Plastic surgery最新文献

Background: Breast-sharing is an innovative reconstructive approach that combines contralateral reduction mammaplasty with autologous breast reconstruction. This method repurposes tissue typically discarded during reduction mammaplasty to restore post-mastectomy symmetry while minimizing donor site morbidity and preserving oncological safety. Case Presentation: A 46-year-old woman with a significant asymmetry following a left mastectomy for invasive ductal carcinoma (pT2N0M0, ER+, PR+) and adjuvant radiotherapy was treated with a breast-sharing procedure. Preoperative imaging confirmed a robust third intercostal internal mammary artery perforator (IMAP) as the flap's vascular pedicle. The procedure included contralateral reduction mammaplasty, harvest of a glandulocutaneous IMAP flap, and its transposition to the mastectomy site. A subcutaneous tunnel facilitated flap transfer, achieving symmetry and natural contour. In the second case, a 50-year-old female with Stage II invasive ductal carcinoma and significant contralateral breast hypertrophy underwent a breast-sharing procedure utilizing autologous tissue from the contralateral breast, achieving improved symmetry, no disease recurrence, and high patient satisfaction during follow-up. Results: In the first case, postoperative monitoring identified venous congestion at the distal flap tip, successfully managed with medicinal leeches and minor debridement. Over 8 years of follow-up, the patient exhibited no recurrence or contralateral breast cancer. Esthetic outcomes were excellent, with natural projection and texture. In the second case, recovery was uneventful, with no cancer recurrence in the follow-up period of 1 year. Conclusion: Breast-sharing offers a transformative, safe, and effective reconstructive option for select post-mastectomy patients with contralateral hypertrophy, encouraging broader application of this innovative technique.

Background: Children presenting with suspicion of a scaphoid fracture pose a diagnostic challenge. Several imaging modalities such as plain radiograph (XR), computed tomography (CT), and magnetic resonance imaging (MRI) have been previously described. Timely and accurate diagnosis is important to avoid overtreatment, and complications, and allow for an earlier return to activity. It is unclear which imaging modality is the most diagnostically accurate for detecting scaphoid fractures in this population. Methods: A systematic review was conducted in concordance with established guidelines to elucidate the diagnostic accuracy of various imaging modalities for detecting scaphoid fractures in children. A comprehensive literature search of electronic databases was developed by experienced librarians. All steps were performed independently by 2 reviewers. Results: Eight articles were included, all evaluating plain radiographs as the index test. One study evaluated CT. XR demonstrated sensitivity values ranging from 16% to 54%, with specificity of 71% to 100%. CT had 95% sensitivity with MRI as the reference standard. The included studies were limited by poor methodologic quality and heterogeneous patient populations. Conclusions: XR demonstrates a wide range of diagnostic accuracy in diagnosing scaphoid fractures in children. CT and MRI, while promising, are limited by a lack of evidence in children. More pediatric-specific prospective studies are required to guide the choice of diagnostic imaging in children with suspected scaphoid fractures.

Introduction: Microvascular reconstruction demands specialized and additional training beyond residency. This study investigates the free flap learning curve at a newly established microsurgery center by analyzing free flap viability rate over 10 years. Methods: A retrospective review of free flap procedures performed between 2014 and 2024 by a single microsurgeon at a National Referral Hospital, Indonesia, was performed to assess free flap viability rates, flap types, and the relationships between specific flap choices and defect locations. The correlation between cumulative flap procedures and flap viability was also analyzed. Statistical analyses, including bivariate and correlation tests, were conducted using SPSS v24. Results: A total of 700 free flap procedures were performed, with a female predominance (51.4%) and patient age of 39 (3-98) years. Sixteen different flaps were utilized, with the most employed being ALT (35.3%), FFF (39%), RFFF (12.6%), LD (3.2%), and DIEP (7.1%). The majority of reconstructions addressed head and neck defects (82.4%). The overall flap viability rate was 91.57%, with specific rates of 87.9% for ALT, 95.2% for FFF, 96.6% for RFFF, and 81% for LD. Chi-square analysis demonstrated significant differences in viability among flap types, particularly ALT and FFF. A negative correlation between procedure volume and flap viability was observed, which weakened after 100 procedures, transitioned to moderate until 300 procedures, became weak until 600 procedures, and uncorrelated entirely thereafter. Conclusions: An emerging microsurgery center will achieve stability after 200 free flap procedures, while prioritizing RFFF and LD flaps as basic or lifeboat options is crucial.

