Annals of Plastic Surgery最新文献

Objective: Breast implant associated anaplastic large cell lymphoma with a single T cell clone is an uncommon complication especially related to implants with a textured surface. Moreover, there are few reports of breast implant-associated Epstein-Barr virus-positive diffuse large B-cell lymphoma (BIA-EBV-positive DLBCL), which typically presents unilaterally. Here, we present a case of bilateral BIA-EBV-positive DLBCL.

Patient: A 79-year-old woman who underwent breast implantation 40 years prior presented with unilateral capsular contracture. However, after bilateral total capsulectomy, the final diagnosis was bilateral BIA-EBV-positive DLBCL. The tumor cells found in the intracapsular effusion and fibrin tissue covering the luminal side of the capsule were positive for LCA, CD20, CD79a, CD30, BCL2, MUM1, and PD-L1 according to immunohistochemical staining, and EBER in situ hybridization revealed a high Ki67 index (60%-70%). The patient was disease free during the postoperative follow-up period of 43 months.

Conclusions: Latent EBV infection plays an important pathogenic role, contributing to the indolent nature and restrictive proliferation of such cases, which are currently classified as fibrin-associated DLBCL. We aim to highlight the reasons for the delayed diagnosis of the disease, the possible pathologic findings on the contralateral side, and the potential need for prophylactic bilateral total capsulectomy. We also reviewed reported cases of BIA-EBV-positive DLBCL to gain a better understanding of its incidence, risk factors, diagnostic tools, pathogenesis, and prognosis.

Background: Bilateral reduction mammaplasty is a common surgical procedure aimed at alleviating the physical and psychological burdens of macromastia. However, disparities in access and outcomes persist, influenced by racial, socioeconomic, and geographic factors. This systematic review synthesizes current literature on these disparities to inform future research and policy.

Methods: We conducted a comprehensive search of PubMed, Embase, and Scopus databases for studies published up to June 2024. Inclusion criteria focused on peer-reviewed studies addressing disparities in bilateral reduction mammaplasty. Data were extracted regarding study design, population, and key findings, with an emphasis on racial, socioeconomic, and geographic disparities.

Results: A total of 11 studies, encompassing 24,812 patients, were included. Findings indicate significant racial disparities, with Black and Hispanic patients more likely to undergo surgery yet facing greater barriers and complications. Socioeconomic factors revealed that higher income and private insurance correlate with increased access, whereas Medicaid patients encountered higher denial rates. Geographic disparities highlighted variations in access based on local funding criteria and healthcare infrastructure. Despite these challenges, all studies reported significant improvements in quality of life post-surgery.

Conclusion: This review underscores the multifaceted nature of disparities in bilateral reduction mammaplasty. Addressing these inequities requires targeted interventions and policy reforms to improve access and outcomes for all patients, ensuring equitable healthcare delivery.

Abstract: Chronic graft-versus-host disease (cGVHD) of the skin represents a complex immunopathologic process triggered by donor-derived immune cells following allogeneic hematopoietic stem cell transplantation (HSCT). While traditionally understood through the lens of alloimmune activation and fibrotic remodeling, emerging evidence highlights the role of microbial dysbiosis-particularly in the skin microbiome-as both a contributor to and a consequence of disease progression. This review explores the evolving understanding of the microbiome-immune interface in cutaneous GVHD, focusing on how shifts in microbial composition, such as the loss of Staphylococcus epidermidis and the overgrowth of S. aureus, may impair barrier function, promote local immune activation, and potentiate systemic inflammation. Disruption of commensal-derived signals leads to reduced antimicrobial peptide production, diminished regulatory T cell activity, and proinflammatory T cell polarization, all of which contribute to immune-mediated skin damage. A self-reinforcing cycle of barrier dysfunction and microbial imbalance emerges, suggesting new avenues for intervention. We discuss microbiome-targeted therapies including donor-derived skin allografting as potential strategies to restore microbial equilibrium and mitigate inflammation. Additionally, we highlight the diagnostic potential of skin microbiome profiling as a biomarker for disease activity and treatment response. Understanding the bidirectional interactions between the microbiome and immune system may offer novel therapeutic and prognostic tools for managing cutaneous cGVHD.

