Plastic and Reconstructive Surgery Global Open最新文献

Extramammary Paget disease (EMPD) is a rare cutaneous malignant tumor. Currently, surgery is the most recommended treatment for EMPD. Here, we present a case of EMPD involving the groin, penis, and scrotum. The patient underwent two lesion resections. A thick split-thickness skin graft was utilized for scrotal reconstruction. After a 37-month follow-up period, no tumor recurrence was detected, and the outcome was deemed satisfactory.

Background: Evidence-based medicine in plastic surgery is essential to provide optimal care to individual patients. Level of evidence (LOE) and number of citations are metrics used to gauge quality of research and impact within a field, respectively. The objective of this study was to determine an association between LOE and number of citations within recently published articles in Plastic and Reconstructive Surgery (PRS).

Methods: A review of original research articles published in PRS from January 2018 to June 2022 was performed. LOE was identified through the PRS website, and the number of citations identified via PubMed. Articles were further divided into sections of their corresponding topic.

Results: A total of 965 articles were reviewed, of which 21 (2.2%) were articles assigned level I evidence. There were 147 (15.2%) level II articles, 360 (37.3%) level III articles, 377 (39.1%) level IV articles, and 60 (6.2%) level V articles. The average number of citations per article was 2.72, and the average LOE of all included articles was 3.31. Level I articles had an average of 4.95 citations, whereas level II, III, IV, and V articles had averages of 2.95, 2.54, 2.64, and 2.71, respectively. Breast articles were cited on average 3.85 times each, more than any other type of article.

Conclusions: Our data show that articles assigned level I evidence in PRS trend toward higher numbers of citations compared with articles assigned lower LOEs. These findings should encourage investigators to publish high-quality research to advance the field of plastic surgery.

Background: The topographic anatomical changes of the upper arms and axilla after massive weight loss (MWL) seem ill-described in the literature. The importance of the axilla in MWL brachioplasty and how the procedure differs from the postmenopausal "batwing" deformity of the upper arms is also unclear. Consideration of the underlying pathology seems imperative for a successful reconstruction. We aim to test a procedure specifically designed to mend the underlying pathology of obesity and MWL, liposuction-assisted axillobrachioplasty (LAAB).

Methods: A prospective pilot study was designed to test the effect of LAAB on the axilla and evaluate the results comparative to patient's preoperative complaints and well-being and allow for adjustments for future trials. We measured the diameter of the arm and axilla at three specific points, A, B and C, and applied the arm module of BODY-Q regarding body perception and psychosocial well-being.

Results: Fifteen women, for a total of 30 arms, were included. Age average was 48 years (29-59) and showed a significant improvement in all measurements A-C, most significantly at point A in the axilla, where the reduction was associated with relief of preoperative ailments and great improvement on BODY-Q ratings. The procedure was uncomplicated, with high patient satisfaction.

Conclusions: LAAB significantly improves the axilla and upper arm contour after MWL and correlates strongly with improvement of preoperative ailments. The study furthermore supports the clinical relevance of a posterior arm fat pad. The presented procedure seems to be uncomplicated and reproducible with a high patient satisfaction warranting a long-term clinical trial.

Background: Unfortunately, current beauty trends greatly advertised by social media are trespassing recognized cannons of beauty. Of particular interest are patients' expectations of soft tissue volume augmentation of the face, specifically of the lips.

Methods: An artificial intelligence picture of a White female face was generated. With the fixed standard golden upper-to-lower (U/L) lip ratio, a first set of pictures was generated with varying lip fullness. A second set of pictures was generated with various U/L ratios and lip fullness. In a survey format, the 2 sets of pictures were rated for attractiveness from the most to the least attractive by adult men and women.

Results: Rating the first set of pictures clearly demonstrates that overinflation of lips with upper lip height in excess of 30% of hemi-lip width is highly regarded as unaesthetic and unattractive, with a net preference of 20%-25%. For the second set, U/L ratios between 0.618:1 and 1:1 are still regarded to be most aesthetic.

Conclusions: Though social media have an influence on perception of beauty, data provided by the survey confirm that golden standards of aesthetics remain constant and that exaggerated requests of some patients may not be attributed solely to social media influence but probably to social media in combination with additional personal predisposing factors. Patients must be made aware that how they are perceived by others is essential for them to be satisfied with their appearance.

