Plastic and Reconstructive Surgery Global Open最新文献

Background: The diagnosis of neuropathic groin pain can be difficult because lumbosacral plexus nerve branches overlap in this anatomically complex region. We reviewed patients over 20 years and present our step-wise approach to the evaluation and management of neuropathic groin pain.

Methods: We retrospectively analyzed adults (18 y or older) evaluated between June 2006 and January 2025 for groin pain localized to 1 or more peripheral nerves: iliohypogastric, ilioinguinal, genitofemoral, lateral femoral, femoral, and obturator. Patients were stratified by (1) physical examination findings, (2) symptom duration, (3) response to image-guided diagnostic and/or therapeutic blocks, and (4) operative treatment. Pain was assessed with the numeric rating scale (0-10) and functional scores on a 0%-100% scale (poor <25%, fair <50%, good 50%-74%, excellent ≥75%). Pre- versus postintervention outcomes were compared. Minimum follow-up was 6 months.

Results: Of 501 patients, 386 (77%) underwent diagnostic blocks, and 291 (58%) proceeded to surgery on 686 nerves (lateral femoral = 209; ilioinguinal = 192; iliohypogastric = 163; genitofemoral = 112; femoral = 8; obturator = 2). Mean numeric rating scale scores decreased from 6.1 ± 1.9 to 1.4 ± 2.1 (P <0.001), and mean functional scores improved 80% from baseline (P < 0.001). At last follow-up (mean 47.9 ± 62.2 mo), functional scores were excellent in 71% of patients, good in 17%, fair in 7%, and poor in 4.8% (P < 0.001).

Conclusions: Neuropathic groin pain is frequently multifactorial, but may be approached systematically with an algorithm consisting of diagnostic and therapeutic nerve blocks. This method enables precise nerve-targeted surgery with selective decompression or neurectomy, decreased pain scores, and increased functional scores with minimal morbidity.

Background: Enhancing intact skin regeneration is a growing focus in dermatology and aesthetics. Human derived exosomes and mesotherapy formulations such as New Cellular Treatment Factor (NCTF) have shown regenerative potential, yet their combined effects on healthy skin remain unstudied. This study evaluated NCTF, two exosome products, and their combinations on markers of skin regeneration.

Methods: A randomized, within-animal controlled study was conducted in 144 adult male Syrian golden hamsters. Each animal received 6 intradermal injections on the dorsum: saline control, CellExosome, ASCE+ Exosome, NCTF, NCTF + CellExosome, or NCTF + ASCE+ Exosome. Skin biopsies were obtained at baseline and on days 3, 7, and 14. Histological assessments (hematoxylin and eosin, Van Gieson, Masson trichrome) evaluated dermal structure and collagen deposition. CD34 immunohistochemistry quantified microvascular density.

Results: By day 14, collagen synthesis and vascular proliferation were significantly greater in all active treatment groups compared with the control (P < 0.0001). The NCTF + CellExosome combination produced the highest improvements in collagen density and microvascularity, followed by NCTF + ASCE+ Exosome, NCTF alone, ASCE+ Exosome, and CellExosome. These findings indicate synergistic biological effects when NCTF is combined with exosomes.

Conclusions: NCTF and human-derived exosomes enhance dermal structural regeneration and angiogenesis in intact skin. Combination therapy, particularly NCTF + CellExosome, provides the strongest regenerative response, supporting further investigation for clinical aesthetic applications.

Treatment of war-related injuries is complex. The mechanism of injury, inherent infection risk, and disrupted medical infrastructure result in worse outcomes after acute extremity amputation. There have been a large number of wartime traumatic and surgical extremity amputations across the globe, namely in connection with the active conflicts in Ukraine and Gaza. Targeted muscle reinnervation is a low-risk procedure that has been shown to be effective in treating and preventing neuroma-associated pain and phantom limb pain in extremity amputation patients. Its utility in Ukraine, Gaza, and future conflicts has not been described and is important to outline. We aimed to describe the utility of targeted muscle reinnervation in the management of traumatic amputations and the overall implications this procedure could have on the adult and pediatric patients affected by these conflicts.

Background: AlloDerm and Cortiva are 2 commonly used human acellular dermal matrices for prosthetic breast reconstruction, yet their comparative clinical performance remains uncertain. The objective of this study is to systematically compare short-term clinical outcomes, patient-reported physical well-being, and perioperative resource use among AlloDerm and Cortiva in immediate or delayed prosthetic breast reconstruction.

Methods: A systematic search of PubMed, Scopus, and Web of Science (from inception to June 15, 2025) identified comparative studies of AlloDerm versus Cortiva. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed. Studies were included if they provided comparative data on complications, BREAST-Q scores, or costs. Random-effects meta-analyses were used to estimate mean differences for continuous variables and odds ratios for binary outcomes. Heterogeneity was quantified with the I² statistic. Cost data (reported heterogeneously) were summarized narratively.

Results: Five studies (1 blinded randomized trial, 1 small interim randomized controlled trial, and 3 propensity-matched or retrospective cohorts) comprising 1180 breast reconstructions in 1072 patients met the inclusion criteria. Across all endpoints, no statistically significant differences were observed between the 2 acellular dermal matrices in terms of complication rates or BREAST-Q scores. Four studies presented cost information. Two detailed economic evaluations showed that the acquisition price of Cortiva was 10%-22% lower per sheet and translated into a 44%-56% reduction in total per-breast episode cost when operative and complication-related expenses were included.

Conclusions: Current evidence shows no clear difference between AlloDerm and Cortiva in terms of clinical outcomes but identifies a potential cost advantage for Cortiva. Pending long-term data, Cortiva represents the more economical choice.

