Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006253
Rod J. Rohrich, E. Dayan, Amy S. Xue
{"title":"Social Media in Plastic Surgery: The Future Is Now?","authors":"Rod J. Rohrich, E. Dayan, Amy S. Xue","doi":"10.1097/PRS.0000000000006253","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006253","url":null,"abstract":"","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"437 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76672062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006255
Nima Khavanin, H. Jazayeri, Thomas Q. Xu, Rachel A. Pedreira, Joseph Lopez, Sashank K Reddy, T. Shamliyan, Z. Peacock, A. Dorafshar
BACKGROUND Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction. METHODS PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar. RESULTS Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent). CONCLUSIONS The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.
{"title":"Management of Teeth in the Line of Mandibular Angle Fractures Treated with Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis.","authors":"Nima Khavanin, H. Jazayeri, Thomas Q. Xu, Rachel A. Pedreira, Joseph Lopez, Sashank K Reddy, T. Shamliyan, Z. Peacock, A. Dorafshar","doi":"10.1097/PRS.0000000000006255","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006255","url":null,"abstract":"BACKGROUND\u0000Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction.\u0000\u0000\u0000METHODS\u0000PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar.\u0000\u0000\u0000RESULTS\u0000Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent).\u0000\u0000\u0000CONCLUSIONS\u0000The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73157368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006226
Austin Y. Ha, T. Myckatyn
www.PRSJournal.com 1291 I this article, Nelson et al. report the number of revision and total procedures required to achieve satisfactory postmastectomy breast reconstruction by seven different modalities: direct-to-implant, two-stage tissue expander/implant, pedicled transversus rectus abdominis myocutaneous flap, free transversus rectus abdominis myocutaneous flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, and combination latissimus dorsi flap and implant.1 This represents an important addition to the breast reconstruction literature, and the authors are to be congratulated for their work. A key finding of this article is that complications lead to an increase in both revision and total procedures; 40.2 percent of women who did not experience complications underwent revision procedures versus 67.1 percent of those who did, and an average of 2.2 procedures were required to achieve a stable reconstruction without complications versus 2.6 procedures with complications. These findings are largely in agreement with earlier studies.2–5 The authors defined elective revisions as any operations performed in the operating room under anesthesia, outside of the standard reconstructive algorithm—the index procedure and nipple-areola complex reconstruction. Fat grafting, recontouring or repositioning of flap, and scar revision and/or dog-ear excision were the three most common elective procedures. Several interesting statistically significant clinical and demographic differences were observed between those patients who pursued revisions and those who did not. On the whole, patients who had autologous reconstruction underwent more revisions than those who had prosthetic reconstruction, contrary to previously published data.3 In the complication group, a greater proportion of women who had prophylactic mastectomies opted for revisions than the women who had therapeutic mastectomies. This may be explained by the fact that women who receive prophylactic mastectomies are generally younger6 and perhaps more motivated to achieve a superior aesthetic outcome. Although radiation therapy is well known to lead to an increased incidence of complications,7–10 it was associated with lower rates of revisions. As the authors discuss, this finding is likely both patientand surgeon-related, as patients with more advanced disease and therefore requiring radiation therapy may be more inclined to defer additional elective surgery, especially if the surgeon considers the increased risks of operating in an irradiated field inadvisable. Lastly, patients who were neither white nor black were almost half as likely to undergo revision procedures, although prior research has shown no relationship between ethnicity and choice of reconstruction modality (prosthetic versus autologous).11 The relatively small sample size of this population makes granular subgroup analysis difficult; however, it is an area that deserves further research. When dis
