Archives of Plastic Surgery-APS最新文献

Background: While various surgical techniques have been developed for blepharoptosis correction, the frontalis suspension technique is commonly applied in cases of poor levator function or prior surgical history. This study evaluates the efficacy of a modified frontalis muscle flap suspension technique in achieving satisfactory outcomes for severe or recurrent blepharoptosis with poor levator function.

Methods: A retrospective study conducted from January 2014 to January 2017 reviewed the medical records of 47 patients with a mean age of 17.3 ± 9.17 years at 108 Military Central Hospital, Ha Noi, Vietnam. These patients were diagnosed with moderate to severe blepharoptosis (marginal reflex distance 1, MRD1 0-2 mm) with poor levator function (<4 mm) and underwent modified C-shaped frontalis muscle flap suspension. The outcomes were measured by the sum of functional and cosmetic grading scales at 6- and 12-month follow-ups. Postoperative complications were also noted.

Results: There are 40 patients (85.1%) who have unilateral ptosis and 7 (14.9%) who have bilateral ptosis. Forty-seven patients (87%) had severe ptosis, while seven (13%) had moderate ptosis. A history of frontalis sling surgery was present in 38.9% of patients. At the 12-month follow-up, 37 patients (78.7%) had good outcomes, 9 patients (19.1%) had fair outcomes, and 1 patient (2.1%) had poor outcomes that underwent surgical revision.

Conclusion: Our analysis of the modified C-shaped frontalis muscle flap suspension technique demonstrates its efficacy in treating moderate and severe blepharoptosis, particularly in cases with poor levator function and prior surgical history.

Complex defects resulting from infected bone or joints with or without osteosynthesis or prosthetic material lead to significant challenges that need to be addressed through orthoplastic approaches. Foot and ankle reconstruction is particularly difficult due to the lack of local or regional flap solutions in this highly mobile joint, which often necessitates microsurgical flaps in extended defects. In addition, rigorous bone reconstruction is critical to acute bone infection to minimize the risks of functional impairments. We present a novel approach using a chimeric osteocutaneous flap to address a complex calcaneus fracture with extended postoperative skin necrosis and septic pseudoarthrosis. A dual skin paddle (16 × 6.5 cm and 14 × 4.5 cm) was created using a superficial inferior epigastric artery (SIEA)-to-superficial circumflex iliac artery (SCIA) anastomosis, while the 7-cm pedicle was increased using a deep inferior epigastric artery graft, which was anastomosed to the tibial anterior vessels. The vascularized iliac crest component enabled optimal reconstruction of the bone defect with rapid healing, while the combined SCIP (superficial circumflex iliac artery perforator)-SIEA skin flap was used to cover the bone reconstruction and skin defect. This microsurgical reconstruction allowed optimal functional recovery at 12 months with successful bone integration and soft tissue coverage. The step-by-step intraoperative technique is described through Video 1 and Supplementary Video 2 .

Background: This study investigates scalp skin thickness using ultrasonography and histometry, exploring its relationship with age and sex.

Methods: The study data were obtained from split-thickness skin grafting using hairy scalp skin as the donor site in 102 Korean patients. The skin thickness of the donor scalps was measured using preoperative ultrasound in all 102 patients, and the histometric thickness of a 3-mm punch biopsy near the donor site was measured in 61 patients postoperatively. The scalp skin thickness was statistically analyzed according to age and sex.

Results: The mean ultrasonographic thickness was 1.71 ± 0.41 mm, while the mean histometric thickness was 1.93 ± 0.47 mm. The difference was statistically significant ( p  < 0.001). Regression analysis showed a significant relationship between ultrasonographic scalp skin thickness and age, but not sex. Thickness increased up to 20 years, with no significant change beyond that.

Conclusion: Scalp skin thickness correlates with age, but not sex. Preoperative ultrasonography is crucial for assessing scalp skin thickness, especially for younger patients under 21 years, to optimize scalp grafting outcomes.

Facial paralysis sequelae result in functional and cosmetic deficits. Myectomy for facial contractures has been reported, and recently, selective myectomy of the smile antagonists (depressor anguli oris [DAO]) for perioral synkinesis has gained attention. Although less invasive, this approach can lead to postoperative depressed deformities of the myectomy site. We report two cases of facial nerve paralysis. In one case, DAO myectomy was performed for synkinesis with the upper lip levator muscles. In the other, the DAO and depressor labii inferioris were myectomized for facial contractures centered on the lower lip. A pedicled buccal fat pad flap was elevated to cover the myectomy defect, preventing postoperative depressed deformity. One year postoperatively, no depressed deformities were observed; lower lip symmetry and oral commissure movement improved, achieving a natural smile. As the procedure involves the transfer of vascularized blood-rich buccal fat, the risk of postoperative induration and contracture is lower than that with fat injections.

