Plastic and Reconstructive Surgery Global Open最新文献

This case involves a 58-year-old man who sustained a severe left forearm injury from a motor vehicle accident. Imaging revealed comminuted fractures and arterial occlusions in the left forearm. As the injury was crush type and exploration revealed vessels with avulsion, the decision was made to perform amputation due to nonsalvageability. The patient underwent irrigation, debridement, and amputation, followed by coverage via a full-thickness skin graft from the amputated hand. Postoperatively, the patient received antibiotics and wound care, resulting in successful graft integration and healing. This case highlights the use of a full-thickness skin graft from the amputated limb for stump coverage, demonstrating that if the patient refuses to take a graft from other common sites, the amputated dorsum of the hand can be an excellent alternative site.

Background: Cosmetic appearance of incisions remains one of the most important aspects of the patient recovery experience. Despite advances in surgery, scar prevention is the gold standard in improved results. Closed-incision negative pressure wound therapy has shown promise in decreasing surgical site infection and healing time. This study aimed to assess outcomes of primarily closed surgical incisions with mechanically powered negative pressure dressings (MP-NPDs) compared with standard dressings.

Methods: This study was a single-center, within-subjects, randomized controlled trial, in which each patient served as both the control and experimental arms. Laparoscopic/robotic port site incisions were randomized to control dressing or MP-NPD. Primary outcomes were cosmetic results at first clinic visit by blinded physicians and nonphysician observers.

Results: Forty patients with a total of 80 incisions were included in the analysis. The average scores for scar spread, erythema, dyspigmentation, scar hypertrophy, and overall impression were lower for the MP-NPD wounds. The only individual variable of the Scar Cosmesis Assessment Rating scale, in which there was no difference noted between the 2 groups, was the presence of suture marks. The average total Scar Cosmesis Assessment Rating score was significantly lower (more favorable) for the MP-NPD wounds compared with the control wounds (3.39 ± 3.18 versus 4.79 ± 3.18, respectively; P < 0.001).

Conclusions: The use of closed-incision negative pressure wound therapy with the application of a novel MP-NPD over surgical incisions resulted in clinical and statistically significant improvement in scar cosmesis in the early/intermediate postoperative period according to both physician and nonphysician observers.

Scar formation is a foreseeable outcome in wound healing. Patients frequently undergo scar revision to improve aesthetic appearance or function. Herein, we present the case of a 49-year-old woman who presented with a painful scar on the abdominal wall. High-resolution computed tomography failed to reveal any underlying source of the abdominal pain. During scar revision, she was found to have extensive fibrosis resulting from a foreign-body response to spinal debris.

Background: The superficial circumflex iliac artery perforator (SCIP) flap has several advantages in hand reconstruction. It is thin and pliable, the extensive branching of the arterial system allows for multiple components, and the donor site can be closed inconspicuously. This article reports our experience using the SCIP flap for hand reconstruction, and we highlight the flexibility of the SCIP for extended and chimeric flaps.

Methods: We conducted a retrospective cohort study from November 2022 to January 2024 of patients with complex hand defects (exposure and/or defect of the bone or tendon) who underwent reconstruction with an SCIP flap. The plane of dissection was above the layer of superficial fascia. In overweight patients, the superficial fat lobules were removed under the microscope to thin the flap. Tailoring, chimeric, and supercharged flaps were constructed as needed for complicated hand defects. Data collected included defect characteristics, flap design, and outcomes.

Results: A total of 44 flaps were performed on 43 patients. The average flap length was 17.8 cm (range 10-42 cm), the average flap width was 7.6 cm (range 2-11 cm), and the average flap thickness was 2.5 mm (range 2-4 mm). Hand defects were reconstructed with 9 chimeric flaps, 8 tailored flaps, 3 chimeric and tailored flaps, and 2 supercharged flaps. Overall, 42 flaps (95.5%) survived and 2 flaps (4.5%) experienced necrosis.