{"title":"Discussion: Elective Revisions after Breast Reconstruction: Results from the Mastectomy Reconstruction Outcomes Consortium.","authors":"Austin Y. Ha, T. Myckatyn","doi":"10.1097/PRS.0000000000006226","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006226","url":null,"abstract":"www.PRSJournal.com 1291 I this article, Nelson et al. report the number of revision and total procedures required to achieve satisfactory postmastectomy breast reconstruction by seven different modalities: direct-to-implant, two-stage tissue expander/implant, pedicled transversus rectus abdominis myocutaneous flap, free transversus rectus abdominis myocutaneous flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, and combination latissimus dorsi flap and implant.1 This represents an important addition to the breast reconstruction literature, and the authors are to be congratulated for their work. A key finding of this article is that complications lead to an increase in both revision and total procedures; 40.2 percent of women who did not experience complications underwent revision procedures versus 67.1 percent of those who did, and an average of 2.2 procedures were required to achieve a stable reconstruction without complications versus 2.6 procedures with complications. These findings are largely in agreement with earlier studies.2–5 The authors defined elective revisions as any operations performed in the operating room under anesthesia, outside of the standard reconstructive algorithm—the index procedure and nipple-areola complex reconstruction. Fat grafting, recontouring or repositioning of flap, and scar revision and/or dog-ear excision were the three most common elective procedures. Several interesting statistically significant clinical and demographic differences were observed between those patients who pursued revisions and those who did not. On the whole, patients who had autologous reconstruction underwent more revisions than those who had prosthetic reconstruction, contrary to previously published data.3 In the complication group, a greater proportion of women who had prophylactic mastectomies opted for revisions than the women who had therapeutic mastectomies. This may be explained by the fact that women who receive prophylactic mastectomies are generally younger6 and perhaps more motivated to achieve a superior aesthetic outcome. Although radiation therapy is well known to lead to an increased incidence of complications,7–10 it was associated with lower rates of revisions. As the authors discuss, this finding is likely both patientand surgeon-related, as patients with more advanced disease and therefore requiring radiation therapy may be more inclined to defer additional elective surgery, especially if the surgeon considers the increased risks of operating in an irradiated field inadvisable. Lastly, patients who were neither white nor black were almost half as likely to undergo revision procedures, although prior research has shown no relationship between ethnicity and choice of reconstruction modality (prosthetic versus autologous).11 The relatively small sample size of this population makes granular subgroup analysis difficult; however, it is an area that deserves further research. When dis","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74231766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006238
Rod J. Rohrich, Min-Jeong Cho
BACKGROUND Brow-lift techniques have evolved from the most invasive approach, such as a coronal brow lift, to a minimally invasive technique, such as an endoscopic brow lift over the past century. Although an endoscopic brow lift offers the advantage of being minimally invasive, it suffers from a high recurrence rate. The authors present their experience of combining an endoscopic and temporal brow lift approach for long-lasting results, and discuss the surgical indication, techniques, and outcome of an endoscopic temporal brow lift. METHODS A retrospective review was performed of patients who underwent brow rejuvenation from 2008 to 2018. Demographic, surgical procedure, complication, and outcome data were collected. RESULTS Of the 159 patients who underwent a brow lift from 2008 to 2018, the mean patient age was 59.1 years, and 96 percent were women. Of the 159 patients, 71 underwent endoscopic temporal brow lift; their average age was 56.6 years, with an average body mass index of 22.9 kg/m, and 99 percent were women. The average brow elevation was 1.8 ± 1.7 mm at the midpupil, 1.9 ± 1.8 mm at the medial canthus, and 1.8 ± 1.7 mm at the lateral canthus. There was no difference in the amount of brow elevation at the three locations (p = 0.48). The complication rate for endoscopic temporal brow lift was 1.4 percent, with a mean postoperative follow-up of 231.7 days; one relapse required a repeated procedure. CONCLUSIONS The authors' study reveals that an endoscopic temporal brow lift can elevate the medial and lateral brow effectively, with a low complication rate of 1.4 percent. This technique is an evolution from the more aggressive coronal brow lift and combines the strength of endoscopic and temporal techniques with less invasive incisions. The authors recommend this technique for patients with mild to moderate brow ptosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
