Plastic surgery最新文献

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.

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.