Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第10页

Reporting of patient-reported outcomes amongst randomized clinical trials in plastic surgery: a systematic review using CONSORT-PRO 整形外科随机临床试验中患者报告结果的报告：使用 CONSORT-PRO 的系统综述。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-11 DOI: 10.1016/j.bjps.2024.09.022

Thomas Milazzo , Morgan Yuan , Amy Graham , Patrick Kim , Lucas Gallo , Kathryn Uhlman , Achilleas Thoma , Christopher Coroneos , Sophocles Voineskos

Background

Patient-reported outcomes (PROs) are key to investigating patient perspectives in randomized controlled trials (RCTs). Standardization of PRO reporting is critical for trial generalizability and the application of findings to clinical practice. This systematic review aimed to evaluate the reporting quality of RCTs published in the top plastic surgery journals according to the consolidated standards of reporting trials (CONSORT)-PRO extension.

Methods

We completed a comprehensive search of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. All RCTs with a validated PRO endpoint published in the top 10 plastic surgery journals (based on the 2021 Web of Science Impact Factor) from 2014 to 2023 were included. Two reviewers independently extracted data and scored the included studies using the CONSORT-PRO checklist. Univariate regression was applied to assess factors associated with reporting adherence. Studies were assessed for their risk of bias using the Cochrane Risk of Bias 2.0 tool.

Results

A total of 88 RCTs were included. PROs were the primary endpoint in 50 (57%) and the secondary endpoint of 38 (43%) studies. Mean overall reporting adherence was poor (39% (±12) and 36% (±13) in studies with PRO as primary and secondary endpoints, respectively). The presence of industry support was significantly associated with greater adherence.

Conclusions

There is low adherence to the CONSORT-PRO extension among plastic surgery RCTs published in the top 10 plastic surgery journals. We encourage journals and authors to endorse and apply the CONSORT-PRO extension. This may optimize the dissemination of clinical findings from RCTs and assist patient-centered care.

背景：患者报告结果（PRO）是随机对照试验（RCT）中调查患者观点的关键。PRO报告的标准化对于试验的可推广性以及将研究结果应用于临床实践至关重要。本系统性综述旨在根据试验报告综合标准（CONSORT）-PRO 扩展标准评估发表在顶级整形外科期刊上的 RCT 报告质量：我们对 MEDLINE、Embase 和 Cochrane 对照试验中央注册中心进行了全面检索。纳入了2014年至2023年期间在排名前10位的整形外科期刊（基于2021年的Web of Science影响因子）上发表的所有具有有效PRO终点的RCT。两名审稿人独立提取数据，并使用 CONSORT-PRO 核对表对纳入的研究进行评分。采用单变量回归评估与报告依从性相关的因素。使用 Cochrane Risk of Bias 2.0 工具评估研究的偏倚风险：结果：共纳入了 88 项研究。50项（57%）研究以PRO为主要终点，38项（43%）研究以PRO为次要终点。在以 PRO 为主要终点和次要终点的研究中，平均总体报告依从性较差（分别为 39% (±12) 和 36% (±13)）。行业支持与更高的依从性明显相关：结论：在排名前十的整形外科期刊上发表的整形外科 RCT 中，对 CONSORT-PRO 扩展条款的遵守程度较低。我们鼓励期刊和作者认可并应用 CONSORT-PRO 扩展。这可能会优化 RCT 临床研究结果的传播，并有助于以患者为中心的护理。

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引用次数: 0

Dynamic anatomical study of the posterior brachial artery perforator flap: Aesthetic refinement and clinical results 肱动脉后穿孔器皮瓣的动态解剖研究：美学改进和临床效果。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-11 DOI: 10.1016/j.bjps.2024.08.079

B. Guena , B. Chaput , R. Lopez , JL Grolleau , E. Lupon , S. Gandolfi

Background

Reconstruction of the axillary fossa represents a surgical challenge given the functional implications for mobility of the upper limb. The posterior brachial flap is a solution of choice for this indication, providing fine and functional local reconstruction, but little is known about its perforasome. This study aimed to identify the location of the perforator, analyze perfusion flow, and link vessel distribution, and propose an aesthetic refinement to the surgical technique by medializing the skin paddle to conceal aesthetic scarring at the donor site.

