Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

Scaphoid proximal pole destruction remains a surgical challenge owing to its high propensity for nonunion and osteonecrosis. The hemi-hamate graft has shown promising results in addressing this issue. However, long-term results of non-vascularized composite grafts remain uncertain. The purpose of this study was to investigate the feasibility of a vascularized hemi-hamate osteo-chondro-ligamentous pedicled flap for the reconstruction of the proximal pole of the scaphoid. Thirty fresh cadaveric wrists were used to harvest the hamate proximal pole on the dorsal intercarpal arch. A loss of substance of the scaphoid proximal pole was simulated and the hamate flap was transferred. In 15 wrists, a canulated screw osteosynthesis was performed to assess donor site morbidity and carpus stability on post-osteosynthesis dynamic radiographs. This study suggests that the proximal hamate can be harvested pedicled on the dorsal intercarpal arch. The pedicle (average pedicle diameter 0.9 mm, mean length 31.5 mm) allowed tension-free graft placement in all dissections, except for one. The morphology of the graft was very similar to that of the scaphoid proximal pole and the palmar capito-hamate ligament allowed scapholunate ligament reconstruction in all dissections. This is the first study that describes the use of a pedicled flap to fully reconstruct the complex osteo-chondro-ligamentous anatomy of the scaphoid proximal pole. This vascularized hemi-hamate flap could facilitate better long-term preservation of cartilage biomechanical properties compared to non-vascularized grafts. Donor site morbidity requires further investigation before recommending clinical use.

Background

Le Fort I (LFI) osteotomy is commonly performed by orthognathic surgeons; however, postoperative changes in nasolabial morphology are of concern. Several factors influence such changes, but it is difficult to accurately predict the postoperative results. This study evaluated the three-dimensional (3D) morphological changes in the nasal region according to the different directions of maxillary movement during LFI osteotomy.

Materials and methods

Forty-one patients who underwent LFI osteotomies were included. All patients were divided into maxilla-up (Group U: 20 patients) and maxilla-forward (Group F: 21 patients) groups. Soft tissue morphologies were determined preoperatively and 3 or 6 months postoperatively using an optical 3D scanner. All datasets were evaluated in terms of volume changes in nine subregions and changes in linear measurements around the nasal area.

Results

Both groups exhibited increased nasal volumes after surgery in the order of the three upper, three central, and three lower subregions. The change in volume of the central nasal region tended to be greater in Group U than that in Group F.

Conclusion

We evaluated 3D morphological changes in the nasal region according to the direction of maxillary movement during LFI osteotomy. Group U exhibited a large change in the volume of the central nasal region.

Objective

This retrospective study investigated the influence of palatal fistula (PF) formation after double opposing Z-plasty (DOZ) on speech outcomes in patients with cleft palate (CP), focusing on cleft width and palatal length as predictors of velopharyngeal insufficiency (VPI).

Methods

This study included 1117 patients with CP (579 males, 538 females) who underwent DOZ, performed by a single surgeon, between 1988 and 2017. Demographic characteristics, cleft dimensions, history of PF formation, and speech outcomes were investigated. Speech evaluations were performed at a minimum age of five to assess nasal emission, hypernasality, compensatory articulation, intelligibility, necessity for VPI surgery, and speech therapy. Logistic regression analysis was performed.

Results

Speech assessments were conducted at the median age of five (interquartile range [IQR], 5–6 years). Overall, 96.5% of patients achieved 'socially acceptable speech' after DOZ. Patients with PF history showed greater cleft width and experienced higher rates of hypernasality, nasal emission, and VPI on videofluoroscopy (VFS) compared to those without PF history (mean, 11.4 mm vs. 7.1 mm; 28.4% vs. 23.6%; 34.8% vs. 14.9%, 38.5% vs. 14.0%, 40.6% vs. 28.3%, respectively; all p < 0.0001). Cleft width was significantly associated with VPI-related speech outcomes in the multivariate logistic regression analysis, affecting both perceptual and VFS-measured outcomes.

Conclusions

A wider CP gap significantly increased the risk of VPI-related speech difficulties after DOZ. Cleft width is a more critical predictor of adverse speech outcomes than the presence of small-to-medium-sized PFs. Patients with a history of PF and wider cleft gaps require targeted interventions and intensified follow-up to effectively manage and improve speech outcomes.

