Archives of Plastic Surgery-APS最新文献

Background: Plastic surgery has broad overlap with other surgical subspecialties. Regarding procedures provided by both plastic surgery and other surgical specialties in the United States, the changes in plastic surgical case volume over time have not been previously investigated.

Methods: Select common procedure terminology (CPT) codes from an array of areas of practice including breast reconstruction, hand, adult craniofacial, peripheral nerve, microsurgery, and ventral hernia were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2010 to 2020. Case numbers, operative times, and complication rates among surgical subspecialties were compared. Aesthetic surgery cases were excluded as they are not well captured by the NSQIP database.

Results: A total of 128,545 procedures were included. In 2010 and 2020, plastic surgeons performed 83.9% versus 89.3% of reconstructive breast ( p  < 0.001), 5.4% versus 4.3% of hand ( p  = 0.23), 33.6% versus 39.1% of adult craniofacial ( p  = 0.28), 36.7% versus 29.5% of peripheral nerve ( p  = 0.45), 9.3% versus 94.6% of microsurgical ( p  = 0.25), and 0.4% versus 0.4% of ventral hernia procedures ( p  = 0.99). Plastic surgery performed the majority of breast reconstruction and microsurgical procedures. Operative times and complication rates varied between specialties and were generally inversely proportional to the number of cases for included specialties.

Conclusion: Plastic surgical involvement did not significantly decrease for any of the included procedural categories in ACS-NSQIP over the study period. Breast reconstruction and microsurgery remain areas of particular specialization with plastic surgeons performing the highest volume. Areas of shared practice suggest opportunities for collaboration.

Craniosynostosis, a condition characterized by the premature closure of one or more cranial sutures, can be classified based on the affected suture, the number of sutures involved, or the presence of syndromic features. Although numerous surgical techniques have evolved to address cranial deformities, there remains a need for systematic categorization of these approaches. This review aims to explore current craniosynostosis treatments, evaluate their respective advantages and disadvantages, and propose a new classification distinguishing preservation cranioplasty from structural cranioplasty. The choice between preservation and structural cranioplasty is influenced by factors such as patient age, complexity of suture involvement, and resource availability. Preservation cranioplasty techniques, including suturectomy and distraction osteogenesis, prioritize maintaining cranial vault integrity and minimizing dural detachment, thus reducing surgical risks and facilitating natural cranial growth. Conversely, structural cranioplasty involves extensive bone displacement and dural exposure, offering effective correction for complex deformities and syndromic cases but with increased procedural risks. We propose categorizing craniosynostosis surgical treatments into two primary approaches: Preservation and structural cranioplasty. Preservation cranioplasty focuses on minimal invasion to support natural brain and skull development, while structural cranioplasty involves extensive remodeling necessary for severe or syndromic cases. Understanding these paradigms enables better-tailored treatment strategies and may improve long-term craniofacial outcomes.

Keloids remain one of the most challenging conditions in cutaneous wound healing, marked by complex pathophysiology and notoriously high recurrence rates. Although a universally accepted standard of care is still lacking, recent advances have significantly improved our understanding and management of this fibrotic disorder. Emerging evidence highlights genetic predisposition, prolonged inflammatory response, and aberrant fibroblast activity as key contributors to keloid formation. Current therapeutic approaches focus on multimodal strategies, including intralesional corticosteroids, cryotherapy, radiation therapy, and chemotherapy. Intralesional triamcinolone remains a first-line treatment, while chemotherapy agents like 5-fluorouracil and vincristine have shown promising efficacy in refractory cases. Surgical excision, often combined with adjuvant therapies such as radiation, is considered for large or recurrent lesions. Given the high recurrence rate, patient-centered, evidence-based treatment algorithms are essential. Stratifying keloids into categories enables tailored interventions. Both established and emerging treatments are now evolving toward more personalized and less invasive approaches to improve outcomes and patient satisfaction. Multimodal, individualized treatment approaches-guided by lesion morphology, anatomical location, treatment history, and patient factors-are essential for optimizing outcomes. Emerging therapies are expanding the therapeutic arsenal, offering additional strategies for resistant or recurrent cases. Moreover, the integration of molecular and genetic insights is paving the way for the development of targeted therapies, which may ultimately transform keloid treatment into a more precise and effective discipline. Future studies should focus on large-scale trials to establish standardized, data-driven treatment guidelines for keloids.

Facial reanimation surgery offers various approaches, with the choice of method influenced by numerous factors. Masseteric nerve transposition (MNT) has become a preferred neural source, often compared with cross-face nerve graft (CFNG) for its respective advantages. This systematic review and meta-analysis aim to compare postoperative outcomes between MNT and CFNG in facial reanimation surgery for patients with facial nerve paralysis sequelae. A comprehensive electronic search was conducted using databases such as PubMed/Medline, Scopus, ScienceDirect, EBSCO, Web of Science, and Cochrane Library, along with gray literature sources like Scopus Preprints and MedRxiv. Statistical analyses were performed using Review Manager version 5.4.1, with the quality of included studies assessed using the Newcastle-Ottawa Scale. Results showed that MNT provided statistically significant improvements in commissural excursion (CE; mean difference [MD] = 2.36 mm) and commissural contraction velocity (CCV; MD = 7.01 mm/s) compared with CFNG. Additionally, MNT had a higher recovery percentage for CE (MD = 26.86%) and CCV (MD = 13.00%). Superior outcomes were also noted for static and dynamic smile symmetry, quality of life, and patient satisfaction. This meta-analysis underscores the advantages of MNT over CFNG in the majority of parameters in the analysis, at once highlighting the need for further research with larger sample sizes for more precise comparisons.

