Hyewon Hu, Soo-Bin Kim, Jovian Wan, Lisa Kwin Wah Chan, Alvin Kar Wai Lee, Olena Sydorchuk, Arash Jalali, Maria Cesar Correa, Jong-Seo Kim, Kyu-Ho Yi
Botulinum toxin can be used for various purposes to enhance neck aesthetics, addressing concerns such as platysmal bands, optimizing the cervicomental angle, preventing worsening of horizontal neckline and decolletage lines during aging, submandibular gland hypertrophy, and hypertrophied superior trapezius muscle. Understanding the anatomy of muscles such as the trapezius, platysma, and submandibular gland is crucial for achieving desirable outcomes with botulinum toxin administration. Techniques for injecting botulinum toxin into these muscles are discussed, emphasizing safety and efficacy. Specific injection points and methods are detailed for treating platysmal bands, optimizing the cervicomental angle, addressing submandibular gland hypertrophy, and managing hypertrophied superior trapezius muscle. Careful consideration of anatomical landmarks and potential complications is essential for successful botulinum toxin injections in these areas.
{"title":"Anatomical Guidelines and Technical Tips for Neck Aesthetics with Botulinum Toxin","authors":"Hyewon Hu, Soo-Bin Kim, Jovian Wan, Lisa Kwin Wah Chan, Alvin Kar Wai Lee, Olena Sydorchuk, Arash Jalali, Maria Cesar Correa, Jong-Seo Kim, Kyu-Ho Yi","doi":"10.1055/s-0044-1788284","DOIUrl":"https://doi.org/10.1055/s-0044-1788284","url":null,"abstract":"Botulinum toxin can be used for various purposes to enhance neck aesthetics, addressing concerns such as platysmal bands, optimizing the cervicomental angle, preventing worsening of horizontal neckline and decolletage lines during aging, submandibular gland hypertrophy, and hypertrophied superior trapezius muscle. Understanding the anatomy of muscles such as the trapezius, platysma, and submandibular gland is crucial for achieving desirable outcomes with botulinum toxin administration. Techniques for injecting botulinum toxin into these muscles are discussed, emphasizing safety and efficacy. Specific injection points and methods are detailed for treating platysmal bands, optimizing the cervicomental angle, addressing submandibular gland hypertrophy, and managing hypertrophied superior trapezius muscle. Careful consideration of anatomical landmarks and potential complications is essential for successful botulinum toxin injections in these areas.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141924454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Jang, Il Young Ahn, T. Bae, S. Kang, Soo Hyun Woo, W. Kim, Mi Kyung Kim, Chanutchamon Sutthiwanjampa, Han Koo Kim
Backgrounds: Capsular contracture of breast implants is a major complication of breast surgery. Clinically, covering a breast implant with acellular dermal matrix or autologous tissue is considered to be the most effective technique to prevent capsular contracture. This study was designed to clearly compare the protective effects of acellular dermal matrix and latissimus dorsi muscle flap placement on capsular contracture by increasing the rate of capsular contracture through controlled radiation exposure in a rabbit model. Methods: Twenty New Zealand white rabbits were divided into three groups. After the implant was placed beneath the pectoralis major muscle, the lateral third of the implant was left exposed in the control group (n=6). In the acellular dermal matrix group (n=7), the exposed implant was covered with AlloDerm. In the latissimus dorsi flap group (n=7), the exposed implant was covered with a pedicled latissimus dorsi muscle flap. All groups were irradiated 3 weeks after implant insertion. After 6 months, peri-implant tissues were harvested and analyzed. Results: Acellular dermal matrix showed markedly lower myofibroblast activity than the latissimus dorsi flap. However, transforming growth factor β1 levels and the activity of collagen types I and III produced in fibroblasts were significantly lower in the acellular dermal matrix group than in the latissimus dorsi flap group. Conclusions: Based on the findings of our rabbit experiments, acellular dermal matrix is expected to have a comparative advantage in reducing the risk of capsular contracture compared to the latissimus dorsi flap.