Conclusions: The SCIP flap is a reliable option for complex hand defect reconstruction. This technique can provide a large, thin, pliable skin paddle incorporating components from the external oblique fascia and iliac bone. We did not encounter any recurrent issues when using it as a supercharged flap, tailored flap, or chimeric flap. Reconstructive surgeons should develop comfort with the SCIP flap in hand reconstruction given its versatility.

Background: Emerging research underscores the heightened risk of vasculitis and microvascular thrombosis in COVID-19 patients, alongside concerns about prothrombotic events post-severe acute respiratory syndrome coronavirus 2 vaccination. Following the pandemic's end, we sought a comprehensive analysis to elucidate its impact on microsurgical thrombosis rates, informed by empirical and anecdotal evidence.

Methods: An institutional review board-approved retrospective review analyzed autologous breast reconstruction cases in women from January 2019 to March 2022. Data on patient history, COVID-19 infection, vaccination status, and postoperative complications were collected. Patients were categorized as prepandemic and pandemic, and based on COVID-19 influence (infection or vaccination) for statistical evaluation.

Results: Among 527 patients, 216 underwent surgery prepandemic and 311 during the pandemic, revealing thrombotic event rates of 3.2% and 5.4%, respectively. Further comparative analysis showed no significant difference in thrombotic events among patients affected by COVID-19 through infection or vaccination during the pandemic.

Conclusions: Contrary to concerns, COVID-19 infection or vaccination status does not significantly increase thrombotic event rates in deep inferior epigastric perforator flap breast reconstructions. This study offers vital insights, affirming the safety and efficacy of microsurgical procedures amid the pandemic, thereby guiding microsurgeons in optimizing patient care in the post-COVID-19 era.

Background: The supraclavicular artery island flap (SCAIF) has been used extensively to reconstruct postburn scars in the head and neck region. Its landmark and vascular supply from the supraclavicular artery have been demonstrated before. The aim was to assess its versatility following an increase in pedicle length to be supplied by the transverse cervical artery, along with tunneling the pedicle under the sternocleidomastoid muscle to reach distant sites that the classic SCAIF could not reach.

Methods: A retrospective analysis was conducted of 25 consecutive patients in whom SCAIFs were performed to reconstruct remote head and neck postburn scars. Pedicle length, flap diameter, and complications were recorded with demographic and burn-related data.

Results: The study included 18 (72%) men and 7 (18%) women. The mean age was 15.7 years, and the mean injury time was 15 months before flap transfer. Isolated neck injury was the most affected site (44%). The mean length and width of the SCAIF were 16.6 and 6.5 cm, respectively. The mean length of its extended vascular pedicle based on transverse cervical artery was 7.2 cm. The donor site was closed primarily in all cases. All flaps survived completely, except 2 (8%) that exhibited partial necrosis.

Conclusions: The SCAIF is reliable for reconstructing postburn deformities in the head and neck region. Our results indicate that the increased pedicle length and the submuscular tunnel allow reliable distant flap transfer without the risk of excessive traction or vessel kinking.

Background: Robin sequence is an anomaly of micrognathia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) performed in early infancy relieves airway obstruction and improves feeding difficulties. Though clinical outcomes data for MDO are strong, studies examining the cost drivers of the procedure are scarce.

Methods: A retrospective 10-year single-institution chart review examined medical and billing records of infants undergoing MDO at an urban tertiary care center. Data included hospital charges, patient characteristics, comorbidities/complications, intubation duration, and length of stay (LOS). Multivariate regression analysis determined significant cost contributors over the course of admission. Conclusions from this smaller sample were compared with analyses from a larger, less detailed, population-based inpatient registry using the Kids' Inpatient Database (2016 and 2019).

Results: In the single-institution analysis, 29 cases were identified with a mean age of 12 days at hospital admission. Mean postoperative and overall LOS were 19 ± 10 and 31 ± 13 days, respectively. Mean total charges were $287K-$118K. The most significant driver of total charges was floor charges (P < 0.01). LOS was a proxy for floor charges, as they were highly correlated (r = 0.98). LOS was significantly driven by intubation duration (P = 0.01). In the nationwide analysis, 165 weighted cases were identified; mean age was 2 months at hospital admission. Mechanical ventilation >96 hours was associated with increased LOS and hospitalization costs.

