Plastic surgery最新文献

Introduction: Tendon grafting is standard for treating tendon defects. Allografts are popular in cruciate ligament reconstruction but not yet in upper limb tendon reconstruction. A scoping review was conducted to map the existing practice of allograft use in hand surgery for tendon reconstruction and identify gaps in knowledge for future research. Methods: Two independent reviewers searched MEDLINE and SCOPUS databases for studies on upper limb tendon reconstruction using tendon allografts until June 2022. Eligible studies included controlled randomised clinical trials, cohort, case-control, cross-sectional, or case report and series studies conducted in English and enrolling patients who underwent tendon allograft reconstruction in the upper limb. Screening for eligibility was done by both reviewers, who reached a consensus through discussion, with no exclusion based on poor methodological quality. Data charting included study title, patients' demographics and outcomes, complications, and follow-up period. Results: The database search found 6 eligible articles with a total of 116 patients and 148 allografts used for reconstruction. Of the studies that looked at functional outcomes, 72.9% of patients had 'good' or 'fair' results, while 25.8% were classed as 'poor'. All of the patients assessed for subjective outcomes were at least partially/fairly satisfied with the allograft. Conclusion: This scoping review has indicated that the utilisation of tendon allografts in the upper limb can potentially be a promising approach for tendon reconstruction, especially in cases of severe trauma or salvage. However, further research is needed to comprehensively assess efficacy, long-term outcomes, complications, postoperative rehabilitation protocols, and comparative effectiveness against autograft tendon reconstruction.

Background: Reconstructed breast with silicone breast implants (SBIs) after nipple-sparing mastectomy (NSM) provides high patient satisfaction from a cosmetic point of view, but low patient satisfaction with respect to hypoesthesia of the reconstructed breast, and reinnervation is required. Currently, few reports are available on reinnervation in breast reconstruction with implants, and detailed data on desensitization of reconstructed breasts are lacking. Therefore, we examined perceptual data after NSM with respect to reinnervation. Methods: In our department, after NSM, tissue expander or SBI was used to perform 1-stage or 2-stage breast reconstruction, and touch, warm and cold, and pain sensations in 31 cases more than 1 year after completion of reconstruction were examined. Results: All tests of sensations tended to be better in the medial region than in the lateral region, but no correlation with postoperative years was found. In the comparison of the incision lines, in the Semmes-Weinstein monofilament test (SW test), a significant difference was observed between the inframammary fold (IMF) incision and the para-areola incision in the breast D region, between the lateral incision and the para-areola incision, and between the IMF incision and the para-areola incision in the areola b region. In addition, linear regression analysis of postoperative years did not establish a predictive formula for the SW test or pain sensation in any of the 9 regions. Conclusions: The difference in the excision range was considered to be the largest factor affecting hypoesthesia. We also speculated that preservation of the internal mammary artery perforators during mastectomy led to preservation of the anterior cutaneous branch of the intercostal nerves, and therefore, the perception of the medial region was better than that of the lateral region. In the case of NSM in which the anterior cutaneous branch was preserved, the recovery of outer perception including that of the nipple-areolar complex (NAC) was poor, so it was considered that nerve reconstruction between the lateral cutaneous branch and the NAC was effective for reinnervation.

Pilomatrixoma, also called Malherbe's calcifying epithelioma or pilomatrixoma, is a benign adnexal tumor that originates from keratinocytes (cells of the hair matrix, the internal sheath of the hair root or the cortex) and constitutes the second most prevalent skin neoplasm in children. These lesions are typically slow-growing, firm, nodules located on the head, neck, trunk, and extremities (in decreasing order of frequency). Due to the rarity, combined with their varied clinical presentations, pilomatrixomas are often misdiagnosed. Current pilomatrixoma classification schemes remain controversial. In this article, we present 4 pediatric patients that exemplify different clinical and atypical scenarios of the same tumor. Accordingly, we invite future studies to create a novel system for the classification of pilomatrixomas based on atypical clinical characteristics, including lesion morphology, number, size, and anatomic location.

Given the proximity and shared structures of Guyon's canal and the carpal tunnel, compression of the ulnar nerve is a rarely observed but possible complication of carpal tunnel release. In this case report, a patient underwent previous carpal tunnel release and immediately experienced ipsilateral hand weakness in keeping with an ulnar nerve compression syndrome. Clinical, electrodiagnostic, and magnetic resonance imaging findings after carpal tunnel release demonstrated a compression or injury to the deep motor branch of the ulnar nerve not previously present. Subsequent release of Guyon's canal identified a separate compartment of the deep motor branch of the ulnar nerve within the ulnar leaflet of the transverse carpal ligament. After the release of the motor branch from this compartment, the patient experienced recovery from their neuropathic symptoms. This case report outlines the relevant anatomy and clinical data surrounding an anomalous compartment of the deep motor branch of the ulnar nerve.