{"title":"Comparison of Effects of Acellular Dermal Matrix and Latissimus Dorsi Muscle Flap on Radiation-induced Peri-implant Capsular Contracture in a Rabbit Model","authors":"S. Jang, Il Young Ahn, T. Bae, S. Kang, Soo Hyun Woo, W. Kim, Mi Kyung Kim, Chanutchamon Sutthiwanjampa, Han Koo Kim","doi":"10.1055/a-2368-1813","DOIUrl":"https://doi.org/10.1055/a-2368-1813","url":null,"abstract":"Backgrounds: Capsular contracture of breast implants is a major complication of breast surgery. Clinically, covering a breast implant with acellular dermal matrix or autologous tissue is considered to be the most effective technique to prevent capsular contracture. This study was designed to clearly compare the protective effects of acellular dermal matrix and latissimus dorsi muscle flap placement on capsular contracture by increasing the rate of capsular contracture through controlled radiation exposure in a rabbit model.\u0000Methods: Twenty New Zealand white rabbits were divided into three groups. After the implant was placed beneath the pectoralis major muscle, the lateral third of the implant was left exposed in the control group (n=6). In the acellular dermal matrix group (n=7), the exposed implant was covered with AlloDerm. In the latissimus dorsi flap group (n=7), the exposed implant was covered with a pedicled latissimus dorsi muscle flap. All groups were irradiated 3 weeks after implant insertion. After 6 months, peri-implant tissues were harvested and analyzed.\u0000Results: Acellular dermal matrix showed markedly lower myofibroblast activity than the latissimus dorsi flap. However, transforming growth factor β1 levels and the activity of collagen types I and III produced in fibroblasts were significantly lower in the acellular dermal matrix group than in the latissimus dorsi flap group.\u0000Conclusions: Based on the findings of our rabbit experiments, acellular dermal matrix is expected to have a comparative advantage in reducing the risk of capsular contracture compared to the latissimus dorsi flap.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nark-Kyoung Rho, Hyun-Seok Kim, Soo-young Kim, Won Lee
Aging-related changes in skin, such as dullness, dehydration, and loss of elasticity, significantly affect its appearance and integrity. Injectable “skin boosters,” comprising various biological materials, have become increasingly prominent in addressing these issues, offering rejuvenation and revitalization. This review offers a comprehensive examination of these injectables, detailing their types, mechanisms of action, and clinical uses. It also evaluates the evidence for their effectiveness and safety in treating age-related skin alterations and other conditions. The goal is to provide an insightful understanding of injectable skin boosters in contemporary dermatological practice, summarizing the current state of knowledge.
{"title":"Injectable \"Skin Boosters\" in Aging Skin Rejuvenation: A Current Overview","authors":"Nark-Kyoung Rho, Hyun-Seok Kim, Soo-young Kim, Won Lee","doi":"10.1055/a-2366-3436","DOIUrl":"https://doi.org/10.1055/a-2366-3436","url":null,"abstract":"Aging-related changes in skin, such as dullness, dehydration, and loss of elasticity, significantly affect its appearance and integrity. Injectable “skin boosters,” comprising various biological materials, have become increasingly prominent in addressing these issues, offering rejuvenation and revitalization. This review offers a comprehensive examination of these injectables, detailing their types, mechanisms of action, and clinical uses. It also evaluates the evidence for their effectiveness and safety in treating age-related skin alterations and other conditions. The goal is to provide an insightful understanding of injectable skin boosters in contemporary dermatological practice, summarizing the current state of knowledge.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nerve decompression is an emerging surgical treatment option for patients with occipital neuralgia. However, limited research is available on the efficacy of this treatment in South Korea. This retrospective study evaluates the efficacy of nerve decompression surgery in patients with chronic migraines, specifically focusing on occipital neuralgia, in South Korea. Between January 2019 and December 2022, six patients diagnosed with occipital neuralgia, who had not responded to conservative treatments, underwent nerve decompression surgery. This procedure, performed under local anesthesia, involved decompression of the greater and/or lesser occipital nerves. Patient data was analyzed for headache frequency and intensity (using the Numeric Rating Scale [NRS]) and the decrease in oral medications needed post-surgery. Results showed significant improvement in headache symptoms post-surgery, with the average preoperative NRS score of 7.9 dropping to 3.7 postoperatively. Additionally, the average number of medications used decreased from 3.2 to 1.3. No significant surgical complications were reported. The study highlights the potential of nerve decompression as an effective treatment for occipital neuralgia, particularly in cases resistant to traditional medical management.
