Plastic and Reconstructive Surgery Global Open最新文献

Background: Aesthetic refinement of labia minora reconstruction remains a challenge with the traditional penile inversion vaginoplasty, which may result in inadequately defined labia minora, a gaping introitus, or redundant labial folds. This study described a refinement based on nonpenile inversion vaginoplasty (NPIV) to address these limitations.

Methods: The NPIV technique uses preputial and penile skin exclusively for external labial reconstruction. Labial aesthetic outcomes were assessed using either standardized photographs or patient-submitted images via telemedicine, graded with a 4-point aesthetic scoring system. Patient satisfaction was evaluated using a customized patient-reported outcome measure with Likert-scale scoring (1-5). Clinical outcomes and complication profiles were also analyzed.

Results: Between July 2023 and March 2025, 74 patients underwent primary vaginoplasty using the NPIV technique. Of these, 72 (97.3%) completed a 1-month follow-up. Mid- to long-term data were available in 42 (56.8%) patients, comprising 15 with standardized photographs and 27 with self-taken photographs. Most aesthetic ratings were excellent or good (80.9%). Patient-reported outcome measures data were available in 40 patients, with mean scores of 4.5 for appearance, 4.3 for symmetry, and 4.6 for overall satisfaction. The most frequent complication was introital wound dehiscence with minor labial necrosis (25.7%), followed by significant labia minora necrosis (12.2%), which occurred more often in circumcised patients (30.0% versus 5.6%, P = 0.014).

Conclusions: The NPIV technique offers a predictable and reproducible approach for labia minora reconstruction with improved labial contour and definition. Clinical and patient-reported outcomes demonstrate high satisfaction and favorable aesthetic results.

Background: Buttock augmentation is increasingly popular in body contouring but remains controversial within the surgical community, partly due to limited larger scale studies on cohesive gel buttock implants, in contrast to the extensive data available for breast implants. The author previously described a composite buttock augmentation technique involving subcutaneous expansion vibration lipofilling and later proposed a dual-plane pocket dissection for improved implant stability.

Methods: A retrospective review was conducted on 482 patients who underwent buttock augmentation using the same surgical technique by a single surgeon from June 2020 to May 2022. After excluding cases involving secondary implants or additional mesh, 423 patients were included. All patients received composite augmentation, consisting of an implant combined with fat grafting.

Results: In the 423 dual-plane procedures, the average surgery time was 1 hour and 50 minutes, with follow-up ranging from 21 to 55 months. The overall complication rate related to implants was 10.8%, with seroma being the most frequent issue. Complications were categorized based on whether they stemmed from the implant or from the liposuction/fat grafting component and were analyzed for frequency, severity, and resolution.

Conclusions: Composite buttock augmentation using a dual-plane pocket technique offers the benefits of both submuscular and intramuscular dissection. This method provides better soft tissue coverage and implant stability, presenting it as a reliable and effective technique for gluteal enhancement.

Background: Lower lid blepharoplasty (LLB) has evolved significantly since its early description. The traditional subciliary incision is no longer the standard, and primary use of fat pad excision has been challenged by orbital fat preservation and repositioning. The current review aimed at determining whether effective pedicled orbital fat repositioning is better performed with a subciliary transcutaneous or a transconjunctival incision.

Methods: A comprehensive population, intervention, comparison, and outcome review of cohort clinical studies published from 2000 up to May 2025 in the English-language literature, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted using the PubMed, Embase, and Web of Science databases.

Results: Twenty-four studies met the inclusion criteria and were retrieved for analysis. LLB with fat excision or flap transposition can be safely performed with both approaches. However, the desired outcome seems to be equally achievable with both pedicle fat flap transposition and fat grafting.

Conclusions: LLB may be safely performed with both transcutaneous and transconjunctival access incisions. Orbital fat transposition is also possible with both approaches, although it is probably easier with the transcutaneous approach. However, fat transposition may not be the ideal technique for blending the lid-cheek junction or correcting tear trough deformity. Fat grafting may be more appropriate and easier to perform. Unfortunately, the LLB literature lacks rigorous reporting of outcomes and complications, greatly limiting the identification of the most appropriate approach. This deficiency needs to be seriously considered and corrected in future studies.

