Plastic surgery最新文献

Introduction: Reduction mammoplasty alleviates physical and psychological discomfort in patients with large breasts. The present study sought to determine preoperative markers that may herald postoperative complications. Methods: The NSQIP 2021 data file was queried using CPT and ICD-10 diagnosis codes to identify patients who underwent reduction mammoplasty at participating hospitals. To reduce confounders, patients undergoing gender affirming surgeries and males were excluded from the analysis. Preoperative comorbidities and laboratory values were analyzed using univariate and multivariate regression to determine their association with overall 30-day postoperative complications. Results: In total, 5909 reduction mammoplasty patients were identified. Patients aged ≥ 65 years had 1.47 times higher odds of developing complications after breast reduction compared to those who were younger in age (95% CI 1.02 - 2.07, P < 0.05). Tobacco use had 1.65 times higher chance of developing complications after their surgery compared to no tobacco use (95% CI 1.11-2.38, P < 0.05) and similarly, patients with ASA class III-V had 1.6 times higher odds of complications after their surgery compared to ASA class I-II (1.25-2.03, P < 0.05). Conclusion: Patients aged ≥ 65 years, those who smoke tobacco, have obesity (BMI ≥ 30), and/or are classified as ASA III-V are significantly associated with increased 30-day complication rates following reduction mammoplasty. Preoperative counseling of these patients should emphasize the importance of modifying risk factors-such as smoking cessation and weight reduction-and clearly communicate their high risk of postoperative complications to support informed decision-making and foster realistic patients expectations.

Introduction: Stenosing tenosynovitis (trigger finger) is a common condition caused by inflammation and hypertrophy of flexor tendons. Corticosteroid injection (CSI) is an effective and safe treatment option. A palmar approach for CSI is typically used; however dorsal injection, which may be less painful, is not well-studied. Methods: A 6-stage scoping review was conducted to characterize outcomes associated with dorsal CSI for trigger finger management. We searched Ovid MEDLINE, EMBASE, and Web of Science for eligible articles in English from inception to July 2024. Data regarding study characteristics and CSI outcomes were synthesized. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. Results: Four articles were included in the review, comprising 1 case series, 2 cohort studies, and 1 randomized controlled trial (RCT). Symptom resolution rates following dorsal CSI ranged from 54% to 73.5%, comparable to a palmar approach. Two studies compared dorsal and palmar injections and found no significant differences in effectiveness. Pain scores for dorsal injections were similar or significantly lower than those for palmar injections in 2 studies. No adverse effects or complications were reported with either injection technique. Conclusion: Current evidence suggests a dorsal approach for CSI in trigger finger management is noninferior to a palmar approach in terms of efficacy and safety, with potential benefits in reducing injection-associated pain. However, more high-quality studies, including RCTs, are needed. Future research should assess anesthetic distribution and patient-reported outcomes to better understand the clinical implications of a dorsal CSI approach.

Introduction: Capsular contracture (CC) is the most common complication following breast augmentation and reconstruction. Although numerous risk factors and preventive strategies have been proposed, the etiology remains poorly understood. This study employs bibliometric analysis to evaluate global research trends, collaboration networks, and emerging hotspots in CC research. Methods: We queried the Web of Science Core Collection using keywords related to breast implants and CC, including publications through December 31, 2024. Data including publication year, author, institution, citations(C), and keywords were analyzed using VOSviewer, Microsoft Excel, and Scimago Graphica to visualize trends, collaboration networks, and research foci. Results: A total of 2065 publications(P) were included. The United States led in both total publication output and citation count (P = 800, C = 27 984), with Harvard (P = 48, C = 1688) and Georgetown Universities (P = 45, C = 2750) being key contributors. Emerging contributions from Asian institutions were noted, though citation impact remained lower. Plastic and Reconstructive Surgery was the most prolific and cited journal (P = 473, C = 23 113). Recent research hotspots identified through keyword analysis include Biofilm, Acellular Dermal Matrix (ADM), Implant placement, contamination, and inflammation. Most top-cited studies were of Level IV or V evidence. Conclusion: Research on CC is increasing, with a shift toward exploring biological mechanisms like biofilm formation and preventative measures such as ADM and implant positioning. Despite growing international interest, most evidence remains low quality. Future work should prioritize clinical studies that generate higher level of evidence and foster broader global collaboration to improve patient outcomes and refine surgical practices.

