Plastic and Reconstructive Surgery Global Open最新文献

Background: Traditional abdominoplasty commonly involves drains, inpatient admission, and significant postoperative discomfort, which increases aftercare demands and delays return to normal activity. Despite technical refinements, many surgeons continue to rely on these long-standing practices. Modern techniques incorporating tissue fixation sutures (TFSs) and regional anesthesia now allow abdominoplasty to be performed as a drainless day procedure with reduced pain and fewer complications.

Methods: A retrospective review was conducted of 210 consecutive lipoabdominoplasties performed by a single surgeon between 2017 and 2024. All cases used a defined TFS configuration consisting of 1 vertical row above and 3 horizontal rows below the umbilicus to obliterate dead space and minimize shear forces. Bilateral transversus abdominis plane blocks were routinely administered before closure. All procedures were performed under general anesthesia in a private hospital, with discharge occurring 2-4 hours postoperatively.

Results: Ninety-nine procedures (47.1%) were standalone lipoabdominoplasties, and 111 (52.9%) were combined with other procedures, most commonly breast surgery. The overall complication rate was low: 1 seroma (0.5%) and 1 deep venous thrombosis (0.5%). Postoperative pain was effectively managed with oral analgesia, and most patients resumed light activity within 1 week.

Conclusions: Abdominoplasty can be safely performed as a day procedure without drains using a reproducible TFS configuration and routine transversus abdominis plan blocks. This approach adds minimal operative time, reduces pain, lowers complication rates, and challenges entrenched norms regarding drainage and hospitalization in abdominoplasty.

This article reports the real-time perfusion assessment of a full-length anterior peritoneal flap vaginoplasty, previously published in Plastic and Reconstructive Surgery, using intraoperative indocyanine green (ICG) fluorescence angiography. A 20-year-old transgender woman with dense pubic and scrotal hair underwent full-length anterior turnover peritoneal flap vaginoplasty to achieve a hairless neovaginal canal. Intraoperative ICG fluorescence angiography was used to assess perfusion of the laparoscopically harvested 20 × 20 cm flap both before and after tubularization. Real-time imaging confirmed rapid, uniform fluorescence throughout the flap, including the distal segment for introital inset, with no perfusion gaps or ischemic zones. The strongest uptake was seen along the midline, likely corresponding to urachal vascular branches, with robust lateral perfusion, particularly in areas including the posterior rectus sheath. Even fascial-free zones demonstrated detectable perfusion. The flap was inset, achieving 14.7 cm of immediate postoperative neovaginal depth. No intraoperative or postoperative complications occurred. This is the first case to confirm real-time perfusion of a peritoneal flap in gender-affirming surgery using ICG angiography, supporting the vascular reliability of the technique and its potential value in optimizing outcomes and guiding broader reconstructive applications.

Raynaud phenomenon (RP) is a vasospastic condition of the digital arteries that can cause pain, skin color changes, and functional limitations. Although botulinum toxin is not currently Food and Drug Administration-approved for the treatment of RP, it has been used in refractory RP and has generally been found to be well tolerated. At our institution, incobotulinumtoxinA (Xeomin) and abobotulinumtoxinA (Dysport) are commonly used. Here, we report our experience with the use of incobotulinumtoxinA (Xeomin) in the hand. We present 2 cases of patients with RP in bilateral hands who presented for Botox injections after failure of conservative and medical therapy. In both cases, incobotulinumtoxinA (Xeomin) was used. A week later, both patients experienced various distributions of severe muscle weakness, including intrinsic, thenar, and hypothenar muscle weakness, which did not improve during the subsequent 4 weeks. Although safe, further studies are needed to assess the diffusion of various botulinum toxin A formulations, especially in the hands, as prolonged intrinsic, thenar, and hypothenar muscle weakness can be detrimental to patients.

