Archives of Plastic Surgery-APS最新文献

Lipedema is an adipose tissue disorder that principally affects women and is frequently misidentified as obesity or lymphedema. There have been relatively few studies that have precisely defined the pathogenesis, epidemiology, and treatment approaches for lipedema. However, successfully recognizing lipedema as a distinct condition is important for proper management. This review aimed to examine the existing literature on the epidemiology, pathogenesis, clinical presentation, differential diagnosis, and treatments for lipedema. The current research indicates that lipedema appears to be a clinical entity related to genetic factors and fat distribution, although distinct from lymphedema and obesity. Some available treatments include complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. The management of lipedema is complex and differs from that of lymphedema. Further high-quality randomized controlled trials are urgently needed to continue advancing our understanding of this often neglected disease and exploring optimal medical and surgical treatment regimens tailored specifically for lipedema patients. In summary, despite frequent misdiagnosis, enhanced recognition, and research into customized therapeutic strategies for this poorly characterized but likely underdiagnosed disorder represent promising steps forward. Level of evidence  N/A.

Both cosmetic and functional aspects are important in reconstructing the lower eyelid tissue defects. In this case report, we describe a two-stage reconstruction of a skin defect, including the orbicularis oculi muscle, after resection of a basal cell carcinoma using a paramedian forehead flap combined with the frontalis muscle and periosteum. In the first stage, the paramedian forehead flap, including the frontalis muscle and periosteum, was elevated, the periosteal flap was fixed to the outer orbital periosteum to lift the lower eyelid, and the skin flap, including the frontalis muscle, was sutured to the defect. In the second stage, the flap was divided and the frontalis muscle flap was sutured to the medial palpebral ligament. Electromyography at 1 year postoperatively confirmed neurotization of the transferred muscle, and at 6 months, voluntary contraction of the transferred muscle was observed during eyelid closure. These results suggest that a paramedian flap combined with the frontalis muscle and periosteum is a useful option for reconstructing horizontal skin defects involving the orbicularis oculi muscle.

Background  This study aimed to investigate the association between the use of different flaps, including random and axial pattern flaps, and sensory recovery following finger soft tissue reconstruction using local pedicle flaps. Methods  A longitudinal study was conducted on 115 patients with 130 finger soft tissue defects treated with local pedicle flaps between December 2016 and December 2020. Assessments were made at early postsurgery (119 flaps), 3 months postsurgery (110 soft tissue defects), and 6 months postsurgery (94 soft tissue defects). Sensory recovery outcomes were compared between soft tissue defects reconstructed using random and axial pattern flaps. Results  In the early postsurgery period, there was a significantly higher prevalence of a static sense of two-point discrimination (s2PD) ≤6 mm among fingers with random pattern flaps (96.2%) than among fingers with axial pattern flaps (64.5%). The probability of s2PD ≤6 mm at the donor and recipient sites with the direct flap was 75.5% and 25.5%, respectively, which was significantly higher than that with the reversed flap. After 6 months, there was a significant difference in sensory recovery compared to that at 3 months postsurgery but not between different flap types. Conclusion  Sensory recovery after reconstruction was observed with all flap types, and better sensory recovery can be achieved in a shorter time postsurgery using random pattern flaps.

Although postparalytic facial nerve syndrome (PFS) is a frequent sequela of partial facial palsy, no effective treatment is currently available. Herein, we report a case of a cross-face nerve graft (CFNG) technique with selective neurectomy of the facial nerve in a 52-year-old female with moderate PFS (especially oral-ocular synkinesis and facial contracture) and a House-Brackmann score grade III. Selective neurectomy resulted in the release of the synkinesis and contractures. Furthermore, we reinnervated the levator muscles of the upper lip and oral commissure by connecting the contralateral facial nerve to the thick zygomatic branch of the facial nerve via a CFNG, which allowed neural signal augmentation of the levator muscles. No obvious PFS recurrence was observed 1 year postoperatively. This procedure is expected to provide a new treatment option for improving PFS because it is effective and less invasive.

Facial asymmetry is inherent from birth, and it becomes more pronounced with age due to changes in the facial skeleton at various rates and locations. As new insights into "multi-axes facial rotation" patterns emerge, there is a pressing need to update the standards for facial assessment, consultation, and treatment to align with modern aesthetic practices. Traditional methods like MD Codes™ and BeautiPHIcation™, which focus on enhancing specific features or applying mathematical beauty principles, may not adequately address overall facial balance and may neglect the underlying skeletal asymmetries that contribute to a person's appearance. These approaches, while innovative, can result in treatments that might not fully appreciate or correct the foundational asymmetries present in the facial skeleton. Therefore, a comprehensive approach that includes a detailed assessment by skilled practitioners is essential to achieve a balanced aesthetic outcome that not only meets individual aesthetic needs but also enhances patient satisfaction through improved education and trust-building between the clinician and the patient.