Conclusions: Of infants with Robin sequence undergoing MDO, the most significant driver of total charges was LOS. Intubation duration was highly associated with LOS.

Total breast reconstruction using only a latissimus dorsi flap (LDF) often has a problem of insufficient volume. Recently, a fat-augmented LDF has been introduced as a solution to this problem. However, there are still many cases in which augmentation with fat grafting alone is not enough to achieve symmetrical breasts. Here, we discuss a new approach for full breast reconstruction, which we refer to as tribrid reconstruction, that combines the fat-augmented LDF with a breast implant. Depending on the need for a skin island, the LDF or muscle flap is harvested and augmented with fat grafting, either to the flap itself or by injecting fat into the pectoral muscle or the subcutaneous tissue of the chest. In cases in which this does not correct asymmetry, an implant is added to enhance the breast volume. This 3-component reconstruction method was applied in 9 cases, and all achieved sufficient postoperative volume and satisfactory aesthetic results. This technique can be used in a single surgery to reconstruct both moderately sized and larger breasts.

Total nasal defects, including adjacent soft tissue damage, present a challenge for plastic surgeons, and in this case, free flaps should be an alternative when local flaps are limited. However, the importance of donor site morbidity must be taken into account for free flaps. Due to flap bulkiness, the anterolateral thigh (ALT) free flaps are less commonly used to restore nasal structures. Our case used a thinned ALT flap to reconstruct the entire nasal defect and part of the upper lip due to the resection of poorly differentiated squamous cell carcinoma. Two ALT flaps were harvested to reconstruct a 10 × 6 cm defect spanning the entire nose and part of the upper lip. Both skin paddles were thinned to a minimum of 4 mm thickness. A costal cartilage graft was used to create a framework for structural support. The donor site was closed with local flaps and skin grafts. No complications were noted during follow-ups. After 24 months, the patient had an excellent nasal contour that matched her skin tone and had no airway obstruction. The thinned ALT chimeric flap can be ideal for large defects composed of multiple anatomical units, even in the facial region. Its advantages are that it is thin, flexible, and well vascularized and can provide favorable aesthetic results with minimal donor site morbidity.

Background: Massive weight loss can often lead to skin redundancy and affect a patient's quality of life. Abdominoplasty has grown in popularity due to its cosmetic and functional effects. There is currently a paucity in the patient-reported outcome measures literature in low-resource areas. As such, this study aimed to apply the BODY-Q measure to evaluate factors impacting abdominoplasty outcomes in Kenya.

Methods: Patients undergoing abdominoplasty were asked to complete BODY-Q scales before and after surgery. Patient demographics, medical history, and postoperative care were retrospectively collected from patient records. Inference statistics were used to assess predictors of improvement in postsurgical BODY-Q scores and seroma formation. Student t tests were used to compare means; chi-square tests were used to assess differences between proportions, and R ² was used to determine the proportion of variance.

Results: Thirty-nine patients underwent abdominoplasty, of whom 38 answered both surveys. Mean age and body mass index (BMI) were 38.30 (±6.35) years and 30.80 (±6.35) kg/m², respectively. The difference in pre- and postoperative BODY-Q scores was -73.5, with an effect size of -6.67 and a minimal clinically important difference of -2.00. Positive predictors of BODY-Q score improvement were concurrent liposuction (P = 0.004), preoperative BMI (P = 0.001), and patient-rated scar quality (P = 0.003). Other factors were not significantly predictive.

Conclusions: Kenyan patients seem to be highly satisfied with abdominoplasty procedures, which result in significant improvements in quality of life. Factors significantly associated with higher satisfaction include concurrent liposuction, higher preoperative BMI, and postoperative scar quality.