Annals of Plastic Surgery最新文献

Abstract: This retrospective study evaluates the efficacy of the serratus anterior muscle (SAm) free flap combined with a split thickness skin graft (STSG) for thin resurfacing in reconstructive surgery, presenting an alternative to pure skin perforator flaps. It analyzes 14 SAm free flap procedures performed between January 2015 and December 2023. The study cohort comprised 5 women and 9 men, aged 31-80 years, addressing defects caused by infection, malignancy, burn, and trauma, located in various body parts.The study involves harvesting the SAm flap while focusing on anatomical features such as the distinct direction of muscle fibers and the surface location of the vascular pedicle for efficient dissection. It emphasizes the anatomical advantages of the SAm flap, such as robust vascular supply, controlled flap thickness, and preservation of the long thoracic nerve, making it suitable for a range of surgical needs. Complications included STSG loss, partial necrosis, and infection, all managed effectively. Postoperative shoulder function assessment showed no significant impairment.Results demonstrated the successful application of the SAm flap in all cases, with an average flap dimension of 38.21 cm2 and pedicle length of 7.3 cm. The average operation time was 122.1 minutes. The study underscores the SAm flap's adaptability, versatility, and minimal donor site morbidity.It concludes that the SAm flap, in conjunction with STSG, is a viable alternative for thin resurfacing in reconstructive surgery. However, limitations such as the small sample size and procedural variability suggest the need for further research to fully establish the flap's potential in diverse surgical contexts.

Background: Currently, the gold standard of treatment for extremity soft tissue sarcoma (STS) is limb-sparing surgery. When the upper extremity is involved, the functional outcome is frequently poor. A 1-step resection and functional reconstruction would be advisable to obtain a fast recovery. Our study aims at retrospectively analyzing our case series of immediate nerves and tendons reconstructions of the upper limb after STS resection, while combining a review of the literature.

Methods: A retrospective review was conducted on a consecutive series of patients who underwent an immediate functional reconstruction after STS resection of the upper limb between 2015 and 2022 among the IRCCS Foundation "Istituto Nazionale dei Tumori." The Disabilities of the Arm, Shoulder and Hand (DASH) score was considered the primary outcome. The obtained DASH scores were compared through groups that underwent different reconstructive procedures. The literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) criteria among 3 databases (PubMed, EMBASE, and Cochrane) using the search parameters "(((upper extremity) OR (upper limb)) AND (functional reconstruction) AND (soft tissue sarcoma)."

Results: Between 2015 and 2022, 52 patients required a functional reconstruction. The mean follow-up time was 49.63 months. The DASH score analysis reported a mean value of 44.1 ± 26.7. A statistically significant difference was found between groups who underwent different reconstruction techniques, whereas no difference was found regarding exposure to neoadjuvant radiation therapy. The literature review reported few articles focusing on immediate functional reconstruction after STS resection, and only 6 articles were included in the review.

Conclusions: Our review aimed at reporting our case series of immediate functional reconstructions after STS of the upper extremity, which is currently the most substantial one reported in literature to set an effective baseline for further studies in the field.

Study design: Systematic, scoping literature review and case presentation.

Objective: The goal of this study is to review current literature on management trends and outcomes of pediatric intranasal lobular capillary hemangioma (ILCH).

Case presentation: A 14-year-old male patient presented with a 15-month history of unilateral epistaxis, nasal congestion, and mouth breathing. Further workup revealed a pale nasal mass obstructing the right nasal cavity. The patient was successfully treated using a minimally invasive endoscopic endonasal approach for mass resection and nasal floor free mucosal graft for septal reconstruction.

Methods: Independent queries of the PubMed Central, MEDLINE, and Bookshelf databases were performed; articles from 1990 to 2023 were abstracted. All studies that described pediatric ILCH using the Boolean method and relevant search term combinations, including "Intranasal," "Lobular capillary hemangioma," "Pyogenic granuloma," "Pediatric," "Outcome," and "Management," were collected for subsequent analysis.

