Annals of Plastic Surgery最新文献

Background: Digital nerve injuries are the most prevalent form of peripheral nerve injuries. We aimed to conduct a systematic review and Bayesian network meta-analysis to determine the optimal technique for sensory restoration in patients undergoing digital nerve repair.

Methods: An electronic search was conducted from inception to September 2025. Thirteen studies were included comparing neurorrhaphy, allograft, autograft, and conduit. Outcomes analyzed included static 2-point discrimination (S2PD) and moving 2-point discrimination (M2PD), presented as mean difference (MD) with 95% confidence intervals (CIs) or as surface under the cumulative ranking curve (SUCRA) scores and mean rank estimates. Sensitivity analyses were also performed by excluding neurorrhaphy. A P value <0.05 was considered statistically significant.

Results: The pooled analysis demonstrated that allograft was the best technique for S2PD (SUCRA: 70.39, mean rank: 1.89), whereas neurorrhaphy ranked highest for M2PD (SUCRA: 70.71, mean rank: 1.88). Traditional meta-analysis also confirmed allograft's superiority for S2PD (MD = -1.44, 95% CI: -2.57 to -0.32; P = 0.01) and neurorrhaphy for M2PD (MD = -0.50, 95% CI: -0.87 to -0.13; P = 0.007). However, sensitivity analyses excluding neurorrhaphy demonstrated that allograft also ranked highest for M2PD (SUCRA: 69.91, mean rank: 1.60). Conduit repair was significantly worse than other techniques for both outcomes (S2PD : P = 0.002; M2PD : P = 0.004).

Conclusion: These findings highlight allograft as the most effective techniques for optimizing sensory recovery in digital nerve injuries, especially in cases where neurorrhaphy is not feasible.

Background: Sacral pressure ulcers present a major reconstructive challenge, especially in elderly and bedridden patients. Although negative pressure wound therapy (NPWT) has been widely used in wound management, its integration into surgical protocols for pressure ulcer closure is underreported in midlevel medical centers. We aimed to evaluate the safety, efficacy, and reproducibility of a streamlined surgical strategy for sacral pressure ulcers combining debridement, primary closure, and closed-incision-NPWT (CI-NPWT) and examine the outcomes in patients treated in 2 institutional settings with different resource levels.

Methods: This retrospective observational cohort study included 35 patients (median age, 76 years; 66% female) with stage III-IV sacral pressure ulcers who underwent surgical reconstruction using a standardized approach involving debridement, tension-reducing wound closure, and CI-NPWT. All procedures were performed by a single reconstructive surgeon at both a medical center and a regional hospital.

Results: Among the 35 patients, 33 were treated at the tertiary center and 2 at the regional hospital. The median wound size was 9 × 6 cm (range 3 × 5-13 × 12 cm). Most patients were elderly with multiple comorbidities. CI-NPWT effectively supported primary wound closure with no major complications. Minor wound-edge dehiscence occurred in a few patients and was managed conservatively. All wounds healed completely.

Conclusion: A simple and consistent surgical protocol combining primary closure with CI-NPWT is safe, effective, and reproducible in both medical center and regional hospital settings.

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: The primary aim of this study was to investigate the effects of Incisional Negative Pressure Wound Therapy (iNPWT) on surgical site complication rates for abdominal body contouring following bariatric surgery that resulted in massive weight loss.

Methods: A large 15-hospital retrospective case-control study was conducted. Inclusion criteria consisted of nonsmokers who achieved massive weight loss, defined as >100 lb or >50% excess body weight, and had an abdominal body contouring surgery between January 2021 and June 2024. We conducted separate unadjusted analyses comparing the iNPWT cohort to the control cohort using separate chi-square or Fisher exact tests for categorical variables, and independent samples t tests or Mann-Whitney rank sums tests for normally distributed and skewed continuous variables, respectively. Statistical significance was set to P = 0.05.

Results: Basic demographics were similar for a majority of the variables between the iNPWT cohort and the standard cohort. Minor wound complications following abdominal body contouring surgery did not significantly differ between the standard and iNPWT (40.54% vs 36.36%, P = 0.070) cohorts. However, among major wound complications, rates of wound dehiscence (22.97% vs 2.27%, P = 0.003) and infection (21.62% vs 6.82%, P = 0.040) were significantly lower in the iNPWT cohort. There was no significant difference in hematoma or seroma formation between the 2 groups.

Conclusion: Given the high volume of patients undergoing abdominal body contouring surgery following bariatric surgery, iNPWT dressings can provide plastic surgeons with an adjunct to further reduce the incidence of wound dehiscence and wound infection.

Background: Primary rhinoplasty (PR) to correct the cleft nasal deformity at the time of unilateral cleft lip repair seeks to achieve durable improvement of nasal symmetry and projection. However, neither the components of primary cleft rhinoplasty nor their expected outcomes are well-established. This study presents a component-based cleft rhinoplasty technique and compares immediate to intermediate-term results.