Androgenic alopecia is the most common form of non-scarring hair loss, affecting both men and women with distinct regional patterns. This study aimed to investigate public perceptions, treatment behaviors, and preferences related to hair loss. A nationwide online survey was conducted from April 25 to 29, 2024, involving 2,579 participants. The questionnaire assessed sources of information, selection criteria for treatment providers, preferred treatment methods, and use of medications. Respondents most frequently relied on internet communities and social media for information. Treatment provider selection was influenced primarily by online reviews and word of mouth. Common treatments included over-the-counter products, clinic-based therapies, and oral medications. Age and gender differences significantly influenced treatment patterns and perceptions. The findings highlight the importance of digital platforms in shaping patient behavior and underscore the need for evidence-based education to guide individuals seeking treatment for hair loss.

Scapular flaps are favored for large soft tissue defects, but with a high risk of shoulder contracture. This case report presents a novel application of a bilobed flap technique to cover the donor site after harvesting a 23-cm scapular flap. The patient was a 25-year-old male with a right-hand open degloving injury measuring 25 × 22 cm. The scapular flap was planned to cover the soft tissue defect, and the bilobed flap was used to close the donor site. After 6 months, the left shoulder showed full range of motion, and the scapular flap was viable with good right-hand function. This case introduces the largest bilobed flap used to date. The report emphasizes two main advantages, it prevents shoulder contracture and allows surgeons to exceed the traditionally recommended flap size with minimal donor site morbidity. The large bilobed flap has proven effective in closing donor site defects following scapular flap harvest, demonstrating satisfactory outcomes. Additionally, this technique can be utilized to address other donor site defects.

Background: This study aims to evaluate the effectiveness of nasal conformers in patients with unilateral cleft lip and palate (UCLP) following primary cheiloplasty.

Methods: We conducted a comprehensive search in PubMed, EMBASE, the Cochrane Central Register of Clinical Trials (CENTRAL), and EBSCO Open Dissertation from inception to November 2023. We included three retrospective and one prospective cohort studies evaluating the effect of postoperative nasal conformers after primary cheiloplasty. Data extraction and risk of bias assessment were performed using the Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) tool. A meta-analysis was conducted using a random-effects model to pool data and determine overall effect sizes with a 95% confidence interval (CI). The mean difference (MD) was calculated for nostril height and nostril width outcomes. The study was registered with PROSPERO (CRD42024511395).

Results: The four included studies represented 83 treated patients and 84 controls. The overall quality of studies was moderate, as assessed by the ROBINS-I tool. Meta-analysis results showed that nostril width was wider on the cleft side compared with controls (MD = 1.10; 95% CI: 0.64, 1.56), while nostril height was lower on the cleft side (MD = -0.73; 95% CI: -1.20, -0.26). Ratios for nostril width and nostril height were generally closer to symmetry.

Conclusion: This study suggests that nasal conformers may improve nasal symmetry in patients with UCLP following primary cheiloplasty. Further research, including randomized controlled trials and long-term follow-up studies, is needed to confirm these findings and refine the use of nasal conformers in clinical practice.

Background: Propeller flap reconstruction has been widely utilized in soft tissue reconstruction due to its versatility and aesthetic outcomes. However, technical challenges and the risk of complications persist. This study aims to provide detailed guidelines on the preoperative planning, intraoperative considerations, and execution of propeller flap surgery to reduce complications.

Methods: A retrospective review was conducted on 20 consecutive patients undergoing propeller flap reconstruction between January 2018 and December 2020. Preoperative planning involved computed tomography (CT) angiography and color Doppler ultrasound. Flap designs prioritized perforator proximity (<3 cm from the defect), vessel axiality, and tissue laxity assessed by skin pinch tests. Surgical techniques including pedicle skeletonization, flap elevation, rotation, and inset were meticulously followed.

Results: No total flap loss occurred. Partial flap loss was observed in one case (5%). Two flaps (10%) exhibited venous congestion, which resolved following leech therapy without necrosis. Defects were predominantly located on the trunk (80%), with malignancy as the primary cause (55%). Mean follow-up duration was 432 days.

Conclusions: Careful preoperative planning and adherence to meticulous surgical techniques can significantly reduce complications in propeller flap reconstruction. This structured approach offers a reliable framework, particularly beneficial for surgeons less familiar with propeller flap techniques.

This case report explores the therapeutic potential of lymphovenous bypass (LVB) surgery performed at the neck in neurodegenerative diseases, specifically Alzheimer's disease (AD) dementia. The subject is a 58-year-old woman who was previously healthy but began experiencing unexplained memory decline and frequent disorientation in the past 7 years, leading to an AD diagnosis. Despite ongoing pharmaceutical therapy, her symptoms progressed to severe dementia accompanied by behavioral and psychological symptoms of dementia (BPSD). Her Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were both 0/30, and ¹⁸ F-AV-45 PET/CT revealed abnormal brain amyloid load. For salvage therapy, she underwent LVBs on her neck bilaterally. Postoperatively, she got better MMSE and MoCA scores with dramatic improvement in communication and activity. ¹⁸ F-AV-45 PET/CT scans 4 months after surgery indicated a reduction in abnormal brain amyloid deposits. This case report highlights the potential effectiveness of LVB surgery in reducing brain amyloid load and attenuating cognitive impairment and BPSD. Further research with animal experiments and clinical trials is necessary to confirm these findings.