{"title":"Endoscopic Temporal Brow Lift: Surgical Indications, Technique, and 10-Year Outcome Analysis.","authors":"Rod J. Rohrich, Min-Jeong Cho","doi":"10.1097/PRS.0000000000006238","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006238","url":null,"abstract":"BACKGROUND\u0000Brow-lift techniques have evolved from the most invasive approach, such as a coronal brow lift, to a minimally invasive technique, such as an endoscopic brow lift over the past century. Although an endoscopic brow lift offers the advantage of being minimally invasive, it suffers from a high recurrence rate. The authors present their experience of combining an endoscopic and temporal brow lift approach for long-lasting results, and discuss the surgical indication, techniques, and outcome of an endoscopic temporal brow lift.\u0000\u0000\u0000METHODS\u0000A retrospective review was performed of patients who underwent brow rejuvenation from 2008 to 2018. Demographic, surgical procedure, complication, and outcome data were collected.\u0000\u0000\u0000RESULTS\u0000Of the 159 patients who underwent a brow lift from 2008 to 2018, the mean patient age was 59.1 years, and 96 percent were women. Of the 159 patients, 71 underwent endoscopic temporal brow lift; their average age was 56.6 years, with an average body mass index of 22.9 kg/m, and 99 percent were women. The average brow elevation was 1.8 ± 1.7 mm at the midpupil, 1.9 ± 1.8 mm at the medial canthus, and 1.8 ± 1.7 mm at the lateral canthus. There was no difference in the amount of brow elevation at the three locations (p = 0.48). The complication rate for endoscopic temporal brow lift was 1.4 percent, with a mean postoperative follow-up of 231.7 days; one relapse required a repeated procedure.\u0000\u0000\u0000CONCLUSIONS\u0000The authors' study reveals that an endoscopic temporal brow lift can elevate the medial and lateral brow effectively, with a low complication rate of 1.4 percent. This technique is an evolution from the more aggressive coronal brow lift and combines the strength of endoscopic and temporal techniques with less invasive incisions. The authors recommend this technique for patients with mild to moderate brow ptosis.\u0000\u0000\u0000CLINICAL QUESTION/LEVEL OF EVIDENCE\u0000Therapeutic, IV.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91130664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006206
C. Delorenzi
www.PRSJournal.com 1301 T present article concerns the detailed analysis of the three-dimensional course of the central retinal artery and its topographic relations to the optic nerve as it passes from its origin (ophthalmic artery) to its final destination in the retina.1 The central retinal artery is a terminal artery that supplies the inner retina, which has no other blood supply (except for some individuals who have cilioretinal artery collateral vessels).2 This is relevant because the pathophysiology of fillerassociated blindness seems to be experimentally attributable to retrograde flow of filler within branches of the ophthalmic artery (from the facial region) and into the central retinal artery.3 The authors wanted to determine the best retrobulbar injection pathway for approaching the central retinal artery safely. The ultimate purpose of this cadaveric study was to determine the precise course of this important vascular structure within the retrobulbar space so that clinicians can better place hyaluronidase close to the central retinal artery in the event of filler-related blindness. This is a beautifully done anatomical study with stunning visualization of the central retinal artery, and the authors are to be congratulated for their excellent work. There is no argument about their findings, nor with their recommendations on how to best approach retrobulbar injection technique. The ultimate consideration, however, is whether or not retrobulbar hyaluronidase should be undertaken in the first place. In a recent animal model, retrobulbar hyaluronidase did not improve outcomes.4 To date, the evidence has been sparse to nonexistent that retrobulbar hyaluronidase has any benefit whatsoever (e.g., Zhu et al.5), apart from a case report that might also be consistent with vasospasm or other causes of visual impairment.6 There are two interrelated issues to consider: location and time. Let us consider time first. The retina is extraordinarily sensitive to hypoxia (it is really an extension of the brain, embryonically from the same neural tissues), and injury is irreversible within minutes of onset7 (again, very similar to the brain). (In contrast, barbiturateanesthetized primates show full recovery following approximately 90 minutes of retinal ischemia.8) There is not very much time allowance to break down the filler embolus before blindness is permanent. Dermal fillers are formulated to be hyaluronidase resistant, so that they will last when injected, and there are differences in sensitivity also (some are easier to dissolve than others).9–14 Although I am referring to hyaluronidase as a generic product, there may be some differences in effectiveness between different sources (bovine, ovine, or human recombinant hyaluronidase) even though they are supposed to be normalized to the same standard international unit (such that one unit of one should be equally effective as one unit of another hyaluronidase).15 Consider also the location of the embol
