Plastic and Reconstructive Surgery Global Open最新文献

Background: Giant cell tumor of bone (GCTB) is a locally aggressive tumor that may affect the bones of the hand and rarely causes pulmonary metastasis. It exhibits a variable recurrence rate after surgical interventions, which presents challenges in its management. This systematic review aims to delineate recurrence rates and identify risk factors for GCTB in the hand.

Methods: We conducted a systematic literature search in April 2024, following PRISMA guidelines, on PubMed and TDNet for studies reporting postsurgical recurrence of GCTB in the hand. Cohort and case-control studies provided recurrence rates, whereas case reports and series were utilized to identify risk factors, compensating for the sparse data in the primary studies. We used descriptive statistics, χ² tests, and logistic regression to analyze demographics, lesion characteristics, treatments, and outcomes.

Results: We reviewed 13 cohort and case-control studies involving 244 patients, finding an overall recurrence rate of 19.57%. Curettage was associated with higher recurrence rates compared with other surgical methods. After additional review of case reports, a limited range of motion in patients emerged as a significant protective factor against recurrence, suggesting potential benefits in surgical management and outcome prediction.

Conclusions: The significant recurrence rate associated with curettage highlights the need for alternative surgical strategies in GCTB management of the hand. The protective role of limited ROM underscores the importance of thorough preoperative assessments to optimize surgical approaches and enhance patient outcomes.

Background: Septal extension grafts allow the precise elongation of the nasal septum to attain facial harmony and optimize aesthetic outcomes. In this context, septal surgery requires meticulous design to address both functional and aesthetic goals. Traditional septoplasty techniques often overlook aesthetic considerations and postoperative nasal structural stability, resulting in unresolved or recurrent deviations, nose tip drooping, and obstruction recurrences. Despite advancements in surgical techniques, achieving simultaneous septal alignment and long-term stability remains a significant challenge.

Methods: This study introduces a systematic 4-step technique. The procedure encompasses caudal septum liberation, placement of the septum extension cartilage graft, positioning of an ethmoidal bone graft, and redefinition through an intermediate cartilage.

Results: A retrospective analysis of outcomes involving 753 patients was conducted with a minimum follow-up of 6 months. During follow-up visits, 1.73% of cases exhibited residual columellar asymmetry, and 0.66% showed tip asymmetries. The infection rate was 0.40%, with no cases of tip drop identified. The overall satisfaction rating on the Rhinoplasty Outcomes Evaluation questionnaire at 12 months postoperative was 9.3.

Conclusions: The technique provides a systematic approach to integrate functional and aesthetic objectives, emphasizing septal stability and alignment while concurrently addressing tip projection and stability. The study provides comprehensive insights into the principles, methodology, and advantages of this rhinoplasty technique. The outcomes underscore the efficacy of the technique, presenting a reliable and long-term stable solution.

Background: Lymphatic fistulas are a common complication from surgery or interventional procedures resulting in persistent lymphatic leakage and delayed wound healing. The management of lymphatic fistula remains a subject of debate, ranging from conservative treatment to surgical lymphatic ligation. The implementation of a novel microsurgical approach involving lymphatic fistula ligation and/or lymphovenous anastomosis (LVA) using indocyanine green (ICG) lymphography is expected to decrease occurrence and complications. In this study, we share our experience in treating lymphatic fistula-guided microsurgical treatment.

Methods: A total of 13 patients from our hospital with persistent lymphatic fistula were enrolled in this retrospective study. Lymphatic fistulas and their leakages were identified and ligated by using ICG lymphography and a surgical microscope. In two cases, additional LVA surgery was performed.

Results: We were able to precisely identify lymphatic fistulas and treat them in all 13 patients. Lymph ligation was performed in all 13 cases, with additional distal LVA in two cases. In all patients, wound healing occurred following lymphatic ligation, except in one patient due to persistent infection. Patients with a lymphatic fistula were referred to our unit within 3 weeks to 1 year after onset, with an average consultation occurring after 5 months of persistent lymphatic fistula.

Conclusions: Targeted lymphatic vessel ligation with or without LVA with ICG-guided surgical microscope represents a promising highly efficacious therapy for persistent lymphatic fistula. This technique may accelerate wound healing and reduce hospitalization duration, thus advocating for its preferential use in managing lymphatic fistulas.

Background: Percutaneous intrafocal pinning is one of the many surgical options for extraarticular distal radius fracture with minimal comminution. This study aims to describe the role and indications of intrafocal pinning.

