Plastic surgery最新文献

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.

Purpose: The emergence of facial reanimation surgery as a reconstructive option has sparked a growing interest among patients with facial paralysis, leading to an increase in patients seeking and sharing information on these surgical modalities. This study evaluated the role of social media in information-sharing on facial reanimation surgery. Methods: We identified 630 Facebook groups based on the initial keyword search for "facial paralysis" and "Bell's palsy." Groups with < 100 members, non-English content, or restricted access were excluded. Within each group, searches were conducted for terms related to surgery and posts were categorized as sharing information, seeking information, sharing support, seeking support, or sharing appreciation. Results: The search yielded 630 groups; 21 groups met the inclusion criteria (average size = 4037, largest = 31 400). Facial reanimation surgery was discussed in 15 groups, with 487 relevant posts tabulated. In the sharing information axis, posts were related to personal experiences (63%), alternatives (14%), link shares (7%), surgeon/center (5%), general recovery progression (8%), objective information on surgical modality (1%), objective information on nerve injury (1%), and general information on relevant medical research (1%). In the seeking information axis, posts were related to personal experience (71%), objective information (12%), surgeon/center (4%), second opinion (13%), and alternatives (1%). Conclusion: Social media is an essential source of information and support for people with facial paralysis. These study findings will inform the implementation of future knowledge translation efforts to maximize education and subsequent uptake of facial reanimation reconstructive surgery.

Introduction: Average wait times for plastic surgery depend on priority, but access to specialist consultation can be upwards of 1-2 years for elective referrals. The Champlain eConsult BASE™ system was developed in 2010 and is a PHIPA-compliant system that allows primary care providers to electronically send specialists questions about specific patients, potentially avoiding the need for a formal in-person consultation. Methods: Electronic Consults (eConsults) through the Champlain eConsult BASE™ system to plastic surgery from January 2021 to December 2022 were assessed by 2 reviewers. A standardized data extraction form was used, categorizing consults for question type and clinical problem. A mandatory close-out survey allowed for analysis on referring physician satisfaction, referral outcome, and impact on patient care. Results: Three hundred and thirty-one eConsults were included and were answered in an average of 2.1 ± 3.1 days. Specialists spent a mean of 14.0 ± 5.7 minutes per case. The most common content of the consults was related to hand trauma (37%), non-hand skin/soft tissue lesions (13%), and hand masses/lesions (bony or soft tissue) (8%). A formal consultation was avoided in 32%. Thirty-nine percent of cases resulted in a change in management: a referral to plastic surgery was avoided but originally contemplated by the family physician in 32%, and a referral was recommended but not originally contemplated in 7%. Conclusions: Our study demonstrates the potential of eConsults to facilitate timely consultation and avoid unnecessary formal consultations with plastic surgeons. This may reduce wait times and improve access to plastic surgeon services.

Introduction: Some patients who are having WALANT (Wide Awake Local Anesthesia No Tourniquet) carpal tunnel surgery are afraid of the pain of local anesthesia injection. Many surgeons do not yet focus on minimally painful injection techniques to avoid unnecessary painful patient experiences. This study measured the number of local anesthetic injection pain events in feedback from patients to the injecting surgeon to decrease the pain of his injections. Methods: A single surgeon asked 250 consecutive carpal tunnel surgery patients to tell him each time they felt a pain event during his local anesthetic injection process for WALANT carpal tunnel surgery. The pain events were counted and provided an objective pain number to score the surgeon's injection skill over the 35 months of the study. Results: The surgeo's injection pain score improved dramatically over the time of the study. In his last 50 patients, he scored a hole-in-one 37 times, where none of his first 50 patients gave him such a high score. A hole-in-one happens when the only pain the patient feels is the small sting of the first 27 gauge needle insertion. Conclusions: Surgeons who inject local anesthesia for carpal tunnel surgery can ask patients to tell them each time they feel a pain event after the sting of the first needle insertion is numbed. Counting the number of pain events provides a score for each injection process. This score from immediate patient feedback can help the surgeons decrease the pain of their injections.