Archives of Plastic Surgery-APS最新文献

Background: Capsular contracture is a common complication following implant-based breast reconstruction. Current assessment methods, primarily relying on the subjective Baker grading system, lack objectivity and quantitative data, which hinders large-scale studies and the development of treatment guidelines. To solve these problems, we conducted a study using computed tomography (CT) scans to quantitatively evaluate morphological changes in breast implants associated with capsular contracture.

Methods: We enrolled 94 patients who underwent breast reconstruction using implants and underwent periodic chest CT scans. We categorized them into two groups: Baker grade I or II ( n  = 72) and Baker grade III or IV ( n  = 22). We analyzed the CT scans to assess changes in the implant base and projection.

Results: In the Baker grade III or IV groups, it was confirmed that the ratio of projection to base increased after capsular contracture compared with before contracture. On the other hand, there was no significant change in the ratio of projection to base in the Baker grade I or II groups.

Conclusion: This study highlights the potential of CT scans as a reproducible method for evaluating capsular contracture. The ratio of projection to base could serve as a new quantitative index alongside the Baker grades for clinical assessment, treatment planning, and research on capsular contracture. When comparing the ratio of projection to base before and after capsular contracture, if the ratio of projection to base increases by more than 1.233 times, it can be considered Baker grade III or IV.

Surgical treatment of axillary hidradenitis suppurativa (HS) requires wide excision followed by definitive wound closure to not limit shoulder function. An international prospective study was undertaken to compare how a keystone perforator island advancement flap can be a reliable solution. Independently, two Transatlantic institutions, from 2019 to 2024, surgically resected axillary HS followed by a keystone perforator flap for defect management. A total of 23 patients were treated, including 4 with bilateral disease, employing 27 total flaps that permitted the comparison of demographic data, Hurley disease stage, flap viability and complications, need for secondary surgeries, duration of treatment, and functional outcome. Demographic data in both countries was similar with regard to mean age, female preponderance, presence of obesity, and prior means of treatment. Surgical treatment was not limited in either country only to Hurley stage III individuals. In Romania, 6/11 (54.5%) compared to 3/12 (25.0%) of U.S. patients were classified as Hurley stage II. No flap necrosis was observed, allowing unrestricted shoulder mobility within 3.5 (2-4) months in Romania, but more slowly by 4.4 (3-9) months in the United States. All complications were minor, occurring in 11 (43.5%) patients, albeit three times more frequently in the United States. Overall, the most common problem was lesser curvature dehiscence (63.6%). No disease recurrences were noted. The keystone perforator island advancement flap is a safe, rapid, and simple local flap option for the closure of the axillary defect after the excision of HS. The learning curve was straightforward, so reconstructive surgeons can readily adapt to utilize this approach.

Free tarsal grafts, the palatal mucosa, and auricular cartilage are commonly used in the reconstruction of the posterior lamella of the eyelid. However, reports describing the sole use of periosteal flaps are limited. We described the cases of two female patients, aged 72 and 85 years, with sebaceous gland and basal cell carcinomas of the left lower eyelids, respectively, who underwent reconstruction with a long L-shaped periosteal flap. The periosteal flap, measuring approximately 6 × 25 mm, was harvested along the vertical axis over the lateral orbital rim, extending across the frontozygomatic suture with the pivot positioned posteriorly at Whitnall's tubercle. This technique enabled the reconstruction of the posterior lamella of the lower eyelid. At the 1-year follow-up, mild sagging of the reconstructed area was observed in the second case; however, no major complications occurred. Thus, the long L-shaped periosteal flap was useful for reconstructing the lateral lower eyelid.

Background: Breathing can occur either through the nose or mouth. Mouth breathing is the process of breathing through the mouth alone or mostly through the mouth for more than 6 months. Mouth breathing can affect facial development. This study aims to look at the effect of mouth breathing on facial anthropometry.

Methods: This study used a case-control design conducted during March to September 2024 at Dr. Hasan Sadikin Hospital, Bandung, on subjects aged 7 to 23 years who were divided into two groups, namely mouth breathing and nasal breathing. Data were obtained from filling out the MBD-MBS (Mouth Breathing in Daytime and Mouth Breathing during Sleep) questionnaire, taking lateral cephalometric photographs, and cephalometric measurements using the WebCeph application. Statistical analysis was performed with SPSS software using the chi-square and Mann-Whitney tests.

Results: There were significant differences in angular parameters between the two groups, namely the Sella-Nasion to Gonion-Gnathion (SN.GoGn) angle ( p  = 0.029), the Frankfort mandibular angle (FMA; p  = 0.023), and the mandibular plane to palatal plane (MP.PP) angle ( p  = 0.012); the Articulare-Gonion-Menton (ArGoMe) angle was greater in the oral breathing group ( p  = 0.003). The linear parameter values in both groups were not different ( p  > 0.05).