Background: Postmastectomy pain syndrome (PMPS) is a chronic condition affecting up to 50% of mastectomy patients, characterized by persistent pain that significantly impairs quality of life. Lipofilling, the transplantation of autologous fat, has emerged as a potential treatment option, offering pain relief and functional improvements through its regenerative properties. This study evaluates the effectiveness of lipofilling in managing PMPS and its impact on patients' quality of life. Methods: A prospective cohort study was conducted on 26 women diagnosed with PMPS at a tertiary care hospital in Jalisco, Mexico. This study exclusively included patients who had undergone modified radical mastectomy (MRM) without any form of breast reconstruction, in order to isolate non-implant-related causes of PMPS. Pain intensity and quality of life were assessed using the Visual Analog Scale (VAS) and EQ-5D-3L questionnaire at baseline, two weeks, and two months post-treatment. The lipofilling procedure included fat harvesting, processing via centrifugation, and reinjection into the affected chest wall areas. Changes in outcomes were analyzed using paired t-tests and Wilcoxon signed-rank tests, with significance set at p < 0.05. Results: The median VAS score decreased significantly from baseline (6, IQR 5-7) to two months post-treatment (4, IQR 3-5, p < 0.05). Quality of life scores improved markedly in the domains of mobility and usual activities (p < 0.05). No significant adverse effects were observed. Conclusion: Lipofilling is an effective intervention for reducing PMPS and improving quality of life, offering a promising option for reconstructive postmastectomy care.

Introduction: This study assesses how Canadian Plastic Surgery Residency Instagram accounts are utilized and perceived by residents, fellows, and attending physicians, and evaluates their influence on medical students' residency program selection. Methods: This 2-part study includes: (1) a descriptive analysis of Instagram activity, content, and engagement, along with a national survey of Canadian plastic surgery residents, fellows, and attendings assessing account utility; and (2) a survey of medical students who attended the University of Toronto Plastic Surgery Residency Information Session, evaluating Instagram's influence on residency selection. Descriptive statistics were reported. Results: Twelve of 13 Canadian Plastic Surgery Residency Programs had active Instagram accounts. Canadian Plastic Surgery Residency Instagram accounts had an average of 119 posts (SD = 94) over 5 years (SD = 2). Among surveyed residents (N = 27/77, 35%) and fellows/attendings (N = 83/328, 25%), Instagram use was reported by 93% and 81%, respectively. Resident recruitment ranked as the top goal (residents 1.75, fellows/attendings 3.17), followed by achievement highlights. Most residents (80%) and fellows/attendings (53%) felt medical students benefitted most. Preferred content included program culture (85%, 84%), resident profiles (90%, 73%), and research highlights (70%, 70%). Among medical student respondents (N = 25/112, 22%), 95% followed Canadian programs on Instagram, seeking program culture, resident profiles, and educational opportunities (all 89%). Over half (56%) said Instagram influenced their perception of a program, with all reporting a positive impact. Conclusion: Instagram is a valuable platform for Canadian Plastic Surgery Residency Programs to share insights and influence medical student decision-making.

Introduction: Despite carpal tunnel release (CTR) being a common procedure in hand surgery, variation in the location of the nerves supplying the palm leads to a high risk of iatrogenic damage. Recommendations have been made for a surgical incision placement that would avoid such damage, yet injury persists in clinical practice. These studies infrequently consider the safety of multiple at-risk nerves when making their recommendation, often optimizing the safety of one and subsequently jeopardizing another's. Methods: Sixty-one dissections were performed on formalin preserved cadavers to define a safe zone in the palm and recommend an incision placement for CTR. Detailed measurements examining the anatomy of the palmar cutaneous branch of the median nerve (PCBMN), the palmar cutaneous branch of the ulnar nerve (PCBUN), and the thenar motor branch (TMB) were taken relative the scaphoid tubercle, pisiform, or the A line. Results: The PCBMN was located 3.3 ± 4.1 mm ulnar to the scaphoid tubercle and 8.7 ± 3.9 mm radial to the A line. The PCBUN was located the 6.5 ± 2.4 mm radial and 6.6 ± 3.7 mm ulnar from the pisiform and A line respectively. The TMB was found 8.0 ± 3.3 mm from the A line and was classified as 56% extraligamentous, 31% subligamentous, and 13% transligamentous. Conclusion: We conclude that an area approximately 6 mm ulnar and 7 mm radial from the A line is the safe zone for CTR and recommend an incision placement in line with the radial aspect of the fourth digit. This knowledge may aid surgeons performing CTR and help reduce iatrogenic damage.

Introduction:Seddon and Sunderland's original nerve injury classification systems have stood the test of time over the last 70 years and continue to be widely used today. However, since those original descriptions, knowledge of nerve pathophysiology and healing has advanced, electrodiagnostic results have become more refined, and surgical options have increased. Methods: We offer a revisited review of the nerve injury classification to incorporate new knowledge for the modern era of nerve surgery. Results: We offer the addition of grades 0 and VI to the existing classification of nerve injuries based on Sunderland's framework, and we present a simplified classification that is patient and physician oriented, reflecting prognosis, time to recovery, and degree of recovery. Discussion: By following this nerve injury framework, clinicians can better assess, prognosticate, and manage patients.

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.