Plastic surgery最新文献

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.

Introduction: Oncoplastic breast reconstruction (OBR) combines breast conservation treatment with breast reduction/reconstruction and is appropriate for breast cancer patients with macromastia and/or ptosis, who want to avoid mastectomy, and who include breast reduction in their goals. This study's purpose was to evaluate complications and patient-reported outcomes associated with OBR at our institution. Methods: A retrospective chart review was conducted for all consecutive OBR cases from April 2009 to April 2020. Data was extracted from a prospectively maintained database and surgeons' EMRs. Risk factors for any complication were evaluated by a univariate logistic regression analysis with significance level set at P < 0.05. Postoperative patient satisfaction was evaluated with the validated BREAST-Q 2.0 questionnaire for which raw scores were obtained. Rasch-transformed scores from 0 (worst) to 100 (best) were calculated from the BREAST-Q conversion tables. Results: 81 patients had OBR of whom 22 experienced 25 post-surgical complications. Increasing ipsilateral and contralateral specimen weight and American Society of Anesthesiologists Physical Status Classification System Score (ASA) were significantly correlated with increased odds for any complication. The BREAST-Q questionnaire was completed post-OBR by 37 patients who reported a high degree of satisfaction with physicians, medical, and office staff. Conclusions: OBR is rated well by patients. All complications were Clavien-Dindo 1 and managed with local office-based wound care.

Introduction: Post-gravidic diastasis recti is corrected with conventional abdominoplasty in patients with adequate skin laxity. For unsuitable patients, other procedures are considered.

Methods: A retrospective review was conducted on patients undergoing mini-abdominoplasty or mini-inverted-T abdominoplasty from 2019 to 2023 at our institution, excluding overweight and post-bariatric patients. Patient-reported outcomes were evaluated using the BODY-Q questionnaire, administered one year postoperatively. Two plastic surgeons assessed pre and postoperative photographs, rating cosmetic outcomes on a Likert scale. Complication rates were also compared.

Results: A total of 64 patients had mini-abdominoplasty and 73 underwent mini-inverted-T abdominoplasty. The groups were similar in age, pregnancies, and smoking habit (P > .05). The mini-abdominoplasty group had a lower mean BMI (20.81 ± 1.69 vs 21.44 ± 1.58 kg/m²; P = .028) and narrower mean diastasis (4.65 ± 1.10 vs 5.08 ± 1.19 cm; P = .031). Mini-abdominoplasty patients reported lower satisfaction with abdomen (59.47 ± 33.82 vs 69.82 ± 25.48; P = .158) and skin excess (74.13 ± 28.50 vs 83.23 ± 25.04; P = .157), but better outcomes in body contouring scars (73.25 ± 27.61 vs 64.56 ± 32.17; P = .232). Multivariate analysis confirmed higher score satisfaction with abdomen scale in the mini-inverted-T group (P < .028). Surgeons rated scar quality (6.94 ± 1.17 vs 5.51 ± 1.25, P < .001) and symmetry (6.44 ± 1.17 vs 5.42 ± 1.36, P < .001) higher for the mini-abdominoplasty group, while profile (6.72 ± 1.20 vs 8.23 ± 1.17, P < .001) and overall appearance (6.53 ± 1.07 vs 7.66 ± 1.07, P < .001) were rated higher for the mini-inverted-T group. Complications and revision rate did not differ statistically between the groups.

Conclusions: Both procedures are viable options for selected patients with advantages and limitations that should be discussed to align with patients' characteristics and expectations. Mini-inverted-T scar abdominoplasty is recommended unless the patient is more concerned about scars rather than the overall abdominal shape and profile.

Level of evidence: III.

Purpose: Nonbinary breast cancer (NBBC) patients have unique healthcare needs that may not be met due to the gendered nature of breast cancer. Herein we explore the multifaceted experiences of an NBBC person. Methods: Qualitative intensive case study methodology was employed. Multisource data was gathered, including an in-depth interview, blogposts examination, and drawn comic evaluation analyzed using polytextual thematic analysis to generate themes. Methodologic rigor was pursued using member checking, maintaining an audit trail and holding several meetings to agree upon themes. Results: The participant's treatment included a double mastectomy, chemotherapy, and radiation. Using multisource triangulation, four themes were identified, named leading, negotiating, being in-between, and confining. Leading encompasses feeling the responsibility of paving the way for NBBC patients. The participant described, for instance, how their blogposts were created as a resource, to ameliorate the "lack of representation" they felt clinically and online. Negotiating encapsulates negative experiences in healthcare settings and having to mentally prepare before entering them. In both interview and blogpost, they mentioned "going into medical spaces [preparing] to be misgendered". Being in-between highlights their intersecting identities shared in their blogposts, and the lack of support groups that supported their intersecting identities, "I felt like an island." Finally, confining captures the lack of control they felt over their gender expression, which was especially salient during chemotherapy when they were hyperaware of how they were perceived "I don't know if [people] see the baldness and flatness as a choice." Conclusion: This individual experienced significant psychosocial stress from isolation, misgendering, and gender dysphoria magnified by the pink-washing of their breast cancer journey.