Conclusion: Mouth breathing affects facial anthropometry, resulting in an increase in retrognathic mandibular and maxillary angles.

Lymphedema is rare adverse effect of coronavirus disease 2019 (COVID-19) vaccination that has been reported in several studies. We present a case of surgically treated secondary lymphedema after COVID-19 vaccination. The patient presented lymphedema at the upper extremity with no specific history except the COVID-19 vaccination 18 months before the visit. Lymphaticovenous anastomosis and liposuction were performed on the posterolateral aspect of the forearm and the upper arm. The volume of the affected arm was reduced to more than 54% at 8 months postoperatively. With precise surgical planning, secondary lymphedema resulting from COVID-19 vaccination could be successfully treated surgically.

Asan Medical Center in Seoul, South Korea, is renowned for its excellence in plastic and reconstructive surgery. This paper aims to share insights from a 2-week fellowship experience in the Department of Plastic Surgery, led by Professor Jong Woo Choi. The program offers comprehensive clinical observership, including participation in daily conferences, ward rounds, outpatient clinics, and surgical procedures. Observers gain exposure to complex microsurgical cases, benefiting from the department's high case volume and state-of-the-art facilities. The center's commitment to pioneering research and innovation provides exposure to cutting-edge techniques and fosters collaboration. Personal reflections highlight the program's impact on professional development and the supportive learning environment created by Professor Hong and his team. This fellowship offers an unparalleled opportunity for surgeons to enhance their expertise in reconstructive microsurgery, engage with leading experts, and witness advanced patient care. The experience provides valuable insights and inspiration for those considering similar educational pursuits in plastic and reconstructive surgery.

Background  Diabetic foot ulcers (DFUs) affect approximately 20% of diabetic patients and pose significant risks, especially for plantar wounds that bear weight. Conventional treatments often have suboptimal results, necessitating the exploration of reconstructive options. Plastic surgery interventions, such as skin grafts and flaps, have shown promising outcomes, but with considerable complications. This study evaluates the efficacy of rotation flap reconstruction with incisional negative pressure wound therapy (NPWT) for plantar DFUs. Methods  We conducted a retrospective review of 42 patients who underwent rotation flap closure for plantar DFUs. We optimized the preoperative conditions with aggressive infection control and vascular assessment. We performed rotation flaps with incisional NPWT as the operative technique. We managed the postoperative conditions with offloading continuous incisional NPWT and footwear. Results  All patients achieved initial wound healing, with a median duration of 36 days. Complications occurred in 14% of cases. The recurrence rate was 21% during follow-up, which was significantly higher in patients with Charcot foot deformity. We present three illustrative cases that demonstrate the efficacy of rotation flaps. Conclusion  Rotation flap closure, supplemented by incisional NPWT, emerges as a viable option for plantar DFUs, achieving high initial healing rates, low complications, and reduced recurrence. Notably, patients with Charcot foot deformity require more attention and intervention to prevent recurrence.

Background  Enchondromas are the most common primary tumors in the small tubular bones of the hand, and fractures are often the result of thinned cortical bone. The main question was whether fractured enchondromas influence long-term clinical and radiological outcomes. Methods  Between 2000 and 2019, 57 patients with previously treated fractured (group I) and non-fractured (group II) hand enchondromas (34 female, 23 male; mean age 39.4 ± 13.7 years) were evaluated for clinical and radiological treatment outcomes. Short Form-36 Health Survey (SF-36) and Disabilities of the Arm Shoulder and Hand (DASH) questionnaires as well as patient-reported experience measures were used to assess subjective health outcomes. Subsequently, 43 patients underwent clinical and radiological follow-ups. Comparative evaluation of objective treatment outcomes in both groups was conducted in terms of hand functionality, perioperative complications, recurrence rates, and osteogenesis. Results  Almost half of the patients suffered enchondromas with fractures (49.1%, n  = 28). Two patients received additional k-wire stabilization due to intraoperative instability. Defect resolution could be reached in 97.7% ( n  = 42) of all cases. No recurrence of enchondroma was observed. Groups were equal regarding radiological and clinical outcomes. The patient-reported experiences were predominantly positive (86%), and both cohorts had good to very good results with a DASH mean score of 4 (± 6.3). The SF-36 demonstrated a return to normal quality of life in both groups. The mean follow-up time was 7.78 years (± 4.8). Conclusion  Sole curettage of enchondromas yields effective outcomes with good to excellent results regardless of the presence of a fracture. Long-term radiological follow-up is not required until symptomatic recurrence.