Archives of Plastic Surgery-APS最新文献

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.

Background  In addressing subungual melanoma, this study presents the efficacy of wide excision followed by reconstruction using a serratus anterior fascial free flap. Methods  The study covers four patients treated between 2017 and 2020 for melanoma in the great toe or thumb, highlighting the successful application of the flap and split-thickness skin graft over exposed distal phalanx cortical bone. Results  The Breslow depths of the melanomas ranged from 0.2 to 6 mm, with four to seven lymph nodes dissected per patient, revealing no metastasis. Over follow-ups of 26 to 57 months, no local or distant recurrences were observed. The serratus anterior fascial free flaps, averaging 2.1 mm in thickness, precisely matched defect depths, negating the need for further debulking. Conclusion  This technique offered satisfactory functional and aesthetic outcomes, proposing the serratus anterior fascial free flap as a viable alternative for acral region reconstruction in subungual melanoma cases after wide excision.

Abdominal wall endometriosis (AWE) is a rare condition representing 1% of patients operated for endometriosis. We describe a case of a 26-year-old woman, with a history of cesarean delivery, who presented with cyclical pain and a subcutaneous mass in the lower abdomen. Where most AWE lesions may be surgically managed by a single surgeon, imaging revealed an unusually large lesion (13 × 4 × 10 cm) involving the rectus abdominis muscle. Plastic, gynecologic, and general surgeons combined their expertise to conduct AWE excision combined with miniabdominoplasty in a single procedure. After resection, a retrorectus mesh (Rives-Stoppa technique) reinforced the primarily closed posterior rectus sheath and an inlay mesh bridged the defect left in the anterior rectus sheath. The patient was discharged 3 days postoperatively, had minimal pain complaints, and was satisfied with cosmetic results at 1-month and later follow ups. One year postoperatively, she gave uncomplicated vaginal birth. We conclude that, in select cases, management of a large, symptomatic AWE may benefit from a multidisciplinary approach, where symptom relief and an aesthetically pleasing result for the patient can be achieved in a single procedure. We distinctively describe double mesh repair as a viable consideration for reconstruction in AWE and review current considerations in mesh repair of the abdominal wall. Further studies into this topic are warranted.

Background  Free flap reconstruction can be performed in patients with chronic limb-threatening ischemia (CLTI). However, early walking training may increase the risk of wound dehiscence and prolong hospitalization. Total contact cast (TCC) treatment effectively addresses diabetic plantar ulcers by immobilizing the foot and distributing weight away from the ulcer area. This study aimed to assess the effect of postoperative TCC use on early limb loading and hospital stay in patients with CLTI with free flaps. Methods  Patients with CLTI who underwent free flap reconstruction between 2006 and 2023 were enrolled in this study. Postoperative time until weight-bearing initiation was compared between the TCC ( n  = 5) and non-TCC groups ( n  = 7). Results  The time to the initiation of weight-bearing on the affected limb was 52.3 ± 33.2 days in the non-TCC group and 19.8 ± 3.56 days in the TCC group ( p  = 0.105). The wound dissection rates were 42.9% (3/7) in the non-TCC group and 20% (1/5) in the TCC group ( p  = 0.408). At discharge, 28.6% (2/7) of the non-TCC group and 20% (1/5) of the TCC group had ulcers ( p  = 0.735). The average flap size was 149 ± 69.1 cm ² in the non-TCC group and 95.6 ± 73.1 cm ² in the TCC group ( p  = 0.268). Conclusion  Postoperative TCC use after free flap foot reconstruction may lead to early weight-bearing of the affected limb. Further studies with larger numbers of cases are needed.

The relatively recent discovery of a novel lymphatic system within the brain meninges has spurred interest in how waste products generated by neurons and glial cells-including proteins associated with Alzheimer's disease (AD) pathology such as amyloid beta (Aβ) and tau-are disposed of. Evidence is building that suggests disease progression in AD and other cognitive impairments could be explained by dysfunction in the brain's lymphatic system or obstruction of drainage. An interesting implication of this hypothesis is that, by relieving the obstruction of flow, lymphatic reconstruction along the drainage pathway could serve as a potential novel treatment. Should this concept prove true, it could represent a surgical solution to a problem for which only medical solutions have thus far been considered. This study is meant to serve as a primer for reconstructive microsurgeons, introducing the topic and current hypotheses about the potential role of lymphatic drainage in AD. A preview of current research evaluating the feasibility of lymphatic reconstruction as a surgical approach to improving Aβ clearance is provided, with the aim of inspiring others to design robust preclinical and clinical investigations into this intriguing hypothesis.