Archives of Plastic Surgery-APS最新文献

Background  Basal cell carcinoma (BCC) is the predominant nonmelanocytic skin cancer, with preservation of both function and aesthetics being essential during tumor removal. Existing surgical margin guidelines primarily target ill-defined BCCs prevalent in Western countries. Therefore, this study aims to demonstrate the efficacy of surgical removal, propose modified guidelines for wide excision tailored to Asian patients, and share experiences with various reconstruction methods. Methods  This study encompasses 418 patients (447 cases) who underwent BCC excision from March 2015 to June 2023 at our institution. Wide excision extended 2 mm beyond the tumor edge universally, with an additional 2 mm resected if tumor cells persisted in the frozen biopsy, followed by appropriate reconstruction. Patient demographics, tumor features, reconstruction methods, complications, and recurrence rates were analyzed. Results  Predominantly, reconstructions involved local flaps (244), skin grafts (102), and direct closure (72). Significant differences were noted in age, location, and tumor size among these groups. The rate of second resection increased from upper to lower facial subunits, peaking at 11.1% in the lower subunit, with a statistically significant difference ( p  = 0.024). Additional resection was required in 5.50% of cases, with a significantly higher incidence of ill-defined borders, pigmentation, and the infiltrative subtype compared with others. Complications were minor; recurrence occurred in only one case, 6 months postinitial nasal dorsum surgery. Conclusion  Surgical excision is highly effective, supported by various reconstruction options. We propose narrower guidelines for wide excision considering tumor characteristics and recurrence locations, resulting in smaller defects addressed with simpler reconstruction methods.

Eyelid lymphedema is a rare condition that presents as persistent swelling and non-pitting edema of the eyelids. Treatment options for this disease are limited, including surgical debulking and medications, which do not achieve complete resolution. Few studies have demonstrated the use of lymphovenous anastomosis (LVA) in the preauricular area for eyelid lymphedema treatment. In this report, we demonstrate the successful treatment of primary eyelid lymphedema by performing multiple LVAs in the periorbital region, where dermal backflow was visualized using indocyanine green lymphography. A total of four LVAs were performed through two separate incisions at the lateral canthal area and lateral eyebrow in a patient with unilateral upper eyelid lymphedema that resulted in significant improvement without recurrence.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma diagnosed in patients with a history of breast implants. Most patients develop a periprosthetic effusion at early stages of disease while less common presentations include a palpable mass, severe capsular contracture, lymphadenopathy, or cutaneous erythema. Due to the complex nature of this disease, a multidisciplinary approach is necessary for optimal management, particularly in locally advanced disease or inoperable patients. We present the successful use of neoadjuvant therapeutic protocols in two cases of locally advanced BIA-ALCL. The first case was a 52-year-old patient with a left breast mass-like stage III disease who underwent combined targeted immunotherapy and chemotherapy (brentuximab vedotin [BV]-cyclophosphamide, doxorubicin, prednisone [CHP]). Following a complete radiological and metabolic response, the patient underwent bilateral implant removal, right total intact capsulectomy, left en bloc capsulectomy, and skin resection from the left inframammary fold in continuity with the capsule. The second case was a 65-year-old patient with right breast swelling and mass-like stage IIA disease who received targeted immunotherapy, BV. Following a complete metabolic response, she underwent bilateral implant removal and en bloc capsulectomy. A literature review and the reported cases suggest the effectiveness of targeted immunotherapy as monotherapy or in combination with chemotherapy in locally advanced BIA-ALCL in disease downstaging, surgical de-escalation, reduction of significant postoperative complications, and an acceptable tolerance profile. Although surgery is an essential part of treatment, the timing and type of intervention should be carefully planned, especially when primary, radical resection is uncertain.

