Archives of Plastic Surgery-APS最新文献

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.

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.

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.