World Journal of Plastic Surgery最新文献

Pressure injury/ulcer is localized damage to the skin and/or underlying tissues primarily caused by prolonged unrelieved pressure, particularly in patients with limited mobility. The increasing incidence of pressure injuries as a result of aging population and growing number of nursing home residents along with the posing socio-economic burden highlights the importance of increasing our understanding of this global problem, and the available preventive and therapeutic strategies. Surgical intervention using flap reconstruction is the mainstay therapy for management of pressure injuries with advanced stages. We present a comprehensive review on various types, indications, advantages and limitations of flaps used in reconstruction of advanced-stage pressure injuries.

Background: Obstruction of the upper airways may lead to dental and skeletal changes. Nasal septal deviation (NSD) and concha bullosa (CB) are associated with nasal airway obstruction. Mouth breathing is also linked to alterations in maxillary growth and palatal dimensions. This study aimed to compare palatal dimensions in Iranian individuals with and without NSD and CB using cone-beam computed tomography (CBCT).

Methods: This retrospective study analyzed 204 CBCT scans obtained with a large field of view. Scans were categorized into four groups based on the presence or absence of CB and NSD. The deviated septal curve angle (DSCA), palatal inter-alveolar length (PIL), palatal arch depth (PAD), and maxillopalatal arch angle (MPAA) were measured. Group comparisons were performed using one-way ANOVA, followed by post hoc pairwise tests.

Results: presence of CB was significantly associated with changes in mean PIL in both males and females (P=0.02). Only mean PIL showed significant sex differences, being longer in males than females (P=0.01). No significant differences in palatal dimensions were observed between individuals with and without NSD. The four groups differed significantly in mean PIL, MPAA, and DSCA (P<0.05).

Conclusion: CB may significantly alter palatal dimensions and could be associated with skeletal malocclusion. No significant differences in palatal depth and length were found between individuals with and without NSD.

Background: Maxillofacial trauma presents unique airway management challenges due to anatomical disruptions, soft tissue compromise, edema, hemorrhage, and emesis. While isolated mandibular fractures are typically non-emergent, specific fracture patterns can precipitate airway obstruction secondary to bony fragment displacement. There is a paucity of data on airway changes after unilateral mandibular fractures. This prompted us to conduct the present study.

Methods: This prospective, quasi-experimental study enrolled patients with isolated unilateral mandibular fractures requiring surgical reduction between December 2023 and December 2024. Airway changes were assessed via lateral cephalometric analysis pre-operatively and at a 3-month post-operative interval. Specifically, the distances of the posterior nasal spine (PSP), the intersection of the inferior border of the mandible with the posterior tongue (PTO), and the highest point of the epiglottis (E) from the PRL reference line (a vertical line connecting the Porion (PO) to the Frankfort plane) were measured and compared on pre- and post-operative cephalometric radiographs. Descriptive and bivariate statistics were employed, with statistical significance defined as P < 0.05.

Results: Twenty eight patients, including 18 males and 10 females with a mean age of 34.4 ± 14.1 years, were investigated. Post-treatment, the average airway space increased slightly at all measured points: PSP (23.6 mm to 23.8 mm, P=0.222), PTO (22.0 mm to 22.1 mm, P=0.366), and E (12.6 mm to 12.9 mm, P=0.590).

Conclusion: Although slight increases in airway space were observed post-treatment at all measured points (PSP, PTO, and E), none of these changes were statistically significant.

Background: Cryolipolysis has emerged as a promising, non-invasive body contouring technique that employs controlled cooling to selectively eliminate adipocytes without damaging surrounding skin or tissues. As global demand rises for non-surgical aesthetic treatments, cryolipolysis offers an appealing alternative to traditional liposuction for individuals seeking fat reduction with minimal recovery time and fewer complications.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed, Scopus, and Web of Science was conducted up to November 2024. Studies included were randomized controlled trials and prospective cohort studies evaluating the outcomes of cryolipolysis on body contouring. Statistical analysis was performed using Review Manager 5.4 software, calculating mean differences (MD) and 95% confidence intervals (CI).

Results: The use of cryolipolysis was associated with decreased BMI showing MD= -1.71 (95%CI: -2.6, -0.82, P=0.0002). However, no significant difference was observed regarding weight with MD= -1.81 (95%CI: -3.93, 0.31, P=0.09). The use of cryolipolysis was also associated with decreased circumference of different body parts with MD= -3.45 (95%CI: -5.55, -1.34, P=0.001), and I2=92%, P<0.00001 and decreased fat thickness with MD= -3.56 (95CI: -4.63, -2.48, P<0.00001), and I2=95%, P<0.00001.

Conclusion: Cryolipolysis is effective in reducing BMI, local circumference, and fat thickness, confirming its utility for non-invasive body contouring. However, it does not significantly affect overall weight. The benefits are more pronounced in short-term follow-up and vary by body region. Further long-term and comparative studies are recommended.

Rhinoplasty is usually associated with adding and subtracting tissues around structural cartilages to provide favorable contour. Minor corrections in cartilage shape and position, may have significant effect on final result. Upon last look in rhinoplasty, surgeon decides to do refinement, especially in thin skin patients. Traditionally blades and scissors are commonly available instruments to apply refinement. We examined a different solution in some patients and here presented our experience in a 36 yr old female in Tehran, Iran. Upon completion all stages of surgery such as osteotomy and cartilage sutures and before skin closure, surgeon examined the nose and if there was any minor hump on dorsum or asymmetric prominence of lower lateral cartilage, he could apply low voltage electrocautery with strict control to do camouflage. This may help surgeon to administer last monitoring before closure. Blades and scissors are commonly used to remove extra marginal cartilages, and reduce remained cartilage hump. We noticed low voltage electrocautery may provide smoother dorsum or even curves with more control during final curve.

