Plastic surgery最新文献

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.

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.