{"title":"Discussion: Topography of the Central Retinal Artery Relevant to Retrobulbar Reperfusion in Filler Complications.","authors":"C. Delorenzi","doi":"10.1097/PRS.0000000000006206","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006206","url":null,"abstract":"www.PRSJournal.com 1301 T present article concerns the detailed analysis of the three-dimensional course of the central retinal artery and its topographic relations to the optic nerve as it passes from its origin (ophthalmic artery) to its final destination in the retina.1 The central retinal artery is a terminal artery that supplies the inner retina, which has no other blood supply (except for some individuals who have cilioretinal artery collateral vessels).2 This is relevant because the pathophysiology of fillerassociated blindness seems to be experimentally attributable to retrograde flow of filler within branches of the ophthalmic artery (from the facial region) and into the central retinal artery.3 The authors wanted to determine the best retrobulbar injection pathway for approaching the central retinal artery safely. The ultimate purpose of this cadaveric study was to determine the precise course of this important vascular structure within the retrobulbar space so that clinicians can better place hyaluronidase close to the central retinal artery in the event of filler-related blindness. This is a beautifully done anatomical study with stunning visualization of the central retinal artery, and the authors are to be congratulated for their excellent work. There is no argument about their findings, nor with their recommendations on how to best approach retrobulbar injection technique. The ultimate consideration, however, is whether or not retrobulbar hyaluronidase should be undertaken in the first place. In a recent animal model, retrobulbar hyaluronidase did not improve outcomes.4 To date, the evidence has been sparse to nonexistent that retrobulbar hyaluronidase has any benefit whatsoever (e.g., Zhu et al.5), apart from a case report that might also be consistent with vasospasm or other causes of visual impairment.6 There are two interrelated issues to consider: location and time. Let us consider time first. The retina is extraordinarily sensitive to hypoxia (it is really an extension of the brain, embryonically from the same neural tissues), and injury is irreversible within minutes of onset7 (again, very similar to the brain). (In contrast, barbiturateanesthetized primates show full recovery following approximately 90 minutes of retinal ischemia.8) There is not very much time allowance to break down the filler embolus before blindness is permanent. Dermal fillers are formulated to be hyaluronidase resistant, so that they will last when injected, and there are differences in sensitivity also (some are easier to dissolve than others).9–14 Although I am referring to hyaluronidase as a generic product, there may be some differences in effectiveness between different sources (bovine, ovine, or human recombinant hyaluronidase) even though they are supposed to be normalized to the same standard international unit (such that one unit of one should be equally effective as one unit of another hyaluronidase).15 Consider also the location of the embol","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"241 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76128913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006274
K. Khouri, R. Khouri
www.PRSJournal.com 1336 M and colleagues should be commended for this novel study on the effects of donor-site tissue preexpansion on fat grafting. Their study suggests that mechanical stretch induces mature adipocytes to dedifferentiate; this dedifferentiated fat has increased regenerative properties, making it ideal for fat grafting.1 The authors found a moderate but statistically significant increase in graft volume retention in the preexpanded group compared with the control group (56 percent versus 32 percent). This is an important proof of concept, but the ultimate use of this technology might not be in volume augmentation, as the authors suggest. In most clinical situations, patients would not accept the morbidity and inconvenience associated with implanting and explanting an internal expander into a donor site for a moderate improvement in final graft volume. Moreover, large-volume fat grafting is already routinely performed safely and effectively without the use of internal expanders.2 Using the principles established by basic scientists, surgeons have developed techniques to solve the problem of fat graft volume retention. Surgeons and scientists must now collaborate to solve much more complex problems in this field. Dedifferentiated fat has exhibited adipogenic, osteogenic, chondrogenic, angiogenic, myogenic, and neurogenic potential in the laboratory.3–5 Regulatory and scaling burdens associated with obtaining sufficient autologous dedifferentiated fat have stalled the clinical translation of this regenerative potential. The finding that a homogenous and functional source of dedifferentiated fat can be obtained by simply applying mechanical stretch could have a far-reaching impact on tissue engineering. As they continue to enhance our understanding and push the frontiers, we encourage the authors and other scientists to shift their focus away from the volume augmentation uses of adipose tissue and toward the other much needed regenerative capabilities.
