Archives of Plastic Surgery-APS最新文献

Galactorrhea is a rare but well-described complication following aesthetic breast surgery. Augmentation with mastopexy is a procedure that combines breast tissue reduction with volume augmentation; however, only few cases of galactorrhea were described following this procedure. This report concerns three cases of galactorrhea after augmentation with mastopexy provided by two surgeons (J.P. and M.P.). Patients did not report any significant gynecological history, including a history of oral hormonal intake or galactorrhea in the past. All three patients underwent the dual plane breast augmentation together with the Wise-pattern breast lift. In two cases, the first symptoms occurred in the second week, and in one case in the third week after surgery, manifesting as breast pain and swelling. These clinical issues, accompanied by a small amount of white fluid secretion from the vertical scar, scar around nipple-areolar complex, and from the T-junction, were presented to the operating surgeons. Galactorrhea came to consideration after a negative microbiological examination. In two cases, galactorrhea was treated with oral dopaminergic medication cabergoline, with a good response to the therapy. All symptoms, including redness and pain, fully resolved at the 21st postoperative day without the necessity of surgical revision. One patient with bilateral secretion was treated by early operative revision. In the following days, secretion ceased, and after drain removal, further complications did not occur. Aesthetic results after 12 months were satisfactory in all patients. In conclusion, galactorrhea is a rare but significant complication of any mammaplasty surgery. Untreated secretion may lead to severe complications; however, early recognition and treatment may lead to good results and patient satisfaction.

Granuloma annulare (GA) is a benign, often self-limited granulomatous skin condition that typically resolves spontaneously. Treatment is often not required, but topical and injectional corticosteroids are the most common interventions. Excision is effective for diagnosis and temporary treatment, but usually not considered curative. This case report describes the unconventional treatment of a recurrent biopsy-proven GA of the index finger. Due to the combination of the recalcitrant nodules interfering with function and patient preference, the nodules were excised multiple times. Ultimately requiring reconstruction with a pedicled radial forearm flap, the patient thereafter received radiation therapy to prevent recurrence, the combination of which has not been previously described in the literature. The patient was treated successfully without evidence of recurrence at 18 months.

Background: Subpectoral implant placement in breast reconstruction has been associated with potential shoulder function impairment compared to prepectoral placement, though the evidence remains inconclusive. This study aimed to investigate differences in shoulder function following mastectomy and direct-to-implant breast reconstruction using prepectoral or subpectoral implant placement.

Methods: Forty-two women aged 18 years or older, eligible for direct-to-implant breast reconstruction, were randomized 1:1 to undergo either prepectoral or subpectoral implant placement. Data were collected at baseline and at 3- and 12-month follow-ups. Shoulder function was assessed using the validated Constant Shoulder Score (CSS), which evaluates pain, activities of daily living, range of motion, and strength. Pectoralis major muscle (PMM) strength was also measured.

Results: Baseline and demographic characteristics were comparable between the groups. No differences were observed in total CSS or the modified CSS (including the PMM strength) between the prepectoral and subpectoral groups at baseline or at the 3- and 12-month follow-ups. At 12 months, total CSS ( p  = 0.74) and modified CSS ( p  = 0.45) remained similar across both groups.

Conclusion: There were no significant differences in shoulder and arm function between the sub- and prepectoral reconstruction groups. These findings suggest that concerns regarding shoulder function should not dictate the choice of implant placement plane in direct-to-implant breast reconstruction.

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.