Results: A total of 407 relevant unique articles were identified for analysis. Of these, 19 articles were deemed appropriate for inclusion in this literature review. Twenty-two pediatric ILCH cases were identified with a mean age at diagnosis of 10.5 years. The majority of cases occurred in males and presented with recurrent epistaxis and nasal obstruction. Most lesions originated from the anterior nasal septum and were resected using an endoscopic endonasal approach with no recurrence at last follow-up.

Conclusions: Pediatric ILCH, a benign vascular neoplasm, often presents with unilateral nasal obstruction and severe, refractory epistaxis. This comprehensive review aims to highlight the importance of including this lesion in the differential diagnosis for unilateral nasal obstruction and epistaxis in young children.

Background: Supratip deformity is one of the most common complications after open rhinoplasty. This study aimed to define a new risk scoring system for supratip deformity and determine the distances that should be left between the tip defining point (TDP) and anterior septal angle (ASA) to prevent it.

Methods: Four hundred sixty-nine patients who underwent open rhinoplasty between 2018-2022 were included in this retrospective study. The patients were evaluated according to the risk scoring system consisting of four parameters (skin thickness, lower lateral cartilage anatomy, amount of hump resection, and soft tissue procedures). Because of the presence of supratip deformity at the postoperative 12th month, the patients were divided into two groups: (i) without supratip deformity (n = 418) and (ii) with supratip deformity (n = 51). Statistical inferences were made regarding the development of supratip deformity by evaluating the relationship between the risk scores and the intraoperative TDP-ASA distances.

Results: There was a significant difference between the groups in risk scores ( P < 0.05). In cases with high-risk scores, it was calculated that the probability of developing supratip deformity decreased significantly when the TDP-ASA distance was above 7.5 mm and increased significantly when the TDP-ASA distance was below 6.5 mm. In cases with low-risk scores, it was found that the probability of developing supratip deformity was reduced considerably when the TDP-ASA distance was over 6.0 mm.

Conclusions: The authors recommend keeping the TDP-ASA distance above 6.0 mm in low-risk patients and 7.5 mm in high-risk patients to avoid supratip deformity.

Introduction: Online patient education materials (PEMs) that are difficult to read disproportionately affect patients with low health literacy and educational attainment. Patients may not be fully informed or empowered to engage meaningfully with providers and advocate for their goals. We aim to assess the readability of online PEMs regarding polydactyly and syndactyly.

Methods: Google was used to query "polydactyly" and "syndactyly" in English and Spanish. The first 50 results were categorized into institutional (government, medical school, teaching hospital), noninstitutional (private practice, blog), and academic (journal articles, book chapters). Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales.

Results: All polydactyly PEMs and >95% of syndactyly PEMs exceeded the National Institutes of Health recommended 6th-grade reading level. Altogether, English PEMs had an average reading level of a university freshman and Spanish PEMs had an average reading level of nearly a high school sophomore. For both diagnoses, English PEMs were harder to read than Spanish PEMs overall and when compared across the 3 categories between the 2 languages. Generally, noninstitutional PEMs were more difficult to read than their institutional counterparts.

Conclusions: To improve patient education, health literacy, and language equity, online resources for polydactyly and syndactyly should be written at the 6th-grade level. Currently, these PEMs are too advanced, which can make accessing, understanding, and pursuing healthcare decisions more challenging. Understanding health conditions and information is crucial to empower patients, regardless of literacy.

Background: Patient-directed Electronic Health Record (EHR) messaging is used as an adjunct to enhance patient-physician interactions but further burdens the physician. There is a need for clear electronic patient communication in all aspects of medicine, including plastic surgery. We can potentially utilize innovative communication tools like ChatGPT. This study assesses ChatGPT's effectiveness in answering breast reconstruction queries, comparing its accuracy, empathy, and readability with healthcare providers' responses.

Methods: Ten deidentified questions regarding breast reconstruction were extracted from electronic messages. They were presented to ChatGPT3, ChatGPT4, plastic surgeons, and advanced practice providers for response. ChatGPT3 and ChatGPT4 were also prompted to give brief responses. Using 1-5 Likert scoring, accuracy and empathy were graded by 2 plastic surgeons and medical students, respectively. Readability was measured using Flesch Reading Ease. Grades were compared using 2-tailed t tests.