Purpose

To explore the influencing factors of syncope in patients after plastic surgery, establish a syncope risk prediction model, and verify its accuracy.

Methods

A total of 265 patients undergoing craniomaxillofacial surgery were included and divided into a syncope group and non-syncope group. Multivariate logistic regression analysis was used to screen for risk factors of syncope, and R language was used to establish a risk prediction nomogram of syncope in craniomaxillofacial surgery patients. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fit of the model, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model.

Results

Syncope occurred in 87 of 265 patients (32.8%), and no syncope occurred in 178 patients (67.8%). Multivariate logistic regression analysis revealed statistical differences in age, orthostatic heart rate, orthostatic diastolic blood pressure, syncope history, weight loss history, and medication history between the 2 groups (P < 0.05). A nomogram was constructed for predicting the risk of syncope after craniomaxillofacial surgery, and the Hosmer-Lemeshow goodness-of-fit test proved that the nomogram fitted well (P = 0.431). The results of ROC curve analysis showed that the alignment graph model had high prediction accuracy; the area under the curve was 0.886 (95% confidence interval, 0.8381–0.9332).

Conclusion

Evaluating the risk of syncope after craniomaxillofacial surgery is helpful and provides guidance for the formulation of preventive strategies.

Background

Question mark ear (QME) is a congenital abnormality characterized by a prominent curve within the helix that resembles a question mark. Several surgical reconstruction techniques have been proposed to treat this deformity. In this study, we aimed to evaluate the cosmetic outcomes of a new cartilage and postauricular flap surgical reconstruction technique for patients diagnosed with severe QME.

Method

From 2017 to 2023, 33 patients with severe QMEs were treated with a new reconstruction surgical technique at the Plastic Surgery Hospital of Peking Union Medical College. The perimeter, width, length, and auriculocephalic angles of both ears were measured and compared to assess the symmetry. The patient’s satisfaction with the surgical outcomes and incidence of post-operative complications were also evaluated. The average follow-up duration was 15.48 months.

Results

The auricular perimeter, width, and length changed significantly after surgery. The dimensions of the left and right ear did not vary significantly in patients with unilateral or bilateral severe QME after surgery and at the end of the 1-year follow-up. Most patients (87.88%) or carers were satisfied with the cosmetic outcomes after surgery. All patients underwent suture removal 14 days after surgery and exhibited excellent wound healing without any complications such as hematoma, infection, and flap necrosis.

Conclusion

Our new surgical reconstruction technique for severe QME resulted in good cosmetic outcomes, high patient satisfaction, fast recovery, and no post-operative complications.

Background

The complexity of a constricted ear shape renders the aim of establishing a uniform surgical method unattainable, thus posing an ongoing challenge in its correction. The Tanzer’s group IIB constricted ear is characterized by a prominent downward folding, an underdeveloped antihelix, and the absence of sacpha. The present study used a V-Y advancement flap combined with concha cartilage for the repair of Tanzer’s group IIB constricted ear.

Method

A total of 16 patients diagnosed with type IIB ear constriction from September 2016 to September 2022 were enrolled in this retrospective study. The correction procedure for the constricted ear involved the utilization of a V-Y advancement flap combined with concha cartilage graft. The auricle shape data of the patients, their visual analog scale (VAS) satisfaction scores, and aesthetic outcomes scale (AOS) aesthetic scores were examined preoperatively and 12 months post-operatively.

Result

The mean duration of follow-up in this study was 18 months. The post-operative measurements of ear length, ear width, bilateral differences in ear length, and bilateral differences in ear width exhibited significant improvement compared to the preoperative values. The mean preoperative AOS score was 1.12 ± 0.34, and the mean post-operative AOS score increased to 3.81 ± 0.40. The preoperative VAS satisfaction score was 2.31 ± 0.70, whereas the post-operative VAS score significantly increased to 8.00 ± 0.89. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence.

Conclusion

The combination of V-Y advancement flap and concha cartilage transplantation for the correction of Tanzer’s group IIB constricted ear can achieve a natural and aesthetically pleasing auricle shape, resulting in high patient satisfaction.

Backgrounds

For patients with concha-type microtia, surgical intervention and the degree of deformity may affect the growth rate of the auricular cartilage, which is different at different ages. This study aimed to explore the auricular growth potential of patients with concha-type microtia at different ages after auricular cartilage stretching surgery.