{"title":"Case series and literature review of up-to-date surgical management of occipital neuralgia","authors":"Seok Joon Lee, Joo Seok Park, Wooshik Jeong","doi":"10.1055/a-2364-5564","DOIUrl":"https://doi.org/10.1055/a-2364-5564","url":null,"abstract":"Nerve decompression is an emerging surgical treatment option for patients with occipital neuralgia. However, limited research is available on the efficacy of this treatment in South Korea. This retrospective study evaluates the efficacy of nerve decompression surgery in patients with chronic migraines, specifically focusing on occipital neuralgia, in South Korea. Between January 2019 and December 2022, six patients diagnosed with occipital neuralgia, who had not responded to conservative treatments, underwent nerve decompression surgery. This procedure, performed under local anesthesia, involved decompression of the greater and/or lesser occipital nerves. Patient data was analyzed for headache frequency and intensity (using the Numeric Rating Scale [NRS]) and the decrease in oral medications needed post-surgery. Results showed significant improvement in headache symptoms post-surgery, with the average preoperative NRS score of 7.9 dropping to 3.7 postoperatively. Additionally, the average number of medications used decreased from 3.2 to 1.3. No significant surgical complications were reported. The study highlights the potential of nerve decompression as an effective treatment for occipital neuralgia, particularly in cases resistant to traditional medical management.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141656072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji Won Hwang, Su Min Kim, Jin-Woo Park, Kyong-Je Woo
Purpose Impact of previous radiation therapy and neoadjuvant chemotherapy (NACT) on early complication in direct-to-implant (DTI) breast reconstruction has not been clearly elucidated. This study investigated whether direct-to-implant reconstruction is viable in patients with NACT or a history of preoperative chest wall irradiation. Methods Medical records of breast cancer patients who underwent nipple-sparing or skin-sparing mastectomy with DTI breast reconstruction from March 2018 to February 2021, with at least one year of follow-up in a single tertiary center, were reviewed. Demographic data, intraoperative details, and postoperative complications, including full-thickness necrosis, infection, and removal were reviewed. Risk factors suggested by previous literature, including NACT and preoperative chest wall irradiation histories, were reviewed by multivariate analysis. Results A total of 206 breast cancer patients were included, of which, 9 were bilateral, 8 patients (3.9%) had a history of prior chest wall irradiation, and 17 (8.6%) had received NACT. From 215 cases, 11 cases (5.1%) required surgical intervention for full-thickness necrosis, while IV antibiotics or hospitalization was needed in 11 cases (5.1%), with 14 cases of failure (6.5%) reported. Using multivariable analysis, preoperative irradiation was found to significantly increase the risk of full-thickness skin necrosis (OR = 12.14, p = 0.034), and reconstruction failure (OR = 13.14, p = 0.005). Neoadjuvant chemotherapy was not a significant risk factor in any of the above complications. Conclusion DTI breast reconstruction is a viable option for patients who have received NACT, although reconstructive options should be carefully explored for patients with a history of breast irradiation.
