Plastic surgery最新文献

Background: Thoracic outlet syndrome (TOS) is characterized by compression of neurovascular structures within the thoracic outlet. Symptoms include upper-extremity paresthesias, weakness, and, in some-cases, effort-induced thrombosis. Implant-based breast reconstruction has been identified as a potential etiology of TOS given the anatomic relationship of the pectoralis muscles to the thoracic outlet. This study aims to investigate the relationship between implant-based reconstruction and TOS diagnosis. Methods: A retrospective, single-institution review was conducted to identify female subjects that presented for evaluation of TOS-like symptoms between April 2014 and December 2022. Results: 319 female patients presented to our institution for evaluation. Sixteen (5.0%) of these subjects previously underwent implant-based breast reconstruction, for which the following outcomes were considered: symptom type, timing to onset of symptoms relative to timing of reconstruction, and diagnosis of TOS as confirmed by imaging or testing. Seven of 16 patients (43.8%) received a formal diagnosis of TOS from a surgical specialist and were also found to have subpectoral implants. Conclusions: Based on clinical evidence, breast reconstruction has been acknowledged as a probable etiology for TOS. However, over half of symptomatic subjects did not receive a formal diagnosis of TOS, suggesting a potential for improvement in screening methods for this population. While the data of this study suggests that the plane of reconstruction, specifically subpectoral, could have an association with TOS, further research with a larger patient cohort is necessary to establish a definitive causal relationship.

Introduction: Emergency department (ED) visits following elective surgeries place significant strain on already overburdened healthcare systems. In Nova Scotia, carpal tunnel release (CTR) and trigger finger release (TFR) are the most common elective hand surgeries performed. This study sought to determine the rates, reasons, and risk factors associated with ED visits following elective outpatient hand surgery. Methods: Patients who underwent CTR or TFR between April 1, 2016 and March 31, 2022, and visited any Nova Scotia ED within 90 days of surgery were identified using provincial healthcare databases. A chart review was completed to explore ED timing, reasons for presentation, and predetermined systems-level factors. Results: During the retrospective period, 2690 patients underwent CTR and 1103 patients underwent TFR. For CTR, 159 patients (5.97%) presented to the ED within 90 days of surgery for surgery-specific concerns. The most common presentation was surgical site infection (2.16%), wound check (1.60%), and suture removal (1.04%). For TFR, 63 (5.71%) patients presented to the ED within 90 days. Similarly, surgical site infection was the most common presentation (2.63%) followed by suture removal (1.45%) and wound check (1.18%). The most frequent timing for ED presentation was days 13-15 (27.9%). Conclusion: In an evaluation of true healthcare utilization after elective surgery, ED visits for surgery-specific concerns after CTR and TFR were nearly 6%, far exceeding expected complication rates. As the presentations are manageable in an outpatient clinic or office setting, a mixed-methods patient-oriented intervention is planned to redirect this population away from the ED.

Background: Surgical repair of orbital fractures comes with risks. One rare risk is interference with the actions of the superior oblique tendon-muscle complex causing an acquired Brown syndrome. We present the case of a 45-year-old man who developed acquired Brown syndrome after undergoing repair of a large orbital floor and medial orbital wall fracture using a titanium mesh implant. A case report was prepared to discuss a rare surgical risk with open reduction internal fixation (ORIF) of an orbital wall fracture. Methods: A retrospective chart review was performed. Results: Post-operative ophthalmological assessment revealed persistent diplopia along with limitations of up-gaze particularly in the adducted position. Ultimately, the patient underwent surgical repositioning of the orbital implant, which seemingly released the superior oblique muscle-tendon complex, resolving most of the diplopia. No further treatment with prisms or strabismus surgery has been required. Conclusions: Acquired Brown syndrome is a potential risk of surgical repair of orbital fractures involving the medial orbital wall. Herein this case study, we describe a case of acquired Brown syndrome following ORIF of an orbital floor and medial wall fracture, which was alleviated with a revision surgery.

Introduction: The landscape of academic research has evolved notably in recent decades, shifting towards earlier career publications and more interdisciplinary collaborations. This study aims to identify research productivity trends among Canadian academic plastic surgeons. Methods: The Web of Science and MEDLINE databases were searched by plastic surgeon names and for each result, the author list position, year of publication, journal, and citation counts were collected. Surgeons' demographics, including gender and medical school graduation year, were obtained from provincial college websites. Publication rates over a plastic surgeon's career trajectory were analyzed by surgeons' current decade of practice. Results: There were 3661 included entries in our database, corresponding to 2831 unique publications by 245 surgeons (71%, 175/245 men). The median year of medical school graduation was 2002 (SD 12 years). Surgeons in more recent decades of practice (decade 1 or decade 2) published earlier and more frequently per career decade. A wide distribution of publication rates (range 0-66) was found for surgeons currently in their fourth decade of practice. From 2005 to 2020, the number of publications per year increased dramatically, from 36 publications in 2005 to 198 publications in 2020. Citations normalized by years from publication remained stable. The proportion of first authorship decreased from 0.63 and 0.42 in the pre-medicine and educational decades, to 0.09 and 0.08 by the third and fourth decades of practice (p < .001). Conclusion: An emerging trend of earlier and increased publications among newer generations of surgeons was seen. Incentives to participate and mentor in research for surgeons gaining seniority are suggested.

