Plastic and Reconstructive Surgery Global Open最新文献

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.

Background: Defects of the ear helix are a frequent challenge in plastic surgery, with more than 5% of all skin cancers occurring in this region. The Antia-Buch flap is a single-stage reconstruction technique utilizing chondrocutaneous flaps for helix repair. However, for defects exceeding 2 cm, it can lead to auricular distortion. To address this limitation, we propose a modified Antia-Buch technique combining chondrocutaneous advancement with a postauricular skin flap to optimize outcomes.

Methods: A retrospective review was conducted of 15 patients who underwent our modified Antia-Buch flap procedure between 2019 and 2022. This approach incorporated chondrocutaneous advancement for primary defect closure and a postauricular skin flap for improved contouring. Functional and aesthetic outcomes were assessed using a questionnaire developed in collaboration with a clinical psychologist. The questionnaire evaluated surgical satisfaction, cosmetic results, self-image, and social integration postreconstruction.

Results: No complications, including ischemic necrosis or the need for surgical revision, were observed in any case. The technique demonstrated excellent vascularity, with no occurrences of flap failure. Patient-reported outcomes revealed high satisfaction rates, with no evidence of self-image distortion or social barriers. Aesthetic results were rated as superior, with minimal risk of auricular distortion even for larger defects.

Conclusions: The modified Antia-Buch technique is a reliable and effective method for helical rim reconstruction, particularly for defects larger than 2 cm. It offers technical simplicity, low complication rates, patient convenience, and excellent cosmetic outcomes, making it a preferred option for many auricular defect reconstructions.

Flap loss is a severe complication of autologous breast reconstruction. Most flap losses are caused by thrombosis of the anastomosed artery or vein. To prevent vascular disorders, we placed a fat-piece graft around the vessel anastomosis and stabilized the graft and the vessel with autologous fibrin glue. From February 2020 to September 2023, 163 patients underwent autologous breast reconstruction, including 179 breasts, using a deep inferior epigastric perforator flap and autologous fibrin glue to stabilize the internal mammary artery and vein at the Toyama University Hospital. Information on complications was collected retrospectively. No flap losses were observed during the study period; however, 1 hematoma and 1 infection occurred. Stabilization of the pedicle geometry may reduce the risk of kinking, and filling the dead space around the anastomosis reduced vessel spasms. Moreover, autologous fibrin glue may decrease complications such as hematoma, infection, and wound healing disturbance. The factors that may lower the risk of complications include flap design, assessment using multidetector computed tomography, selection of perforator and recipient vessels, vascular anastomosis method, postoperative management, and so on. In addition to these factors, this technique, stabilization of vessels using a fat-piece graft and fibrin glue, may lead to fewer complications during autologous breast reconstruction.

Background: Approximately one-third of patients undergoing axillary lymph node dissection (ALND) for breast cancer will develop breast cancer-related lymphedema (BCRL). To prevent BCRL, immediate lymphatic reconstruction (ILR) has been proposed, whereby lymphatics cut during the ALND are anastomosed to adjacent veins to restore lymphatic drainage. As evidence for ILR grows, the aim of this study was to investigate its efficacy at our institution.

Methods: This prospective single-center study included 17 women undergoing ALND with ILR. Our primary outcome was the incidence of BCRL, diagnosed using a greater than 10% relative difference in arm volume. Use of compression therapy was also followed. Our secondary outcome was patient-reported outcome measures, determined by the validated Lymphedema Quality of Life (LYMQOL-Arm) survey. Postoperatively, patients were followed up at regular intervals for a minimum of 18 months.

Results: The median age of included patients was 49 (interquartile range [IQR] 46-58). The average follow-up time was 34.4 months (range 18-42 mo). Two patients met the criteria for BCRL. Patients with BCRL had a significantly higher median arm volume difference of 27.5% (IQR 21.8%-33.2%) versus 4.2% (IQR 1.6%-7%; P = 0.02). Three patients used compression to control symptoms. Patients without lymphedema scored better in several domains of the LYMQOL-Arm survey, including function, appearance, and overall quality of life; however, these results did not meet statistical significance.