Background: Patient expectations have been shown to influence postoperative outcomes across surgical specialties. However, the impact of expectations in breast reconstruction is not well understood. The purpose of this project is to perform the first large-scale analysis and classification of BREAST-Q Expectations responses in patients undergoing implant-based reconstruction. Methods: We performed a retrospective analysis of patients who underwent postmastectomy implant-based reconstruction and completed the BREAST-Q Expectations module preoperatively between 2012 and 2021. Variables of interest included patient demographics, comorbidities, and surgical characteristics. Outcomes of interest included BREAST-Q Expectations module scores. Shapiro Wilk Normality Tests demonstrated that none of the domains had a normal distribution of scores; scores were categorized by thirds to generate thresholds for optimistic, neutral, and pessimistic scores. Results: 298 patients met criteria. The mean age of the cohort was 50.3 and the mean BMI was 25.4. Half of the patients had at least one comorbidity - most commonly obesity, followed by diabetes. About two-thirds had a psychiatric diagnosis. Scores on all domains were skewed overwhelmingly positive (expectations of Medical Team, Coping, Appearance, Self-feelings, and Sexuality) or overwhelmingly negative (expectations of Pain and Recovery), which informed score categorization and interpretation. Conclusions: Preoperative expectations in patients undergoing implant-based reconstruction skew overwhelmingly optimistic for most domains, but overwhelmingly pessimistic on expectations of Pain and Recovery. These results emphasize a need for improved preoperative patient education and counseling as well as a closer analysis of the relationship between preoperative expectations and postoperative outcomes and quality of life.

Background: Rhinoplasty is one of the most common cosmetic procedures performed by plastic surgeons and otolaryngologists. Previous studies have concluded that the readability of rhinoplasty information does not meet the recommended guidelines for the 8th grade reading level. In this study, we performed an updated readability analysis and a comprehensive online review of decision-making factors for patients considering rhinoplasty. Additionally, the differences between plastic surgery and otolaryngology-specific web pages were also analyzed in this study. Methods: This study analyzed 30 websites from universities and private practice webpages for decision-making factors, readability, and tone. These sites were identified by performing a depersonalized Google search using the search terms "nose job decision factors" and "rhinoplasty decision factors." An independent t-test was performed to assess the differences between webpages. Results: A total of 30 websites were comprehensively reviewed for a comparative analysis of readability for potential rhinoplasty patients. Decision-making factors were divided into 3 categories: individual factors, goals of the procedure, and technical considerations. These categories were then further divided into subcategories. The most common decision-making factor discussed was procedural considerations (83.3%), the least common being lifestyle (10%). Additionally, only 26.7% of web pages mentioned ethnic background and skin type as potential considerations before surgery. Less than half (40%) discussed the importance of setting realistic expectations for the procedure. Of the total sites analyzed in the study, 65.5% were ENT-based, 24.1% were plastic surgery-based, 3.4% were dental/oral maxillofacial surgeons, and 6.9% were combined plastic surgeons and ENT. Statistically significant differences between ENT- and plastic surgeon-based webpages were observed. Risks and complications were more frequently discussed on ENT web pages (P = .02). ENT sites also had more adverbs (P = .024) and more uses of passive voice (P = .006). Additionally, plastic surgery web pages appeared to elicit more of the emotion "disgust" after analysis utilizing IBM Watson Natural Language Understanding (P < .001). Conclusions: This study highlights the necessity for continued improvement in the readability of webpages designed for patients considering rhinoplasty. Additionally, there were statistically significant differences between decision-making factors presented on ENT-based webpages and plastic-surgery-based webpages. This study may aid surgeons in developing websites that are more accessible, equitable to patients, and contain a more comprehensive discussion regarding key patient decision-making factors and preoperative considerations.

Background: Non-surgical rhinoplasty with hyaluronic acid (HA) filler is a three-dimensional reshaping technique that achieves tissue enhancement by placing HA deep to nasal skin. Due to its unique rheology, Restylane® Lyft (HA-L, Galderma, Uppsala, Sweden) may be particularly well-suited for injection rhinoplasty, as it has high gel firmness (G') for strong structural support with minimal integration propensity. Methods: A prospective clinical trial was conducted to evaluate HA-L use for non-surgical rhinoplasty. Thirty-three females were observed over eight months, using the following schedule: Visit 1 = Baseline/Treatment 1; Visit 2 = Optional touch up (Week 2); Visits 3-6 = Follow-ups (Months 1,3,6,8). The primary endpoint was subject improvement at Month 1 assessed by a blinded evaluator using the Global Aesthetic Improvement Scale (GAIS). Subject satisfaction and adverse events (AEs) were also evaluated. Results: A deep, periosteal injection using a bolus technique and 0.34 cc of HA-L was most often used. Seven cases of positive aspiration occurred in 167 injection points (4.19%), among 6/33 (18.18%) subjects. Based on the GAIS, 100% of subjects met the primary endpoint. Subject satisfaction was maximal at Month 1 (100%) and largely maintained at Month 8 (78.57%). Besides expected injection-related AEs (eg, ecchymosis, erythema), immediate AEs during/following treatment were limited to presyncopal symptoms [5/33 subjects (15.15%)]. Importantly, no cases of ischemia were observed. Subject-reported AEs (eg, swelling, erythema, pain) dissipated within 2 to 7 days. Conclusion: Given the technical nature of this technique, HA-L may be well-suited for injection rhinoplasty, due to its strong safety and efficacy profile. Level of Evidence: Level III: Evidence obtained from well-designed cohort study.