Currently available hyaluronic acid filler technologies concentrate on reflation of the aging midface primarily with the use of fillers to reinflate the deep fat compartments. However, filler technology has evolved, which allows us to reconsider how to address midface volume loss more appropriately. We propose that balanced restoration, a multilayered technique, should be the contemporary approach to midface revolumization with hyaluronic acid fillers, as it is based on an advanced understanding of anatomy and can achieve natural-looking outcomes that maintain dynamic facial expression. The midface comprises 2 distinct fat layers, superficial and deep, with different morphological and mechanical attributes that reflect the different functions that fat tissue plays in each layer. Because of the more dynamic nature of the superficial fat layer over the more static deep fat layer, and its roles in providing facial contours and permitting skin mobility and facial expression, multilayered techniques for balanced restoration involve selecting appropriate products that match the viscoelastic properties of the fat that is being replaced. Reflation of the superficial fat compartments requires fillers with cohesivity and more dynamic properties than deep fillers to enable adaptation to facial movement and to provide natural outcomes. Here, we summarize the advances in the understanding of the anatomical considerations for midface rejuvenation and provide guidance on how to differentiate superficial fat loss from deep fat loss and on how to select the most appropriate injectable hyaluronic acid fillers to achieve balanced restoration in patients requiring midface rejuvenation.

Background: Plastic surgery is underrepresented in UK medical curricula; most students receive minimal teaching or clinical exposure. This contributes to misconceptions and may deter interest in the specialty. Early exposure is an important indicator in pursuing plastic surgery. Despite a clearly structured training pathway, little is known about students' understanding and awareness of plastic surgery training in the United Kingdom.

Methods: A national cross-sectional survey was conducted among UK medical students across 8 medical schools between July and October 2024. Student collaborators recruited participants through informal social media channels and student groups, supported by the Plastic Reconstructive and Aesthetic Surgery Students Association. A total of 702 responses were received. Ethical approval was granted. Statistical testing included χ² and Monte Carlo analyses, with significance set at a P value less than 0.05.

Results: Only 25.9% of students reported being familiar with the training pathway. Familiarity was significantly associated with having received formal teaching through lectures or clinical placements (P < 0.001). Over half relied on online resources, with only 23.4% reporting formal teaching. Nearly 80% believed more exposure was needed during medical school.

Conclusions: This study confirmed a widespread deficit in undergraduate exposure to plastic surgery and limited awareness of the training pathway. Students mainly rely on informal resources, exacerbating inequality in access to career information. Despite differing levels of knowledge, students advocated for more structured exposure during medical school. These findings support calls for curricular reform to improve inclusivity and diversity within training and create a more accessible and equitable pathway for all aspiring trainees.

Avulsions of the upper third of the ear often present with skin flaps of compromised vascularity. Although initially viable, these flaps may later develop ischemic changes ranging from epidermolysis to full-thickness necrosis, delaying healing. Angiogenesis, primarily mediated by vascular endothelial growth factor (VEGF), is essential for tissue repair. In children, VEGF promotes endothelial cell migration and proliferation, accelerating wound healing. Currently, VEFG is the primary target of therapeutic angiogenesis approaches, and microRNAs have emerged as key angiogenic regulators. Exosomes have gained relevance in regenerative medicine as paracrine mediators of skin repair. VEGF expression peaks between days 3 and 7 after injury; hypothetically, this VEGF window is considered optimal for delivering proangiogenic exosome cargo directly to the ischemic skin flap. By providing microRNA-mediated proangiogenic signals early in the healing process, exosomes may enhance tissue perfusion and improve flap survival. We report the case of a 10-year-old girl with a partial soft-tissue degloving injury of the upper third of the auricle. The avulsed flap had folded onto itself, causing venous congestion. After repositioning, flap distal congestion persisted and progressed to partial tissue necrosis by postoperative day 3. The wound was treated with Rosa damascena stem cell-derived exosomes, resulting in complete skin regeneration, evident by day 14. This case demonstrated the safe clinical use of Rosa damascena stem cell-derived exosomes in a pediatric posttraumatic ischemic auricular flap, suggesting their potential as a therapeutic option for flap salvage in children. Larger controlled studies are required to confirm efficacy and establish treatment protocols.

Background: Patients with penicillin allergies often receive alternative preoperative antibiotics despite antimicrobial stewardship guidelines supporting cefazolin in nonanaphylactic cases. These alternative regimens may be less effective, and recommendations to administer cefazolin under such circumstances have not been widely adopted. This study evaluated differences in infectious complications, preoperative antibiotic use, and timing of prophylaxis in breast reconstruction patients with penicillin allergies.

