Plastic and Reconstructive Surgery Global Open最新文献

We present an approach for evaluating abdominal computed tomography (CT) scans that generates reproducible measures relevant to donor site morbidity after abdominally based breast reconstruction. Seventeen preoperative CT metrics were measured in 20 patients with software: interanterior superior iliac spine distance; abdominal wall protrusion; interrectus distance; rectus abdominis width, thickness, and width-to-thickness ratio; abdominal wall thickness; subcutaneous fat volume; visceral fat volume; right/left psoas volumes and densities; and right/left rectus abdominis volumes and densities. Two operators performed measures to determine interrater reliability (n = 10). Interclass coefficients (ICCs) were calculated, and Bland-Altman plots were fashioned. Intrarater reliability was excellent (ICC > 0.9, 0.958-1) for 15 measures, and good (0.75 < ICC < 0.9, 0.815-0.853) for 2 measures. Interrater reliability was excellent (ICC > 0.9, 0.912-0.995) for 12 measures and good (0.75 < ICC < 0.9, 0.78-0.896) for 5 measures. Bland-Altman plots confirmed intra/interrater agreement. Our study meets its objective of establishing a protocol for obtaining abdominal CT measurements with high reproducibility and intrarater and interrater reliability. Although this study is not meant to weigh the particular influences of various CT measurements on clinical outcomes, we are now actively studying this with the intention of reporting our findings in the near future. Larger patient cohorts must be leveraged to determine correlations between abdominal CT scan findings and donor site outcomes using machine learning algorithms that generate models for predicting abdominal donor site complications.

Background: Radical surgery is the best treatment for axillary osmidrosis to eliminate the apocrine glands. However, marked postoperative hyperpigmentation may occur. Clinicians need an objective skin pigmentation examination to identify and treat hyperpigmentation. In this study, we aimed to use the Taylor Hyperpigmentation Scale (an objective visual scale) for evaluating long-term hyperpigmentation after osmidrosis surgery.

Methods: Twenty female patients with Fitzpatrick skin type III-IV who had undergone osmidrosis surgery were included in this study.

Results: The findings demonstrated that although there is an initial variation in the intensity of hyperpigmentation, in the majority of patients, there is a peak in hyperpigmentation between the third and sixth months after surgery. This is then followed by a gradual decline over the ensuing months. Some patients resolve hyperpigmentation completely, suggesting reversibility.

Conclusions: These results can help guide patient expectations and provide suitable postoperative management, thereby improving patient satisfaction and overall quality of life.

Background: The reconstruction of the nipple-areola complex (NAC) is a crucial step for completing breast restoration with patient satisfaction. Surgical reconstruction or tattooing of the NAC may not be preferable or feasible for some patients. There is no universal method for NAC that is ideal for every patient or clinical situation. Various approaches often do not maintain projection over time. Over time, several techniques have been perfected, including the C-V flap, to improve and support projection for patients with bilateral implant-based reconstructions.

Methods: We used, for the first time, prosthetic devices for NAC reconstruction and examined the safety of these devices associated with ease of implantation and patient satisfaction levels using a survey conducted during a 1-year follow-up. We enrolled 20 individuals who opted for these NAC prostheses following unilateral or bilateral breast reconstruction and following NAC excision.

Results: Ninety percent of the participants expressed satisfaction or high satisfaction with the appearance and balance of the new NAC. The prosthetics enhanced the overall body self-image and self-regard of all the study participants. Except for 4 patients, there were no reports of skin adverse reactions, infections, or erosion.

Conclusions: Encouraged by these auspicious outcomes that indicate a significant rate of safety and satisfaction, we believe that this straightforward, noninvasive, affordable medical device deserves consideration as a reconstructive option for all patients seeking breast reconstruction, promoting full body integrity.

Background: Prepectoral (PP) immediate implant-based breast reconstruction (IBBR) is gaining popularity over the retropectoral (RP) breast reconstruction technique. This study aims to compare complication rates across different body mass index (BMI) groups in patients undergoing PP or RP IBBR.

Methods: A monocentric retrospective analysis was conducted on patients who underwent mastectomy and IBBR from January 2018 to December 2023. Preoperative characteristics, BMI, type of mastectomy procedure, PP or RR implant placement, and postoperative outcomes were collected and analyzed.

Results: A total of 217 patients were included, representing 276 IBBRs. The overall complication rate on a per breast basis was 26.4%. The overall complication rate did not differ across BMI groups (P = 0.314) and between PP and RP IBBR (P = 0.8083). In the PP group, anemia rate increased with low BMI (odds ratio [OR] 0.0215, P = 0.033) and skin complications were more frequent with higher BMI (OR 0.0428, P = 0.0389). In the RP group, higher BMI was correlated with a higher seroma rate in the RP IBBR group (OR 1.2045, P = 0.0334) and a longer hospital length of stay (coefficient 0.248, adjusted R² 0.082, SD 0.098, P = 0.014).

Conclusions: PP IBBR was associated with a significantly higher rate of anemia in patients with low BMI, and a significantly higher rate of skin complications in high BMI. RP IBBR was associated with higher seroma rate and longer hospital length of stay in patients with higher BMI.

Background: Social media platforms such as TikTok have recently emerged as influential tools for information dissemination, offering plastic surgeons new opportunities to promote their practices. However, these platforms also present significant challenges regarding online safety, ethical considerations, and the potential spread of misinformation.

