Plastic surgery最新文献

Background: Hypertrophic and keloid scars are chronic fibroproliferative disorders with major psychosocial impact. Conventional assessment tools-Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS)-are limited by subjectivity and poor reproducibility. Artificial intelligence (AI), especially convolutional neural networks (CNNs), offers opportunities for more objective scar evaluation. Objective: To systematically review AI applications in hypertrophic and keloid scar assessment, focusing on model types, imaging inputs, performance metrics, clinical endpoints, and translational readiness. Methods: A PRISMA-compliant search of online databases identified peer-reviewed AI studies on hypertrophic or keloid scar evaluation. Non-AI, non-English, and editorial articles were excluded. Two reviewers independently screened all records, with strong inter-rater reliability (κ = 0.94). Results: Among 1520 records, 24 studies met inclusion criteria. CNNs were the most common models, followed by support vector machines (SVMs) and hybrid approaches. Imaging modalities included smartphone photography, dermoscopy, thermal imaging, second-harmonic generation microscopy, and structured light. Clinical applications involved scar classification, segmentation, recurrence prediction, and treatment monitoring. Reported performance varied widely: accuracy (63%-98.5%), sensitivity (14.9%-99.7%), specificity (80%-99.9%), AUC (0.342-1.0), Dice coefficient (0.5-0.952), and r² (0.234-0.998). Larger datasets and multimodal imaging generally improved model performance. Small or low-quality datasets produced more variable results. External validation occurred in approximately 58% of studies and typically resulted in modest performance drops, indicating overfitting. Conclusions: CNN-based models using mobile or dermoscopic imaging shows promise for objective scar assessment. Key barriers to adoption include limited external validation, explainability, and regulatory integration.

Background: Carbon emissions associated with patient travel for hospital visits contribute to climate change. This study estimated carbon emissions from patients travelling for in-person visits and carbon emissions associated with virtual health visits at the BC Children's and Women's Hospital Campus in 2021-2022. Methods: Anonymized visit data categorized by in-person/virtual, and aggregated by patients' home city/town, and fiscal quarter was obtained. Mode of travel assumptions were based on economic region and seasonality. Carbon dioxide equivalent emissions (CO_2e) for a realistic scenario and alternative scenarios were calculated using equations derived from reference data. Results: There were 397,962 patient visits (19% virtual) associated with an estimated 10,001 metric tons of CO_2e. Alternative scenarios showed that if patients from Northern or Interior regions travelled by plane during the winter, emissions decreased (-14%). While the proportion of visits that were virtual ranged from 16% to 40% by region, if all regions had 40% virtual visits, emissions would decrease by 14%. The largest reduction in carbon emissions (-26%) was found in the scenario where patients from Northern and Interior regions travelled by plane in the winter and the proportion of virtual visits increased to 40%. Conclusion: These findings underscore the need to raise awareness of the carbon footprint of healthcare related travel. The study urges a thoughtful consideration of planetary health when choosing between in-person and virtual visits, recognizing the ability to lower emissions by conducting virtual visits where appropriate.

Background: The optimal surgical management of complex pressure injuries (PIs) relies on adequate education during residency. However, both classroom-based and clinical exposure to these injuries may be inconsistent across training programs. This study aimed to evaluate Ontario surgical residents' exposure to PI management and identify deficiencies in current curricula. Methods: A cross-sectional survey was developed and distributed to general, orthopaedic, and plastic surgery residents across Ontario. The survey collected data on didactic and clinical exposure to PI management, confidence in debridement and reconstruction, and perceptions of current training. Statistical analyses included descriptive statistics and comparisons between surgical specialties. Results: Forty-nine responses were obtained (response rate = 14%). Results demonstrated limited didactic and clinical exposure to PI management in nonplastic surgery residency programs. Most nonplastic surgery residents did not anticipate feeling comfortable performing PI debridement as part of their future practice following residency completion. In contrast, plastic surgery residents reported greater confidence in performing debridement but lacked confidence in selecting appropriate surgical candidates for reconstruction. Conclusions: Exposure to PI reconstruction for plastic surgery residents appears to be limited. Both nonplastic and plastic surgery residents expressed strong interest in additional educational initiatives focused on the surgical management of PIs. This study highlights the need for enhanced educational opportunities, including structured curricula and increased clinical exposure, to ensure surgical trainees develop the necessary competencies for managing PIs effectively.