{"title":"Impact of neoadjuvant chemotherapy and preoperative irradiation on early complications in direct-to-implant breast reconstruction","authors":"Ji Won Hwang, Su Min Kim, Jin-Woo Park, Kyong-Je Woo","doi":"10.1055/a-2358-8864","DOIUrl":"https://doi.org/10.1055/a-2358-8864","url":null,"abstract":"Purpose\u0000Impact of previous radiation therapy and neoadjuvant chemotherapy (NACT) on early complication in direct-to-implant (DTI) breast reconstruction has not been clearly elucidated. This study investigated whether direct-to-implant reconstruction is viable in patients with NACT or a history of preoperative chest wall irradiation.\u0000Methods\u0000Medical records of breast cancer patients who underwent nipple-sparing or skin-sparing mastectomy with DTI breast reconstruction from March 2018 to February 2021, with at least one year of follow-up in a single tertiary center, were reviewed. Demographic data, intraoperative details, and postoperative complications, including full-thickness necrosis, infection, and removal were reviewed. Risk factors suggested by previous literature, including NACT and preoperative chest wall irradiation histories, were reviewed by multivariate analysis.\u0000Results\u0000A total of 206 breast cancer patients were included, of which, 9 were bilateral, 8 patients (3.9%) had a history of prior chest wall irradiation, and 17 (8.6%) had received NACT. From 215 cases, 11 cases (5.1%) required surgical intervention for full-thickness necrosis, while IV antibiotics or hospitalization was needed in 11 cases (5.1%), with 14 cases of failure (6.5%) reported. Using multivariable analysis, preoperative irradiation was found to significantly increase the risk of full-thickness skin necrosis (OR = 12.14, p = 0.034), and reconstruction failure (OR = 13.14, p = 0.005). Neoadjuvant chemotherapy was not a significant risk factor in any of the above complications. \u0000Conclusion\u0000DTI breast reconstruction is a viable option for patients who have received NACT, although reconstructive options should be carefully explored for patients with a history of breast irradiation.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141686337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Basal cell carcinoma(BCC) is the most common of non-melanoma skin cancer. Typically, resection requires a safety margin ≥ 4 mm. When removing tumor cells, achieving complete excision with minimal safety margins and reconstructing the defect to preserve the original appearance are important. In this study, we used a 3 mm resection margin to confirm recurrence and re-resection rates. Methods Electronic medical records and photographic data were obtained for patients with primary BCC lesions less than 2cm in diameter who underwent wide excision with a 3mm surgical margin from January 2015 to November 2021. We analyzed factors determining recurrence and re-resection rates, such as tumor size, location, age, sex, underlying diseases (including immunosuppression state), ethnicity, subtypes, tumor borders etc. Results This study included 205 patients. The mean age and follow-up period were 73.0 ± 11.5 years and 10.2 ± 8.0 months, respectively. The recurrence and re-resection rates were 1.95%, and 25.85%, respectively. A statistically significant correlation was found between recurrence rate and tumor border. (P = 0.013) And the re-resection rate was correlated statistically location (P = 0.022), and immunosuppressed patients. (P = 0.006) Conclusion We found that a 3 mm excision margin provided sufficient safety in small facial BCC, resulting in ease of surgery and better aesthetic outcomes. However, surgical margins must be determined case by case by integrating various patient factors. In particular, a surgical margin of ≥ 4 mm is required for BCC in high-risk areas or immunosuppressed patients or poorly-defined border.