Methods: This was a retrospective review of patients who underwent tissue expander breast reconstruction between 2015 and 2022. Demographic data and comorbidities were collected, and infectious complication rates were compared between penicillin-allergic and non-penicillin-allergic patients. Secondary outcomes included timing to onset of infection and infection as a function of preoperative antibiotic administration timing.

Results: Among 427 patients, 96 (22.4%) reported a penicillin allergy. Baseline characteristics were comparable between groups. Infection occurred in 37.5% (36 of 96) penicillin-allergic patients versus 23.8% (79 of 331) of non-penicillin-allergic patients (P = 0.002). Among those who received clindamycin prophylaxis, patients developing infection had a significantly shorter antibiotic administration-to-incision interval compared with those who did not (P = 0.03). The median time from surgery to infection onset was 72 (interquartile range 24-126) days for penicillin-allergic patients and 96 (interquartile range 30-196) days for non-penicillin-allergic patients (P = 0.15).

Conclusions: In this population, penicillin-allergic patients experienced significantly higher infection rates than those who received cefazolin prophylaxis. The increased infection risk may be partially explained by protocol-driven alterations leading to a shorter interval between antibiotic administration and incision in patients receiving clindamycin, though multiple factors related to penicillin allergy and the community antibiogram could also contribute.

Background: The escalation of conflict in Gaza since October 2023 has devastated an already fragile healthcare system and generated an overwhelming civilian need for reconstructive surgical care. Traditional humanitarian approaches often defer reconstructive planning until conflict resolution, which delays care and worsens morbidity. The global plastic and reconstructive surgery community has extensive experience in collaboration, but few published models exist for the proactive formation of ethically grounded, multidisciplinary teams during active conflict.

Methods: We used a community-based participatory research framework to establish a multinational, multidisciplinary team focused on reconstructive surgical planning in Gaza. The team included academic plastic surgeons, clinicians with relevant geographic experience, implementation scientists, and regional scholars. We prioritized early engagement of Gaza-based partners and institutional review board approvals from relevant Palestinian entities to ensure contextual relevance.

Results: Within 1 year, we established a functional, ethically approved collaboration with institutional funding and administrative support. Key lessons included the importance of early stakeholder engagement, leveraging short-term goals for long-term progress, adapting to dynamic conflict conditions, establishing internal infrastructure, and maintaining flexible communication channels. The first wave of initiatives focused on actionable outputs is underway, including estimating reconstructive surgical need, conducting capacity evaluations, and documenting current care delivery.

Conclusions: Our approach offers a replicable, ethical framework for context-sensitive collaboration in conflict zones. It enables plastic surgeons to engage proactively in humanitarian crises beyond direct care. Actionable outputs can be used by local leaders, organizations, and policymakers to reduce delays between conflict resolution and delivery of reconstructive care.

Background: Facial skin cancer and surgical removal can alter appearance, contributing to patient morbidity through effects on self-perception and psychosocial well-being. This study aimed to assess the impact of surgical intervention on appearance and health-related quality of life before and after surgery.

Methods: A single-center, prospective cohort study of 108 participants undergoing facial skin cancer surgery was conducted between November 2021 and December 2023. Participants completed the FACE-Q Skin Cancer questionnaire preoperatively up to 12 months postoperatively. Statistical significance was defined as P < 0.05.

Results: A total of 105 participants completed the preoperative questionnaires, with 101, 96, 93, and 76 completing questionnaires at 1, 3, 6, and 12 months postoperatively. Postoperatively, participants were more satisfied with their facial appearance and reported improvements in appearance-related distress. Significant improvements (P < 0.001) were shown in cancer worry, appraisal of scars, sun protection behaviors, and adverse effects. Younger age (<65 y) was a significant predictor of worse outcomes across all domains. Participants with melanoma and those managed with reconstructive repair were associated with lower satisfaction and greater appearance-related distress. Women were more satisfied with their facial appearance, although they rated their scars less favorably. Nonmelanoma skin cancers were predictive of increased cancer worry.

Conclusions: Facial skin cancer surgery improves health-related quality of life, appearance factors, and sun protection behaviors. Younger participants, and those with melanoma or managed with a component of reconstructive repair, may benefit from targeted perioperative support alongside interdisciplinary care. Further clinical integration of the FACE-Q Skin Cancer module will assist in providing individualized patient care.