Background: The gracilis muscle flap is valuable as a reconstructive option because of its reliable anatomy and minimal donor-site morbidity. The aim of this systematic review was to evaluate acute perioperative complications and long-term outcomes of the gracilis muscle flap in distal lower limb reconstruction following trauma, infections, or oncological resections.

Methods: This review was registered with PROSPERO (CRD42023486475) and adhered to PRISMA guidelines. All primary studies on gracilis flaps for lower leg soft tissue reconstruction were included, excluding those with flap recipient sites above the knee, isolated tendon repair, or nonprimary research articles. Searches were performed across Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, and PubMed.

Results: Fifty-eight articles involving 1232 patients who underwent lower extremity reconstruction with a gracilis flap were included. Indications for surgery were trauma (n = 146), diabetes (n = 116), oncological (n = 31), infection (n = 27), other (n = 2), and heterogeneous (n = 910). A total of 397 (32.2%) complications were reported. In heterogeneous studies, pooled proportions were 0.22 for acute postoperative complications, 0.17 for recipient-site events, and 0.12 for donor-site morbidity, with oncological and infection cases showing the highest complication rates. The most common complications for each category were total flap loss (79, 6.4%), recipient infection (14, 1.1%), and donor-site scarring (14, 1.1%).

Conclusions: The gracilis flap is a reliable option for reconstructing a wide array of soft tissue defects of the distal lower extremity, with modifications to increase its coverage area. The long-term functional and aesthetic outcomes after gracilis flap reconstruction are undescribed.

Lymphatic ultrasound has recently emerged as a noninvasive, contrast-free modality for evaluating lymphatic vessels, particularly as a preoperative tool for lymphaticovenous anastomosis. Although high-frequency linear probes (18-20 MHz) are commonly used, their availability may be limited, and ultra-high-frequency probes (≥30 MHz) are limited by poor tissue penetration. This study investigated the feasibility of using lower frequency linear probes (10-12 MHz), including a portable 10-MHz device, to visualize lymphatic vessels in patients with extremity lymphedema. A total of 24 limbs from 13 female patients were examined. Dilated lymphatic vessels were first identified using an 18-MHz probe, then reevaluated with either a 12- or 10-MHz probe. Among 44 sites, 86.4% of lymphatic vessels detected with the 18-MHz probe were also visible with lower frequency probes. Identification was more successful in the lower extremities (89.5%) than in the upper extremities (66.7%). Visualization rates were comparable between the 12- (87.0%) and 10-MHz (85.7%) probes. These findings suggest that lower frequency probes, including portable devices, can adequately visualize lymphatic vessels in most cases. This may facilitate wider adoption of lymphatic ultrasound in general clinical settings and resource-limited environments. However, further studies are needed to evaluate their standalone diagnostic performance and ability to assess lymphatic degeneration, and their limitations in de novo identification should also be acknowledged. Addressing these issues may help optimize probe selection and further expand the clinical utility of lymphatic ultrasound.

Background: The thigh is an alternative donor site for autologous breast reconstruction when abdominal flaps are unsuitable, though limited tissue and donor-site complications pose challenges. To improve volume and reduce morbidity, thigh flaps evolved from the transverse upper gracilis to the diagonal upper gracilis (DUG) designs. This study presented the largest DUG flap review, evaluating outcomes and donor-site morbidity.

Methods: A retrospective review of patients undergoing DUG flap breast reconstruction was performed between 2012 and 2022. Demographics, surgical details, and complications were analyzed. Odds ratios assessed the association between unilateral versus bilateral donor-site harvest and revision surgery rates.

Results: During a 10-year period, 109 flaps (70 patients, mean body mass index 24.3 kg/m²) were performed. Of these, 100 flaps were used for mastectomy reconstruction, 13 of which were stacked, and 9 were used for partial oncoplastic reconstruction. No flap failures occurred. The complication rate was 13.6%, of which 9.1% was related to the donor site, primarily cellulitis. No donor-site wound dehiscence, labial spreading, contour irregularity, or lymphedema was observed. Revisions occurred in 20% (breast) and 25.7% (donor site) of patients. Unilateral thigh flap harvest reduced the odds of donor-site revision and symmetrization procedures.