Methods

Fifteen fresh cadavers were harvested and dissected. Twenty-six arms were injected with methylene blue. Two arms were injected with radiopaque dye. A dynamic (4-dimensional) computed tomographic angiography was performed to complete the analysis.

Results

The perforasome was centered on the posterior axis of the arm with a perfusion area ranging from 82.2 to 142.9 cm², with a median of 112.7 (96.7–125.6) cm². The median length of the pedicle was 83 mm on an average (65–91 mm). Its caliber at the emergence of the source vessel had a mean diameter of 1.43 mm (1.27–1.61 mm). The distal limit of the paddle was located on an average 10.7 cm from the olecranon (7.8–12.2 cm). The scans showed direct linking vessels toward the perforasomes on the medial side of the arm, suggesting that it is possible to medialize the cutaneous paddle.

Conclusion

The posterior brachial flap presents with a constant perforasome. It can be harvested more medially than previously described to improve the aesthetic results, while maintaining reproducibility and satisfactory vascular reliability.

背景：鉴于腋窝重建对上肢活动功能的影响，腋窝重建是一项外科挑战。肱骨后皮瓣是这一适应症的首选方案，可提供精细和功能性局部重建，但人们对其穿孔知之甚少。本研究旨在确定穿孔器的位置，分析灌注流和链接血管的分布，并通过内侧化皮瓣以隐藏供体部位的美学瘢痕，对手术技术提出美学改进建议：方法：采集并解剖 15 具新鲜尸体。方法：采集并解剖 15 具新鲜尸体，在其中 26 只手臂上注射亚甲蓝。两只手臂注射不透射线染料。为完成分析，进行了动态（四维）计算机断层扫描血管造影：穿孔以手臂后轴为中心，灌注面积从82.2到142.9平方厘米不等，中位数为112.7（96.7-125.6）平方厘米。基底的中位长度平均为 83 毫米（65-91 毫米）。源血管出现处的直径平均为 1.43 毫米（1.27-1.61 毫米）。桨的远端距离肩胛骨平均为 10.7 厘米（7.8-12.2 厘米）。扫描结果显示，手臂内侧的穿孔直接连接血管，这表明可以将皮瓣内侧化：结论：肱骨后皮瓣具有恒定的穿孔。结论：肱骨后皮瓣具有恒定的穿孔，可以比之前描述的更内收，以改善美学效果，同时保持可重复性和令人满意的血管可靠性。

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引用次数: 0

Magnetic Resonance Imaging appearance of regenerative peripheral nerve interface 再生周围神经界面的磁共振成像外观

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.bjps.2024.09.017

Yoav Morag , Theodore A. Kung , Samer Soussahn , Qiaochu Chen , Paul S. Cederna

Purpose

To describe the MRI appearance of regenerative peripheral nerve interface (RPNI) and the potential association between the MRI appearance and RPNI revision.

Material and methods

A retrospective assessment was undertaken of the MRI appearance of RPNIs performed at our institution between 1/1/2010 and 7/29/2023 with clinical correlation.

Results

Fourteen patients (8 men and 6 women, age range 31–80 years, median age 51 years) with technically adequate MRI of RPNIs were included in this study including 5 patients with below knee amputation with 5 tibial and 4 common peroneal nerves RPNI, 8 patients with above knee amputations (AKA) with sciatic RPNIs, and 1 patient following forequarter amputation with a brachial plexus RPNI. Two patients underwent revision RPNI surgery thrice (AKA-sciatic nerve) for a total of 6 RPNI revisions. On T1 weighted sequences, all RPNIs were isointense to the muscle and blended with the surrounding scar and muscle tissues whereas on T2 weighted sequences, all RPNIs were hyperintense in signal compared to the muscle. All but 1 RPNI underwent post contrast enhancement in variable patterns. No statistically significant difference in MRI appearance was found between RPNIs with or without a following RPNI revision surgery.