Conclusions: ILR in patients undergoing ALND is associated with a low incidence of BCRL. Our study is one of the first to use patient-reported outcome measures to study ILR.

Background: The insertion of a mesh "internal bra" has been used in cosmetic breast procedures for soft-tissue reinforcement as a means to mitigate postoperative ptosis. However, there have been concerns regarding complications as a result of mesh placement and a lack of quantitative data regarding postoperative cosmetic outcomes.

Methods: Articles that assessed the effects of the mesh internal bra for soft-tissue support on cosmetic and patient-reported outcomes, complications, and surveillance were reviewed. Meta-analysis was performed to determine the overall complication rates, and cosmetic outcomes and patient-reported outcomes were reviewed.

Results: Meta-analysis showed the following summary effect sizes: infection/abscess had a pooled rate of 3.61% (Q = 33.8, I ² = 76.33%), hematoma was 1.34% (Q = 4.16, I ² = 68.1%), seroma was 5.04% (Q = 14.8, I ² = 73.11%), fat necrosis was 0.86% (Q = 693, I ² = 99.7%), and capsular contracture was 2.5% (Q = 693.4, I ² = 99.6%). Only 2 of 5 studies attempting to quantify cosmetic outcomes compared outcomes between patients who underwent procedures with and without the use of mesh. Both reported smaller increases in sternal notch-to-nipple distance and nipple-to-inframammary fold distance without clear statistical significance.

Conclusions: Although there does not seem to be a significant difference in risk profile with and without the use of mesh, the current data do not support the claims of improved cosmetic outcomes. Well-controlled, quantitative studies are necessary to objectively evaluate the cosmetic benefits of using mesh.

Background: Breast reconstruction after mastectomy is one of the most common procedures performed in plastic surgery. Autologous reconstruction is associated with better long-term patient satisfaction than implant-based reconstruction but with the requisite donor site and potential for associated morbidity.

Methods: The authors review the literature regarding the technical evolution of abdominally based autologous breast reconstruction and the effect of these changes as well as patient morbidities on bulge, hernia, and all-cause donor-site morbidity.

Results: The impact of patient risk factors on surgical outcomes is evaluated in the context of constantly improving technical surgical innovation. Patients' premorbid abdominal condition and prior abdominal procedures along with traditional complicating factors such as age, obesity, and smoking are associated with increased rates of donor-site complications. Conversely, shorter fascial incisions with or without robotic and laparoscopic assistance are associated with lower rates of abdominal weakness and healing complications than traditional abdominal free flap harvest. Perforator selection and abdominal closure techniques also play a key role.

Conclusions: There are contributions of both patient factors and technical aspects that when optimized can help minimize the risk of donor-site morbidity in deep inferior epigastric artery perforator flap breast reconstruction.

Dermabond Prineo, a 2-octyl cyanoacrylate-based skin closure system, is widely used in surgical procedures, but reports of adverse effects remain limited. This study aimed to report and analyze 4 cases of type IV hypersensitivity reactions to Dermabond in plastic surgery patients. The study was conducted in a private hospital in Cali, Colombia, between 2022 and 2024. Four patients who underwent reconstructive surgery and presented type IV hypersensitivity reaction after the use of Dermabond were included. Variables such as time of onset of symptoms, number of Dermabond applications, and postoperative management were considered. A literature review was performed for the analysis. All patients developed type IV hypersensitivity reactions after Dermabond application. Symptoms included erythema, pruritus, and other localized signs. These reactions improved significantly after the withdrawal of Dermabond and treatment with topical corticosteroids. All patients had been previously exposed to Dermabond in previous procedures. Dermabond reexposure in sensitized patients may induce type IV allergic reactions. Early identification and treatment of these reactions is crucial.