Results: Combined provider responses had better Flesch Reading Ease scores compared to all combined chatbot responses (53.3 ± 13.3 vs 36.0 ± 11.6, P < 0.001) and combined brief chatbot responses (53.3 ± 13.3 vs 34.7 ± 12.8, P < 0.001). Empathy scores were higher in all combined chatbot than in those from combined providers (2.9 ± 0.8 vs 2.0 ± 0.9, P < 0.001). There were no statistically significant differences in accuracy between combined providers and all combined chatbot responses (4.3 ± 0.9 vs 4.5 ± 0.6, P = 0.170) or combined brief chatbot responses (4.3 ± 0.9 vs 4.6 ± 0.6, P = 0.128).

Conclusions: Amid the time constraints and complexities of plastic surgery decision making, our study underscores ChatGPT's potential to enhance patient communication. ChatGPT excels in empathy and accuracy, yet its readability presents limitations that should be addressed.

Objective: Utilizing biological scaffolds for cartilage tissue engineering is a promising tool for improving auricular reconstruction. Decellularized auricular scaffolds provide a means of regenerating cartilage for in vivo implantation, but identifying the ideal regenerative mix remains challenging.

Methods: Human cadaver auricular cartilage was decellularized and recellularized with either auricular chondrocytes alone, auricular chondrocytes with adipose-derived stem cells, or both cells with platelet-rich plasma. Confirmation of decellularization and recellularization was done by hematoxylin and eosin staining. Extracellular matrix preservation and production were determined by Masson's trichrome, Alcian blue, and Verhoeff-van Gieson staining. Collagen II assessments were made using immunohistochemistry.

Results: Decellularization of cadaver auricular cartilage was confirmed by the absence of cells, reduction in glycosaminoglycans, and the preservation of collagen and elastin. Recellularization was more efficient when chondrocytes were seeded with adipose-derived stem cells, which was enhanced by adding platelet-rich plasma. Coculture with platelet-rich plasma yielded better total collagen (56% increase) and glycosaminoglycan (47% increase) induction. Moreover, when platelet-rich plasma was added, collagen II induction was significantly increased (42%; P < 0.05).

Conclusion: We identified a regenerative protocol that included auricular chondrocytes, adipose-derived stem cells, and platelet-rich plasma, which stimulated chondrogenesis on decellularized auricular cartilage. This finding provides a model to explore cartilage formation and the potential for improving auricular and cartilage-based reconstruction.

Purpose: Estimating resection weight for patients undergoing reduction mammoplasty (RM) informs surgical planning and outcomes. Existing formulas have limitations that make insurance coverage and accurate surgical planning challenging. We identified the most commonly used scales to evaluate their accuracy in estimating resection weight by applying them to a database of patients to compare calculated and actual resection weights.

Methods: A database search was conducted using combinations of relevant terms. A regression analysis was conducted using formulas with strong R2 values (0.72-0.93) on a cohort of 1128 RM patients at a single institution.

Results: A total of 570 articles were identified. Fourteen manuscripts (n = 2232 patients [3320 breasts]) were ultimately included for review. Data on incisional patterns, pedicle supply, and breast measurements, such as sternal notch to nipple distance (n = 8 [57.1%]) or nipple to inframammary fold distance (n = 5 [35.7%]), were recorded. R2 values in our cohort (>500 g, n = 891; <500 g, n = 237) were calculated via regression analyses with five formulas: Appel (0.391 vs 0.146), Boukovalas (0.3552 vs 0.043), Descamps (0.391 vs 0.238), Eder (0.328 vs 0.114), and Kocak (0.3283 vs R2 indeterminate).

Conclusions: Our analysis suggests that formulas reporting strong R2 values may have resulted from tailoring to surgeons' technique. Variation between cohorts is inevitable; however, we expect reliable results given our large sample. It is reasonable to conclude that existing formulas are not accurate representations of resection weights and thus are unreliable for surgical planning.