Background:Qualitative research incorporates patients' voices into scientific literature. To date, there has been no formal review of qualitative research in plastic surgery. The primary objective of this study was to evaluate the reporting quality of "breast specific" plastic surgery qualitative research. Secondary objectives were to record study methodology and examine associations between reporting quality and publication/journal characteristics. Methods: MEDLINE, Embase, Psychinfo, and PubMed were searched to identify qualitative studies in breast plastic surgery. Findings were presented with descriptive analysis. Reporting quality was evaluated using the Standards for Reporting Qualitative Research (SRQR), a 21-item checklist. Results: Eighty studies were included. The median SRQR score was 17/21 (range: 6-21). The lowest reported SRQR items were qualitative approach (n = 29/80, 36%) and data collection method (n = 36/80, 45%). Nine (11%) studies described following a reporting guideline. Articles published in nursing journals had the highest average SRQR scores (18.4/21). There was no significant difference between studies published before or after the publication of SRQR (P = .06). Eighty-six percent of studies focused on patient experiences with breast reconstruction (n = 69/80). Conclusions: The introduction of the SRQR has not led to significant improvement in the reporting of qualitative research. Rationale for methodology was frequently missing. We recommend that investigators conducting qualitative research in breast plastic surgery ensure they provide a rationale for their methodology and become familiar with the SRQR reporting guideline.

Background: Opioid dependence can occur in 6% to 10% of patients undergoing breast reconstruction. With the expansion of interdisciplinary initiatives to decrease opioid use after surgery, an updated look at the incidence of and risk factors for prolonged opioid dependence after free flap breast reconstruction is essential. Methods: We retrospectively identified all cases of free flap breast reconstruction completed at our institution from 2017 to 2020. Patients undergoing additional surgery within 120 days of the free flap procedure were excluded. Postoperative opioid prescriptions were identified; prolonged opioid use was defined as the receipt of additional prescriptions 91 to 120 days after surgery. Demographic and perioperative variables were assessed for their relationship with prolonged opioid use by logistic regressions. Results: A total of 732 patients were included in the final analysis; of these, 15 patients (2%) received additional opioid prescriptions 91 to 120 days after surgery (ie, had prolonged opioid use). Univariable associations were identified between prolonged opioid use and intraoperative morphine milliequivalents (OR = 2.3 per 50 units [95% CI, 1.5-3.5]; P < .001), opioid prescriptions 31 to 60 days after surgery (OR = 16.1 [95% CI, 4.0-65.0]; P < .001) and 61 to 90 days after surgery (OR = 89.4 [95% CI, 13.7-584.5]; P < .001), and history of substance use disorder (OR = 8.3 [95% CI, 2.2-31.6]; P = .002), anxiety (OR = 3.8 [95% CI, 1.2-12.1]; P = .023), or mood disorder (OR = 12.7 [95% CI, 1.3-121.3]; P = .027). Conclusion: In our cohort, 2% of patients who underwent autologous breast reconstruction (15/732) had prolonged opioid use. The currently used perioperative opioid minimization initiatives may benefit patients undergoing autologous breast reconstruction.

Background: Gender disparities in academic leadership positions may be influenced by several factors, including research productivity. We aimed to describe the publication gender gap in major plastic surgery journals, assess gender-related and gender-neutral research publications, and identify any potential gender disparities associated with publication characteristics. Methods: For this cross-sectional study, we reviewed all original research publications in Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery, and Aesthetic Surgery Journal from 2014 through 2018. Genderize.io was used to identify the gender of all authors. Each publication was classified as either gender-neutral, transgender health, women's health, or men's health-related based on the article's content. Results: Of the 12,718 authors across 2234 publications analysed, females were first authors in 30%, last authors in 17%, and all authors in 27%. Among the publications, 1782 (79.8%) were focused on gender-neutral, 419 (18.8%) on women's health, 18 (0.8%) on transgender health, and 15 (0.7%) on men's health. Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI]  =  1.4 [1.1-1.8] and OR [95% CI]  =  51.0 [47-55], p < .001) and had a higher mean number of citations compared to gender-neutral articles (p < .001). Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI]  =  1.4 [1.1-1.8] and OR [95% CI]  =  51.0 [47-55], p < .001) and had a higher mean number of citations compared to gender-neutral articles (p < .001). Conclusion: The publication gender gap persists in academic plastic surgery. The academic community should continue to prioritize addressing gender disparity from the perspective of research productivity.