Arteriovenous malformations (AVMs) are uncommon congenital vascular anomalies characterized by direct, high-flow connections between arteries and veins. Forehead AVMs present unique challenges due to their aesthetic considerations, risk of complications, and proximity to critical neurovascular structures. A 26-year-old male presented with a pulsatile forehead swelling present since birth, which gradually increased in size. Doppler ultrasound and magnetic resonance imaging (MRI) revealed a forehead AVM fed by branches from the superficial temporal and ophthalmic arteries, without evidence of intracranial extension. Presurgical embolization using cyanoacrylate glue achieved 90% occlusion. However, the procedure was complicated by glue migration into the cavernous sinuses, resulting in headache and dizziness. The patient was initially managed with low-molecular-weight heparin and close clinical observation. Definitive surgical resection was performed successfully 1 month later. The wound healed without complications, and no recurrence was observed during 6 months of follow-up. This case highlights the importance of a multidisciplinary approach in managing AVMs and emphasizes the need to balance embolization risks with therapeutic benefits to achieve optimal outcomes.

Background: The Keystone Design Perforator Island Flap (KDPIF), developed by Behan in 2003, has significantly impacted reconstructive surgery. This technique utilizes angiotomes, which integrate vascular, dermatomal, neural, and lymphatic networks, providing various approaches for complex reconstructions.

Methods: This study enhances the initial PACE framework (Pain, Aesthetic appearance, Complication rates, Economic feasibility) by adding "S" for Sensibility, creating the PACES framework to include sensory improvements in the assessment.Our retrospective analysis included 121 patients over 51 months, primarily with defects from skin malignancies (66.9%) and chronic wounds (16.5%), mainly on the trunk (51.2%). The average age was 56.2 years, with males comprising 73.6% of the cohort.

Results: Outcome measures included pain, assessed using the Visual Analog Scale at 1 and 12 months postoperatively, revealing a significant reduction in pain. Aesthetic outcomes were evaluated through the Manchester Scar Scale, showing notable improvements in scar appearance. Complication rates were low, indicating the safety of the flap in this series. Economic efficiency was assessed by operative time and hospital stay, with shorter durations indicating cost-effectiveness.Sensory outcomes, measured with the Postoperative Flap Sensitivity Self-Assessment Questionnaire, showed substantial gains in sensory function, enhancing patients' quality of life.

Conclusion: The PACES framework facilitated a comprehensive evaluation of KDPIF, confirming its effectiveness across various defect types and patient populations. Our findings support the wider adoption of KDPIFs for reconstructive purposes, alongside ongoing efforts to optimize patient outcomes and functionality.

Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder caused by ANTXR2 gene mutations, resulting in abnormal deposition of hyaline material in connective tissues. Fewer than 100 cases have been documented worldwide. Patients often present with painful joint contractures, gingival hyperplasia, cutaneous nodules, and restricted mobility. Here, we report a 7-year-old boy with HFS who underwent surgical management for near-total obstruction of the external ear canal and multiple ulcerative lesions. A multidisciplinary approach facilitated successful mass excision and reconstruction with a split-thickness skin graft. Postoperative evaluations showed stable wound healing at 6 months, allowing consideration of further surgeries. This case highlights the importance of comprehensive genetic assessment, careful preoperative planning, and individualized surgical intervention, as well as the critical role of nutritional support to optimize wound healing and clinical outcomes in HFS.

Background: Fingertip injuries present a challenge for surgeons. Factors such as appearance, sensation, and grip strength influence the choice of procedure. The neurovascular island (NVI) flap is commonly used due to its reliability and favorable results. However, it can lead to reduced sensation and a limited range of motion, which are significant concerns.

Methods: This study analyzed 56 adult patients with 66 finger injuries treated with a modified NVI flap by a single surgeon. The flap is based on branches of the proper digital artery to the volar and dorsal skin, including two nerves in the resected flap. The FIOS score was used to assess long-term flap outcomes at follow-up. Patients with thumb injuries, incomplete records, or loss of follow-up were excluded.

Results: The study found that NVI flaps had a survival rate of 98%. Post-surgery, the patients' outcomes were assessed using the FIOS score, with 61 cases rated as "excellent," 4 as "good," and 1 as "fair." During long-term follow-up, none of the patients experienced cold intolerance or sensory abnormalities, which is attributed to the inclusion of the dorsal cutaneous nerve in the flap.

Conclusion: In conclusion, the NVI flap procedure proved to be a reliable method for reconstructing fingertip pulp loss, offering long-term satisfactory outcomes. It provided good coverage with preserved sensation, dexterity, and preservation of finger length, meeting the patients' cosmetic expectations.