Background  Indocyanine green (ICG) lymphography has limited use in the detection of functioning lymphatics in advanced lymphedema. This study presents the use of normal-side ICG lymphography to navigate the potential sites of functional lymphatics and reports its impact on the lymphatic detection rate and operative time. Methods  This was a retrospective study of unilateral lower extremity late-stage II or III lymphedema patients who underwent lymphaticovenous anastomosis (LVA) between February 2018 and June 2022. Markings for possible lymphatic vessels were made on the affected side solely in the early group (2018-2019) and on both the affected and normal side in the late group (2020-2022) using ICG lymphography. Results  Between 2018 and 2022, 86 patients had complete data for analysis. Dermal backflow stage III was present in 5 limbs (5.81%), stage IV in 40 limbs (46.51%), and stage V in 41 limbs (47.67%). The late group had a higher mean lymphatic detection rate, which was statistically significant in the proximal leg incision site (2.05 ± 0.91 vs. 0.74 ± 0.82; p  = 0.041). There was a significant tendency toward lower total LVA operative time per limb in the late group, which was led by the normal side mapping, with a mean operative time of 158 ± 14.88 minutes compared with 199 ± 12.45 minutes in the early group ( p  = 0.035). Conclusion  Mirroring the affected limb by utilizing the normal-side ICG lymphography in guiding the incision sites for LVA could improve the lymphatic detection rate, minimize the number of incisions, and shorten the operative time.

Targeted muscle reinnervation (TMR) is a surgical technique originally created to improve prosthetic function following upper extremity amputation. TMR has since been shown to be effective in the prevention and treatment of chronic postamputation phantom and residual limb pain in both upper and lower extremity amputees and for neurogenic pain in the nonamputee patient population. This article provides a current review of the various indications for TMR and surgical techniques, organized by amputation site, timing, and regional anatomy.

In breast reconstruction with a flap transfer, symmetry is often difficult to achieve when the contralateral breast projection has a downward peak. Although minimally invasive and effective methods for postoperative correction of the reconstructed breast mound are desirable, none has been comprehensively reported. We devised a correction method comprising downward movement of the reconstructed breast mound using early postoperative dissection and pressure. This method was applied to four patients undergoing primary two-stage ptotic breast reconstruction with a flap transfer. All of their reconstructed breast mounds were positioned above the contralateral side in the early postoperative period. They underwent manual dissection of the upper edge in flaps under local anesthesia 3 weeks after reconstruction or downward pressure correction using a sponge for 6 months or both procedures. The reconstructed breast mound moved 2 to 2.5 cm downward with early postoperative manual dissection or pressure correction using a sponge and moved 3 cm downward with the combination of both dissection and pressure. Manual dissection in the early postoperative period under local anesthesia and compression with a sponge is minimally invasive and useful for the downward correction of the reconstructed breast mound. The combination of dissection and compression provides a greater corrective effect.

Autologous platelet-rich plasma (PRP) has gained popularity for hair restoration due to its effectiveness and safety. PRP could be administered through direct local injections to the scalp or applied topically with the aid of microneedling therapy. This systematic review aims to elaborate on the effectiveness of PRP administered with syringe injection and topical PRP with microneedling combination for the treatment of androgenetic alopecia (AGA). A literature search was employed through PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, and Scopus. The database was searched using terms and keywords: "platelet-rich plasma" and "microneedling" and "androgenetic alopecia." Inclusion criteria are human study, patients with AGA, studies that compare PRP with syringe injection and the combination of PRP and microneedling. Exclusion criteria are animal study, review, case reports, or studies on other form of alopecia. A total of 108 articles found in the database. Title and abstract screening yield 12 articles. After full-text reading three articles were included in the review. A combination of PRP and microneedling appears to yield more superior results than direct syringe injection. Topical PRP and microneedling potentially give better results on AGA cases. Further high-quality studies with uniform protocol are needed to confirm these findings. Level of Evidence  I.

Background  Prepectoral direct-to-implant (DTI) is a common implant-based breast reconstruction method used for patients with breast cancer, although patients often present capsular contracture as a common complication. This study aimed to investigate the causes and surgical outcomes of capsular contractures in patients with breast cancer who underwent prepectoral DTI. Methods  The medical records of 392 patients (472 breasts) who underwent prepectoral DTI between August 2019 and July 2022 were retrospectively reviewed. Comparative and multivariate analyses were performed to identify risk factors for capsular contracture. The outcomes of patients who underwent surgical procedures were analyzed. Results  Of the 472 breasts enrolled in the study, 47 (9.9%) showed capsular contracture. Multivariate analysis revealed that patient age, seroma, rippling, and postmastectomy radiotherapy were independent correlating factors for capsular contracture in prepectoral DTI. Partial capsulectomy was performed on 18 breasts with capsular contracture, which resolved in 88.9% of cases. The mean follow-up period was 14.4 months. Conclusion  Age, seroma, rippling, and radiotherapy were independent correlating factors for capsular contracture in prepectoral DTI. Further, partial capsulectomy is recommended as a treatment option to improve results. A better understanding of the causes and surgical outcomes of capsular contracture on prepectoral DTI will help reduce capsular contracture and eventually lead to better outcomes in breast cancer reconstruction.