Plastic and Reconstructive Surgery Global Open最新文献

Background: Abdominal wall reconstruction represents an ambitious and demanding challenge. This study aimed to illustrate the versatility of the anterolateral thigh (ALT) flap in its different designs for the reconstruction of complex defects of the abdominal wall.

Methods: Charts of patients with complex abdominal wall defects who underwent a reconstruction with an ALT flap at the University Hospital of Zurich (2018-2020) were reviewed retrospectively. Patient characteristics and ALT flaps used were analyzed in detail.

Results: Ten patients received a total of 12 ALT flaps. Free flaps were applied to defects in the upper third of the abdomen. All flaps were harvested with a fascial component. An iliotibial tract reinforcement was incorporated in 4 (33%) cases, and 1 case included a muscular component and motor nerve, to provide functional reconstructive potential. A total of 30% of cases experienced complications requiring surgical revision during a mean follow-up of 5 months.

Conclusions: The ALT flap represents a workhorse in abdominal wall reconstruction due to its versatility and anatomical proximity. Depending on the localization of the defect, this flap can be used in a pedicled or free microsurgical manner. The fascial component of the ALT fasciocutaneous flap and of the extended iliotibial tract provides stable fascia for reinforcement or fascial reconstruction of the abdominal wall. Raised as a chimeric flap with vastus lateralis muscle and motor branch of the femoral nerve, it is a viable option for functional reconstructions.

Background: This study evaluated the sensory and breast pain outcomes in inferior versus superomedial pedicle breast reduction.

Methods: Twenty patients undergoing the inferior pedicle technique were matched to 20 patients undergoing the superomedial pedicle technique based on age, BMI, and resection weight. Patients were evaluated preoperatively and postoperatively at 1, 3, 6, and 12 months. Monofilament testing was performed on the nipple-areola complex (NAC) and surrounding breast. Patient-reported outcomes included nipple and breast sensation (5-point Likert scale), pain intensity (0-10), and the Patient-reported Outcome Measurement Information System Neuropathic Pain Quality scale.

Results: At the NAC, mean monofilament values and patient-reported sensation were significantly better in the inferior versus the superomedial pedicle group at 1 and 3 months postoperatively (P < 0.05) and comparable at 6 and 12 months (P > 0.05). At 12 months, 72.5% of patients reported complete (5 of 5) nipple sensation (77.5% inferior versus 67.5% superomedial, P > 0.05). At the breast, the mean monofilament values and patient-reported sensation were similar between pedicle groups throughout follow-up. At 12 months, 82.5% of the patients reported complete (5 of 5) breast sensation (85.0% inferior versus 80% superomedial, P > 0.05). Rates of postoperative breast pain were similar between groups throughout follow-up (P > 0.05). At 12 months, 25% of patients reported breast pain, with neuropathic qualities in 85% of cases.

Conclusions: The inferior pedicle may allow for earlier restoration of quantitative and patient-reported NAC sensation, but long-term sensation is comparable between techniques. A quarter of patients reported persistent breast pain regardless of the pedicle type.

Pyoderma gangrenosum (PG) is a rare, often idiopathic, noninfectious inflammatory neutrophilic dermatitis that causes painful ulcerative cutaneous papillomatous lesions. PG often mimics surgical infection, wound dehiscence, and postoperative cellulitis, leading to high rates of misdiagnosis and mistreatment. Here, a healthy 17-year-old adolescent girl with congenital breast asymmetry, macromastia, and a history of only mild intermittent autoimmune conditions developed an open wound along her inferior left breast incision 2 weeks after reduction mammoplasty. With continued enlargement and development of new ulcerative lesions despite appropriate local wound care, clinical suspicion for PG was raised. Standard treatment with oral prednisolone and topical tacrolimus led to incomplete resolution, and subsequent regression on attempts to taper the corticosteroid. Transition to oral cyclosporine with continued daily topical tacrolimus ultimately led to complete healing. This case underscores the need for a high clinical suspicion for PG in nonhealing ulcerative lesions after breast surgery, in addition to the importance of timely initiation of immunomodulatory agents and modification of the regimen if incomplete resolution is encountered.

Background: The use of fat grafting has expanded to include cell and tissue regeneration, necessitating investigations to ensure the viability of stromal and adipose-derived mesenchymal stem cells (ASCs) within the transferred fat parcels. This study explored the impact of harvesting technique and centrifugation on the viability of stromal cells and ASCs in lipoaspirate.

Methods: Fat was harvested from patients undergoing fat grafting using 2 types of liposuction cannula: (A) a 3-mm blunt tip cannula with 3 smooth holes and (B) a 2.4-mm, sharp point port, multihole blunt tip cannula. Fat from cannula B underwent different processing methods: no centrifugation, 300g, 600g, and 900g centrifugation. Stromal cells were isolated, quantified, and evaluated for viability. ASCs were cultured from these samples to confirm survival.

Results: Lipoaspirates from 21 patients were analyzed. The mean stromal cell counts were 0.937 × 10⁹ ± 0.346 × 10⁹/mL for cannula A and 0.734 × 10⁹ ± 0.266 × 10⁹/mL for cannula B (P = 0.684), with viabilities of 98.79% and 98.22% (P = 0.631), respectively. ASCs isolated and after 2-passage culture were also higher for cannula A. Stromal cell quantification and viability were lowest in the noncentrifuged group (P < 0.05) and highest in the 600g centrifugation group.