Background: The medial sural artery perforator (MSAP) flap is thin, pliable, and versatile. This study aims to understand the anatomical basis of the MSAP flap and the subcutaneous course of the perforator for safe flap thinning.

Methods: A total of 24 MSAP flaps were dissected under red silicone dye injection guidance. Full-thickness horizontal slides of flaps were performed, and the perforator courses were identified in the subcutaneous plane. Slides were placed on a millimeter board, and the perforator patterns were photographed and observed with loupes.

Results: A total of 68 perforator courses were identified: type 1: 30.9%, type 2: 57.3%, and type 3: 11.8%. They traveled 1-25 mm to the subdermal plexus, with percentile 2.5 at 1 mm, percentile 90 at 18.2 mm, percentile 95 at 21.65 mm, and percentile 100 at 25 mm. The mean flap thickness was 7.75 ± 1.7 mm, with an average of 5.7 ± 1.3 perforators per flap. Perforators clustered between 2 and 18.4 cm from the popliteal crease and 0-8 cm from the posterior midline of the leg. The dominant perforators accounted for 45.2% (62 of 137), averaging 2.58 per flap. The medial sural artery branching pattern types were type 1: 37.5%, type 2: 50%, and type 3: 12.5%. The average pedicle length was 16.2 ± 1.3 cm, and the mean external diameter of the medial sural artery was 1.98 ± 0.13 mm.

Conclusions: MSAPs branch within a maximal radius of 2.5 cm after emerging from the deep fascia. To maintain vascularity, the safe suprafascial dissection should be 2.5 cm apart from the point of emerging.

Achieving a functional and aesthetic reconstruction following complex trauma is a challenge. Skin substitutes, including acellular dermal matrices, and newer, synthetic options such as NovoSorb biodegradable temporizing membrane (BTM) have given the reconstructive surgeon a useful tool where autologous options have been exhausted, are inappropriate, or would present a suboptimal reconstruction. This case series describes 6 patients admitted to an urban level I major trauma center between July and December 2022. All patients underwent complex reconstructive lower limb surgery using BTM as either a primary or salvage option. In each case, this approach was chosen on a case-by-case basis where it was felt BTM would offer a reconstructive advantage, or where primary reconstructive options had been exhausted. Data were collected retrospectively from case notes. Three patients received BTM as a primary reconstructive option. BTM integrated successfully in all 3. Three patients received BTM as a salvage option. In 1, the exposed fracture site was successfully bridged, and in another, BTM was successfully reapplied over exposed fracture site where BTM had previously failed to incorporate. Although BTM is a relatively new tool in the reconstructive surgeon's armamentarium, requiring further research into long-term outcomes, cost-effectiveness, and patient satisfaction, it can be a useful and versatile tool.

Background: Despite its many advantages, the deep inferior epigastric artery perforator flap requires fascial incision and intramuscular dissection, which can lead to pain and weakening of the abdominal wall. The superficial inferior epigastric artery (SIEA) flap offers an alternative to avoid this damage but is often considered unreliable due to its variable anatomy. In this study, we report our experience in autologous breast reconstruction using either the superficial branch of the superficial circumflex iliac artery (SCIA-SB) or the SIEA as the sole flap pedicle.

Methods: A retrospective study was conducted from August 2022 to December 2023. A total of 17 patients underwent breast reconstruction with 18 flaps (1 bilateral and 16 unilateral reconstructions). The SCIA-SB (14 flaps) or SIEA (4 flaps) served as the exclusive arterial sources. Preoperative vessel identification was performed using color-coded duplex sonography, and the flap design was adjusted accordingly. Intraoperative flap perfusion was assessed via indocyanine green angiography. Demographic, intraoperative, and postoperative data were recorded.

Results: The mean follow-up was 5.7 months (range: 3-17 mo). Of the 18 flaps, 1 was lost due to arterial insufficiency. Partial flap necrosis requiring revision occurred in 1 case, whereas minor complications (seroma, wound dehiscence, mastectomy skin necrosis, and infection) were observed in 7 patients.

Conclusion: In our experience, either the SCIA-SB or SIEA can be successfully used as a pedicle in autologous breast reconstruction, provided that the abdominal flap design is modified to include their functional angiosomes.