Conclusion

RPNI on MRI typically have a bright and intermediate signal on T2 and T1 weighted sequences, respectively, and typically undergo postcontrast enhancement in variable patterns without a statistically significant difference between the cases with and without follow-up RPNI revision. However, enhancement of RPNI should not be misconstrued as pathological.

目的描述再生周围神经界面（RPNI）的核磁共振成像外观以及核磁共振成像外观与 RPNI 修复之间的潜在关联。材料和方法对 2010 年 1 月 1 日至 2023 年 7 月 29 日期间在我院进行的 RPNI 的核磁共振成像外观及临床相关性进行回顾性评估。结果14名患者（8男6女，年龄范围31-80岁，中位年龄51岁）的RPNIs核磁共振成像技术合格，其中包括5名膝下截肢患者的5条胫神经和4条腓总神经RPNI，8名膝上截肢（AKA）患者的坐骨神经RPNI，以及1名前肢截肢患者的臂丛神经RPNI。两名患者接受了三次 RPNI 翻修手术（AKA-坐骨神经），共进行了 6 次 RPNI 翻修。在T1加权序列上，所有RPNI与肌肉呈等密度，并与周围的疤痕和肌肉组织相融合，而在T2加权序列上，与肌肉相比，所有RPNI的信号均呈高密度。除 1 例 RPNI 外，其他所有 RPNI 都出现了不同模式的对比后增强。结论 MRI 上的 RPNI 在 T2 和 T1 加权序列上分别呈明亮和中间信号，通常会出现不同模式的对比后增强，但在进行和未进行后续 RPNI 修复手术的病例之间没有明显的统计学差异。不过，不应将 RPNI 的增强误解为病理增强。

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引用次数: 0

Management of thoracic aortic graft infections with combined omental and bilateral pectoralis major flaps 用网膜和双侧胸大肌联合皮瓣治疗胸主动脉移植感染

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.bjps.2024.09.016

Kevin G. Kuonqui , Myles N. LaValley , Sarah E. Diaddigo , David E. Janhofer , Hiroo Takayama , Jeffrey A. Ascherman

Background

Aortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. We describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps.

Methods

Data from all patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995–2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included.

Results

Complete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Postoperative complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None of the patients underwent reoperation for flap-related complications.

Conclusions

Despite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections.

背景主动脉血管移植物/内膜移植物感染（VGEI）一直以来都是通过移植物切除和重新置换来处理的，但新方法表明血管化组织转移是一种有效的辅助治疗方法。我们描述了用联合网膜和双侧胸大肌（PMM）推进皮瓣治疗胸主动脉血管移植物感染的经验。方法回顾了 1995-2023 年间由资深作者在一家高难度心脏外科中心进行联合皮瓣闭合手术的所有患者的数据。结果有598名胸骨和纵隔伤口患者的完整数据。在 11 例胸主动脉血管移植感染患者中，移动了 PMM 和网膜瓣。皮瓣处理的指征包括培养阳性感染（8/11；72.7%）、开裂（5/11；45.5%）、引流（7/11；63.6%）以及因血流动力学不稳定而无法关闭胸骨切开术（5/11；45.5%）。在胸腔探查过程中，6/11（54.5%）人完全切除了受感染的移植物，而 5/11（45.5%）人则进行了保留移植物的冲洗和清创。6/11（54.5%）例患者立即进行了皮瓣缝合。术后并发症包括裂开（2/11；18.2%）、血清肿（1/11；9.1%）、血肿（1/11，9.1%）、腹部疝（1/11；9.1%）和复发性感染（1/11；9.1%）。一名患者（9.1%）在胸骨重建后30天内死于二尖瓣关闭不全快速性心律失常。结论尽管合并症显著，但术后发病率和死亡率较低，这表明网膜和胸大肌联合皮瓣是一种安全有效的辅助治疗方法，可用于选择性胸主动脉血管移植感染的抗菌和手术治疗。