Objective: Peripheral nerve injuries resulting from tumor resection are unusual, but occasionally unavoidable. It can result in serious morbidity in motor deficits, sensory deficits, and even chronic pain. Nerve reconstruction after tumor resection is possible and seems to have positive recovery outcomes. However, nerve reconstructions are rarely performed and clear outcomes of nerve reconstructions after tumor resection are missing. This review aims to create an overview of the indications and outcomes in these patients. Methods: A systematic review was performed in May 2024 in PubMed and Embase databases according to the PRISMA guidelines. Search terms related to "tumor" and "nerve reconstruction" were used. Studies evaluating nerve reconstructions (nerve graft, transfer or coaptation) after tumor resection were included. Tumors not located in the extremities were excluded. A qualitative synthesis was performed on all studies. Where possible, motor, and sensory grades were recalculated according to the Medical Research Council (MRC)-scale. Results: Fifty-nine articles were included for quality synthesis after full-text screening. A total of 90 patients were described of which 44 after resection of malignant tumors. Most patients improved in motor and sensory function after nerve reconstruction. In both benign and malignant tumors, 77% demonstrated functional recovery on the MRC scale of ≥3. Most of the patients, >80%, recovered to a protective sensation of S2 or higher. Conclusion: Nerve reconstruction after tumor resection can help recover both sensory and motor function and may avoid chronic nerve pain. Nerve reconstructions should therefore be considered in tumor surgery.

Introduction: Wound healing by fibrosis allows for closure of a wound, but leaves behind a permanent scar with physical and psychological effects. The primary aim of this narrative review was to summarize the current status of the evidence supporting the use of oral or topical medications to minimize scarring in humans. Methods: With the help of a health sciences librarian, PubMed, Embase, and Scopus were searched up to March 31, 2023, to investigate potential medications to ameliorate scarring. Based on this search, the medications pirfenidone, losartan, trichostatin A, enalapril, and atorvastatin were identified as 5 therapies with the most research to support their use. Studies discussing noncutaneous scarring (myocardial, intraabdominal, etc) or in animal models were excluded. Results: There is a paucity of quality literature describing the use of oral or topical medications to minimize fibrosis and produce more favorable scarring. Six studies describing the medications listed above all demonstrated an improvement in scarring parameters, most commonly based on the Vancouver Scar Scale. Conclusions: Though preliminary, emerging evidence suggests that therapies already exist with the potential to improve cutaneous scarring. Some of these medications are already ubiquitous, affordable and have a known safety profile. Excitingly, these treatments are either oral or topical, meaning that they are more accessible for patients than some current modalities for scar treatment, including steroid injections or laser therapy. Further larger-scale trials are needed before these treatments can be recommended as a routine part of scar management.

