Archives of Plastic Surgery-APS最新文献

One of the most common complications of rhinoplasty and septorhinoplasty is intraoperative bleeding, which poses challenges for both surgeons and patients. This systematic review and meta-analysis aimed to evaluate the effectiveness of various bleeding control methods in rhinoplasty and septorhinoplasty surgeries. This study conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in reputable international databases to identify relevant studies. Ultimately, 16 randomized controlled trials (RCTs) with 933 patients were included in the analysis. The bleeding control methods evaluated included tranexamic acid (TXA), desmopressin, steroids, magnesium sulfate, clonidine, remifentanil, and patient positioning (reverse Trendelenburg position). Data were combined using meta-analysis methods in STATA version 17, and the standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated to assess the effects of the methods. The results showed that TXA (SMD: -1.31; 95% CI: -2.01 to -0.62) and steroids (SMD: -1.07; 95% CI: -1.70 to -0.43) had the most significant impact on reducing bleeding. Patient positioning also showed a considerable effect (SMD: -0.65; 95% CI: -1.01 to -0.30), and desmopressin had a positive impact (SMD: -1.53; 95% CI: -3.12 to 0.06), though this effect was not statistically significant. This study demonstrates that pharmacological and non-pharmacological interventions, such as TXA and patient positioning, can significantly reduce intraoperative bleeding. However, further studies with larger sample sizes and standardized designs are recommended for magnesium sulfate, clonidine, and remifentanil methods. Level of Evidence I.

Phytophotodermatitis (PPD) is an uncommon dermatologic condition that occurs after exposure to furocoumarins found in certain plant saps, which become activated upon ultraviolet A radiation exposure. This condition is frequently misdiagnosed as cellulitis, allergic dermatitis, or other common skin disorders. Here, we present a case of severe PPD in a 52-year-old male who initially developed a rash and blistering on his forearm following outdoor activity. He was initially misdiagnosed with cellulitis; however, his symptoms persisted despite antibiotic treatment, prompting further evaluation. A detailed patient history revealed recent contact with a mulberry tree, and together with characteristic biopsy findings, confirmed the diagnosis of PPD. The patient showed significant improvement following the administration of oral corticosteroids and topical steroid treatment. This case underscores the importance of recognizing PPD in clinical practice to prevent misdiagnosis and ensure effective management.

Background: Social media platforms, particularly Instagram, have revolutionized residency recruitment by offering integrated plastic surgery programs innovative avenues to showcase their culture and engage directly with prospective applicants. The COVID-19 pandemic accelerated this digital shift, making virtual interactions essential for evaluating program fit.

Methods: We identified 88 Accreditation Council for Graduate Medical Education-accredited integrated plastic surgery programs for the academic year 2023 to 2024. Instagram posts from January 1, 2020, to October 26, 2024, were reviewed, focusing on "engagement posts" (e.g., meet-and-greets, question-and-answer [Q&A] sessions, open houses, workshops, conference meet-ups). Programs were stratified into cohorts based on Doximity rankings (Top 20, 21-40, 41-60, and 61-88), geographic region, and program size.

Results: All programs maintained active Instagram profiles, collectively sharing 13,719 posts and averaging 32.4 posts per program annually. Among these, 369 (2.7%) were engagement posts, with meet-and-greets accounting for 71.3% of such content. Notably, Top 20 programs posted significantly more frequently (52.6 posts/year) than lower-ranked cohorts (21-40: 35.0, 41-60: 26.8, 61-88: 20.1; p  < 0.001) and had a higher engagement post rate (3.9% vs. 2.0-2.7%; p  = 0.033).

Conclusion: Higher-ranked and larger programs exhibit a more robust Instagram presence with greater emphasis on engagement opportunities, despite these posts comprising only a small fraction of overall content. These findings highlight the potential for optimized social media strategies to enhance digital outreach and improve residency recruitment in an evolving virtual landscape.

Delayed breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in patients with a history of abdominal wall hernias and/or cesarean sections presents unique challenges. This study examines 10 such cases, emphasizing key technical considerations. Our findings highlight the importance of lateral row perforators, as medial paraumbilical perforators are often compromised in patients with prior umbilical hernia repairs. Additionally, deep inferior epigastric arteries (DIEAs) may be damaged in previous lower abdominal surgeries, necessitating intraoperative confirmation of vessel patency. While preoperative CT angiography aids in planning, it may misrepresent perforator size or location due to adherence to fascia. In our approach, a gastrointestinal surgeon performed concurrent hernia repair while the plastic surgery team secured the DIEP flap perforators and pedicle. Preservation of umbilical vascularity was ensured by avoiding complete skeletonization. In the case shown, only a single lateral row perforator was usable, despite preoperative imaging suggesting additional perforators. All patients had successful flap integration, with no cases of flap failure, necrosis, postoperative hernias, wound dehiscence, seroma, hematoma, or infection. A delayed flap inset was performed using the Rosebud technique, ensuring optimal aesthetic outcomes and high patient satisfaction. This study highlights the critical role of a multidisciplinary approach, precise perforator identification, and careful interpretation of preoperative imaging in achieving optimal outcomes in complex DIEP flap breast reconstruction.