{"title":"Is 3mm surgical margin safe in head and neck basal cell carcinoma smaller than 2cm; in relation to various risk factor.","authors":"Hea Kyeong Shin, Min Jun Yong","doi":"10.1055/a-2338-9192","DOIUrl":"https://doi.org/10.1055/a-2338-9192","url":null,"abstract":"Background \u0000Basal cell carcinoma(BCC) is the most common of non-melanoma skin cancer. Typically, resection requires a safety margin ≥ 4 mm. When removing tumor cells, achieving complete excision with minimal safety margins and reconstructing the defect to preserve the original appearance are important. In this study, we used a 3 mm resection margin to confirm recurrence and re-resection rates.\u0000\u0000Methods \u0000Electronic medical records and photographic data were obtained for patients with primary BCC lesions less than 2cm in diameter who underwent wide excision with a 3mm surgical margin from January 2015 to November 2021. We analyzed factors determining recurrence and re-resection rates, such as tumor size, location, age, sex, underlying diseases (including immunosuppression state), ethnicity, subtypes, tumor borders etc. \u0000\u0000Results \u0000This study included 205 patients. The mean age and follow-up period were 73.0 ± 11.5 years and 10.2 ± 8.0 months, respectively. The recurrence and re-resection rates were 1.95%, and 25.85%, respectively.\u0000A statistically significant correlation was found between recurrence rate and tumor border. (P = 0.013) And the re-resection rate was correlated statistically location (P = 0.022), and immunosuppressed patients. (P = 0.006) \u0000\u0000Conclusion \u0000We found that a 3 mm excision margin provided sufficient safety in small facial BCC, resulting in ease of surgery and better aesthetic outcomes.\u0000However, surgical margins must be determined case by case by integrating various patient factors. In particular, a surgical margin of ≥ 4 mm is required for BCC in high-risk areas or immunosuppressed patients or poorly-defined border.\u0000","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Vaena, Kevin Sicalo, Caterina Goulart Alessio, Eduardo Pantoja Bastos
Many failures in total or subtotal nasal reconstructions result from an underestimation of the amount of skin required for an adequate result, especially for sufficient lining. Such planning errors usually lead to poor results, with exposure of structural grafts, infection, scar retraction, airway obstruction and finally loss of projection and shape of the reconstructed nose. Reconstruction options for cases in which previous attempts have failed are always limited, as well as in cases of trauma or burns affecting the soft tissues of the forehead and face. In such complex situations, one may employ free flaps or tissue expansion, but such resources may not be always available. We describe a technique indicated for salvage surgeries in patients whose previous nasal reconstruction have failed, allowing a generous amount of tissue transfer for the nasal region. The technique combines the use of supraclavicular and submental flaps, with simple execution, not requiring microsurgical skills or devices such as tissue expanders. Done in three stages, the described technique provides enough skin for a total nasal reconstruction. The final result is obtained after subsequent refinements, and the total number of procedures is equivalent to when more sophisticated techniques are employed, such as tissue expansion or microsurgery.
{"title":"A LIFEBOAT FOR FAILED NASAL RECONSTRUCTIONS: THE SUPRACLAVICULAR-SUBMENTAL SANDWICH FLAP","authors":"M. Vaena, Kevin Sicalo, Caterina Goulart Alessio, Eduardo Pantoja Bastos","doi":"10.1055/a-2337-2131","DOIUrl":"https://doi.org/10.1055/a-2337-2131","url":null,"abstract":"Many failures in total or subtotal nasal reconstructions result from an underestimation of the amount of skin required for an adequate result, especially for sufficient lining. Such planning errors usually lead to poor results, with exposure of structural grafts, infection, scar retraction, airway obstruction and finally loss of projection and shape of the reconstructed nose. Reconstruction options for cases in which previous attempts have failed are always limited, as well as in cases of trauma or burns affecting the soft tissues of the forehead and face. In such complex situations, one may employ free flaps or tissue expansion, but such resources may not be always available. We describe a technique indicated for salvage surgeries in patients whose previous nasal reconstruction have failed, allowing a generous amount of tissue transfer for the nasal region. The technique combines the use of supraclavicular and submental flaps, with simple execution, not requiring microsurgical skills or devices such as tissue expanders. Done in three stages, the described technique provides enough skin for a total nasal reconstruction. The final result is obtained after subsequent refinements, and the total number of procedures is equivalent to when more sophisticated techniques are employed, such as tissue expansion or microsurgery.