Annals of Plastic Surgery最新文献

Abstract: To minimize confusion in description of the clinical examination of the patient with migraine/headaches and implement peripheral nerve concepts into the surgical approach to treating the patient with migraines, the historical origin of the phrase "trigger point" is explored. The symptoms of migraine/headache are due to stimulation of the cranial/peripheral nerve being interpreted as due to stimulation of the meningeal innervation. Use of the phrase "extraction of trigger points" is discouraged in favor of either neurolysis of a compressed nerve or resection of a neuroma, depending upon the peripheral nerve pathology.

Introduction: Detection of critical colonization is gaining importance in wound management, but its pathophysiology remains unclear. We previously clarified that a dysbiotic wound microbiota differing from skin commensal microbiota may be involved in critical colonization and that such wounds contain fewer Forkhead box protein P3 (FOXP3)-positive cells in the tissue. However, it is not clear whether FOXP3-positive cells contribute to the development of critical colonization. Here, we examined whether inhibition of FOXP3-positive cell could induce critical colonization when the commensal microbiota was present in the wounds.

Methods: Sprague-Dawley rats were administered FK506 or vehicle to inhibit differentiation into FOXP3-positive cells. Full-thickness wounds were made on the dorsal skin and inoculated with bacterial solution (dysbiosis group) or Luria-Bertani medium (commensal group). A bacterial solution was prepared by anaerobically culturing bacteria from the skin of donor rats on an artificial dermis in Luria-Bertani medium for 72 hours. Tissues were collected on day 4 postwounding for histological evaluation.

Results: After microbiota transplantation, excessive inflammation occurred in the FK506 + commensal group. In contrast, wounds with transplanted dysbiotic microbiota showed the same level of neutrophil infiltration, regardless of FK506 administration. Furthermore, the wound area was larger in the FK506 + commensal group than in the vehicle + commensal group on day 4 postwounding ( P = 0.01). This area was also significantly larger in both the vehicle + dysbiosis ( P = 0.01) and FK506 + dysbiosis groups ( P = 0.03) than in the vehicle + commensal group.

Conclusions: This study has shown that dysbiosis may be at least related to developing critical colonization, and the results suggest that FOXP3-positive cells are involved in this process. Our study may contribute to establishing new interventions that prevent critical colonization by correcting wound microbiota.

Introduction: Wide-awake and office-based hand surgeries are increasingly common. The association of these techniques with postoperative pain and pain control has garnered recent attention. A prior study demonstrated that office-based trigger finger release (TFR) were associated with decreased perioperative opioid prescriptions compared to those performed in the operating room. The current study provides an in-depth analysis of the association between surgical setting and perioperative opioid prescriptions for wide-awake TFR.

Methods: Patients undergoing TFR between 2010 and 2021 were identified in PearlDiver, a national administrative claims database. Exclusion criteria were age <18 years, <6 months of preoperative data, <1 month of postoperative data, bilateral TFR, and concomitant hand surgery. To identify wide-awake cases, patients with procedural codes for general anesthesia, monitored anesthesia care, sedation and regional blocks were excluded. Patients were stratified by surgical setting (office or operating room), then matched based on age, sex, Elixhauser Comorbidity Index score, and geographic region. Patients with prior opioid prescriptions, opioid dependence, opioid abuse, substance use disorder, chronic back/neck pain, generalized anxiety, and major depression were identified. Perioperative opioid prescriptions (those filled within 7 days before or 30 days after surgery) were characterized.

Results: There were 16,604 matched wide-awake TFR patients in each cohort. In the cohort of office-based patients, 4,993 (30%) filled a prescription for perioperative opioids, in contrast to 8,763 (53%) patients who underwent surgery in the operating room. This disparity was statistically significant in both univariate and multivariate analyses. Univariate analysis indicated that office-based surgeries were linked to lower morphine milligram equivalents (MME) in opioid prescriptions than those performed in operating rooms (median of 140 vs 150, respectively). However, multivariate analysis demonstrated that opioid prescriptions for office-based surgeries were actually associated with greater MME.