Background: Mastopexy is a technique that repositions the nipple-areolar complex to a more aesthetically desirable position within the profile of the breast. The BREAST-Q is a vital tool that can be used to assess patient-reported outcome measures (PROMs). Given the known importance of PROM following mastopexy surgery, we aim to provide a systematic review of the literature to summarize the available information and provide direction for further optimization of patient care and research.

Methods: A systematic review was performed using the Ovid (MEDLINE/PubMed) database in accordance with the preferred reporting items for systematic reviews and meta-analyses checklist. The inclusion criteria comprise studies in the English language from 1976 to 2024, female patients only, and studies reporting patient satisfaction following mastopexy or augmentation mastopexy. Case reports, studies without validated PROMs, animal studies, conference proceedings, and bariatric patients were excluded. Risk of bias was assessed using the Critical Appraisal Skills Programme checklist.

Results: A total of 10 studies qualified for qualitative synthesis of data, and meta-analysis was performed where possible. A total of 510 patients underwent mastopexy procedures. The mean ages across studies ranged from 31 to 54 years. Mean body mass index values were reported in 6 studies, ranging from 20 to 27 kg/m². The mean follow-up duration varied from 6 to 38 months. Inconsistent data across all studies significantly limited the meta-analysis.

Conclusions: Mastopexy procedure leads to higher rates of patient satisfaction and quality of life. This analysis has highlighted the need for more consistent PROM reporting in mastopexy surgery.

Background: Recruitment and retention of academic surgeons is challenging. Decreased academic support and high clinical loads cause recruits to leave within 2 years. Here, we explore creative ways to manage top talent in academic practices.

Methods: A scoping review of scholarly databases and business literature was performed, and the cumulative experience of the authors was incorporated.

Results: New academic recruits feel the gap between their expectations and their actual experience. Despite known advantages of academics over private practice, including resident coverage, salary support, malpractice coverage, and professional advancement opportunities, the dwindling finances in academics have forced departments to use clinical revenues to fund their academic missions. Compensation plans are now more heavily linked to clinical productivity thresholds, often at the cost of academic goals. Additionally, institutions offer limited support for practice-building, and academic promotion criteria have not adapted to the clinical demands. Finally, these pressures have transformed academic practices into becoming fiercely competitive and noncollaborative. To prevent an exodus of new recruits from academic practices, retention strategies need to change. Individual goals must be respected and aligned with the success of all 3 groups: individual, the team, and the organization. Strong practice-building tools need to be developed for new recruits to create a collaborative culture. Fair compensation must include academic metrics, and a new, creative rewards plan that improves faculty experience is vital.

Conclusions: Recruitment and retention are critical elements of academic plastic surgery, and redesigning strategies to keep and grow high-value faculty will ensure the growth and advancement of the field.

Background: This study explores an alternative method of delivering polynucleotides (PNs) using a transdermal drug delivery device instead of traditional injection methods. These devices can deliver PNs in a noncontact manner and may offer several advantages over traditional injection techniques, including reduced pain and faster recovery time.

Methods: A clinical trial was conducted to compare the effectiveness of PN injections and transdermal drug delivery devices in 4 participants. Each participant received 3 treatments using the injection method on one side of the face and the transdermal drug delivery device on the other. The right hemiface was treated with cryogenic transdermal delivery (TargetCool), and the left hemiface was treated with manual intradermal injection. Outcomes were assessed through standardized photography and skin analysis, and participant satisfaction was examined using the Global Aesthetic Improvement Scale and visual analog scale.

Results: Treatment with the transdermal drug delivery device showed similar skin improvement to PN injection, with the advantage of less pain and a shorter recovery time. Skin density measurements using ultrasound showed that both methods were effective, but the transdermal drug delivery device provided slightly better skin density improvement in some cases.

Conclusions: Transdermal drug delivery devices are a safe and effective alternative to traditional PN injections, with similar skin improvement outcomes.

Cold atmospheric plasma, a novel therapeutic modality, has demonstrated promising effects in promoting wound healing through its antimicrobial, inflammation-modulating, and pro-angiogenic properties. However, its clinical application in wound management remains limited. We present the case of a 52-year-old woman with extensive third- to fourth-degree burns, complicated by a chronic postoperative wound secondary to flap necrosis following reconstructive surgery, and persistent infection despite standard wound care and antibiotic therapy. She underwent 2 courses of cold atmospheric plasma treatment, totaling 19 sessions, in conjunction with standard management. The treatment resulted in successful wound healing and eradication of the bacterial infection without adverse effects. This case highlighted the potential of cold atmospheric plasma as a safe and effective adjunctive therapy for chronic, difficult-to-heal wounds with infection, warranting further investigation to establish its role in clinical practice.

Papillary hemangiomas (PHs) are rare, benign vascular tumors, typically described in adults. Few pediatric cases have been reported, and recurrence is uncommon. We presented a unique case of PH in a 15-month-old male patient with recurrence after surgical excision. The patient presented with a left cheek lesion present since birth, which had grown proportionally with his development. Initial ultrasound demonstrated a superficial, hypoechoic, heterogeneous lesion with increased vascularity. Surgical excision was performed, and pathology demonstrated large, thin-walled, irregular vascular channels with arborizing fronds, eosinophilic hyaline globules, and CD31+ endothelial cells, findings consistent with PH. Four months postoperatively, imaging revealed recurrence. Re-excision was performed, including branching structures initially thought to be nutrient vessels. Nitro paste was applied postoperatively due to concern for the thin overlying skin. PH is rarely congenital and can be misdiagnosed as other vascular anomalies. This case emphasized the importance of recognizing branching structures that may represent lesion extensions to optimize complete excision. Multidisciplinary management is recommended for diagnosis, treatment planning, and follow-up.