Plastic and Reconstructive Surgery Global Open最新文献

Background: Prepectoral (PP) immediate implant-based breast reconstruction (IBBR) is gaining popularity over the retropectoral (RP) breast reconstruction technique. This study aims to compare complication rates across different body mass index (BMI) groups in patients undergoing PP or RP IBBR.

Methods: A monocentric retrospective analysis was conducted on patients who underwent mastectomy and IBBR from January 2018 to December 2023. Preoperative characteristics, BMI, type of mastectomy procedure, PP or RR implant placement, and postoperative outcomes were collected and analyzed.

Results: A total of 217 patients were included, representing 276 IBBRs. The overall complication rate on a per breast basis was 26.4%. The overall complication rate did not differ across BMI groups (P = 0.314) and between PP and RP IBBR (P = 0.8083). In the PP group, anemia rate increased with low BMI (odds ratio [OR] 0.0215, P = 0.033) and skin complications were more frequent with higher BMI (OR 0.0428, P = 0.0389). In the RP group, higher BMI was correlated with a higher seroma rate in the RP IBBR group (OR 1.2045, P = 0.0334) and a longer hospital length of stay (coefficient 0.248, adjusted R² 0.082, SD 0.098, P = 0.014).

Conclusions: PP IBBR was associated with a significantly higher rate of anemia in patients with low BMI, and a significantly higher rate of skin complications in high BMI. RP IBBR was associated with higher seroma rate and longer hospital length of stay in patients with higher BMI.

Background: Social media platforms such as TikTok have recently emerged as influential tools for information dissemination, offering plastic surgeons new opportunities to promote their practices. However, these platforms also present significant challenges regarding online safety, ethical considerations, and the potential spread of misinformation.

Methods: This study analyzes the experience of gaining 100,000 followers on TikTok within 6 months, highlighting the excitement of rapid growth alongside the challenges posed by the potential for misinformation. We propose a strategic approach to leveraging social media effectively and ethically, focusing on storytelling, educational content, and audience engagement; highlighting unique selling propositions; utilizing analytics; and maintaining consistency. Ethical considerations in medical communication are also discussed, emphasizing the need for robust guidelines.

Results: From December 2023 to June 2024, the author posted 56 videos in Arabic, the target market's language. These videos garnered 16,566,900 views and 758,500 likes, with an average video length of 95.36 seconds. This growth led to a 47% increase in nonsurgical aesthetic consultations. Engagement and educational content, such as study tips, received the highest views, totaling 5.6 million, demonstrating the importance of such content in building a follower base for targeted marketing.

Conclusions: Our findings highlight the power and potential risks of social media in healthcare, advocating for a balanced approach that maximizes benefits while mitigating the spread of misinformation.

The gluteal region has become a rising area of interest in plastic surgery in recent years, as reflected in body contouring surgery trends. In this study, the authors explain what the arrow effect consists of and how to highlight it during a Brazilian butt lift or a gluteal liposculpture: liposuction of the sacral triangle, fat grafting of the upper gluteal quadrants, liposuction of the dimples of Venus and of the midline superficially to the spinal column, and fat grafting of the erector spinae muscles.

Background: The Brunelli flap is an option in the reconstruction of the thumb after trauma or oncological resections. The arc of movement of the flap makes it possible to resolve defects in the proximal, palmar, dorsal, and lateral regions.

Methods: We present a case series of 11 patients in whom a Brunelli flap was performed for postoncological reconstruction, melanoma in situ, and invasive squamous cell carcinoma of the thumb nail unit associated with Mohs micrographic surgery. This combination has not been described before.

Results: The reconstruction was carried out using a Brunelli flap, incorporating certain variations to the original technique. Clinical follow-up was performed during a 1-year period. All flaps showed good viability. In 3 flaps, there was mild distal suffering that resolved with local healing. Three patients presented hypersensitivity in the distal part, which was managed with physical therapy. The functionality of the thumb was not altered in any case, and there were no complications in the donor site. No tumor recurrence was documented in any patient.

