Plastic surgery最新文献

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.

A 24-year-old, 19-week pregnant female presented to a community hospital emergency department following an acute hyperextension injury to the left wrist. The pertinent findings on the initial examination included pain, swelling of the ulnar aspect of her palm, and decreased, painful flexion of her small finger. The emergency room physician suspected a flexor tendon injury, and urgent referral to a tertiary level plastic surgery center was made. After plastic surgery evaluation, it was determined that her symptoms were related to the ulnar nerve opposed to an acute tendon injury. After ruling out common surgical pathologies, the diagnosis of palmaris brevis syndrome was provided. Palmaris brevis syndrome does not typically present acutely or post-trauma, and thus is not commonly observed by emergency physicians or acute care hand surgeons. This atypical presentation highlights that palmaris brevis syndrome should be considered in the differential diagnosis of new onset ulnar-sided hand pain.

This article presents a case series of 4 patients who underwent primary reconstruction of oncologic defects in the lower extremities using Integra Dermal Regeneration Template (IDRT). The patients had either primary or recurrent tumors, which resulted in exposure of deep underlying structures including tendon, nerve, muscle, and bone. IDRT was selected to manage these defects due to the uncertain malignant potential of tissue margins and its ability to facilitate later margin revision without sacrificing tissue. The use of IDRT allowed for the growth of a neodermis that supported subsequent split-thickness skin grafting in all cases. Additionally, for those with positive margins, surgical revision and skin graft application was able to be performed in a single procedure, maximizing operating room use and patient convenience. This case series highlights the potential of IDRT in managing complex oncologic defects in the lower extremities, expanding options for reconstructive surgeons. Key findings: (1) IDRT is a viable option for reconstruction in oncologic resections exposing deep structures. (2) In cases with unknown malignant potential of tissue margins, use of IDRT can allow for revision of positive margins without sacrificing graft or flap tissue. (3) Negative pressure wound therapy is an important adjunct in achieving a favorable neodermis for acceptance of a spilt thickness skin graft.

Introduction: Research is an important component of medical student applications to plastic surgery residency. However, little is known about institution-level factors that may influence research productivity among plastic surgery applicants and how productivity during medical school impacts research output during residency. Methods: Plastic surgeons who graduated from an integrated plastic surgery residency program in the United States and obtained board certification between 2020 and 2022 were included in the study. Website profiles were used to obtain medical school and residency training information, and the National Institutes of Health (NIH) iCite database was utilized to identify publications during medical school and residency training. Linear regression was performed to assess the correlation between research productivity during medical school and residency. Unpaired t tests were performed to compare the mean number of publications between medical students. Results: A total of 277 plastic surgeons were included in the analysis. The mean number of publications during medical school and residency was 3 and 8.7, respectively. The number of first-author publications during medical school had the strongest correlation with total research output during residency (r ²= 0.23, P < .0001). Students at schools with plastic surgery residency programs (3.29 vs 1.56, P < .0001) and students from top 40 NIH-funded medical schools (4.44 vs 1.84, P < .0001) had significantly more publications than their peers. Conclusion: First-author publications during medical school may be the strongest predictor of productivity during residency. Students at schools without affiliated plastic surgery residency programs may have fewer opportunities to participate in scholarly activity.

Purpose: Nonsyndromic sagittal craniosynostosis is treated surgically to improve skull cosmesis and to decrease the risk of raised intracranial pressure. The purpose of this study is to compare the outcomes of two current surgical techniques for craniosynostosis treatment, open and endoscopic strip craniectomy. Methods: A single institution retrospective chart review was conducted of patients with nonsyndromic sagittal craniosynostosis treated surgically from 2011 to 2016. Patients were divided into two groups based on surgical technique: open or endoscopic strip craniectomy. The head shape was assessed using pre- and postoperative cephalic index (CI). Complications and operative details were compared. Mean absolute CI over time and 95% confidence intervals were graphed. Results: A total of 51 children (36 male, 15 female; 13 open, 38 endoscopic) were included with an average length of follow-up of 27.2 months (range 4-60). The median age at surgery was 4.0 months for open and 3.0 months for endoscopic. There was no significant difference in preoperative CI between endoscopic and open groups (0.67 vs 0.66). The largest improvements in CI were seen 3 to 6 months postoperatively. There was a significant improvement in postoperative CI for both groups (endoscopic 0.75, P = .02; open = 0.74, P < .01). From maximal postoperative CI to >2 year follow up there was no significant regression in CI for the endoscopic group (P = .12) and a small regression for the open group (-0.02, P = .01). There were no transfusions, brain injuries, or deaths. Patients in the endoscopic group had significantly less blood loss intraoperatively (P = .01) and a significantly shorter duration of hospital stay compared to the open group (P < .001). Conclusions: Endoscopic and open surgical techniques are both effective treatments for nonsyndromic sagittal synostosis, with no difference in initial postoperative CI. These findings support the use of either technique and corroborate previous literature.

Introduction: Hypertrophic and keloid scars are abnormal tissue growth that can be disfiguring, for which the available treatment has not yielded consistent results. Therefore, this study aimed to evaluate the capability of Adipose tissue-derived stem cell (ADSC) therapy in treating these scars. Methods: A literature search was conducted on PubMed, Scopus, Cochrane Library, and Web of Science from inception until July 2022. We included experimental studies that evaluated ADSCs as a therapy for hypertrophic and keloid scars in both in-vivo and in-vitro models. Results: Our findings extracted from 12 included studies demonstrated that ADSCs have a promising potential in reducing collagen deposition, proliferation, and migration rates of fibroblast, decreasing gene/protein expression of scar-related molecules including levels of TGF-β1 and lowering intracellular signal pathway-related molecules of hypertrophic and keloid scars in both models. However, no significant difference (P > .05) was found in the hypertrophic scar in-vitro models in terms of DCN gene expression. Conclusion: Ultimately, the current studies included in this systematic review support the use of ADSCs to alleviate hypertrophic and keloid scars.

Purpose: This study compares complication rates for minor reconstructive procedures done under local anesthesia in a hospital setting versus out-of-hospital premises (OHP) setting during the COVID-19 pandemic. If it could be shown that minor plastic surgeries have similar, if not reduced, complication types and frequencies, this would provide a strong rationale for more procedures to be delegated to non-hospital office settings. Not only would complication rates be lower for patients, resulting in improved quality of life and health outcomes, but there would be increased efficiency for minor plastic surgery procedures, improved patient wait times, and reduced burden on hospital resources to allow for accommodation of more complex and major procedures that cannot be performed elsewhere. Methods: This is a retrospective medical record review of patients who underwent minor plastic surgery procedures at a community hospital and OHP settings. All procedures were performed by the same plastic surgeon. Minor plastic procedures were defined as day procedures performed with only local anesthesia. Procedures were completed with field sterility (eg, use of drapes and sterile gloves) but not room sterility. A total of 2739 charts (537 hospital charts and 2202 clinic charts) from January 2022 to December 2022, were reviewed with annotation of patient demographics, procedure type, procedure site, follow-up dates, complications, and complication type, if any. Statistical analysis involving chi-squared tests was performed on anonymized data to primarily compare complication rates between the hospital and the outpatient clinic setting, as well as secondary comparisons of subgroups such as patients with diabetes and patients using blood thinners. Results: There was a 3.5% complication rate for the minor procedures in the hospital compared to 1.2% in OHP setting which was a statistically significant finding. Conclusion: There were fewer complications for patients undergoing minor reconstructive procedures in an outpatient clinic setting versus in-hospital, indicating the potential for delegation of minor surgeries to OHP clinics and ambulatory surgery centers.