Background: Burn reconstruction restores function and appearance after initial burn treatment, yet these interventions may remain underutilized due to fragmented care systems and inadequate follow-up. National datasets and procedural coding systems often fail to capture the scope of secondary reconstruction, limiting insights into long-term care needs. Therefore, this prospective analysis employs a prospective registry to track the volume, procedural patterns, and care settings of secondary burn reconstruction to create a basis of practice development of reconstructive burn surgery within a burn unit practice.

Methods: A prospective registry was implemented from January 2023 to December 2024 to track secondary burn reconstruction procedures. Data collected included procedural type, timing from initial injury, original total body surface area burned, and the types of healthcare systems in which the procedures were performed. Registry data were compared to institutional acute burn care data from 2023 and 2024 to contextualize reconstructive volume and demographics.

Results: From 2023 to 2024, 353 reconstructive cases were identified. Laser scar revision was the most common procedure (50.4% in 2023; 44.7% in 2024). Most patients had initially minor injuries (<10% total body surface area). Average time to reconstruction was 319 days (2023) and 425 days (2024). Cases were performed across diverse settings, including rural hospitals (12-18%) and outpatient clinics (0.5-5%). The registry provided detailed procedural data not available in administrative datasets.

Conclusions: This prospective burn reconstruction registry identified a number of reconstructive burn cases performed in the initial years of focus on the burn patient population. The characteristics of these patients create a basis for concentration on increased patient recruitment, faster time to reconstruction, and better analysis of indications and outcomes.

Abstract: Immediate lymphatic reconstruction (ILR), originally described as the lymphatic microsurgical preventative healing approach (LYMPHA), reduces the risk of developing lymphedema secondary to breast cancer treatment. ILR involves the intussusception of arm lymphatic channels into a vein draining centrally. However, performing this technique in a deep surgical field is technically challenging. We introduce a technical modification to ILR by repurposing a pulmonary wire to facilitate the intussusception technique. Intraoperatively, fluorescein isothiocyanate (FITC) was injected into the first and forth webspaces on the dorsum of the hand and the volar wrist. A vein graft was harvested from the lower leg during the axillary lymph node dissection. The accessory branch of the axillary vein was isolated. Lymphatic channels were identified under a 560-nm filter in the axillary bed. The largest-diameter channel was selected and isolated. An anastomosis was performed between the vein graft and targeted lymphatic channel utilizing the intussusception technique. A mini-forceps was passed retrograde through the vein graft to grasp the lymphatic channel. The channel was then intussuscepted into the vein graft and released. The vein graft was sutured to the surrounding peri-lymphatic fat using 8-0 sutures. Lymphatic flow from the proximal end of the vein graft was confirmed with FITC imaging. The vein graft was then anastomosed to the accessory vein using a coupler device. Patency was confirmed by visualizing FITC dye crossing the anastomosis and filling the recipient vein. Use of mini-forceps in ILR improves lymphatic channel manipulation in a deep surgical field and eliminates the U-Stitch.

Background: Fat grafting is commonly utilized to enhance outcomes in breast reconstruction. Despite their routine implementation, perioperative antibiotics lack sufficient evidence in reducing rates of surgical site infection (SSI). Leveraging the largest patient cohort to date, this study examines the association between perioperative antibiotics and SSI after fat grafting for breast reconstruction.

Methods: The Epic Cosmos database (Verona, Wisconsin) was queried for patients who underwent fat grafting within one year following either implant-based or autologous breast reconstruction from January 2017 to January 2025. SSIs within 30 days were identified using either International Classification of Diseases (ICD) codes or identification of a new antibiotic prescription starting >7 days post-surgery. Perioperative antibiotics, age, body mass index (BMI), diabetes, smoking status, intraoperative intravenous antibiotics, and volume of fat grafted were included for multivariable regression.

