Seminars in Plastic Surgery最新文献

Given the visibility of the face and the importance of its cosmesis, undesirable results following facial reconstruction present significant challenges for both the patient and the surgeon. Intraoperative measures and postoperative management can ameliorate some unfavorable outcomes, but others may require more extensive intervention. Approaching undesirable results with a frank assessment followed by shared decision-making not only improves outcomes but is also essential for patient satisfaction.

Complex nasal reconstructions require adequate planning with an accurate estimation of the time necessary to perform each stage. Reconstructions of the entire nose, multiple subunits, or a substantial subunit typically require lining replacement and cartilage grafting. Securing the lining prior to a staged reconstruction is preferred, but options such as the Menick folded paramedian forehead flap (PMFF) allow for lining coverage at the time of the first stage. The free radial forearm flap and the PMFF remain the gold standard for the initial lining coverage. Cartilage grafting is fundamental to complex nasal reconstructions and can be secured in either the first or the second stage. Staged reconstructions require thorough patient education, patience from both the patient and the surgeon, and an understanding that final revisions may be necessary.

Relative to other regions of the body, the ear has a high risk of developing cutaneous malignancies that often necessitate Mohs micrographic surgery (MMS) for removal. This procedure can create defects that are immediately noticeable if left untreated. Reconstructive techniques are often needed to restore the appearance of the affected ear and its symmetrical relationship to the contralateral ear. However, achieving optimal aesthetic results can be challenging due to the subtle intricacies of the external ear. Therefore, careful planning and execution should be implemented prior to managing the acquired defect. Additionally, depending on the size and location of the defect, various options aligning with the reconstructive ladder can provide desired outcomes. The purpose of this article was to highlight and discuss the different techniques used in ear reconstruction following MMS.

Computer-assisted surgery is the most significant recent advancement in osseous head and neck reconstruction. Computer-aided design (CAD) software allows computerized planning of resection and reconstruction. Computer-aided manufacturing (CAM) can be used to create models, cutting guides, and patient-specific plates. Several studies have shown that these techniques are more accurate and result in decreased flap ischemia times compared with conventional techniques. CAD also facilitates the immediate placement of dental implants. The most useful application of computer-assisted surgery is delayed reconstruction, in which soft tissue contraction and the absence of a specimen as a reference make accurate estimation of the defect challenging. The drawbacks of CAD/CAM are lack of intraoperative flexibility and cost. Some centers have created in-house CAD/CAM processes using open-source software and commercially available three-dimensional printers.

Face transplantation (FT) has emerged as a critical intervention for patients with complex facial deformities unsuitable for conventional reconstructive methods. It aims to restore essential functions such as facial expression, mastication, and speech, while also improving psychosocial health. The procedure utilizes various surgical principles, addressing unique challenges of craniofacial complexity and diverse injury patterns. The integration of Computerized Surgical Planning (CSP) leverages computer-aided technologies to enhance preoperative strategy, intraoperative navigation, and postoperative assessment. CSP utilizes three-dimensional computed tomography, printing, angiography, and navigation systems, enabling surgeons to anticipate challenges and reduce intraoperative trial and error. Through four clinical cases, including a groundbreaking combined face and bilateral hand transplant, CSP's role in FT is highlighted by its ability to streamline operative processes and minimize surgical revisions. The adoption of CSP has led to fewer cadaveric rehearsals, heightened operative precision, and greater alignment with preoperative plans. Despite CSP's advancements, it remains complementary to, rather than a replacement for, clinical expertise. The demand for technological resources and multidisciplinary teamwork is high, but the improved surgical outcomes and patient quality of life affirm CSP's value in FT. The technology has become a staple in reconstructive surgery, signaling a step forward in the evolution of complex surgical interventions.

Mandibular distraction osteogenesis is a technically challenging procedure due to complex mandibular anatomy, especially in the treatment of Pierre-Robin Sequence due to variable bone thickness in the infant mandible and the presence of tooth buds. Computerized surgical planning (CSP) simplifies the procedure by preoperatively visualizing critical structures, producing cutting guides, and planning distractor placement. This paper describes the process of using CSP to plan mandibular distraction osteogenesis, including discussion of recent advances in the use of custom distractors.

Craniosynostosis, a medical condition characterized by premature fusion of one or multiple cranial sutures, has historically been treated through surgical correction. Computerized Surgical Planning (CSP) and three-dimensional (3D) modeling have gained significant popularity across craniofacial surgery. Through a collaborative effort between surgeons and engineers, it is now possible to virtually execute a surgical plan based on preoperative imaging using computed tomography scans. The CSP workflow involves several elements including virtual 3D modeling, CSP computer-aided surgical guide design, manufacturing of guides and templates, and intraoperative implementation. Through the gradual optimization of this workflow, it has been possible to achieve significant progress in the surgical process including improvements in the preoperative planning of complex craniosynostosis cases and reduction of intraoperative time. Furthermore, CSP and 3D modeling have had a positive impact on surgical simulation and residency training, along with patient education and counseling. This article summarizes the CSP workflow in the treatment of craniosynostosis and the implications of this treatment modality on medical trainee education and patient management.