Conclusions: The use of the Brunelli flap to reconstruct the nail unit after an oncological resection with Mohs surgery is a good alternative. The advantages include a dorsal artery as a constant vessel and a homodigital flap that does not cause morbidity in the donor area, and with Mohs surgery, amputation is avoided. Disadvantages include lack of sensation of the flap. Some limitations of our study are the sample size and lack of long-term follow-up.

Background: Loss or displacement of a fat pad on the foot increases plantar pressure, leading to pain and plantar ulcers. These ulcers, especially in patients with diabetic neuropathy, have high recurrence rates, often resulting in amputations. Standard of care focuses on reducing plantar pressure with shoe padding or orthotic devices, leaving the restoration of the fat pad as an unmet medical need. To address this, a human cryopreserved adipose tissue (hCAT) allograft has been developed to repair adipose tissue defects.

Methods: Scientific characterization of hCAT included assessments of its structural properties, immunogenicity, persistence, and remodeling in both in vitro and in vivo models. The incidence of adverse events and ulcer recurrence was analyzed retrospectively in 12 patients with diabetic neuropathy with preulcerative lesions who received 1.5-3.0 mL subcutaneous hCAT implants in areas with fat pad defects.

Results: When implanted in patients, hCAT remained palpable at the implantation sites, and no ulcerations occurred for an average of 6.4 months (range, 2-10 months). No product-related adverse events have been recorded to date. Long-term follow-up for implanted patients is ongoing.

Conclusions: Use of hCAT seems to be safe and potentially beneficial for managing patients at risk for plantar ulcerations. Further studies are warranted to evaluate hCAT's potential to manage patients at high risk for plantar ulcer formation.

Background: Many studies assess aesthetic effectiveness of calcium hydroxylapatite (CaHA), with single-group designs as the most frequently applied designs in practice. This study systematically reviewed CaHA's effectiveness for aesthetic purposes among these studies.

Methods: A comprehensive search was conducted across 5 bibliographic databases. Single-group studies with at least 10 human adults were included. Summary measures of patients satisfaction and global aesthetic improvement scores were combined using the generalized linear mixed model. This systematic review adhered to the PRISMA reporting standards.

Results: Of 3131 records, 46 single-group studies, majority focused on facial areas (n = 32), were included for final qualitative analysis. A total number of 27 studies were included in the meta-analysis. Findings of the meta-analysis showed that 98% (95% confidence interval [CI], 91%-99%; I ², 0.0%) of patients were satisfied with the injection results in the facial area and 90% (95% CI, 67%-97%, I ², 35%) in other treated body areas. Also, patients reported 89% (95% CI, 76%-96%; I ², 65%) improvement on the global aesthetic improvement scale in facial areas and 94% (95% CI, 75%-99%; I ², 0.0%) in other treated regions. Similarly, investigators reported global aesthetic improvement in 92% of patients (95% CI, 33%-100%; I ², 92%) in facial areas and 95% (95% CI, 1%-100%; I ², 89%) in other treated areas.

Conclusions: Our findings showed aesthetic improvements and satisfaction following CaHA injections in both facial and nonfacial areas. However, studies focusing on nonfacial regions are limited. We recommend more rigorously designed trials to better understand CaHA's clinical effects.

Background: The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated.

Methods: A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A bottom-up approach was adopted to calculate carbon dioxide equivalent estimates for the initial consultation, preoperative, intraoperative, and immediate postoperative periods.

Results: This study estimated the carbon footprint of a patient undergoing DIEP flap surgery to be approximately 233.96 kg CO₂eq. Induction, maintenance, and running of anesthesia had the highest overall contribution to the carbon footprint (158.17 kg CO₂eq, 67.60% overall). Patient and staff travel contributed more than 15% overall carbon emissions in this study. The impact of sterilization was less than half of that from waste management (0.81 versus 1.81 kg CO₂eq, respectively). Waste management alone contributed 4.21 kg CO₂eq of the overall carbon emissions, the majority of which was accountable to the incineration of 14.75 kg of noninfectious offensive waste.

Conclusions: This study estimates the carbon footprint of the DIEP pathway. Strategies to mitigate the impact of carbon emissions including usage of reusable vs single-use equipment, virtual consultations, standardization of equipment packs, and optimizing waste disposal were suggested areas for improvement. Data from manufacturers on life-cycle assessments were limited, and further work is needed to fully understand and optimize the impact of DIEP surgery on the environment.