Conclusions: Fat harvesting using cannulas A and B showed no significant difference in stromal cell yield or viability. Handheld syringe liposuction preserved stromal vascular fraction cell and ASC viability. Centrifugation at different speeds did not significantly affect stromal cell viability.

Aphallia is an exceedingly rare congenital malformation. The condition is the result of a sporadic anatomic anomaly during fetal development in a 46, XY male patient with otherwise normal functioning testes and male sexual hormone metabolism. Neophallus reconstruction using the De Castro phalloplasty technique is currently the most accepted treatment modality for this condition. However, most case reports in the literature do not use tissue expansion. To achieve a larger neophallus and possibly decrease the need for secondary phalloplasty postpuberty, tissue expansion should be a standardized adjunct to the De Castro procedure in the management of all patients with congenital aphallia.

Background: Postoperative dressings expedite wound healing and decrease the rate of infection. Options for wound dressings vary based on cost, time to apply, method of wound healing, and availability at the hospital; however, a significant difference in postoperative complications between each type has not been found. As such, this study evaluates patient cosmetic preferences for various wound dressings as it relates to early postoperative satisfaction.

Methods: A cross-sectional study was conducted using an online crowdsourcing service that connects research studies to participants. The survey asked users to rate images of various wound dressings. Steri-Strips, Dermabond PRINEO (Johnson & Johnson, Ethicon, Inc.), gauze, surgical tape, and metal staples were the materials assessed. The ratings, based on cleanliness, compactness, and aesthetics, culminated in an average cosmetic score for each dressing.

Results: Controlled for demographics, Steri-Strips and staples were the highest rated dressing types by participants and may correlate with increased patient satisfaction in the immediate postoperative period. Gauze was highly rated for aesthetics and cleanliness but averaged lower scores due to dressing bulk. Dermabond and surgical tape had the lowest and second lowest cosmetic score, respectively.

Conclusions: Although cost, availability, and time to apply are common factors surgeons evaluate when picking a dressing, cosmetic preference is another consideration. Allowing the patient to participate in dressing selection may give them more perceived autonomy and increase immediate postoperative satisfaction. Limitations of this study include limited lighting/positioning standardization of dressing photographs. This analysis does not consider opinions on later wound healing or scarring using the chosen material.

Liposuction is a common procedure for patients with lymphedema with nonpitting adipose tissue hypertrophy. However, routinely, the lipoaspirate is discarded. Experimental studies have shown that adipose-derived stem cells in fat may enhance the regenerative and lymphangiogenic effects of the fat. Recent evidence has shown that lymphedema fat is enriched in adipose-derived stem cell populations, thus making it an interesting regenerative option. This article introduces a novel surgical technique using the lipoaspirate of a patient with lymphedema for regenerative purposes. A 42-year-old woman developed lymphedema 18 months after mastectomy and axillary lymph node dissection surgery. The patient underwent upper limb liposuction and latissimus dorsi flap reconstruction of the breast. Lipofilling of the flap and axillary area after scar release was performed using suctioned lymphedema fat. The results showed a sustained reduction in the volume of the lymphedema arm, an improved lymphatic transport index, decreased fluid extravasation, and new lymphatics in the upper arm. At 64-month follow-up, the patient had good breast symmetry, had minimal swelling of the lymphedema arm, and rarely used compression garments. This report is the first to use lymphedema fat for regenerative purposes, differentiating it from existing literature that uses healthy fat. In conclusion, successful dual-effect fat grafting with lymphedema fat presents a promising avenue for further investigation. This innovative approach addresses breast cancer-related lymphedema and offers potential benefits in regenerative and lymphangiogenic effects without the need for microsurgical expertise. This case report emphasizes the importance of exploring this novel option for future research and clinical applications.

Background: Instagram has become one of the most powerful marketing tools available to plastic surgeons because patients have increasingly turned to online resources to find physicians. Within, we review the online presence of self-ascribed plastic surgeons in the United States to identify potential misinformation and dishonest advertising.

Methods: The Inflact database was queried for the search terms: "plastic surgeon/surgery," "plastic and reconstructive surgeon/surgery," "aesthetic surgeon/surgery," and "cosmetic surgeon/surgery." US physician account information, history of medical training, American Board of Plastic Surgery (ABPS) certification status, and posts were reviewed.

Results: In total, 1399 physicians practicing within the United States were identified. Most attended medical school in the United States (93%), a minority received integrated plastic surgery training in the United States (14%), and the majority attended general surgery residency in the United States (57%) followed by independent plastic surgery residency in the United States (50%). Altogether, 1141 individuals were explicitly listed as "plastic surgeons" on Instagram, nearly a quarter of these (325 individuals, 28%) were not certified by the ABPS, and nearly a fifth (251 individuals, 22%) received no training in plastic surgery.

Conclusions: Nearly one-third of "plastic surgeons" on Instagram are not certified through the ABPS. This is detrimental to the reputation of plastic surgery and has the potential to create broader consequences and may lead to patients mistakenly receiving care from unqualified physicians. It is paramount that plastic surgeons create a united front against such endeavors through advocacy efforts within the American Society of Plastic Surgeons.