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引用次数: 0

Thighs lift in the post-bariatric patient – A systematic review 减肥后患者的大腿移位术--系统性综述

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.bjps.2024.09.011

Pietro Susini, Gianluca Marcaccini, Roberto Cuomo, Luca Grimaldi, Giuseppe Nisi

Background

Thigh lift, first described by Lewis in 1957, consists of thigh recontouring by various strategies. In post-bariatric thigh lift (PBTL), the technical details become fundamental due to both patient comorbidities and increased risk of complications. Moreover, post-bariatric weight loss affects the thighs, resulting in significant tissue redundancy, inner excess, lower thigh deformity, later excess, and buttocks ptosis. With the present paper, a systematic review of PBTL procedures is reported and a comprehensive classification system is proposed, aiming to improve their medical and surgical management.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was carried out by searching the PubMed (MEDLINE) database from May 2004 to May 2024 using the search string “thighplasty OR thigh lift OR post-bariatric thighplasty OR (thigh lift AND weight loss) OR (thigh lift AND liposuction)”. Original studies discussing PBTL with a minimum of three clinical cases were eligible for inclusion.

Results

The final synthesis included 17 articles and 496 patients. The articles were published in the last 20 years. Several papers discussed significant PBTL surgical strategies and technical measures.

Conclusions

PBTL is challenging because of both technical factors and complex comorbidities of post-bariatric patients. This comprehensive assessment of PBTL may help in choosing the appropriate treatment based on a patient’s individual needs. Liposuction-assisted inner thigh lift with combined horizontal-vertical scars and skin-only excision is effective and versatile for most patients. However, select cases may benefit from alternative and more invasive strategies. Artificial intelligence is a topic of growing interest, and it will probably become increasingly relevant in PBTL.

背景1957年，刘易斯（Lewis）首次描述了大腿移位术，它包括通过各种策略对大腿进行重塑。在减肥后大腿提升术（PBTL）中，由于患者的合并症和并发症风险的增加，技术细节变得至关重要。此外，减肥后体重下降会影响大腿，导致大腿组织明显冗余、内侧赘肉、大腿下部畸形、后期赘肉和臀部下垂。本文报告了对 PBTL 手术的系统性综述，并提出了一个全面的分类系统，旨在改善其医疗和手术管理。方法通过使用搜索字符串 "大腿成形术或大腿提升术或减肥后大腿成形术或（大腿提升术和减肥）或（大腿提升术和吸脂）"搜索 PubMed (MEDLINE) 数据库，对 2004 年 5 月至 2024 年 5 月期间的系统性综述（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）进行了系统性综述。对至少有三个临床病例的 PBTL 进行讨论的原创研究符合纳入条件。这些文章发表于过去 20 年。结论由于技术因素和减肥后患者复杂的合并症，PBTL 具有挑战性。对 PBTL 的全面评估有助于根据患者的个人需求选择合适的治疗方法。吸脂辅助大腿内侧提升术结合水平-垂直疤痕和单纯皮肤切除术，对大多数患者来说都是有效且通用的。然而，一些特定病例可能会受益于其他更具创伤性的策略。人工智能是一个越来越受关注的话题，它在 PBTL 中的作用可能会越来越大。