Background: Currently, interest in surgical careers is declining globally, whereas aging populations are contributing to a rising demand for surgical procedures. Surgeons who conduct scientific investigations and share clinical advances internationally pay little attention to comparing differences in ways nations attract, educate, and train their surgeons. This study compares international pathways toward surgeon development with the aim of seeking best practices and improving the outlook of surgery as an attractive career.

Methods: A 70-question anonymous survey was distributed internationally to surgeons of all specialties. Data were analyzed in SPSS Statistics for Macintosh (IBM). A value of P less than 0.05 indicates statistical significance.

Results: The 463 respondents from the United States (59%), the United Kingdom (16%), Europe (10%), Canada (5%), and the rest of the world (10%) averaged age 46, and 64% were women. Non-US/Canadian respondents (93%) attended 5- and 6-year medical schools; US respondents were far more likely (91%) to attend nonmedical 4-or-more-year university before medical school. Weekly training-hour mandates spanned less than or equal to 48 (9%) to 80 or more (45%); 76% surpassed mandate hours, and just 9% reported accurate hours. Average educational debt ranged from $14,000 (Europe) to $179,000 (US). Few (19%) felt training allowed family building.

Conclusion: Based on best practices from different countries, the authors recommend a 6-year maximum university/medical education requirement, elimination of nonsurgical training years (mandatory in some countries), single-program surgical training, objective measure of work hours, optimizing weekly hours, improved support for family building, and end-of-training certification options.

Background: Asian individuals often seek solutions to address midface depression and enhance nasal alar base morphology to achieve Western facial aesthetics. Current treatment options, including injections and invasive procedures, have limited efficacy and safety. To address these challenges, we introduced the "modified A-10 surgery," which integrates the Point A-Koji method, titanium plates, and artificial dermis insertion.

Methods: The efficacy of the modified A-10 surgery was illustrated using a case study of a 22-year-old woman. Surgical planning was based on dental cone-beam computed tomography data, with lateral cephalometric radiographs used to determine the titanium plate dimensions. The surgery involved customized plate alignment, fixation, and artificial dermis insertion.

Results: The modified A-10 surgery substantially improved facial aesthetics and structural parameters. Facial convexity increased from 15.5 degrees to 23.2 degrees, enhancing the 3-dimensionality. The nasolabial angle shifted from 91.9 degrees to 110.2 degrees, achieving the desired mouth projection. Other measurements, such as the E-line to the lower lip and the distance from point A to the subnasal point, contributed to refined aesthetics. The nasal alar base thickness increased by 2.2 mm (19.5%), correcting the depression.

Conclusions: The modified A-10 surgery represents a minimally invasive and comprehensive solution for midface depression and nasal alar base enhancement. By combining the Point A-Koji method, titanium plates, and artificial dermis insertion, this surgery successfully achieved improved facial aesthetics and contours. The results validate its potential as a long-term solution, with implications for antiaging interventions and promising avenues for future research.

Background: Delivering ethical care in global plastic surgery is challenging due to the unique complexities of resource-limited settings. Additionally, the rise of medical tourism has highlighted the importance of informed consent and awareness of the potential risks that are associated with seeking medical care in foreign countries. This article aims to consider core medical ethics principles and apply them in the context of delivering global plastic surgery.

Methods: This article examines the application of the four core medical ethics principles in a framework set forth by Beauchamp and Childress, namely autonomy, beneficence, nonmaleficence, and justice, in the context of delivering plastic surgery in international settings. A literature review was performed, where all potential global plastic surgery articles were reviewed to better understand the application of the four core medical ethics framework in this context.

Results: Increased communication between visiting surgeons and local healthcare providers; heightened education of surgeons traveling to low-to-middle-income countries regarding local medical practices, resource availability, and cultural norms before providing surgical education; and a greater emphasis on collecting and publishing data analyzing short- and long-term outcomes in low-to-middle-income countries are all likely to improve the success of international medical missions, ensuring that all patients receive medical treatment in a manner that upholds Beauchamp and Childress' four core medical ethics principles.

Conclusion: Providing plastic and reconstructive surgery abroad can be done ethically if the four main principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) are used.