Seminars in Plastic Surgery最新文献

Digit replantation has undergone significant advancements since the 1960s. Despite progress, distal digit replantation remains one of the most challenging microsurgical procedures due to technical and clinical complexities. This review examines current challenges, strategic solutions in distal digit replantation, grounded in clinical experience and literature review. Key obstacles include managing minute vessel structures, venous congestion, and the critical condition of no available vessels for revascularization. Advances in surgical techniques, including preosteosynthesis vein grafting, intravascular stent, solitary central pulp artery bifurcation division, subdermal pocketing method, and postoperative management, have enhanced outcomes.

Vascularized toe proximal interphalangeal joint transfer has evolved as a biological solution for posttraumatic finger joint reconstruction. Extension lag has been recognized as a major challenge since its introduction in the 1980s. A significant advancement came from the 2013 anatomical study that characterized two distinct patterns of toe extensor mechanism: Type 1 (>95%) lacking obvious central slip insertion, and Type 2 (<5%) with clear central slip insertion. This understanding led to customized reconstruction strategies based on both donor toe anatomy and recipient finger condition. Various techniques, including centralization, direct repair, and central slip reconstruction, have been developed. The Te technique was developed to minimize bone manipulation while achieving similar functional outcomes to the traditional Stack technique. Current evidence demonstrates that proper execution of central slip reconstruction can achieve consistent functional results regardless of the technique chosen.

Microsurgical toe-to-hand transfer has revolutionized the reconstruction of missing thumbs and fingers, either from trauma or congenital etiologies, since its introduction in the late 1960s. The subsequent developments by global pioneers have made it a reliable surgical procedure with good functional and aesthetic results, yet acceptable donor site morbidities. This review article aims to highlight some significant concepts, surgical skills, and reconstruction strategies developed at Chang Gung Memorial Hospital over the past four decades, which are pivotal to the current landscape of toe-to-hand transfers practice. Avoiding unnecessary shortening of bone, joint, neurovascular bundle, tendon, and pulley in the amputation stump at the initial emergency management, provision of adequate coverage, and several other factors are essential for good results. Retrograde dissection of the vascular pedicle facilitates a quick and safe toe harvest for less experienced surgeons. Developing a modified great toe and lesser toe wrap-around flap, trimmed great toe, and combined second and third toes allows for optimal thumb and finger reconstruction even for challenging metacarpal hands. Both preservation of the proximal 1 cm of proximal phalanx in the remaining great toe and inclusion of a smaller skin flap from the foot, especially in combined second and third toes transfer for primary wound closure, can ensure minimal donor site morbidities.

Raynaud's phenomenon (RP) is characterized by digit discoloration including pallor, cyanosis, and rubor. While some experience only mild numbness or tingling during RP attacks, many progress to severe conditions, including intractable pain, nonhealing digital ulcers, and even self-amputation. Although mild symptoms can often be managed conservatively through lifestyle modifications, such as avoiding triggering factors, or with pharmacological interventions, surgical treatments are often required for those with persistent pain and ulcers. Advances in microsurgical techniques have introduced peripheral sympathectomy, peripheral neurectomy, and distal artery bypass as promising options for managing refractory and severe cases of RP. This review explores the epidemiology, pathophysiology, and particularly the evolution of microsurgical interventions for the treatment of RP.

Body contouring procedures have become increasingly common to meet the growing demand for aesthetic surgery, particularly in the context of bariatrics. Massive weight loss (MWL) patients are complex and often require extensive management of comorbidities, malnutrition status, physical debilitation, and psychological sequelae. Patient optimization prior to body contouring surgery in addition to strict postoperative maintenance are crucial to achieve favorable and sustainable outcomes. Surgical candidates should be screened thoroughly, and in the MWL patient population specifically, multidisciplinary care is needed for proper evaluation and support. Notable specialists that routinely contribute in MWL and body contouring patient care include plastic surgeons, bariatric surgeons, primary care physicians, dieticians, endocrinologists, mental health providers, and physical therapists. This article details essential roles within the multidisciplinary approach to body contouring surgery and MWL patients and reviews critical pre-, intra-, and postoperative aspects of care.

Head and neck cancers (HNCs) require a multidisciplinary team (MDT) approach to address their complex functional, aesthetic, and psychological impacts. This manuscript highlights the central role of plastic surgeons in the MDT, emphasizing their collaboration with other MDT members to align aesthetic and functional surgical outcomes with oncologic and rehabilitative goals. Our intention is for this to be used as a practical guide for plastic surgeons detailing the roles of key MDT members and their contributions across the preoperative, intraoperative, and postoperative phases. We will also highlight how MDTs improve survival, functional outcomes, and quality of life for HNC patients.

Facial reanimation refers to the array of options available to manage patients with facial nerve injury or palsy. From congenital to acquired etiologies, a multidisciplinary approach and team is needed to treat the functional and aesthetic deficits these patients may experience. This is particularly true in the pediatric population, who frequently experience significant psychosocial stress from their peers, and cannot adequately voice their experiences due to age. The purpose of this article is to highlight the multidisciplinary team members, their roles, and provide our perspective at Texas Children's Hospital.

Without early diagnosis and intervention, brachial plexus birth injuries (BPBIs) can result in permanent upper extremity debilitation. Previously, BPBI was treated by single-specialty surgeons; however, given the complexity of the injury, BPBIs necessitate multidisciplinary team care. Common specialists involved within brachial plexus injury clinics include radiologists, physical medicine and rehabilitation physicians, occupational therapists, nerve surgeons, and shoulder surgeons. Care plans are meticulously designed by all team members, and depending on injury severity and clinical course, patients may undergo treatment including range-of-motion exercises, splinting, botulinum toxin injections, nerve surgery, or shoulder surgery. The objective of this article is to highlight and discuss key providers within BPBI clinics and describe the BPBI experience here at Texas Children's Hospital.