Introduction: Despite rising rates of post-mastectomy immediate breast reconstruction (IBR), there are fears of local recurrence (LR) among patients and physicians. This systematic review and meta-analysis compare long-term LR incidence in patients with mastectomy and IBR (Mast + IBR) to patients with mastectomy alone (Mast - IBR). Methods: Medline, Embase, and Web of Science databases were searched for relevant articles. Articles published between January 2000 and December 2020 were included when LR rates were reported for patients with breast cancer (stage I or II) who underwent mastectomy with or without IBR. A random-effects model was used to calculate pooled odds ratios (ORs) with a 95% confidence interval (CI), adjusted for age, and follow-up time. Results: In total, 1475 unique articles were identified, with 1434 excluded in title abstract screening and 31 excluded in full-text screening. Ten articles, amounting to 15 173 patients (3478 Mast + IBR, 11 695 Mast - IBR), were included. In total, 111 (3.2%) patients in Mast + IBR experienced LR after a mean follow-up time of 72.9 months, while 245 (2.1%) in Mast - IBR experienced LR after a mean follow-up time of 73.3 months. There were no increased odds of LR in Mast + IBR, adjusted for age, and follow-up time (OR 1.17, CI 0.86-1.59, P = 0.59). Conclusion: This meta-analysis supports that IBR is not associated with increased LR odds compared to mastectomy alone. Patients with breast cancer may undergo mastectomy and IBR without concern of increased rates of LR, which contributes to improved quality of life.

Introduction: Sensory function in the V2 and V3 territories of the trigeminal nerve is critical for facial sensation and quality of life. Injuries to these branches often result in significant sensory deficits, impairing daily activities. Nerve transfer techniques offer potential solutions for restoring lost sensation for patients with loss of proximal nerve stump, central pathway damage, or in the presence of large nerve gaps. However, they remain underutilized in clinical practice. Objective: This systematic review assesses the feasibility and effectiveness of nerve transfer techniques for sensory reconstruction of the V2 and V3 territories. Methods: A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted. Studies reporting sensory reconstruction outcomes, such as 2-point discrimination (2PD) or directional brush stroke detection, were included. Articles published from 2009 to 2024 were reviewed, alongside relevant references outside this timeframe providing important clinical insights. Ten studies meeting the inclusion criteria were analyzed, and their quality was assessed using PRISMA guidelines. Results: Sixteen patients (mean age: 32.1 years) and 24 repairs were identified. Trigeminal nerve injuries resulted from surgical complications (31.2%), trauma (25%), and oncological resections (18%) in most cases. Sixty-six percent of cases underwent cross-facial nerve grafts (CFNG), while the remaining repairs were reconstructed using regional nerve transfers. Recovery times varied, with a mean follow-up of 20.6 months. All patients achieved significant improvement in facial sensation and symptoms. Conclusion: CFNGs and nerve transfers are effective for restoring sensation in V2 and V3 territories, with promising recovery rates. Larger studies with extended follow-ups are needed to refine and validate these techniques.

Introduction: Kirschner-wire (K-wire) fixation (KF) is the most common operative technique for hand fractures among Canadian plastic surgeons. However, postoperative rehabilitation varies widely and rely on low-quality studies and expert opinion. The study reviewed KFs of phalangeal and metacarpal fractures at a single academic center to quantify practice variation and patient outcomes. Methods: This retrospective chart review analyzed all cases of KF of isolated phalangeal and metacarpal fractures performed by all plastic surgeons at a single tertiary care center in the last 7 years. The primary outcome was the duration from operation to K-wire removal. Secondary outcomes included the time from KF to range of motion (ROM) initiation, the interval between K-wire removal and ROM initiation, postoperative complications, and functional outcomes. Results:Among 289 patients, mean time from KF to K-wire removal was 28.6 days (SD 8.2). There was a high variability among the surgeons, with the shortest duration averaging 26 ± 6 days and the longest averaging 33.7 ± 8.6 days (P < .001). Mean time to initiation of ROM was similar across surgeons (mean 25.2 ± 11.4 days). Postoperative complications occurred in 26 patients (10.9%), primarily pin site infections (6.7%). Early versus late K-wire removal did not affect complication rates. There were no differences in functional outcomes between surgeons. Conclusion: There is considerable variability in postoperative rehabilitation following KF of hand fractures among surgeons at a single academic center. Our study suggests that supervised ROM can be initiated safely as early as 3 weeks postoperatively, regardless of whether K-wires remain in situ.