Archives of Plastic Surgery-APS最新文献

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.

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.

Complex vulvar defects are challenging owing to their three-dimensional characteristics. We introduce a combined flap approach to maximize the use of locoregional tissues. Four patients had defects involving the vaginal wall, anal canal, and perineum, with a size range of 108 to 157 cm ² . The outcomes were analyzed using a questionnaire regarding micturition, defecation, coital function, introitus opening, and aesthetics. For the vulva, the gluteal fold flap was the primary flap, which was augmented by the mons pubis rotation flap, gracilis muscle flap, pudendal thigh flap, and medial thigh VY advancement flap. The perianal skin and anal defects were covered by the gluteal fold and buttock VY advancement flaps. Patients' satisfaction scores were favorable on follow-up. Our multi-flap approach optimized the aesthetic and functional results of combined vulvar-anal defects.

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.