Objectives: To present the cauda helicis as a novel and anatomically compatible graft source for reconstructing the cartilaginous support structure of the nasal tip, highlighting its morphological similarity to the alar cartilages and potential advantages over traditional donor sites. Methods: A surgical dissection protocol was performed on anatomical models from 14 fresh cadavers in 2017. The approach included harvesting the cauda helicis, with the possibility of extending the donor area to the scaphoid fossa. A systematic literature search was conducted, considering all publications indexed up to May 2025, no publications reporting the use of the cauda helicis as a graft were identified. Results: The cauda helicis demonstrated anatomical and structural similarities to the alar cartilages. The harvesting technique proved to be technically straightforward, with a low complication profile and imperceptible impact on the natural auricular contour. The donor area extension into the scaphoid fossa provided sufficient graft material for total or partial reconstruction, achieving consistent outcomes in terms of morphology and graft compatibility. Conclusions: The cauda helicis is a viable, safe, and technically simple alternative for structural nasal tip reconstruction. Its anatomical similarity to the alar cartilages and low morbidity at the donor site position it as a promising option for both reconstructive and aesthetic nasal surgery. To our knowledge, this technique has not been previously reported in the literature.

Introduction: Cubital tunnel syndrome (CuTS) occurs due to compression or traction of the ulnar nerve at the elbow. When conservative management fails, CuTS release (including decompression and transposition) can be performed. Recently, more research has investigated local anesthesia (LA) and regional anesthesia (RA) for CuTS release. The objective of this scoping review was to summarize current literature on the safety and efficacy of LA and RA for CuTS release. Methods: A scoping review was conducted following the PRISMA-ScR protocol and reporting guidelines. A search was conducted of MEDLINE, EMBASE, Web of Science and CINAHL based on the key concepts of CuTS release, and LA or RA. Covidence was used for abstract and full-text screening. Results: A total of 21 studies consisting of 1385 patients and 1406 elbows were included. Most studies were case series or cohort studies. Patients received LA in 15 studies (n = 429 elbows), RA in nine studies (n = 616 elbows) and general anesthesia (GA) in six studies (n = 361 elbows). Complication rates after surgery were 2.9% for LA, 2.3% for RA, and 2.5% for GA. Overnight hospital stay was more often required in GA compared to RA. One study reported significantly less postoperative pain using LA compared to GA. Four studies reported preference for LA or had high satisfaction with their procedures. Conclusions: Regional and local anesthetic techniques are safe and feasible for CuTS release. They have similar complication rates to GA, but may offer additional benefits such as intraoperative feedback, and better postoperative pain management.

Introduction: Increased awareness of textured breast implants' association with breast implant-associated anaplastic large cell lymphoma has led to rising rates exchange from textured anatomic implants to smooth round implants, which can alter breast esthetics. This study used 3-dimensional (3D) imaging to evaluate breast shape changes following textured anatomic to smooth round implant exchange in breast reconstruction patients. We hypothesized a decrease in upper pole fullness after conversion to round implants. Methods: A retrospective review was conducted of breast reconstruction patients who underwent exchange from textured anatomic to smooth round implants between January 2019 and December 2020. Patients with preoperative and postoperative 3D images were included, excluding those with concurrent or prior fat grafting. VECTRA 3D imaging measured changes in breast surface projection. Linear regression modeling was used to evaluate associations between projection changes and body mass index (BMI), implant volume, and implant type. Results: Ten patients (18 breasts) were analyzed. The mean volume of round implants was significantly larger than anatomic implants (486.7 vs 453.9 mL, P = .01). All breasts exhibited superior hollowing postoperatively, with an average projection loss of 1.4 cm (SD = 0.8 cm). Regression analysis revealed no significant associations between projection loss and implant volume change (P = .887), BMI (P = .481), or round implant style (P = .389). Conclusions: Exchange from anatomic to round implants results in significant loss of superior breast projection. VECTRA imaging underscores these changes, aiding patient counseling and surgical planning. Fat grafting may help address these issues, warranting further research.