Methods

A total of 66 patients with unilateral grade II and III concha-type microtia were involved in this prospective cohort study. All patients underwent auricular cartilage stretching surgery. Relevant data were collected before surgery, immediately after surgery, and at the last follow-up.

Results

The perimeter, width, and length of auricle, between each follow-up, was statistically significant, which supported the effect of surgery and auricular development. For patients in the grade II group, no statistical significance was found in the difference in the perimeter, width, and length between the affected and normal auricle. For the patients in the grade III group, the difference in the relevant indexes of the affected auricle was significantly different from those of the normal auricle. Between subgroups divided according to their age, the growth potential of affected auricle with the same degree of deformity was statistically significant.

Conclusions

Growth potential of the affected auricle of the grade II group was consistent with that of the normal auricle, which was significantly higher than that of the grade III group. For patients at different ages, auricles grew faster before 3 years of age. Surgical intervention improved the auricular aesthetics and released the auricular growth potential. Thus, surgical intervention should be recommend as early as possible.

Conventional gingivoperiosteoplasty (GPP) performed during infancy adversely affects maxillary development. However, the outcomes of this procedure in early childhood have rarely been reported. Therefore, we examined the postoperative outcomes of GPP conducted in patients aged 1.5 years with unilateral cleft lip and palate (UCLP).

This study included 87 non-syndromic patients with complete UCLP who had undergone early two-stage palatoplasty during the 1999–2004 period. The protocol comprised soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age. In the GPP group (n = 34), we introduced the GPP procedure during hard palate closure; in the non-GPP group (n = 53), the labial side of the alveolar cleft remained intact. We examined computed tomography images taken at 8 years of age to observe bone formation at the alveolar cleft site. We also conducted cephalometric analysis to examine maxillary development at 12 years of age.

Bone bridges at the alveolar cleft site were observed in 92% and 5.6% of the GPP and non-GPP groups, respectively. Moreover, 56% of the GPP group did not require secondary alveolar bone grafting (sABG), whereas all the patients in the non-GPP group underwent sABG. No statistically significant differences were noted in the maxillary anteroposterior length (GPP: 45.5 ± 3.7 mm, non-GPP: 45.9 ± 3.5 mm, p = 0.67) and sella–nasion–point A angle (GPP: 75.6 ± 4.5°, non-GPP: 73.8 ± 12.6°, p = 0.49).

This study’s findings suggest that GPP performed at 1.5 years of age minimises the necessity of sABG and does not exert a negative influence on maxillofacial development.

Objective

Reversed great saphenous vein (GSV) graft is widely used for revascularization in limb-sparing surgery for sarcoma invading great vessels. However, a mismatch in caliber between the reverse graft and cut end of the artery can threaten graft patency. Recently, we introduced the use of a venous valvulotome to allow nonreversed GSV graft. The purpose of this study was to evaluate the safety and versatility of this technique.

Design

We retrospectively compared long-term patency and limb salvage rates between nonreversed GSV and reversed GSV in patients undergoing limb-sparing surgery for sarcoma.

Methods

Thirty-seven patients were included, with 21 in the nonreversed GSV group and 16 in the reversed GSV group. Patient characteristics, surgical details, and complications were reviewed from the hospital records. The patency of the reconstructed vessels was assessed using contrast-enhanced CT or MRI. Statistical analyses, including Kaplan–Meier survival analysis, were employed for comparisons.

Results

The median follow-up was 38 months. Overall graft patency was 90.4% (19 of 21 patients) in the nonreversed GSV group and 81.2% (13 of 16) in the reverse GSV (RGSV) group. In the nonreversed GSV group, there was 1 case of graft occlusion each in the acute and chronic phases, but limb circulation remained intact and all limbs were spared.

Conclusion

Nonreversed GSV grafting with valvulotome offers a safe and versatile alternative to reversed GSV grafts in limb-sparing sarcoma surgery. It eliminates the need for vein reversal and minimizes diameter mismatch, potentially expanding the indication for autologous revascularization to previously ineligible cases.

3D-printed vascular models can enhance flap harvesting efficiency in abdominal free flap breast reconstruction, reducing the use of operating room time. However, no economic analyses with respect to model use in this context have been conducted to date. As such, this study examines model cost-benefit tradeoffs for use in abdominal free flap breast reconstruction.