Results: We analyzed 12,247 fat grafting procedures (8416 implant-based, 3831 autologous). In the implant-based cohort, perioperative antibiotics (OR, 1.21; P = 0.031), diabetes (OR, 1.65; P < 0.0001), higher BMI (OR, 1.02; P = 0.001), and younger age (OR, 0.99; P = 0.021) were significant risk factors for infection, defined by additional postoperative antibiotic prescriptions. For infections defined by ICD codes, only BMI was significantly associated with SSI (OR, 1.04; P = 0.001). In the autologous cohort, diabetes was the only significant risk factor for SSI (OR, 1.3; P = 0.033).

Conclusion: Perioperative antibiotic prescriptions do not decrease SSI after fat grafting in either implant or autologous breast reconstruction patients. However, they are associated with increased additional postoperative antibiotic prescriptions in implant-based breast reconstruction patients. These data suggest reconsidering routine perioperative antibiotic prophylaxis and focusing on patient-specific risk factors.

Introduction: Dercum's disease (DD) is a rare connective tissue disorder characterized by multiple painful progressive adipose deposits. No definitive treatment for DD exists; therefore, the purpose of this study was to aggregate the current treatment options and outcomes in the literature to guide clinical decision-making regarding intervention.

Methods: A comprehensive search was conducted across the selected databases, PubMed, Web of Science, and clinicaltrials.gov , for studies including at least 3 patients with DD without concurrent lipedema. Given the rarity of the pathology, descriptive analysis was primarily utilized if there were no homogenous endpoints.

Results: A total of 837 studies were extracted from the databases, of which 10 met the inclusion criteria. The majority of studied interventions included liposuction (4 studies), followed by dermolipectomy, transcutaneous electrical stimulation, cyclic pneumatic compression, and injections with either Tapencarium (RZL-012) or deoxycholic acid, and prostigmine and aminoacetic acid. One hundred ninety patients underwent these intervention types, of which 95.3% were female, with a mean age of 51.7 years and an average body mass index of 34.0 kg/m 2 . Four intervention types (liposuction, pneumatic compression, dermolipectomy, and electrical stimulation) included pain assessments utilizing a visual analog scale. All interventions demonstrated a decrease in pain scores, although the effect of electrical stimulation did not reach significance. Of the 2 studies assessing liposuction, there were significantly decreased visual analog scale scores at the following time points: 3 and 6 months, and 3 and 5 years, with nonsignificant reductions at 1 and 2 years.

Conclusion: Dercum's disease is a rare pathology that continues to cause pain and distress in a primarily middle-aged, obese female population. Our systematic review calls for further investigation for optimal management of an often debilitating disease.

Background: Since the first facial vascularized composite allotransplantation (fVCA) performed in France in 2005, the procedural, ethical, and legal structures regarding donor procurement and institutions have significantly evolved. Initially developed by local institutions that were pioneering the procedure, the regulations progressively became more standardized with national oversight. This study reviews the global evolution of bodies governing face transplant regulation and procurement process, highlighting a shift toward more formalization and national standards through 3 distinct eras.

Methods: A review of publicly available literature was conducted to identify all face transplant procedures performed worldwide from 2005 to 2023. Each documented procedure was classified based on the level of local, regional, and national institutions involvement. Information on the procedure approval, ethics approval, consent models, and fVCA procurement was analyzed.

Results: Forty-eight face transplants across 11 countries were identified. Pioneering procedures (2005-2008) were approved mostly by local or university committees. Between 2008 and 2014, although more and more national entities were participating in protocol approval and donor allocation, VCA-specific policies remained limited. Finally, since 2014, we noted the trend toward national standardization with an important shift marked by the United States, the country executing most face transplant procedures around the world, incorporating face transplantation within formal national frameworks.

Conclusion: The evolution of fVCA governance from locally governed and experimental surgeries toward nationally standardized frameworks demonstrates the field's growth into a viable therapeutic option, which will continue to play a key role in promoting safety, patient education, and long-term success in fVCA.