Plastic surgery最新文献

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.

Background: Loss of nipple projection is a common concern following local tissue nipple-areolar complex (NAC) reconstruction, with contracture leading to inevitable projection loss over time. While multiple techniques have been developed, few studies have measured long-term projection loss, and none have utilized 3D imaging for accurate assessment. This study aimed to analyze long-term nipple projection loss using 3D imaging to improve patient education and expectations. Methods: A retrospective analysis of patients who underwent skin-sparing postmastectomy breast reconstruction with local flap-based (C-V flap) NAC reconstruction between 2010 and 2022 was conducted. Patients with available 3D images were included. The VECTRA Analysis Module (VAM) was used to measure nipple projection at 3, 6, 12, and 24 months postoperatively. Subgroup analysis was performed for autologous and implant-based reconstruction. Results: Among 136 patients (281 observational time points), nipple projection decreased by 14% at 3 months (P = .002), 15% at 6 months (P = .001), and 19% at 1 year (P < .001) compared to 1 month postoperatively. After 1 year, projection stabilized, with only a 2% decrease in height by year 2 (P = .13). C-V flap limb length was not significantly associated with long-term projection retention (P = .10). Subgroup analysis showed similar nipple projection retention patterns for autologous and implant-based reconstruction, stabilizing at 1 year postoperatively. Conclusions: Nipple projection following flap creation decreases significantly up to 1-year post-reconstruction and plateaus from year 1 to 2. Patients opting for local flap-based reconstruction should be counseled preoperatively regarding expected projection loss and when they can expect their nipple height to plateau.

Introduction: Use of breast implants has nearly doubled for reconstructive and aesthetic surgery throughout North America. This growing demand highlights the need for breast implant registries to monitor safety and quality of care. Despite wide adoption of implant registries in other countries, there is currently no Canadian system to track implantation of breast prostheses. This review aimed to inform the development and implementation of a Canadian breast implant registry (BIR). Methods: A systematic review was conducted to include searches of Medline Ovid, Web of Science, Embase Ovid and grey literature databases. Data were extracted for: patient participation, registry structure, data quality, funding and reporting outputs. Results: Of 1577 articles, a total of 19 met inclusion criteria. The Dutch, Australian, American, German, United Kingdom and Korean implant registries were analyzed. Opt-out systems were commonly used and correlated with higher capture rates. Data input relied on physician or surgeon data entry. Funding was private for the Dutch BIR through a patient or insurance surcharge, and government funding was used in the United Kingdom, Australian and Korean registries. Finally, all registries disseminated outcomes via annual reports. Conclusion: Based on strategies used in existing registries, it is recommended a Canadian BIR have an opt-out structure, funding from a combination of government or private stakeholders, use a standardized data set and annual reporting.

Background: Willingness to pay (WTP) has been an important tool in healthcare used to understand public priorities and satisfaction rates. We utilized a crowdsourcing platform to assess WTP for pediatric versus adult scar "removals." Our hypothesis is that scar visibility and scar bearer's age will affect respondents' WTP. Objectives: To assess social perception of pediatric and adult scars on faces and hands, and to assess effects of crowdsourcing survey's respondents' income, gender, and having own children on WTP. Methods: Images of pediatric and adult face and hand scars were obtained on Shutterstock. Two crowdsourcing Qualtrics surveys assessed WTP, scar severity rating from 1 to 5, and demographics of interest. Results: Face and hand scar surveys obtained 100 and 142 responses, respectively. Willingness to pay was higher for pediatric face scar "removal" than adult (USD$4946 vs $3130; P < .001) and pediatric hand scar "removal" than adult (USD$1418 vs $807; P < .001). Higher income was associated with higher WTP for face scars, but not hand scars. Gender did not influence WTP for child versus adult. Having children demonstrated higher WTP only for face scars in children. The severity of both face and hand pediatric scars was perceived to be worse than that of similar scars in adults. Per one point on the scar severity rating, respondents were willing to pay more for pediatric scar "removal" compared to that for adults. Conclusions: Willingness to pay is a useful tool for understanding the general population's priorities regarding scar revisions.

Diced cartilage glue graft is a technique where small pieces of diced cartilage are mixed with fibrin glue to form a malleable cohesive graft. This technique is routinely used in rhinoplasty or nasal dorsum augmentation. Here we present the case of a 52-year-old man who sustained craniofacial trauma and developed supraorbital irregularities following the primary reconstruction surgeries. We, for the first time, used diced glue graft technique to perform superomedial orbital rim reconstruction and contouring to resolve the irregularities. Based on our experience, this method can be successfully adapted for orbital rim reconstruction while achieving seamless contouring and enhanced aesthetic results.

Introduction: There is equipoise regarding the use of closed-incision negative pressure therapy (ciNPT) versus conventional dressings for abdominal incisions in deep inferior epigastric perforator (DIEP) flap breast reconstruction. The primary objective was to determine the feasibility of conducting a randomized controlled trial (RCT) comparing ciNPT versus conventional dressings for abdominal incisions in DIEP flap breast reconstruction. Methods: A parallel, between-group randomized controlled pilot trial was conducted at two academic breast reconstruction centers. Participants were included if they were adult female patients (≥18 years old) receiving immediate or delayed DIEP flap breast reconstruction. Participants were excluded if they were pregnant, had an allergy to adhesive dressings, or had a body mass index ≥40 kg/m². Primary feasibility outcomes were attaining a 90% eligibility rate, 85% recruitment rate, and 85% retention rate. Secondary outcomes were abdominal site complications and patient-reported health-related quality of life measurements. Block randomization was performed in a 1:1 ratio intraoperatively following abdominal incision closure. Outcome assessment was performed by a blinded assessor. Results: There were 12 patients randomized to each group. The eligibility rate was 90.6%, recruitment rate was 86.2%, pre-randomization retention rate was 96.0%, and post-randomization retention rate was 95.8%. Wound dehiscence rates were 16.7% in the intervention and 41.7% in the control group. Conclusion: The full RCT was deemed feasible based on a priori feasibility outcomes. The anticipated sample size will be 54 patients per group to achieve adequate statistical power. The full multicenter trial is currently in the recruitment process. Trial Registration: NCT04985552.