Cleft lip and palate is one of the most common congenital malformations of the skull and face (craniofacial). The deformity is characterized by a loss of integrity of the lip muscles, alveolar bone, and hard and soft palate. The severity of the deformity can range from a small hole in the lip to a large fissure extending into the roof of the mouth and nose. Management and control of cleft patients is a challenge. Intervention in these patients begins very early in life, from the fetal period, and continues into adulthood, and the patient's relatives are always involved in the treatment process. Since there are multiple problems in these patients, the treatment process is managed in a group and multidisciplinary manner to achieve the desired result. The goal of all treatment measures for a person with a cleft lip and palate is to provide intelligible speech, hearing within a normal range, good facial appearance, proper lip and nose symmetry, an attractive smile, good occlusion, healthy oral structures, and ultimately appropriate self-confidence. In the current study, I reviewed the causes, pathophysiology, surgical repair, and treatment approaches in patients with cleft lip and palate.

Upper extremity lymphedema is a common and disabling complication of breast cancer treatment, especially following axillary lymph node dissection (ALND). Its risk may be reduced with the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) procedure, which involves anastomosis of one or more upper limb lymphatic channels to a recipient vein, usually a branch of the axillary vein within the axilla. However, these branches may sometimes be difficult to identify or even not be in suitable condition, especially if extensive electrocautery was used during ALND. If autologous breast reconstruction is performed simultaneously, a flap vein may serve as a reliable recipient vein for anastomosis. We describe a simple and potentially useful technique of utilizing the flap vein (deep inferior epigastric vein) of a pedicled transverse rectus abdominis myocutaneous flap, as a recipient vein for the lymphaticovenular anastomosis in LYMPHA.

Background: Bilateral sagittal split osteotomy (BSSO) is the most common procedure in orthognathic Surgey of mandible also in asymmetries. However, the methods of fixation are different. Few studies worked on asymmetric cases especially with the use of finite element analysis (FEA). We aimed to evaluate stress distribution of two different Fixation techniques in mandibular setback surgery in asymmetric cases using FEA.

Methods: A 3-dimensional model of asymmetric mandible was obtained. SSRO with modified osteotomy was simulated unilaterally and another side osteotomized as common. Then differential set back was done and rigid fixation of that modified side with miniplate and monocortical screws was simulated then rigid fixation of other side by different fixation technics include 2 or 3 bicortical screws. With the force of 132N and 300N on the occlusal surface of first molars, the Von Mises Stress (VMS) distribution was calculated.

Results: Stress distribution in threads of screws in use of three bicortical screws was higher than two bicortical screws (161%). VMS distribution in spongy bone of left ramus in use of three bicortical screws was higher than the use of two bicortical screws (78% difference). VMS distribution in cortical bone of mandible body in use of three bicortical screws was significantly higher than the use of two bicortical screws (1.3% difference) (P<0.5).

Conclusion: The use of modified osteotomy and fixation with rigid fixation of two bicortical screws can create a more predictable and uniform stress distribution in mandibular setback surgery in asymmetric cases.

Background: Adjuvant-induced autoimmune syndrome (ASIA), described in 2011, includes autoimmune reactions triggered by environmental adjuvants, such as silicone breast implants (SBI). Symptoms include fatigue, sleep disturbances, appetite changes, muscle pain, fever, among others, with pathophysiology involving a combination of genetic predisposition and adjuvant exposure, leading to abnormal immune responses. We aimed to define clinical profiles and outcomes of patients with SBI, clarify ASIA's clinical implications, and guide future research.

Methods: Using the PRISMA-ScR framework, a scoping review was conducted to identify clinical profiles, preexisting conditions, prosthetic anomalies, and outcomes of patients with ASIA syndrome associated with SBI. Searches were performed in Medline, Scopus, Lilacs, and Google Scholar to locate relevant studies.

Results: Of 35 selected studies, 21 were case reports, 6 case series, and 8 cohort studies, identifying 848 patients, predominantly from the Netherlands (n=513), with an average age of 45-47 yr. Common medical histories included autoimmune diseases and breast cancer, while frequent implant-related anomalies were capsular contracture and rupture. Musculoskeletal symptoms and fatigue were the most prevalent, and implant explantation was the primary treatment, resulting in symptom improvement for most patients.

Conclusion: This review highlights the clinical features of ASIA syndrome in patients with SBI, particularly musculoskeletal symptoms, fatigue, and the presence of positive antinuclear antibody as a potential marker. However, the relationship between SBI and ASIA remains controversial. Despite limitations in current evidence, ongoing clinical monitoring and further research are crucial to better understanding and managing ASIA syndrome in patients with SBI.

Gynecomastia, the excess growth of glandular breast tissue in males, is a common condition associated with hormonal imbalance or the use of certain drugs. Although medically benign, persistent gynecomastia often causes psychological distress and adversely affects quality of life. Published literature on the evaluation and management of patients seeking surgical treatment for gynecomastia is predominantly from Western populations. Here, we present insights from our practice in a multi-ethnic Asian population, with >550 cases treated at Amaris B. Clinic, Singapore from 2018-2023. We illustrate these insights and principles with a representative selection of 6 patient cases. We discuss specific considerations for optimizing the consultation process and outcomes in Asian patients, with reference to profiles commonly seen in our local setting. These were: adult males, the most encountered patient profile who are typically overweight/obese; young (adolescent) males, typically overweight, had a history of recent significant weight loss, or lean and experiencing gynecomastia due to puberty-related hormonal changes; males with drug-induced gynecomastia, typically athletes/bodybuilders. Our experience highlights several important considerations, including management of the consultation process, the range of patient expectations, and addressing surgical aspects of management to achieve the desired aesthetic outcomes.