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141271810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: Spontaneous recovery of a birth brachial plexus disorder is difficult to predict. Although root avulsion is strongly indicated for surgical management, early nerve surgery in non-root avulsion patients is still doubtful. This study aimed to report the recovery time of birth brachial plexus palsy who did not undergo surgery. Methods: In this retrospective study review, 75 patients with a mean follow-up time of 33.5 months, were included. Although patients met indications, surgical management was abandoned for various reasons. All infants were classified according to anatomical involvement and evaluated for clinical improvement by motor power grading. The recovery time was reported as the median and interquartile range. Results: Forty-five patients were initially diagnosed with total brachial plexus injury type. Thirty - seven patients had clinical evidence of recovering their hand motion in a median of 3 (IQR 2-5.5) months. The median time of recovery for elbow flexion and shoulder abduction was both 4 (IQR 3-6) months. The medians of antigravity or full motion recovery of shoulder abduction, elbow flexion, and hand flexion were 7.5 (IQR 5-16), 8 (IQR 5-17), and 7 (4-13) months, respectively. Conclusion: In this study, spontaneous recovery of shoulder, elbow and hand motion substantially occurred even in the patient initially diagnosed with a total birth brachial plexus palsy. True total plexus palsy can be distinguished from transient palsy by the recovery of hand motion at 3 months. Most of the shoulders and elbows of the patient, who had a spontaneous recovery, achieved antigravity movement without surgery.
{"title":"Recovery of the Total Birth Brachial Plexus Palsy without Surgical Treatment: A Single Center Retrospective Study and Literature Review","authors":"Chaiyos Vinitpairot, Surut Jianmongkol","doi":"10.1055/a-2321-0468","DOIUrl":"https://doi.org/10.1055/a-2321-0468","url":null,"abstract":"Abstract\u0000Background: Spontaneous recovery of a birth brachial plexus disorder is difficult to predict. Although root avulsion is strongly indicated for surgical management, early nerve surgery in non-root avulsion patients is still doubtful. This study aimed to report the recovery time of birth brachial plexus palsy who did not undergo surgery. \u0000\u0000Methods: In this retrospective study review, 75 patients with a mean follow-up time of 33.5 months, were included. Although patients met indications, surgical management was abandoned for various reasons. All infants were classified according to anatomical involvement and evaluated for clinical improvement by motor power grading. The recovery time was reported as the median and interquartile range.\u0000\u0000Results: Forty-five patients were initially diagnosed with total brachial plexus injury type. Thirty - seven patients had clinical evidence of recovering their hand motion in a median of 3 (IQR 2-5.5) months. The median time of recovery for elbow flexion and shoulder abduction was both 4 (IQR 3-6) months. The medians of antigravity or full motion recovery of shoulder abduction, elbow flexion, and hand flexion were 7.5 (IQR 5-16), 8 (IQR 5-17), and 7 (4-13) months, respectively.\u0000\u0000 \u0000Conclusion: In this study, spontaneous recovery of shoulder, elbow and hand motion substantially occurred even in the patient initially diagnosed with a total birth brachial plexus palsy. True total plexus palsy can be distinguished from transient palsy by the recovery of hand motion at 3 months. Most of the shoulders and elbows of the patient, who had a spontaneous recovery, achieved antigravity movement without surgery.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Franchi, L. Patanè, Bettina Gogh, Florian Jung, Abdul Rahman Jandali
Getting enough volume in autologous breast reconstruction can be difficult and transferring multiple free flaps to reconstruct a single breast can provide a solution to that problem. How to connect the free flaps pedicles to the recipient site has been a point of discussion in the literature and two main approaches have been described. The first one involves using the caudal stumps of the internal mammary (IM) vessels and is usually referred to “cranial-caudal” approach. The second one implies the anastomosis between one flap’s pedicle to a branch of the other one . This technique has been named in different ways in the literature: intraflap, flow-through, daisy-chain, chain-link and others. In the present letter we want to list what we think are all the advantages of the intraflap approach compared to the cranial-caudal one. To our knowledge, some of them have not been mentioned in the available literature.