Introduction: Industry financial relationships for physicians in the United States are reported publicly in the Sunshine Act Open Payments Database. This study aims to highlight trends and compare plastic surgery with subspecialty data, such as hand and craniofacial surgery. Methods: The Open Payments Database was utilized to retrieve all industry relationship payments made to plastic surgeons in the United States from January 1, 2017 to December 31, 2023. The individual payment dollar values per plastic surgeon were evaluated along with their subspecialty, payment year, type of financial relationship, partnering company, and region. Results: On average, there were 35,333 individual payments made to 4050 plastic surgeons, 1336 payments made to 208 hand surgeons, and 1091 payments made to 214 craniofacial surgeons each year. The top five percent of plastic surgeons received 85.0% of the total payment value, while the top five percent of hand and craniofacial surgeons received 99.8% and 87.8%, respectively. Royalties and licensing were the largest type of payment by dollar value for general plastic (43.0%) and craniofacial surgeons (98.4%), but ownership or investment interest was the most valued type of payment for hand surgeons (48.0%). Conclusion: Within the Open Payments Database, there were a variety of industry payments made to plastic, hand, and craniofacial surgeons over the last 7 years. Current trends suggest that the majority of payment dollar value will continue to go to a specific minority of those in plastic surgery and its subspecialties in the form of royalties, licensing, or ownership and investment interests.

Background: Dupuytren disease (DD) is a fibroproliferative disorder characterized by excess collagen deposition in the digitopalmar fascia resulting in disabling flexion contractures. The angiotensin II type 1 receptor (AT1R) pathway has previously been shown to be upregulated in a variety of other fibrotic disorders. We explored the potential association between DD and activating autoantibodies (AAb) against the profibrotic AT1R or counterregulatory antifibrotic angiotensin II type 2 receptor (AT2R). Methods: Patients with DD and controls were recruited from a single hand clinic. Demographic and clinical data and total flexion deformity angle of each digit were recorded. Serum levels of AT1R-AAb and AT2R-AAb were measured by enzyme-linked immunosorbent assay. Results: No differences were noted in serum AT1R-AAb levels between control and DD patients. In women with DD, circulating AT2R-AAb were significantly lower than in control women (7.61 ± 3.0 U/mL vs 13.5 ± 3.1 U/mL, respectively). AT2R-AAb observed values tended to be lower in women with higher Tubiana severity scores. In contrast, AT2R-AAb levels were not different between control or DD male subjects. Conclusions: These early findings suggest angiotensin II signaling differences may contribute to sex differences in DD and that an AT2R agonist may be particularly beneficial in treating women with DD.

Level of evidence: Diagnostic, Level II.

Background: Negative pressure wound therapy (NPWT) following breast surgery has emerged as a promising intervention theorized to reduce complication rates, improve patient-important outcomes, and enhance cost-effectiveness. This systematic review and meta-analysis aims to determine outcomes of NPWT following breast surgery. Methods: MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL were searched to include all English-language, peer-reviewed observational and randomized controlled trials (RCTs) investigating NPWT on the breast or donor site among patients undergoing breast surgery. Studies evaluated at least one of the following outcomes: wound dehiscence, surgical site infection (SSI), implant loss, re-operation, re-admission, hematoma, seroma, and skin/wound necrosis. Quality of evidence was assessed with GRADE methodology. Results: This review includes 31 studies (eight RCTs, 23 observational) analyzing 3320 patients (4326 breasts). High certainty of evidence indicates decreased risk of wound dehiscence among NPWT patients in RCTs for all NPWT application sites (donor: 0.40; 95%CI 0.21, 0.79; breast: 0.59; 95%CI 0.41, 0.84) and observational trials where NPWT was placed on donor sites (0.64; 95%CI 0.42, 0.98). Some evidence indicates NPWT may reduce SSI, hematoma, seroma, and skin/wound necrosis incidence, however results are uncertain and varied in statistical significance. No effect was identified on rates of breast implant loss, re-operation, and re-admission, although this certainty of evidence is very low. Conclusions: Our findings suggest NPWT following breast surgery reduces the risk of wound dehiscence, may have some effect on SSIs, hematoma, seroma, and skin/wound necrosis; and does not demonstrate an effect on rates of implant loss, re-operation or re-admission.