{"title":"Thighs lift in the post-bariatric patient – A systematic review","authors":"Pietro Susini, Gianluca Marcaccini, Roberto Cuomo, Luca Grimaldi, Giuseppe Nisi","doi":"10.1016/j.bjps.2024.09.011","DOIUrl":"10.1016/j.bjps.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Thigh lift, first described by Lewis in 1957, consists of thigh recontouring by various strategies. In post-bariatric thigh lift (PBTL), the technical details become fundamental due to both patient comorbidities and increased risk of complications. Moreover, post-bariatric weight loss affects the thighs, resulting in significant tissue redundancy, inner excess, lower thigh deformity, later excess, and buttocks ptosis. With the present paper, a systematic review of PBTL procedures is reported and a comprehensive classification system is proposed, aiming to improve their medical and surgical management.</div></div><div><h3>Methods</h3><div>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was carried out by searching the PubMed (MEDLINE) database from May 2004 to May 2024 using the search string “thighplasty OR thigh lift OR post-bariatric thighplasty OR (thigh lift AND weight loss) OR (thigh lift AND liposuction)”. Original studies discussing PBTL with a minimum of three clinical cases were eligible for inclusion.</div></div><div><h3>Results</h3><div>The final synthesis included 17 articles and 496 patients. The articles were published in the last 20 years. Several papers discussed significant PBTL surgical strategies and technical measures.</div></div><div><h3>Conclusions</h3><div>PBTL is challenging because of both technical factors and complex comorbidities of post-bariatric patients. This comprehensive assessment of PBTL may help in choosing the appropriate treatment based on a patient’s individual needs. Liposuction-assisted inner thigh lift with combined horizontal-vertical scars and skin-only excision is effective and versatile for most patients. However, select cases may benefit from alternative and more invasive strategies. Artificial intelligence is a topic of growing interest, and it will probably become increasingly relevant in PBTL.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"98 ","pages":"Pages 357-372"},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A novel lower eyelid reconstruction using a skin-tarsoligamentous sling to prevent postoperative drooping deformity: Quantitative analyses using drooping index and angular difference in canthal tilt 利用皮肤-跗韧带吊带防止术后下垂畸形的新型下眼睑重建术：使用下垂指数和眼轮匝肌倾斜角度差进行定量分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.bjps.2024.09.021

Yoshiro Abe, Kazuhide Mineda, Yutaro Yamashita, Shinji Nagasaka, Hiroyuki Yamasaki, Shunsuke Mima, Ichiro Hashimoto

Lower eyelid reconstruction using skin flaps sometimes results in undesirable deformities due to postoperative flap drooping. We aimed to examine the effectiveness of a novel procedure for reconstructing the skin-tarsoligamentous sling of the lower eyelid. We included 37 patients who underwent anterior lamellar reconstruction with a cheek rotation flap for full-thickness lower eyelid defect. They were divided into two groups: Group A included 19 patients who underwent tarsoligamentous sling reconstruction with a fascia lata strip and buccal mucosa grafting, and Group B comprised 18 patients who underwent skin-tarsoligamentous sling reconstruction using an additional combination of a periosteal flap and de-epithelialized triangular flap at the lateral canthal region, representing our novel approach. To evaluate the severity of postoperative deformities, we used the drooping index, the ratio of drooping compared to the healthy side, along with the angular difference in canthal tilt, obtained between the reconstructed and healthy sides, using photographs taken ≥6 months post-reconstruction. Group B demonstrated superior outcomes, with mean drooping indices of 1.13 compared to 1.33 in Group A (P = 0.031) and mean angular differences in canthal tilt of −0.73° compared to −2.45° in Group A (P = 0.021). Patient satisfaction was significantly higher in Group B than in Group A (P = 0.042). Furthermore, patients with drooping index <1.2 and an angular difference in canthal tilt ≥−1.0° exhibited higher satisfaction scores. Our novel approach to lower eyelid reconstruction using a skin-tarsoligamentous sling yielded improved aesthetic outcomes, fewer complications, and higher patient satisfaction.