Methods: This study analyzes the experience of gaining 100,000 followers on TikTok within 6 months, highlighting the excitement of rapid growth alongside the challenges posed by the potential for misinformation. We propose a strategic approach to leveraging social media effectively and ethically, focusing on storytelling, educational content, and audience engagement; highlighting unique selling propositions; utilizing analytics; and maintaining consistency. Ethical considerations in medical communication are also discussed, emphasizing the need for robust guidelines.

Results: From December 2023 to June 2024, the author posted 56 videos in Arabic, the target market's language. These videos garnered 16,566,900 views and 758,500 likes, with an average video length of 95.36 seconds. This growth led to a 47% increase in nonsurgical aesthetic consultations. Engagement and educational content, such as study tips, received the highest views, totaling 5.6 million, demonstrating the importance of such content in building a follower base for targeted marketing.

Conclusions: Our findings highlight the power and potential risks of social media in healthcare, advocating for a balanced approach that maximizes benefits while mitigating the spread of misinformation.

The gluteal region has become a rising area of interest in plastic surgery in recent years, as reflected in body contouring surgery trends. In this study, the authors explain what the arrow effect consists of and how to highlight it during a Brazilian butt lift or a gluteal liposculpture: liposuction of the sacral triangle, fat grafting of the upper gluteal quadrants, liposuction of the dimples of Venus and of the midline superficially to the spinal column, and fat grafting of the erector spinae muscles.

Background: The Brunelli flap is an option in the reconstruction of the thumb after trauma or oncological resections. The arc of movement of the flap makes it possible to resolve defects in the proximal, palmar, dorsal, and lateral regions.

Methods: We present a case series of 11 patients in whom a Brunelli flap was performed for postoncological reconstruction, melanoma in situ, and invasive squamous cell carcinoma of the thumb nail unit associated with Mohs micrographic surgery. This combination has not been described before.

Results: The reconstruction was carried out using a Brunelli flap, incorporating certain variations to the original technique. Clinical follow-up was performed during a 1-year period. All flaps showed good viability. In 3 flaps, there was mild distal suffering that resolved with local healing. Three patients presented hypersensitivity in the distal part, which was managed with physical therapy. The functionality of the thumb was not altered in any case, and there were no complications in the donor site. No tumor recurrence was documented in any patient.

Conclusions: The use of the Brunelli flap to reconstruct the nail unit after an oncological resection with Mohs surgery is a good alternative. The advantages include a dorsal artery as a constant vessel and a homodigital flap that does not cause morbidity in the donor area, and with Mohs surgery, amputation is avoided. Disadvantages include lack of sensation of the flap. Some limitations of our study are the sample size and lack of long-term follow-up.

Background: Loss or displacement of a fat pad on the foot increases plantar pressure, leading to pain and plantar ulcers. These ulcers, especially in patients with diabetic neuropathy, have high recurrence rates, often resulting in amputations. Standard of care focuses on reducing plantar pressure with shoe padding or orthotic devices, leaving the restoration of the fat pad as an unmet medical need. To address this, a human cryopreserved adipose tissue (hCAT) allograft has been developed to repair adipose tissue defects.

Methods: Scientific characterization of hCAT included assessments of its structural properties, immunogenicity, persistence, and remodeling in both in vitro and in vivo models. The incidence of adverse events and ulcer recurrence was analyzed retrospectively in 12 patients with diabetic neuropathy with preulcerative lesions who received 1.5-3.0 mL subcutaneous hCAT implants in areas with fat pad defects.

Results: When implanted in patients, hCAT remained palpable at the implantation sites, and no ulcerations occurred for an average of 6.4 months (range, 2-10 months). No product-related adverse events have been recorded to date. Long-term follow-up for implanted patients is ongoing.

Conclusions: Use of hCAT seems to be safe and potentially beneficial for managing patients at risk for plantar ulcerations. Further studies are warranted to evaluate hCAT's potential to manage patients at high risk for plantar ulcer formation.

Background: Many studies assess aesthetic effectiveness of calcium hydroxylapatite (CaHA), with single-group designs as the most frequently applied designs in practice. This study systematically reviewed CaHA's effectiveness for aesthetic purposes among these studies.

Methods: A comprehensive search was conducted across 5 bibliographic databases. Single-group studies with at least 10 human adults were included. Summary measures of patients satisfaction and global aesthetic improvement scores were combined using the generalized linear mixed model. This systematic review adhered to the PRISMA reporting standards.

Results: Of 3131 records, 46 single-group studies, majority focused on facial areas (n = 32), were included for final qualitative analysis. A total number of 27 studies were included in the meta-analysis. Findings of the meta-analysis showed that 98% (95% confidence interval [CI], 91%-99%; I ², 0.0%) of patients were satisfied with the injection results in the facial area and 90% (95% CI, 67%-97%, I ², 35%) in other treated body areas. Also, patients reported 89% (95% CI, 76%-96%; I ², 65%) improvement on the global aesthetic improvement scale in facial areas and 94% (95% CI, 75%-99%; I ², 0.0%) in other treated regions. Similarly, investigators reported global aesthetic improvement in 92% of patients (95% CI, 33%-100%; I ², 92%) in facial areas and 95% (95% CI, 1%-100%; I ², 89%) in other treated areas.

Conclusions: Our findings showed aesthetic improvements and satisfaction following CaHA injections in both facial and nonfacial areas. However, studies focusing on nonfacial regions are limited. We recommend more rigorously designed trials to better understand CaHA's clinical effects.