{"title":"Summarizing the advantages of the intraflap versus cranial-caudal anastomoses in stacked free flap breast reconstruction.","authors":"Alberto Franchi, L. Patanè, Bettina Gogh, Florian Jung, Abdul Rahman Jandali","doi":"10.1055/a-2321-6279","DOIUrl":"https://doi.org/10.1055/a-2321-6279","url":null,"abstract":"Getting enough volume in autologous breast reconstruction can be difficult and transferring multiple free flaps to reconstruct a single breast can provide a solution to that problem. How to connect the free flaps pedicles to the recipient site has been a point of discussion in the literature and two main approaches have been described. The first one involves using the caudal stumps of the internal mammary (IM) vessels and is usually referred to “cranial-caudal” approach. The second one implies the anastomosis between one flap’s pedicle to a branch of the other one . This technique has been named in different ways in the literature: intraflap, flow-through, daisy-chain, chain-link and others.\u0000In the present letter we want to list what we think are all the advantages of the intraflap approach compared to the cranial-caudal one. To our knowledge, some of them have not been mentioned in the available literature. \u0000","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Jaiswal, Bharat Rajivkumar Saxena, S. Mathews, Mayur Mantri, Vineet Pilania, A. Bindu, V. Shankhdhar, P. Yadav
Background: Antero-lateral thigh flap (ALT) is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Antero-medial thigh flap (AMT) is an option, but the low incidence and thickness restricts its utility. TFL perforator flap (TFLP) is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity and lends itself with ALT perforator, to large conjoint flap, chimeric designs and possible two free flap harvest from the same thigh. Methods: Analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP. Results: All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5) and multiple (3) free flaps manner. Most common perforator location was septo-cutaneous between the TFL and Gluteus Medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed. Conclusion: TFLP can be used to counter ALT/AMT unavailability, injury, suboptimal quality or need of a thicker flap. Chimeric ALT-TFL can be harvested for large, complex, multicomponent and multidimensional defects. We recommend, harvesting flaps from the thigh with a non-committal straight line incision initially, perceiving ALT-AMT-TFL perforators as a unit.
背景：大腿前外侧皮瓣（ALT）是头颈部微血管重建最常用的软组织皮瓣。由于穿孔器特征的变化、损伤或复杂缺损的不利结构，其采集具有一定的不可预测性。大腿前内侧皮瓣（AMT）也是一种选择，但其发生率低、厚度小，限制了其实用性。TFL穿孔器皮瓣（TFLP）是补充ALT的最佳选择。其穿孔一致、坚固、邻近，可与 ALT 穿孔瓣一起用于大型联合皮瓣、嵌合设计以及从同一大腿上获取两个游离皮瓣。 方法：分析29个使用游离皮瓣进行头颈部重建的病例，其中包括TFLP：结果：所有病例主要计划进行 ALT 重建。16例患者没有ALT穿孔器，但有相当大的TFL穿孔器。在13个病例中，由于缺损情况复杂，需要以联合（5个）、嵌合（5个）和多个（3个）游离皮瓣的方式同时使用ALT和TFL。最常见的穿孔器位置是TFL和臀中肌之间的隔膜。有两个病例的皮瓣完全脱落，两个病例的皮瓣部分坏死。没有延误辅助治疗。 结论：TFLP 可用来应对 ALT/AMT 缺失、损伤、质量不佳或需要更厚皮瓣的情况。对于大面积、复杂、多成分和多维度的缺损，可以采集嵌合 ALT-TFL 皮瓣。我们建议，最初从大腿上采集皮瓣时采用非一致性直线切口，将ALT-AMT-TFL穿孔器视为一个整体。
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