Indian Journal of Plastic Surgery最新文献

In surgery for gynecomastia, it is not sufficient to just remove the gland or do a liposuction that addresses the front of the chest only as it is not aesthetically pleasing for the patient and the surgeon alike. Most patients expect to achieve a sculpted look, which includes not only the breast area but also the surrounding areas such as the sides, the axillae, and the infraclavicular region. To tackle these areas and achieve a well-sculpted and aesthetic look, we describe the 4Dx (4 Directions) technique of liposuction for gynecomastia. It also makes the procedure more objective for plastic surgeons while allowing for individualization of the procedure.

Postaxial polydactyly (PAP) in the form of rudimentary soft tissue masses is quite common. Management involves ligation or surgical excision. Rarely do literature discussions cover complex variants in which the extra finger is fully developed. Ellis-van Creveld syndrome (EVC) or chondroectodermal dysplasia is a rare disorder characterized by PAP. When chondral dysplasia encompasses PAP, dwarfism, and genu valgum, ectodermal dysplasia involves nails and teeth. We describe two EVC cases. When one had cardiac malformations, the other had dental anomalies. One of them underwent genu valgum correction and removal of the additional finger. The hand surgery proved complex due to fusion of its metacarpal with the fifth metacarpal. Pediatric Outcomes Data Collection Instrument (PODCI) scores at 1.5 and 2.5 years after hand and knee surgeries were excellent. A multidisciplinary approach is essential to achieve comprehensive care. Additional embryological research is necessary to elucidate the clinical manifestations described in this report.

Introduction  Contemporary medical science has been using fat grafting in aesthetic and reconstructive procedures, consistently achieving successful outcomes. Hansen's disease, caused by Mycobacterium leprae , leads to hand deformities due to peripheral neuropathy, resulting in soft-tissue atrophy, volume loss, and compromised hand function. Tendon transfer surgery is a common remedy for functionality, but it often does not address aesthetic concerns and the patient's psychological impact of living with an atrophic hand. Autologous fat grafting can effectively address these concerns. Materials and Methods  This prospective study evaluates the efficacy of fat grafting for hand rejuvenation in patients with Hansen's disease posttendon transfer surgery, focusing on aesthetic and psychological outcomes. We recorded data from 12 patients who underwent the procedure between 2015 and 2024. Using the Coleman technique, fat was harvested from the paraumbilical region of the abdomen and injected into various hand regions. Results  Autologous fat grafting showed high patient satisfaction with significant improvements in hand contour, skin texture, and psychological health. The benefits of the procedure included improved self-esteem, enhanced quality of life, reduced social stigma, and psychological well-being. Conclusion  Autologous fat grafting is a safe and effective technique for hand rejuvenation in patients with Hansen's disease, after functional treatment addressing both physical deformities and their psychological impacts. It could be considered one of the components in the comprehensive management of Hansen's disease-related hand deformities, significantly enhancing patients' overall quality of life.

Background  There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation. Materials and Methods  The outcomes of 61 patients that underwent lower extremity local flap reconstruction ( n  = 33) or amputation ( n  = 28) between 2014 and 2020 were recorded. Chart reviews were performed to collect perioperative data. Patients were contacted via telephone for participation in the survey portion of our study. PROs were recorded utilizing both the Lower Extremity Functional Scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36). Results  Surveys were completed by 61 patients (response rate 59.2%). The mean time of survey after flap reconstruction or amputation was 2.7 ± 1.4 years. Recent trauma (within 90 days) was the most common indication for local flap coverage ( n  = 23). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared with fasciocutaneous flaps ( p  = 0.021 and p  = 0.022). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS ( p  = 0.01), SF-36 physical functioning ( p  = 0.031), physical role functioning ( p  = 0.031), and emotional role functioning ( p  = 0.047) scores than amputation patients. Conclusion  Patients who underwent local fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. These data suggest that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient-perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.