Conclusions: The DUG flap's diagonal design maximizes tissue harvest while minimizing donor-site morbidity. Unilateral harvest often achieves aesthetic results, curtailing the need for contralateral symmetrization. The DUG flap avoids concerns with thigh-based flaps, such as genital/gluteal distortion and lymphedema. Moreover, it offers a reliable learning curve, with bailout options via profunda artery perforator flaps.

Background: Minimal access cranial suspension (MACS) lift is a well-established face lift technique commonly included in the facial plastic surgeon's armamentarium. It has consistently demonstrated safety and efficacy. The midface may also be addressed using various adjunctive maneuvers in combination with the MACS lift. The aim of this study was to evaluate the use of supraperiosteal midface lift via a subciliary incision with a 2-looped MACS lift.

Methods: This retrospective case series included patients who underwent a MACS lift with 2 suspension purse-string loops, combined with upper and lower blepharoplasty and a supraperiosteal midface lift via a subciliary incision. Outcomes were evaluated by comparing the palpebromalar groove position before and after surgery. Patient satisfaction was measured at 6 weeks postoperatively using a 1-10 scale. Complications were documented during follow-up.

Results: The study enrolled 25 patients. The palpebromalar groove position improved from a mean of 54 mm preoperatively to 62 mm postoperatively (mean improvement = 8 mm). Mean patient satisfaction was 8.96 on a 1-10 scale.

Conclusions: Combining a supraperiosteal midface lift via a subciliary incision with a MACS lift proved safe and effective, resulting in a low complication rate and high patient satisfaction.

Background: Symptomatic neuroma is a debilitating complication of peripheral nerve injury. Techniques like targeted muscle reinnervation and regenerative peripheral nerve interfaces have shown promise but have critical limitations, including inconsistent efficacy, increased operative time and morbidity, and the need for microsurgical training specific to peripheral nerves. We present the first clinical experience with a sutureless, bioresorbable hydrogel (allay Nerve Cap) for the treatment and prevention of symptomatic neuroma.

Methods: A single-center retrospective review of 11 patients who underwent 12 nerve procedures (23 nerves) involving hydrogel nerve cap placement was conducted. Ten of the 12 procedures were prophylactic, and 2 were for established diagnosis of symptomatic neuroma. In the symptomatic neuroma group, pre- and postoperative visual analog scale scores were obtained. All patients had a minimum 6 months of follow-up and were monitored for the development of neuropathic symptoms. The time required for intraoperative nerve hydrogel application was recorded.

Results: No patients in the prophylactic group developed symptomatic neuromas or neuropathic symptoms postoperatively. Both patients with established symptomatic neuroma experienced a significant decrease in visual analog scale score (4 and 7 points, respectively). There were no hydrogel-related complications. Minor wound issues occurred in 3 patients, and 1 patient died approximately 6 months postoperatively due to her underlying medical condition. The duration of hydrogel application averaged 55 seconds per nerve.

Conclusions: Early experience with the hydrogel cap suggests it is a safe, effective, and scalable device for prevention and treatment of symptomatic neuroma across a broad range of procedures and anatomical locations.

Squamous cell carcinoma (SCC) of the lip is rare in young individuals, usually associated with chronic sun exposure, tobacco use, or genetic predisposition. We report a 20-year-old woman with epilepsy who developed lower lip SCC. This case is unique for its early onset and is the first lower lip reconstruction with a radial forearm free flap in Ethiopia. The patient underwent wide local excision, bilateral selective neck dissection (levels I-III), and radial forearm free flap reconstruction with a palmaris longus tendon sling. Postoperatively, recovery was uneventful with complete flap survival, improved oral competence, and restored speech. This case highlighted invasive SCC in a young patient and demonstrated the feasibility of free flap reconstruction in a resource-limited setting.