使用皮瓣重建下眼睑有时会因术后皮瓣下垂而导致不良畸形。我们的目的是研究一种重建下眼睑皮肤-跗关节吊带的新型手术的有效性。我们共纳入了 37 名因下眼睑全层缺损而接受了颊旋转皮瓣前板层重建术的患者。他们被分为两组：A组包括19名患者，他们接受了筋膜条和颊粘膜移植的跗韧带吊带重建术；B组包括18名患者，他们接受了皮肤-跗韧带吊带重建术，额外结合了骨膜瓣和外侧眼轮匝肌区域的去上皮三角瓣，这代表了我们的新方法。为了评估术后畸形的严重程度，我们使用了下垂指数，即与健侧相比下垂的比率，以及眼轮匝肌倾斜的角度差。B 组的疗效更佳，平均下垂指数为 1.13，而 A 组为 1.33（P = 0.031）；平均眼窝倾斜角度差为 -0.73°，而 A 组为 -2.45°（P = 0.021）。B 组患者的满意度明显高于 A 组（P = 0.042）。此外，下垂指数<1.2和眼睑倾斜角度差≥-1.0°的患者满意度评分更高。我们使用皮肤-跗韧带吊带重建下眼睑的新方法改善了美学效果，减少了并发症，提高了患者满意度。

{"title":"A novel lower eyelid reconstruction using a skin-tarsoligamentous sling to prevent postoperative drooping deformity: Quantitative analyses using drooping index and angular difference in canthal tilt","authors":"Yoshiro Abe, Kazuhide Mineda, Yutaro Yamashita, Shinji Nagasaka, Hiroyuki Yamasaki, Shunsuke Mima, Ichiro Hashimoto","doi":"10.1016/j.bjps.2024.09.021","DOIUrl":"10.1016/j.bjps.2024.09.021","url":null,"abstract":"<div><p>Lower eyelid reconstruction using skin flaps sometimes results in undesirable deformities due to postoperative flap drooping. We aimed to examine the effectiveness of a novel procedure for reconstructing the skin-tarsoligamentous sling of the lower eyelid. We included 37 patients who underwent anterior lamellar reconstruction with a cheek rotation flap for full-thickness lower eyelid defect. They were divided into two groups: Group A included 19 patients who underwent tarsoligamentous sling reconstruction with a fascia lata strip and buccal mucosa grafting, and Group B comprised 18 patients who underwent skin-tarsoligamentous sling reconstruction using an additional combination of a periosteal flap and de-epithelialized triangular flap at the lateral canthal region, representing our novel approach. To evaluate the severity of postoperative deformities, we used the drooping index, the ratio of drooping compared to the healthy side, along with the angular difference in canthal tilt, obtained between the reconstructed and healthy sides, using photographs taken ≥6 months post-reconstruction. Group B demonstrated superior outcomes, with mean drooping indices of 1.13 compared to 1.33 in Group A (P = 0.031) and mean angular differences in canthal tilt of −0.73° compared to −2.45° in Group A (P = 0.021). Patient satisfaction was significantly higher in Group B than in Group A (P = 0.042). Furthermore, patients with drooping index <1.2 and an angular difference in canthal tilt ≥−1.0° exhibited higher satisfaction scores. Our novel approach to lower eyelid reconstruction using a skin-tarsoligamentous sling yielded improved aesthetic outcomes, fewer complications, and higher patient satisfaction.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"98 ","pages":"Pages 263-271"},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The curious case of medical advisor: The house of cards in aesthetic medicine 医疗顾问的奇特案例：美容医学中的纸牌屋

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.020

Marco Borin, Rebecca Susanna Degliuomini, Giulio Nittari, Luigi Schiraldi, Pietro Giovanni Di Summa, Giovanni Buzzaccarini

引用次数: 0

Taps, wicks, bridges and LIFTs: Clarification on the origins of lymphatic flaps 水龙头、灯芯、桥梁和 LIFT：澄清淋巴瓣的起源

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.018

Alberto Franchi , Jakob R. Schnegg , Pietro G. di Summa

引用次数: 0

Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study 使用血管化纤维移植治疗股骨干和胫骨创伤后骨缺损后的长期效果和患者报告结果：回顾性队列和横断面调查研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.08.056

MP Noorlander-Borgdorff , EMJ Alkemade , WB van der Sluis , T de Jong , C Driessen , GF Giannakópoulos , JM Smit , D van Embden , HAH Winters , M Botman

Objectives

Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts.

