cleft palate was the most common defect (53%), with a female predominance. Significant associations were found between cleft anomalies and cardiac (P < 0.000001), central nervous system (P < 0.000001), endocrine, gastrointestinal, renal, genitourinary, and musculoskeletal comorbidities. More than 25% (n = 22) of patients had a known genetic or chromosomal syndrome, particularly those with isolated cleft palate (n = 18), followed by cleft lip and palate (n = 3). Functional impairments, including feeding (32.5%), speech (20.5%), and hearing (8.4%), were also common.

Conclusions: Multisystem comorbidities are prevalent among cleft lip and/or palate patients in the Appalachian region, especially in those with cleft palate. Early identification of associated anomalies is critical to guiding multidisciplinary management and improving outcomes in underserved populations.

Background: Otoplasty corrects auricular deformities, which affect 5%-10% of the global population and can significantly impact psychological well-being, especially in children. This review examined various otoplasty surgical techniques, clinical outcomes, complications, and emerging innovations, with a focus on prominent ear correction.

Methods: A literature search was conducted in November 2024 on PubMed/MEDLINE and Web of Science using the query "otoplasty," identifying 1397 studies from 1915 to 2024. Studies were included if they detailed operative techniques, patient data (population >30), and mastoid-to-helical rim measurements. Exclusions included nonhuman studies, case reports, and incomplete data. Data extracted study characteristics, operative techniques, and complication rates. The Oxford Centre for Evidence-Based Medicine framework classified studies by evidence level.

Results: Eighteen studies with 1590 patients and 3060 ears were included. The average patient age was 16.0 years, with a mean follow-up of 24.5 months. The average preoperative mastoid-to-helical rim measurement was 27.1 mm, reduced to 15.4 mm postoperatively. Suture extrusion (5.4%) was the most common complication. Meta-analysis showed a pooled recurrence rate of 2.8% and revision rate of 2.1%. Cartilage-sparing techniques, as well as 4-0 polypropylene (Prolene) and 4-0 braided polyester (Ethibond) cartilage fixation sutures, showed favorable outcomes.

Conclusions: This review summarizes decades of research, highlighting effective techniques such as modified Mustardé-Furnas methods and cartilage-sparing approaches. Innovations and advancements in otoplasty, such as lasers, minimally invasive surgery, and postoperative care, demonstrate the field's evolution. Future research should focus on refining techniques and exploring animal models to improve otoplasty procedures.

Pyomyositis is a rare bacterial infection of skeletal muscle. Staphylococcus aureus is the most common pathogen. Pyomyositis is typically seen in tropical regions and/or in individuals with underlying conditions, and it usually affects the large muscles of the lower limbs and pelvis. We presented the case of a 60-year-old healthy man who developed pyomyositis of the sartorius muscle after sustaining a motorcycle-related contusion to his left knee. Thirteen days postinjury, he was admitted with severe thigh swelling, erythema, and systemic symptoms indicative of necrotizing soft-tissue infection. Laboratory tests revealed elevated inflammatory markers. Contrast-enhanced computed tomography was suggestive of an abscess within the sartorius muscle. Emergency surgery with incision and drainage was performed. S. aureus was isolated from the aspirated pus. The patient was treated with broad-spectrum antibiotics, including meropenem and vancomycin, followed by tailored antibiotic therapy based on culture results. Despite having an allergic reaction to one of the antibiotics, there was no recurrence, and the wound closed completely on postoperative day 11. Only 2 cases of sartorius pyomyositis have been reported previously. Thus, this condition is exceedingly rare. This case indicated that pyomyositis should be considered in patients with muscle infections after trauma, regardless of whether they are healthy and/or whether the anatomical location is unusual. This awareness will promote early diagnosis and the prompt institution of imaging-guided surgical and antibiotic intervention, thus ensuring favorable outcomes.

Immediate breast reconstruction has advanced significantly, yet optimal implant placement remains debated. Prepectoral implant-based breast reconstruction (IBR) offers aesthetic benefits but risks implant exposure and ptosis. Although acellular dermal matrices mitigate these risks, they pose complications such as infection, red breast syndrome, and high costs. Here, we aim to describe and evaluate our technique using the serratus anterior fascia as an autologous alternative for lower pole and lateral support in prepectoral IBR. All patients undergoing prophylactic or curative nipple-sparing mastectomy with immediate prepectoral direct-to-implant reconstruction between October 2023 and December 2024 received the hybrid plane technique and were included. In total, 10 patients received this technique (19 breasts). The mean age was 40.9 years, and the mean body mass index was 22.6 kg/m². All patients had pathogenic mutations, most commonly BRCA1. Three (30%) patients experienced complications, but no reconstruction failures occurred. Mean follow-up was 12.8 months. The absence of implant exposure despite postoperative complications, including wound dehiscence, highlights the safety and protection from the serratus anterior fascia. Similar to its use in subpectoral reconstruction, the serratus anterior fascia can improve prepectoral IBR, offering a safe and cost-free solution for total skin- and nipple-sparing mastectomies.

Background: As the diagnosis of breast cancer has increased during the past 2 decades, so too has the number of resection procedures, including mastectomies. Of the available reconstructive options postmastectomy, implant-based breast reconstruction (IBBR) predominates. Biologic scaffolds, such as human acellular dermal matrices, are routinely used to support tissue expanders and implants. However, human acellular dermal matrices have several limitations, including high infection rates, high cost, and supply concerns. Synthetic scaffolds address some of these concerns, though they differ significantly in time to resorption. In this study, we reported data from IBBR using polydioxanone (PDO) mesh.

