Plastic and Reconstructive Surgery Global Open最新文献

Dermoid cysts are congenital lesions formed by the entrapment of ectodermal tissues along embryological closure lines. These cysts do not have direct etiologic causes and are not seen as typical in any race. Diagnostic evaluation typically includes ultrasound and computed tomography imaging to assess for complications. The mainstay treatment is surgical excision, which sometimes leads to unwanted scarring. We herein present a case of a glabellar dermoid cyst successfully treated using surgical suction.

This article described the fabrication and clinical application of a simple relative motion extension orthosis constructed using readily accessible materials such as a wooden tongue depressor, an aluminum strip, and a cohesive bandage. Initially developed to facilitate early active mobilization following extensor tendon repairs, the relative motion extension orthosis is applied by positioning the metacarpophalangeal joint of the injured finger 15-20 degrees more extended relative to the adjacent fingers. The proposed orthosis, produced with low-cost and easily obtainable materials, is considered an effective and practical option for implementing early active mobilization protocols, particularly in settings with limited resources.

Injectable fillers, such as hyaluronic acid (HA)-based fillers and calcium hydroxylapatite (CaHA) collagen stimulators, have been used to replenish lost volume by physically filling gaps or stimulating collagen synthesis. A commercially available hybrid filler combining HA and CaHA in a new gel-form collagen stimulator has yet to be extensively studied in an Asian population. This was a case series of patients attending 2 centers in Hong Kong between August 2023 and February 2024 to document the safety of HA-CaHA in Asian patients. Outcomes included patients' overall satisfaction with the treatment experience, based on the Global Aesthetic Improvement Scale assessment and treatment-emergent adverse events reported after treatment at the 3- and 6-month follow-ups. Twenty-five Chinese patients (22 female; age range [median]: 25-63 [37] y) received 2-3 syringes of HA-CaHA with a mean total volume of 2.8 mL (range: 2.5-3.75 mL). Immediately after treatment and at the 1- and 3-month follow-ups, 60% (15 of 25) of patients reported "very much improved," 32% (8 of 25) reported "much improved," 8% (2 of 25) reported "improved," and 0% reported "unchanged" or "worse" throughout the 6 months. Treatment-emergent adverse events immediately after treatment included bruising (n = 3, 12%), edema (n = 8, 32%), erythema (n = 1, 4%), tenderness (n = 3, 12%), and skin induration (n = 4, 16%). A hybrid filler combining HA and CaHA represents a promising advance in facial rejuvenation, offering immediate volumizing effects, longer-lasting results, and few adverse events.

Bullous pemphigoid (BP) is a rare but devastating autoimmune dermatologic condition and can be triggered by infection, trauma, radiation, or surgery, all conditions routinely encountered by reconstructive surgeons. Chronic wounds secondary to BP are difficult to manage with local wound care and can necessitate soft tissue coverage, yet there remains a paucity of literature surrounding the evaluation and management of autoimmune skin conditions as they relate to the reconstructive surgeon. A 57-year-old man presented with a chronic left heel wound secondary to BP, and despite medical therapies, continued to have worsening ulcerations. He underwent debridement of the wound followed by free anterolateral thigh flap reconstruction. On postoperative day 3, he developed erythema and blistering of the distal edge skin flap. The dangle protocol was halted, and dermatology was consulted, who recommended 0.05% clobetasol cream applied to the areas of erythema. By the day of discharge on postoperative day 16, the flap remained stable in appearance, and erythema had significantly improved. Literature surrounding the management of chronic wounds in patients with pemphigoid diseases remains scarce. This case report added to the literature on the evaluation and management of wounds in these patients. The ideal treatment of chronic wounds secondary to BP necessitates the involvement of a multidisciplinary team, stabilization of the dermatologic disease preoperatively, aggressive resection of diseased tissue, and adequate wound bed preparation. Following this, the preferred method of reconstruction should take into consideration the pathophysiologic mechanism of the disease, followed by close postoperative monitoring and early intervention for postoperative skin changes.

Background: Surgical intervention, particularly sentinel lymph node and lymph node dissection, is essential in managing melanoma, targeting locoregional disease. Our aim was to elucidate risk factors for postoperative lymphatic complications in melanoma patients undergoing lymph node surgery in Peru.

Methods: A retrospective cohort study was conducted, reviewing records of melanoma patients who underwent lymphatic surgery at the Instituto Nacional de Enfermedades Neoplásicas from 2010 to 2019. Descriptive statistics and logistic regression analyses were performed to identify predictors of lymphatic complications.