Introduction: Breast reduction mammoplasty incision patterns vary in benefits and drawbacks. The Wise pattern enables lateral skin resection but leaves medial and lateral scars, while the Vertical pattern yields a smaller scar yet limits lateral skin removal. A novel, Paisley pattern allows lateral skin resection without a medial scar. This study compares postoperative outcomes of the various techniques. Methods: A retrospective chart review of 118 patients undergoing bilateral breast reduction mammoplasty from January 2020 to November 2024 at a single institution was performed. Demographics, comorbidities, operative details, and 60-day complications were collected. Analyses included chi-squared tests, ANOVA, and t-tests. Results: Of 118 patients, 60 (51%) underwent Wise, 44 (37%) Vertical, and 14 (12%) Paisley reductions. The Paisley group had the highest BMI (35.5 ± 5.5), significantly higher than Vertical (31.3 ± 4.4, P = .005) but not Wise (33.8 ± 4.6, P = .204). Operative time was shortest for Paisley (2.47 ± 0.41 h) versus Vertical (3.05 ± 1.06 h) and Wise (4.71 ± 1.97 h), significant between Paisley and Wise (P < .001) and Wise and Vertical (P < .001). Paisley had the highest resection volume (2026.9 ± 780.6 g), greater than Vertical (1137.3 ± 624.7 g, P = .03) and comparable to Wise (1860.1 ± 866.1 g, P = .423). Complication rates were 36.4% Vertical, 21.4% Paisley, and 14.8% Wise; no Paisley patients required revision surgery. Conclusions: The Paisley pattern offers comparable complication and reoperation rates, shorter operative time, and greater resection volume, with technical and aesthetic benefits.

Earlobe keloids are difficult to manage due to their high recurrence rates and the challenges of applying consistent compression over the ear's complex shape. Common treatments, including surgical excision, intralesional corticosteroid injections, cryotherapy, laser therapy, and radiotherapy, often have recurrence rates exceeding 50 percent when used alone. Combining surgical excision with adjuvant measures can significantly improve outcomes. We describe a novel, low cost, time efficient, and easily fabricated compression device used alongside core excision, low tension closure, and intralesional corticosteroids. Two 25-gauge syringe hubs are removed from the syringe and modified with cautery to create suture channels. They are soaked in chlorhexidine or alcohol, layered with xeroform gauze, and applied bilaterally to the earlobe using nylon sutures in a horizontal mattress or figure-of-eight configuration. Worn continuously for six months, the device delivers sustained, conforming compression, integrates recurrence-reducing principles, and offers a practical alternative to commercial or custom 3D printed devices.

Auricular amputations are rare injuries, particularly in children, and most published literature reports complete ear amputations rather than partial defects. We present a case of a paediatric patient who sustained a partial amputation of the right ear from a dog bite. This was treated with single vessel microvascular arteriovenous replantation without venous repair. The ear survived with excellent cosmetic outcome at 8 months. This case highlights the feasibility of single vessel replantation in paediatric partial ear injuries and adds to the limited published experience of such cases.

Introduction: Immediate lymphatic reconstruction (ILR) during axillary lymph node dissection (ALND) has been shown to reduce breast cancer-related lymphedema (BCRL). However, some authors report many "non-reconstructable" patients, meaning that there were no suitable lymphatics or veins available in the axilla to complete the reconstructive procedure once the extirpative portion was complete. In contrast, almost all of our patients planned for ALND/ILR have had appropriate donor and recipient vessels. The purpose of our study was to contrast the incidence of "non-reconstructable" patients in the literature with our experience and highlight tips to improve the reconstructable rate. Methods: Step 1: A systematic review identified publications on ILR during ALND, which reported the number of "non-reconstructable" patients. Step 2: A chart review of ILR cases at the University of Calgary was conducted. From both data sets, patient demographics, cancer stage, node dissection results, treatment details and operative details were collected. The data was then analyzed to identify factors that could contribute to the number of "non-reconstructable" patients. Results: 11 studies were identified in the review, which included 949 patients planned for ILR during ALND. One hundred and thirty-three (14%) were deemed "non-reconstructable," and did not undergo ILR. Analysis of 68 consecutive ALND/ILR cases at the University of Calgary identified 4 (5.9%, p = .03) "non-reconstructable" patients. A similar method of lymphatic mapping was used in the review studies as at the University of Calgary. The patients' demographics and treatment details were similar in the review and our prospective series: average age (49 vs 54, p = .07, BMI (27 vs. 27, p = .47) and receipt of radiation (76.5% vs. 69%, p = .79). The only difference noted was the presence and the level of involvement of a plastic surgeon throughout the extirpative portion of the procedure, in order to identify and preserve vessels. At our institution, the plastic surgeon attends throughout and participates in a well-coordinated "dance" between the oncologic surgeon and the plastic surgeon. This coordination was not described in any of the studies reviewed. Conclusions: For ILR, coordinated plastic surgical involvement during ALND may reduce the number of "non-reconstructable" patients.