{"title":"Discussion: Mechanical Signals Induce Dedifferentiation of Mature Adipocytes and Increase the Retention Rate of Fat Grafts.","authors":"K. Khouri, R. Khouri","doi":"10.1097/PRS.0000000000006274","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006274","url":null,"abstract":"www.PRSJournal.com 1336 M and colleagues should be commended for this novel study on the effects of donor-site tissue preexpansion on fat grafting. Their study suggests that mechanical stretch induces mature adipocytes to dedifferentiate; this dedifferentiated fat has increased regenerative properties, making it ideal for fat grafting.1 The authors found a moderate but statistically significant increase in graft volume retention in the preexpanded group compared with the control group (56 percent versus 32 percent). This is an important proof of concept, but the ultimate use of this technology might not be in volume augmentation, as the authors suggest. In most clinical situations, patients would not accept the morbidity and inconvenience associated with implanting and explanting an internal expander into a donor site for a moderate improvement in final graft volume. Moreover, large-volume fat grafting is already routinely performed safely and effectively without the use of internal expanders.2 Using the principles established by basic scientists, surgeons have developed techniques to solve the problem of fat graft volume retention. Surgeons and scientists must now collaborate to solve much more complex problems in this field. Dedifferentiated fat has exhibited adipogenic, osteogenic, chondrogenic, angiogenic, myogenic, and neurogenic potential in the laboratory.3–5 Regulatory and scaling burdens associated with obtaining sufficient autologous dedifferentiated fat have stalled the clinical translation of this regenerative potential. The finding that a homogenous and functional source of dedifferentiated fat can be obtained by simply applying mechanical stretch could have a far-reaching impact on tissue engineering. As they continue to enhance our understanding and push the frontiers, we encourage the authors and other scientists to shift their focus away from the volume augmentation uses of adipose tissue and toward the other much needed regenerative capabilities.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79300770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006276
D. Chiu, Michael K. Matthew, Anup J. Patel
BACKGROUND Treating ring avulsion injuries continues to challenge the reconstructive hand surgeon. The complex operation draws from plastic surgery and orthopedic surgery principles to provide soft-tissue coverage, skeletal fixation, tendon repair, and neurovascular reconstruction. Furthermore, the application of microsurgical techniques has enabled the revascularization and replantation of completely avulsed fingers. METHODS A retrospective review of 22 consecutive ring avulsion injuries (seven amputations, five replantations, and 10 revascularizations) from 1987 to 2015 performed by a single senior surgeon (D.T.W.C.) was conducted. RESULTS Of these 22 ring avulsions, 10 revascularizations, five replantations, and seven amputations (five because of clinical factors, and two because of patient request) were performed. None of the 15 replantations and revascularizations resulted in loss of the ring finger or necrosis of the revascularized tip. CONCLUSIONS With proper patient selection, appropriate level of injury identification, and meticulous surgical execution, the restoration of form and function to the hand is feasible in ring avulsion injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
{"title":"The Impact of Microsurgery on the Treatment of Ring Avulsion Injuries.","authors":"D. Chiu, Michael K. Matthew, Anup J. Patel","doi":"10.1097/PRS.0000000000006276","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006276","url":null,"abstract":"BACKGROUND\u0000Treating ring avulsion injuries continues to challenge the reconstructive hand surgeon. The complex operation draws from plastic surgery and orthopedic surgery principles to provide soft-tissue coverage, skeletal fixation, tendon repair, and neurovascular reconstruction. Furthermore, the application of microsurgical techniques has enabled the revascularization and replantation of completely avulsed fingers.\u0000\u0000\u0000METHODS\u0000A retrospective review of 22 consecutive ring avulsion injuries (seven amputations, five replantations, and 10 revascularizations) from 1987 to 2015 performed by a single senior surgeon (D.T.W.C.) was conducted.\u0000\u0000\u0000RESULTS\u0000Of these 22 ring avulsions, 10 revascularizations, five replantations, and seven amputations (five because of clinical factors, and two because of patient request) were performed. None of the 15 replantations and revascularizations resulted in loss of the ring finger or necrosis of the revascularized tip.\u0000\u0000\u0000CONCLUSIONS\u0000With proper patient selection, appropriate level of injury identification, and meticulous surgical execution, the restoration of form and function to the hand is feasible in ring avulsion injuries.\u0000\u0000\u0000CLINICAL QUESTION/LEVEL OF EVIDENCE\u0000Therapeutic, IV.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82402036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006225