Methods: This monocentric, retrospective study included 49 patients who underwent intrafocal pinning for distal radius fractures in 2013 in our French hand surgery department. All the patients underwent posteroanterior and lateral x-ray on days 2 and 45 to measure radial inclination, distal radioulnar index, and volar tilt.

Results: The mean age of the patients was 45.4 years, with women representing approximately 61.2% of the sample (n = 30). The patients were divided into three groups: group A (17-50 y), 26 patients; group B (50-70 y), 15 patients; and group C (>70 y), eight patients. We documented on x-ray images, 21 secondary displacements, including seven in group C. There were three displacements (all in group C) and one surgical revision within 15 days for a previous displacement. The distal radioulnar index increased in all three groups.

Conclusions: The percutaneous intrafocal pinning fixation technique exposes a high risk of complications, especially for those older than 50 years, for whom this technique should be avoided. Overall, due to the frequency of secondary displacements encountered, our first-line treatment favors plate osteosynthesis for all patients. Pinning fixation should only be considered with caution in younger patients if plate osteosynthesis is not possible, but it requires a strict 6-week immobilization. The fracture morphology must also be considered.

Background: Biopolymers, which are diverse and permanent synthetic fillers, are nonbiocompatible allogeneic materials. Their implantation can result in clinical, radiological, and histopathological manifestations that contribute to our understanding of foreign-body-induced human adjuvant disease.

Methods: We conducted a descriptive observational case series involving 20 patients who underwent open biopolymer removal surgery in the buttocks and lumbosacral regions using the Meticulous Approach Safer and Keeper technique, followed by gluteal reconstruction with autologous tissue. Histopathological analysis was performed. This study was conducted in Bogotá, Colombia, from 2020 to 2023.

Results: Documented clinical records and histopathological analyses of the 20 patients revealed an inflammatory response that was initially considered healthy. Cytoplasmic vacuolization in reactive adipocytes was observed in all cases, meriting consideration in the differential diagnosis of liposarcoma and suggesting local aggressiveness. One patient showed a positive lymphocytic inflammatory response in the Alcian blue test. Hypercalcemia was present in 30% of the patients, elevated lactate dehydrogenase in 40%, and elevated parathyroid hormone levels in 15%.

Conclusions: Surgeons should consider measuring lactate dehydrogenase, serum calcium, and parathyroid hormone levels to assess the severity and guide clinical practice. Secondary prevention through the open surgical removal of biopolymers is recommended.

In the current era of advanced technologies, robotic surgery is rapidly evolving. New articles are emerging on the use of robots in general surgery, urology, and oncology, with single cases in maxillofacial surgery. In this article, we describe the successful use of robotic techniques for simultaneously performing suturing repair of the diastasis of the rectus abdominis muscles, aesthetic correction of the anterior abdominal wall with lipoabdominoplasty, and cholecystectomy. That, according to our knowledge, has not ever been done before.

Artificial intelligence (AI) is becoming increasingly important in society, and medicine can benefit from its advantages. What scenario can we envision when AI becomes as powerful and accurate as human physicians? How will the traditional patient-doctor relationship be affected by AI? Will patients come to trust and accept AI-assisted healthcare as much as their human counterparts? Our research team has been working on applications of AI in plastic surgery for more than 4 years. Between 2020 and 2024, AI algorithms were developed by the authors and applied on patients for symmetry evaluation after breast cancer surgery. Patients were aware of being evaluated with images for AI model training and assessment. Feedback was reported, and a survey was carried out among patients who underwent evaluation by our team. Among patients with breast cancer who underwent surgical reconstruction, 65% of patients reported very high levels of comfort with AI, given that it was mediated by a human doctor. Patients stated that nondoctor-mediated AI in medicine would greatly reduce trust. The influence of AI on the patient-doctor relationship is an important aspect that will greatly affect medicine. In this preliminary work, patients showed high levels of trust and comfort with the use of AI in healthcare, despite stating that they knew little about AI. Patients insisted that the mediation of a human doctor is key for acceptance. Currently, little is known about the acceptance of AI in medical roles among patients.

Lipomas are frequently found as benign neoplasms in humans, mainly in the head, neck, and upper limb regions. Because of their rare occurrence in hands and digits, such cases attract researchers' attention. A case description of a 28-year-old Saudi male patient is presented with a large-size lipoma at the distal forearm, carpal tunnel, and Guyon canal area, with numbness of the central three digits and grip strength weakness of his left hand. The nature of the lesion was a benign, subcutaneous, multilobulated lipoma, removed surgically to prevent malignant transformation and deterioration in neuropathy.