Results: The study included 699 melanoma patients (mean age 60.70 y, 51.4% women). Most patients were Hispanic (99.3%) and from Lima (52.8%), with lower extremity involvement being common. Surgical interventions included wide local excision (56.9%), sentinel lymph node surgery (67%), and lymph node dissection (32.3%). Complications at the site of lymph node dissection included wound dehiscence (1.6%), infection (6.2%), lymphoceles (5.7%), and lymphedema (2.7%). Multivariate analysis identified lymphatic invasion (odds ratio [OR] = 2.601, 95% confidence interval [CI]: 1.232-5.491) and positive lymph node pathology (OR = 2.066, 95% CI: 1.034-4.127) as risk factors, whereas primary lesion location in the upper extremity (OR = 0.055, 95% CI: 0.007-0.408) and trunk (OR = 0.106, 95% CI: 0.014-0.818) were protective factors.

Conclusions: Key risk factors for postoperative lymphatic complications in melanoma patients undergoing lymph node surgery include lower extremity involvement, lymph node dissections, lymphatic invasion, and positive lymph nodes. Understanding these risk factors can help clinicians optimize management strategies to reduce postoperative lymphatic complications.

[This corrects the article DOI: 10.1097/GOX.0000000000007323.].

Background: Despite the ability of both plastic surgeons and orthopedic surgeons to treat hand and wrist injuries, significant differences exist in clinical practice between hand surgeons with differing residency training backgrounds. This study sought to investigate the influence of residency training on medicolegal exposure among hand surgeons trained in orthopedic and plastic and reconstructive surgery (PRS).

Methods: The Westlaw database was queried for all jury verdicts and settlements related to hand and wrist surgery and filed directly against an orthopedic or PRS hand surgeon. Extracted data included patient and defendant demographics, alleged negligence, damages, and payouts.

Results: A total of 66 cases out of 3933 were included. A defendant verdict was reached in 55 (83.3%) cases. The average monetary award was $2.1 million. The most common preceding treatment was fracture repair (n = 20, 30.3%) and carpal tunnel release (n = 13, 19.7%). Out of 66 cases, 52 (78.8%) were levied against orthopedic-trained hand surgeons. Therapeutic delay (P = 0.0068) or patient death (P = 0.0242) were predictive factors of a plaintiff verdict. PRS surgeons faced greater risks of litigation in cases following soft tissue repair, therapeutic delay, or negligence requiring an amputation. Conversely, orthopedic surgeons were more likely to face litigation following fracture repair.

Conclusions: Although specialty training of hand surgeons alone does not considerably influence the risk of facing medical malpractice litigation, differences in medicolegal trends within hand surgery reflect key differences in prevailing residency training emphases, clinical exposure, and geographic practice distribution between orthopedic- and PRS-trained hand surgeons.

Background: "Pipelining" is a phenomenon whereby a residency program repeatedly matches individuals from the same medical school across several application cycles. This is potentially disadvantageous to qualified applicants without a history of institutional legacy at their schools. We aimed to evaluate the prevalence of pipelining by US integrated plastic surgery residency programs to promote an equitable playing field for future applicants.

Methods: An analysis of every Accreditation Council for Graduate Medical Education-accredited US integrated plastic surgery residency program was conducted. The graduated medical schools of 2229 current and former plastic surgery residents were collected. Pipeline scores were defined as the ratio of total residents to number of unique medical schools represented at the program (Pipeline^C, current residents; Pipeline^C+F, current and former residents). Programs were stratified by geographic location and by affiliation with the top 25 medical schools that graduate plastic surgery residents.

Results: The average Pipeline^C score was 1.23, and the average Pipeline^C+F score was 1.45. Programs in the Northeast had the highest Pipeline^C (P < 0.001) and Pipeline^C+F (P = 0.042) scores. Programs affiliated with the top 25 medical schools had higher Pipeline^C (P < 0.001) and Pipeline^C+F (P = 0.015) scores than all other programs. Overall, 17.4% of current and 22.6% of former residents matched at their home residency programs.

Conclusions: There is a measurable prevalence of pipelining in plastic surgery, especially in the Northeastern US and at programs affiliated with medical schools with historical match success. Fostering an inclusive and meritocratic match process will benefit the field of plastic surgery entirely.