J. Nelson, S. Voineskos, Ji Qi, Hyungjin Kim, J. Hamill, E. Wilkins, A. Pusic
BACKGROUND Rates of breast reconstruction following mastectomy continue to increase. The objective of this study was to determine the frequency of elective revision surgery and the number of procedures required to achieve a stable breast reconstruction 2 years after mastectomy. METHODS Women undergoing first-time breast reconstruction after mastectomy were enrolled and followed for 2 years, with completion of reconstruction occurring in 1996. Patients were classified based on the absence or presence of complications. Comparisons within cohorts were performed to determine factors associated with revisions and total procedures. Mixed-effects regression modeling identified factors associated with elective revisions and total operations. RESULTS Overall, 1534 patients (76.9 percent) had no complications, among whom 40.2 percent underwent elective revisions. The average number of elective revisions differed by modality (p < 0.001), with abdominally based free autologous reconstruction patients undergoing the greatest number of elective revisions (mean, 0.7). The mean total number of procedures also differed (p < 0.001), with tissue expander/implant reconstruction patients undergoing the greatest total number of procedures (mean, 2.4). Complications occurred in 462 patients (23.1 percent), with 67.1 percent of these patients undergoing elective revisions, which was significantly higher than among patients without complications (p < 0.001). The mean number of procedures again differed by modality (p < 0.001) and followed similar trends, but with an increased mean number of revisions and procedures overall. Mixed-effects regression modeling demonstrated that patients experiencing complications had increased odds of undergoing elective revision procedures (OR, 3.2; p < 0.001). CONCLUSIONS Breast reconstruction patients without complications undergo over two procedures on average to achieve satisfactory reconstruction, with 40 percent electing revisions. If a complication occurs, the number of procedures increases. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
{"title":"Elective Revisions after Breast Reconstruction: Results from the Mastectomy Reconstruction Outcomes Consortium.","authors":"J. Nelson, S. Voineskos, Ji Qi, Hyungjin Kim, J. Hamill, E. Wilkins, A. Pusic","doi":"10.1097/PRS.0000000000006225","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006225","url":null,"abstract":"BACKGROUND\u0000Rates of breast reconstruction following mastectomy continue to increase. The objective of this study was to determine the frequency of elective revision surgery and the number of procedures required to achieve a stable breast reconstruction 2 years after mastectomy.\u0000\u0000\u0000METHODS\u0000Women undergoing first-time breast reconstruction after mastectomy were enrolled and followed for 2 years, with completion of reconstruction occurring in 1996. Patients were classified based on the absence or presence of complications. Comparisons within cohorts were performed to determine factors associated with revisions and total procedures. Mixed-effects regression modeling identified factors associated with elective revisions and total operations.\u0000\u0000\u0000RESULTS\u0000Overall, 1534 patients (76.9 percent) had no complications, among whom 40.2 percent underwent elective revisions. The average number of elective revisions differed by modality (p < 0.001), with abdominally based free autologous reconstruction patients undergoing the greatest number of elective revisions (mean, 0.7). The mean total number of procedures also differed (p < 0.001), with tissue expander/implant reconstruction patients undergoing the greatest total number of procedures (mean, 2.4). Complications occurred in 462 patients (23.1 percent), with 67.1 percent of these patients undergoing elective revisions, which was significantly higher than among patients without complications (p < 0.001). The mean number of procedures again differed by modality (p < 0.001) and followed similar trends, but with an increased mean number of revisions and procedures overall. Mixed-effects regression modeling demonstrated that patients experiencing complications had increased odds of undergoing elective revision procedures (OR, 3.2; p < 0.001).\u0000\u0000\u0000CONCLUSIONS\u0000Breast reconstruction patients without complications undergo over two procedures on average to achieve satisfactory reconstruction, with 40 percent electing revisions. If a complication occurs, the number of procedures increases.\u0000\u0000\u0000CLINICAL QUESTION/LEVEL OF EVIDENCE\u0000Risk, II.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80060961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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