Background  Cleft lip and palate (CLP) impact nasolabial appearance, influencing the physical, psychological, and quality of life (QoL) of affected individuals. Evaluations of the nasolabial aesthetics by patients and medical professionals (both experienced and inexperienced) are critical for enhancing patient care. Methods  This cross-sectional study enrolled 32 patients aged 16 to 20 years with CLP who underwent continuous treatment at a university hospital in Thailand. Participants were asked to complete the Thaicleft QoL questionnaire for nasolabial aesthetic self-assessment and had their two-dimensional facial images captured and then evaluated by two groups of medical evaluators: four experienced and four inexperienced professionals. Data are presented as means and percentages, with analysis including standard deviations, Cronbach's α for evaluator consistency, kappa for interrater reliability, and the Wilcoxon signed-rank test to compare aesthetic judgments between the experienced and inexperienced medical evaluators. Results  Among the 32 patients, 19 (59.37%) were females, and 22 (68.75%) had unilateral CLP and 10 (31.25%) had bilateral CLP, all reporting high nasolabial aesthetic satisfaction. Inexperienced evaluators assigned higher aesthetic scores than their experienced counterparts ( p  = 0.01), with statistically significant agreement among inexperienced evaluators in their assessments ( p  < 0.05). Both group of evaluators demonstrated high reliability in terms of the lip. Conclusion  Experienced evaluators assigned lower aesthetic scores than inexperienced evaluators did. The patients themselves expressed high levels of satisfaction with their nasolabial appearance, indicating that the treatment outcomes were favorable from the patients' perspective.

Malignant pilomatricoma, an extremely rare tumor arising from hair follicles, most commonly occurs on the head, neck, and back. This tumor exhibits several noteworthy characteristics. First, it frequently recurs if it is incompletely excised and can occasionally metastasize to the lungs, bones, and lymph nodes. Additionally, it possesses unique histological features that aid in differentiating it from its benign counterpart, including atypical cells, multiple mitoses with ghost cells, nuclear polymorphisms, and necrosis accompanied by serial desmoplasia. While no definitive criteria have been established for the surgical management of this malignant tumor, it is recommended to perform wide local excision with a safety margin of at least ≥5 mm. To the best of our knowledge, very few cases of malignant pilomatricoma with lung metastasis have been reported in Korea. Here we report the case of a patient diagnosed of malignant pilomatricoma with lung metastasis who underwent wide local excision for a lesion on the flank.

Background  Direct-to-implant breast reconstruction (DIR) is becoming more and more accepted. There is a lack of high-quality studies assessing differences in patient-reported quality of life (QoL) between different implant placement methods. The aim of this randomized controlled (clinical) trial was to compare QoL between women reconstructed by sub- or prepectoral implant placement. Methods  We included women over 18 years eligible for DIR. Patients were randomly assigned to reconstruction by subpectoral or prepectoral implant placement. Assessment of QoL and patient satisfaction was made using the BREAST-Q questionnaire for postmastectomy breast reconstruction and compared between the sub- and prepectoral reconstructed groups preoperatively and after 3 and 12 months of follow-up. Results  A total of 42 women were allocated to sub- or prepectoral reconstruction with 21 patients in each group. There were no differences in patient characteristics between groups. Regarding all the selected BREAST-Q scales: (1) satisfaction with the reconstructed breast, (2) satisfaction with the breast implant, (3) satisfaction with the overall outcome, (4) psychosocial well-being, (5) sexual well-being, and (6) physical well-being-we found no significant differences between the two groups. Assessing each group independently we found, that in both groups sexual well-being improved after surgery postoperatively compared to the preoperative scores. Conclusion  We found high satisfaction and QoL following both sub- and prepectoral breast reconstruction. We found no significant differences between groups suggesting both methods for DIR can be used. Despite our high-quality data, a larger sample size and longer postoperative follow-up are needed to further investigate the differences in QoL between sub- and prepectoral breast reconstruction.

Volkmann's ischemic contracture is a condition characterized by permanent ischemic damage to muscles and nerves due to vascular insufficiency, resulting in flexion contractures of the affected limb. In contrast, pseudo-Volkmann's contracture presents with similar clinical features but lacks ischemic damage and has the potential for complete recovery. We report a case of a 39-year-old man who developed failure of extension in the middle and ring fingers of the left hand following blunt forearm trauma from a rolling machine. Despite no skin breakage or fracture, his symptoms progressively worsened over 2 months without treatment. Surgical exploration 2 years later revealed severe adhesions of the flexor digitorum profundus muscle at the myotendinous junction to the ulnar periosteum, with immediate recovery after release. This case highlights pseudo-Volkmann's contracture in an adult without fracture, likely due to blunt trauma causing delayed adhesion formation.