Methods: This prospective, multisite, observational registry study evaluated the use of PDO mesh (DuraSorb) implanted during IBBR, including 2-stage and direct-to-implant procedures. Based on the timing of PDO mesh placement, success was defined as the placement of a permanent implant or completion of reconstruction in the absence of major adverse events requiring expander or permanent implant removal. Adverse events were also recorded.

Results: Procedural success with PDO mesh was 97.2% (n = 71), 96.9% (n = 32), and 75% (n = 4) when implanted at the time of the tissue expander, permanent implant placement, and direct-to-implant procedures, respectively. The incidence of infection, skin flap necrosis, and seroma requiring drainage was 6.5%, 12.2%, and 10.3% of breasts, respectively. No medical complications (deep vein thrombosis, pulmonary embolism, cardiac events, acute renal failure, difficulty weaning from the ventilator) were reported.

Conclusions: IBBR using PDO mesh demonstrated favorable safety and performance outcomes in this observational study.

Reconstruction of the penile shaft represents a complex surgical challenge, especially when both cutaneous and urethral components are involved. Although total phallic reconstruction is well established, partial ventral penile defects lack standardized treatment strategies, particularly in older or multimorbid patients unfit for microsurgical procedures. We present the case of a 78-year-old man with a 2.5 × 3.5 cm full-thickness ventral shaft defect and associated urethral involvement, secondary to Fournier gangrene. A 3.0 × 5.0 cm freestyle propeller flap based on the deep external pudendal artery was designed and harvested. Urethral continuity was restored by suturing a buccal mucosal graft to the internal surface of the flap. The procedure was performed without microsurgical anastomosis, using a minimally invasive approach suitable for high-risk surgical candidates. The postoperative course was uneventful, with spontaneous resolution of minimal venous congestion. At 12-month follow-up, the patient demonstrated complete recovery of normal urinary function, excellent aesthetic results of the penile shaft, and stable flap viability with preserved urethral patency. The deep external pudendal artery-based propeller flap offers a reliable, reproducible, and low-morbidity solution for partial penile shaft reconstruction, combining functional and cosmetic restoration. This technique represents a valuable alternative for patients at high surgical risk who are not candidates for microsurgical phalloplasty. Further anatomical and clinical studies are needed to consolidate its indications.

Background: Urinary tract infections (UTIs) at the time of surgery have been associated with worse postoperative outcomes in various surgical specialties, but their impact in plastic surgery remains poorly understood.

Methods: We analyzed National Surgical Quality Improvement Program data (2012-2023) for adult elective plastic surgery patients to determine the relationship between preoperative UTI and postoperative outcomes. Logistic regression estimated odds ratios adjusted for clinical covariates.

Results: A total of 319,511 elective plastic surgery patients were analyzed, among whom 117 (0.04%) had a documented preoperative UTI. Preoperative UTI was associated with significantly worse outcomes. The incidence of postoperative wound infection was markedly higher in the UTI group, and multivariable logistic regression confirmed preoperative UTI as an independent predictor of surgical site infection with an adjusted odds ratio of 5.87 (95% confidence interval: 1.54-22.36, P = 0.009). Additionally, patients with UTIs had prolonged hospital stays (12.2 versus 1.3 d, P < 0.001), were more likely to return to the operating room (11.1% versus 3.7%, P < 0.001), and had a substantially higher 30-day mortality rate (4.3% versus 0.1%, P < 0.001). They were also more likely to require postdischarge care at a facility rather than returning home.

Conclusions: Preoperative UTI, although infrequent, significantly increases postoperative complications in elective plastic surgery patients, including surgical site infections, mortality, and discharge to a care facility. These findings support more aggressive preoperative screening and the postponement of elective procedures until UTI resolution.

Vascular occlusion is an uncommon but serious complication of hyaluronic acid filler injections. If not recognized and managed early, it can lead to ischemia and even skin necrosis. Timely diagnosis and intervention are therefore crucial to minimize tissue damage and avoid long-term consequences. With the rising popularity of chin augmentation procedures, awareness of these rare complications is increasingly important for aesthetic practitioners. This report describes the case of a 54-year-old woman who presented with increasing pain, skin discoloration, and livedo reticularis approximately 24 hours after she had received hyaluronic acid filler injections in her chin. Clinical examination revealed delayed capillary refill time and mottled skin changes across the chin and neck. The high-dose pulsed hyaluronidase protocol was initiated 25 hours after injection. A total of 2850 IU of hyaluronidase was administered in a series of doses during a 15-hour period. Alongside enzyme therapy, the patient received oral aspirin, warm compresses, and gentle massage. Her symptoms improved quickly, and by day 21, she had fully recovered with no scarring or volume loss. This case highlights that even minimal filler volumes can trigger vascular occlusion. Preparedness to identify the vascular complications and apply the high-dose pulsed hyaluronidase protocol is essential to ensure full recovery and safeguard patient outcomes.

Various surgical procedures were proposed for cosmetic alar reduction, but concerns including prominent scars and unnatural appearence remain. From January 2023 to January 2025, the author performed alar reduction using a modified rotation-advancement alar flap technique in 80 Asian patients. All 80 patients were followed up for 3-12 months (average 10.6 mo). Patients' satisfaction was assessed with a questionnaire focusing on profile improvement and scar prominence. The modified rotation-advancement alar flap technique was shown to be less invasive. It simultaneously improved nostril show, flared alae, and bilateral symmetry, yielding a natural and aesthetic outcome in Asians.