Methods

A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function.

Results

The median bone defect size was 8 cm (IQR 9–7 cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, p < 0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients.

Conclusion

Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.

目的创伤后临界大小骨缺损给整形外科医生带来了整形挑战。血管化腓骨移植是一种治疗股骨和胫骨骨缺损的成熟疗法。本研究旨在评估患者报告的长期生活质量、血管化腓骨移植物下肢重建的成功率和并发症发生率。方法回顾性队列纳入了1990年至2021年期间因创伤后胫骨和股骨头缺损而接受腓骨移植物重建治疗的29例临界大小骨缺损患者。为了评估与健康相关的生活质量以及重返工作岗位的情况和满意度，研究人员使用短表-36、下肢功能量表和自制问卷（包括 DN4、满意度和主观踝关节功能）进行了横断面调查。心理成分得分与荷兰人口标准值相当，而身体功能受损得分与疼痛相关（r 0.849，p <0.001）。19 名患者中有 7 名出现了神经病理性症状，19 名患者中有 11 名恢复了正常的日常活动。所有受访者对康复的总体满意度均为正面或中性。29 名患者中有 19 人的骨愈合顺利。29 位患者中有 25 位实现了骨结合。结论血管化腓骨移植术可使胫骨和股骨创伤后节段性骨缺失患者的骨愈合率和肢体挽救率提高。患者对整体恢复情况的满意度很高，但功能结果仍然受损。

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引用次数: 0

Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation 半颌畸形的综合治疗方法：正颌外科手术与按顺序定制的植入手术相结合。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.015

Kai Liu , Hongpu Wei , Hao Sun , Zhixu Liu , Lei Zhang , Jian Cao , Xudong Wang

Objective

This study aimed to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult patients with hemifacial microsomia (HFM).

Methods

Six adults with HFM (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial computed tomography scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry.

Results

At T1, no significant differences were observed in skeletal movements compared with planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. After personalized implantation (T3), further significant improvements were observed in skeletal symmetry.

Conclusion

Combining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult patients with HFM, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.

研究目的本研究旨在评估将正颌手术与分期患者特异性植入体（PSI）相结合，对半颜面小畸形（HFM）成人患者的颅面部不对称进行全面重建的临床效果：六名成人半面小畸形患者（1 名 I 型，5 名 IIa 型）接受了正颌手术，以矫正骨骼错位和下巴偏斜。为解决颅面部不对称问题，患者接受了序列 PSI 植入术。在正颌手术前（T0）、正颌手术后三个月内（T1）、正颌手术后一年及个性化植入前（T2）和个性化植入后（T3）四个时间点采集了数字头颅侧位图和头颅计算机断层扫描。评估参数包括骨骼和牙槽骨测量、咬合角度、下巴偏差、骨骼稳定性和面部轮廓对称性：结果：在 T1 阶段，骨骼移动与计划的手术移动相比无明显差异（P > 0.05）。同样，在 T2 阶段，骨骼运动与 T1 阶段观察到的骨骼运动没有明显差异（P > 0.05），这表明手术的精确性和稳定性。对骨骼和牙槽骨参数、咬合角度和下巴偏差的分析表明，与T0相比，T1时的SNB、FH-NPo和ST N vert-Pog显著增加（p 0.05），表明术后稳定性很高。在个性化植入后（T3），骨骼对称性进一步得到显著改善：结论：将正颌手术与分期 PSIs 结合使用，可有效重建高频颌面整形术成年患者的颅面不对称，显著改善骨骼对齐、咬合倾斜和下巴偏斜，且术后效果稳定。

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引用次数: 0