Introduction: Increasing the thickness of the capsule around the tissue expander, as in breast reconstruction complicates the expansion process and increases the time to achieve the required flap size. The aim of this study was to investigate the effect of changes in inflation intervals and amounts on the capsule thickness around the tissue expander. Methods: Fifteen adult rats were divided into 3 groups, and 25 cc elliptical tissue expanders were placed on the back of each, and inflated with 5 cc saline. Expanders were inflated daily in Group 1, every 3 days in Group 2, and every 10 days in Group 3. Inflation was stopped, then expanders were removed and skin flaps were harvested after the results of the expansion were measured. Biopsies containing skin and capsule tissue were evaluated by histomorphometry and immunohistochemistry. Results: Skin flaps were measured as 81 cm² in Group 1 and 89.3 cm² in both Groups 2 and 3. When capsule thickness and number of vessels were examined; the thickest capsule was found in Group 2 while Group 3 had the densest vascularization. On histopathological examination of the biopsies, no significant difference was found between groups, except for the histiocyte density, which was the lowest in Group 1 and the highest in Group 3. Conclusions: This experiment showed that inflating tissue expander in small amounts at frequent intervals decreased the thickness of the capsule but it resulted in smaller skin flaps. Thus, it may be beneficial to adopt this protocol in some patients, for example in patients who are predicted to have increased capsule thickness due to the effect of radiotherapy and/or chemotherapy, or who are prone to fibrosis. Additionally, in patients whose flap size is important, it may be reasonable to inflate the tissue expander at less frequent intervals and in relatively large volumes for preventing flap loss and avoiding an increase in capsule thickness.

Introduction: Self-examinations for skin cancer detection are limited by sensitivity. ChatGPT-4 has image recognition capabilities that can be a useful adjunct for screening cancers and tele-health applications. This study investigated the efficacy of ChatGPT-4 in identifying skin lesions. Methods: Dermoscopic images were retrospectively selected from the PH² dataset, categorized by clinical diagnosis, and uploaded to ChatGPT-4 with a predesigned prompt. Responses were compared against clinical diagnoses. Confidence intervals were calculated using the bootstrap method assessing precision and significance was calculated using McNemar's test. Analyses were performed using Jupyter Notebook and Python. Results: The GPT-4 model showed moderate performance in melanoma detection with 68.5% accuracy, 52.5% sensitivity, and 72.5% specificity, significantly differing from the clinical standard (P = .002). For suspicious lesion detection, it performed better with 68.0% accuracy, 78.0% precision, and 70.0% F-measure, still not closely matching clinical diagnosis for atypical nevi and melanoma (P = .0169). Conclusion: The statistical difference between ChatGPT-4 diagnosis of melanoma and suspicious lesions compared with clinical diagnoses and other AI models suggests the need for improvement in ChatGPT-4 algorithms. This study's limitations included the use of a secondary care database with a higher melanoma incidence, high-quality dermoscopic images that limit generalizability, a small sample size lacking diversity, and the need for larger datasets to validate findings in broader contexts.

Introduction: Tendon grafting is standard for treating tendon defects. Allografts are popular in cruciate ligament reconstruction but not yet in upper limb tendon reconstruction. A scoping review was conducted to map the existing practice of allograft use in hand surgery for tendon reconstruction and identify gaps in knowledge for future research. Methods: Two independent reviewers searched MEDLINE and SCOPUS databases for studies on upper limb tendon reconstruction using tendon allografts until June 2022. Eligible studies included controlled randomised clinical trials, cohort, case-control, cross-sectional, or case report and series studies conducted in English and enrolling patients who underwent tendon allograft reconstruction in the upper limb. Screening for eligibility was done by both reviewers, who reached a consensus through discussion, with no exclusion based on poor methodological quality. Data charting included study title, patients' demographics and outcomes, complications, and follow-up period. Results: The database search found 6 eligible articles with a total of 116 patients and 148 allografts used for reconstruction. Of the studies that looked at functional outcomes, 72.9% of patients had 'good' or 'fair' results, while 25.8% were classed as 'poor'. All of the patients assessed for subjective outcomes were at least partially/fairly satisfied with the allograft. Conclusion: This scoping review has indicated that the utilisation of tendon allografts in the upper limb can potentially be a promising approach for tendon reconstruction, especially in cases of severe trauma or salvage. However, further research is needed to comprehensively assess efficacy, long-term outcomes, complications, postoperative rehabilitation protocols, and comparative effectiveness against autograft tendon reconstruction.