Background: The multifactorial nature of aging necessitates a comprehensive assessment addressing contour, volume, and facial laxity, and a holistic treatment plan. We evaluated combined use of HArmonyCa with HA fillers to improve laxity and overall aesthetic outcomes. A detailed guide is also presented regarding facial shapes, special areas, and volume needs.

Methods: This retrospective case series evaluates 10 patients' facial laxities with Facial Laxity Rating Scale using 2-dimensional before and after photographs (posttreatment and 6-month mark). Overall improvement was assessed by the investigator and patients by comparing to baseline. Patient satisfaction was measured with a questionnaire.

Results: The Facial Laxity Rating Scale scores (jowl and neck) were highest at baseline and lowest at 6-month mark. Facial laxity significantly improved over time for jowl (P < 0.001) and neck (P = 0.007). At the sixth month, facial laxity significantly improved compared with baseline both in jowl (P = 0.001) and neck (P = 0.011). Global Aesthetic Improvement Score evaluations improved significantly during the 6-month period (P < 0.001). Global Aesthetic Improvement Score was significantly higher at 6-month posttreatment compared with immediate posttreatment evaluation (P < 0.001). Patients were satisfied immediately after treatment and 6 months after. The satisfaction significantly improved at the sixth month compared with immediately after treatment (P = 0.033).

Conclusions: A combined use of HArmonyCa and HA fillers improves laxity in the lower face and neck and enhances aesthetic outcomes with high patient satisfaction. Overall improvement and patient satisfaction are higher at the sixth month, which is attributable to biostimulation.

Background: Concurrent panniculectomy with abdominal wall reconstruction (CP-AWR) as a single-stage operation has reported increased complications, but constant quality improvement can improve results. This study describes outcomes for 21 years, impacted by evidence-based-practice changes.

Methods: Prospectively maintained database was reviewed for CP-AWR and separated by surgery date: "early" (2002-2016) and "recent" (2017-2023). A 1:1 propensity-scored matching was performed based on age, tobacco use, body mass index (BMI), American Society of Anesthesiologists (ASA) score, wound class, and defect size.

Results: Of 701 CP-AWRs, 196 pairs matched. Match criteria were not significantly different between early and recent groups, except for BMI (34.6 ± 7.2 versus 32.1 ± 6.01 kg/m²; P = 0.001). Groups were comparable in sex and diabetes, but recent patients had fewer recurrent hernias (71.4% versus 56.1%; P = 0.002). Recent patients had more biologic (21.9% versus 49.0%; P < 0.001) and preperitoneal mesh (87.2% versus 97.4%; P = 0.005). Readmission and reoperation did not significantly differ, but length of stay (8.3 ± 6.7 versus 6.5 ± 3.4 d; P = 0.001) and wound complications decreased over time (50.5% versus 25.0%; P < 0.001). Hernia recurrence rates improved (6.6% versus 1.5%; P = 0.019), but follow-up was shorter (50.9 ± 52.8 versus 22.9 ± 22.6 months; P < 0.0001).

Conclusions: Despite patient complexity, outcomes of CP-AWR improved with implementation of evidence-based-practice changes in preoperative optimization, intraoperative technique, and postoperative care. This large dataset demonstrates the safety of a single-stage repair that should be part of hernia surgeons' repertoire.

Chronic postoperative pain after breast surgery is a significant concern, with studies indicating varying rates depending on the type of surgical procedure. The risk of developing neuropathic pain is notably increased with axillary lymph node dissection due to potential nerve injuries. Additionally, the method of breast reconstruction may influence postsurgical pain rates, with conflicting findings on the impact of reconstruction type. Recent advancements in techniques such as targeted muscle reinnervation, among others, show promise in addressing postoperative pain in these patients. As the prevalence of these procedures rises, future research is likely to focus on assessing and managing pain in this patient population. The development of patient-reported outcome measures specific to breast surgery pain can aid in clinical assessment and treatment planning. This review emphasizes the importance of gaining a deeper understanding of risk factors, nerve anatomy, and treatment options to enhance outcomes and quality of life for individuals undergoing breast surgery.