Early detection of perfusion deficits is crucial for optimal flap outcomes. Hyperspectral imaging (HSI) offers a non-invasive method to assess tissue perfusion, potentially detecting complications earlier than Doppler ultrasound or near-infrared spectroscopy. This systematic review and meta-analysis evaluate the efficacy and diagnostic accuracy of HSI in monitoring flap viability, particularly in detecting ischemia and necrosis. A systematic search of PubMed, ScienceDirect, and Cochrane Library was conducted following PRISMA 2020 guidelines. Studies on HSI's role in flap viability were critically appraised using the Critical Appraisal Skills Programme checklist. A random-effects model was applied for the meta-analysis. Nine studies were included, six focusing on flap complications. HSI demonstrated a median sensitivity of 93% (63-100%) and a median specificity of 96% (81-100%) for detecting compromised flaps, outperforming clinical assessments in some cases. Significant differences were observed between viable and necrotic tissues in four key HSI parameters: Oxygen saturation, tissue hemoglobin index (THI), tissue water index, and near-infrared perfusion index (NIR-PI). THI and NIR-PI effectively differentiated venous congestion from arterial occlusion. However, heterogeneity across the studies indicated a need for standardized protocols. Notably, HSI detected perfusion deficits up to 4.8 hours before clinical signs. HSI shows promise for postoperative flap monitoring, enabling earlier detection of ischemia and necrosis. Future research should focus on standardized imaging protocols, real-time analysis, and larger multicenter trials to confirm HSI's clinical utility and cost-effectiveness.

Background: Infection is a challenging complication in prosthetic breast reconstruction. Recently, we encountered cases of Corynebacterium striatum infection following prosthetic breast reconstruction in breast cancer patients. We would like to share our experience of preventing reconstruction failure from this uncommon infection.

Methods: This is a retrospective study on consecutive cases of Corynebacterium infection that occurred within 2 months in five patients who underwent implant-based breast reconstruction. One patient had a history of preoperative radiation therapy, one required reoperation due to postoperative bleeding, and two experienced hemovac obstruction events. Patients were immediately hospitalized and treated with hemovac insertion, IV antibiotics, and, if necessary, reoperation for salvage.

Results: Corynebacterium striatum was identified in the hemovac cultures or intraoperative specimens of all patients. Based on the antibiotic susceptibility of the identified strain, infection with a single bacterial strain was suspected. All patients underwent hemovac re-insertion, and one patient was successfully salvaged with IV antibiotic treatment alone. However, the remaining four patients required implant change during the salvage process. The bacteria became negative within a period ranging from 1 to 7 weeks after identification, and salvage was successfully achieved without reconstruction failure in all patients by postoperative days 20 to 58.

Conclusion: Corynebacterium is an uncommon pathogen in implant-based breast reconstruction, and reports of its treatment are very rare. This study presents our experience with successful treatment and outlines the clinical symptoms and treatment methods. We hope that this report can serve as a reference for reconstructive surgeons who may encounter similar situations.

Background: Pressure ulcers are a common and debilitating complication in patients with spinal cord injuries (SCIs), often requiring reconstructive surgery. However, scarred areas remain vulnerable to recurrence. This study evaluates lipografting as a secondary prevention strategy to enhance soft tissue padding over bony prominences and reduce ulcer recurrence. Additionally, it investigates whether fat resorption rates are higher in compromised tissue.

Methods: Five wheelchair-bound male patients with SCIs who had previously undergone reconstructive surgery for ischial pressure sores were included. Lipografting was performed, and soft tissue thickness was measured using ultrasonography preoperatively, immediately postoperatively, and at 3 and 12 months. Scar pliability, patient satisfaction, and fat resorption rates in the compromised area were also assessed.

Results: Significant soft tissue augmentation was observed immediately postoperatively, with an average retention rate of 60.7% at 1 year. Scar pliability improved in all patients, and no new pressure ulcers developed during the follow-up period. Patients reported high satisfaction, with one noting increased tolerance for prolonged sitting.

Conclusion: Lipografting appears to be a promising, minimally invasive approach for secondary prevention of pressure ulcer recurrence in SCI patients. While these findings are encouraging, further studies with larger cohorts and longer follow-up are necessary to confirm the long-term benefits of this technique.

Digital ischemic necrosis can result from circumferential compression by medical dressings or domestic materials, particularly in pediatric patients. We present nine cases of ischemic necrosis caused by constrictive finger dressings between 2014 and 2024. Seven cases were iatrogenic, related to medical dressings, and two were caregiver-induced. Caregiver-induced cases tended to show more severe injuries, often necessitating reconstructive procedures such as free flaps, and these patients generally presented later than those with iatrogenic injuries. The contrast in timing and severity between the two groups suggests that delayed recognition may contribute to less favorable outcomes. These cases highlight the preventable nature of this condition and emphasize the importance of early recognition, proper wound monitoring, and caregiver education to minimize tissue loss and reduce the need for complex reconstructive surgery.

This review highlights current surgical approaches for carpal tunnel syndrome (CTS), the most common compressive neuropathy of the upper extremity. Open, mini-open, endoscopic, and emerging minimally invasive techniques are compared in terms of outcomes, complications, pillar pain, and reoperation rates. Surgical indications, anatomical considerations, and management of recalcitrant CTS-including recurrent, persistent, and new-onset symptoms-are discussed. Adjunct procedures such as opponensplasty and flexor synovectomy are reviewed, with emphasis on patient selection, individualized decision-making, and the importance of thorough anatomical knowledge to ensure safe adoption of novel techniques.