Conclusions: Patients undergoing office-based TFR were less likely to fill perioperative opioid prescriptions but were prescribed opioids with greater MME. In wide-awake TFR, it appears that a disparity may exist in patient and provider beliefs about postoperative pain control. Future patient- and provider-level investigations may produce insights into perceptions of postoperative pain and pain control, which may be useful for reducing opioid prescriptions across surgical settings.

Background: This study aimed to identify patient preferences and outcomes of chest masculinization surgery in patients identifying as nonbinary versus transgender (trans-) males.

Methods: Patients who underwent chest masculinization (2003-2022) were included. Demographics, medical comorbidities, surgical approaches, complications, secondary procedures, and BODY-Q chest module survey responses were compared between cohorts.

Results: Three hundred two patients were included. Thirteen percent identified as nonbinary and 87% as trans-male. The most common surgical approach in both groups was double incision with free nipple-areola graft (63% vs 71%, P = 0.33). Nonbinary patients more frequently opted for double incision without free nipple areola graft compared to trans-male patients (18% vs 2.7%, P < 0.001). Other unique surgical requests of nonbinary patients included nipple areola preservation and small breast mound preservation (5.2%) and balance between losing bulk and achieving a more androgynous appearance (5.3%). The survey response rate was 31% (93/302). Both groups reported improved quality of life postoperatively ( P = 0.16). Three nonbinary patients elected not to keep their nipple-areola complexes ( P = 0.005). Trans-male patients were more likely to report having a male chest as very important for their gender identity (82% vs 95%, P = 0.043). Nonbinary patients were less likely to prefer small nipples (82% vs 95%, P = 0.033) and 18% stated that they preferred no nipples (vs 2.7% trans-male patients, P < 0.001).

Conclusions: Nonbinary patients have distinct surgical preferences regarding nipple-areola complexes. Chest masculinization planning can differ for this group of patients compared to their trans-male counterparts.

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.

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.

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: Lipedema is a chronic fat disorder characterized by disproportionate fat deposition in the lower limbs, leading to pain, mobility issues and reduced health related quality of life (HRQoL).There is growing evidence that liposuction of the excess fat not only reduces soft tissue pain but also improves HRQoL. The published data, however, remain limited, and there are no studies of liposuction in the UK lipedema population. This study aimed to evaluate the effectiveness of liposuction on HRQoL and symptoms in UK lipedema patients using 2 HRQoL instruments and a Lipedema Symptom Scale.

Patient and methods: Lipedema patients undergoing liposuction between January 2016 and December 2021 completed Short-Form Health Survey (SF-36), World Health Organization Quality-of-Life Assessment (WHOQOL-BREF), and 17-question Lipedema Symptom Scale preoperatively and postoperatively. Paired t test was used to compare the preoperative and postoperative mean scores of the different domains of the SF-36 and WHOQOL-BREF and preoperative and postoperative mean scores for the lipedema symptom scale. Paired t test was also used to compare preoperative and postoperative SF-36 scores to age-matched normative data for the English population to assess the extent of HRQoL improvement relative to the general population.

Results: Seventy-six women were included in the study with a mean age of 46.4 ± 12 years. Mean follow-up (interval between first liposuction surgery and postoperative completion of the instruments) was 25.3 ± 23.2 months. There was significant improvement in all SF-36 and WHOQOL-BREF domains postoperatively (P < 0.001). Compared with age-matched normative data, postoperative SF-36 scores remained lower in physical functioning, social functioning, and general health. Postoperative results also showed a highly significant improvement (P < 0.001) across all 17 items of the Lipedema Symptom Scale.

Conclusion: This longitudinal study indicates liposuction is an effective treatment for improving HRQoL and symptoms in lipedema patients, although it may not completely restore HRQoL to normative levels. Limitations include potential selection bias, sampling bias, and the need for longer follow-up. The findings support liposuction as a first-line treatment for lipedema and could inform decision-making for both patients and policymakers.