Methods: The following 6 components of cleft nasal deformity are addressed: absent (1) nasal floor and (2) nasal sill, (3) tethered and malrotated alar base, (4) deviated caudal septum, (5) dysmorphic alar rim, and (6) deficient tip. Technical maneuvers to counteract each component are presented. Subjects who underwent component PR between 2018 and 2024 were retrospectively reviewed. Anthropometric measurements on standardized 2D and 3D photographs preoperatively, immediately postoperatively, and 1 year postoperatively were compared.

Results: Complete photographic data were present for 29 subjects with unilateral cleft lip and nasal deformity. Symmetry from preoperatively to immediately postoperatively increased for most measures, including nostril width (1.95 ± 0.63 vs 0.95 ± 0.15), nasal base width (1.75 ± 0.50 vs 0.99 ± 0.14), columellar height (0.77 ± 0.20 vs 1.13 ± 0.27), and alar height (0.82 ± 0.17 vs 1.02 ± 0.16; each P < 0.05). Columellar deviation angle similarly decreased (14.09°± 7.7° vs 6.3°±2.3°, P < 0.05). Each of these measures remains significantly improved from preoperatively to 1 year postoperatively. However, from immediately to 1 year postoperatively, multiple anthropometric measures of symmetry showed recapitulation toward the original deformity, including: nostril width (0.95 ± 0.15 vs 1.15 ± 0.23), nasal base width (0.99 ± 0.14 vs 1.16 ± 0.22), columellar height (1.13 ± 0.27 vs 0.91 ± 0.17), and alar height (1.02 ± 0.16 vs 0.88 ± 0.07; each P < 0.05).

Conclusions: Component PR improves symmetry in the immediate and extended postoperative period. However, multiple measures, including alar and columellar height as well as nasal base and nostril width all show approximately 20% relapse over the first year postoperatively. Overcorrection by approximately 20% may therefore be beneficial to optimize long-term symmetry.

Background: Radiation therapy following surgical excision is an effective strategy for recurrent keloids in adults. However, concerns about radiation-induced malignancy in children have limited its use and study in younger populations. This study aimed to assess clinical outcomes of postoperative radiation for recurrent pediatric keloids through a pooled literature analysis and review of our institutional experience.

Methods: A retrospective review was conducted of all pediatric patients treated at the Children's Hospital of Philadelphia from 2000 to 2024 who underwent reexcision followed by postoperative radiation for recurrent keloids. Recurrence was defined as clinical evidence of regrowth beyond scar borders. A systematic review was also performed in March 2025 in accordance with PRISMA guidelines, using terms related to "keloid," "radiation," and "pediatric." Studies' eligibility criteria were assessed for quality using the Oxford Levels of Evidence.

Results: Five published studies and 1 institutional series comprising 60 patients and 85 keloids were included (mean age, 14.4 ± 3.5 years). Most lesions were on the earlobes (38.3%). Brachytherapy (53.3%) and external beam radiation (46.7%), most commonly at 12 Gy in 3 fractions, were the primary modalities, typically delivered within 24 hours postoperatively. Adjunctive treatments included corticosteroids (21.7%) and compression therapy (20.0%). Overall recurrence was 22.4%. Hyperpigmentation (53.3%) and transient pruritus (15.0%) were common side effects. No cases of secondary malignancy or growth disturbance were observed (mean follow-up, 32.3 ± 24.0 months).

Conclusion: Postoperative radiation following reexcision may serve as an effective treatment for recurrent pediatric keloids. Further long-term prospective studies are warranted to evaluate durability and oncologic safety in the long term.

Background: Age-related physiological changes may influence surgical outcomes following breast reduction. This study investigates the association between patient age and postoperative complications using a large institutional cohort.

Methods: We retrospectively reviewed 985 patients who underwent bilateral reduction mammaplasty between 2002 and 2024 by a single surgeon. Patients were stratified by age into 3 groups: <31, 31 to 50, and >50 years. Baseline demographics, comorbidities, surgical techniques, and complication rates were analyzed. Univariable and multivariable logistic regression was used to assess associations between age and minor and major complications, adjusting for diabetes, hypertension, smoking history, and prior radiation.

Results: Our patient cohort's mean age was 39.3 (13-76) years. A total of 276 (28.0%) had either a minor or major complication. The minor complications across the cohort (154) included seroma, skin necrosis, delayed wound healing, infection, nipple necrosis, hematoma, and fat necrosis. Major complications (122) included cases requiring readmission and/or reoperation. Patients in the 31- to 50-year age group were more likely to have a minor complication (17.9%) compared to those in the <31-year age group (13.1%) (P = 0.05). Patients aged 31 to 50 years (13.0%) and >50 years (18.7%) were more likely to develop major complications than those aged <31 years (6.56%) (P < 0.05 and P = 0.0001, respectively). The >50-year age group was more likely to be readmitted (7.4% vs 1.3%, P = 0.05) and reoperated (11.3% vs 5.3%, P < 0.05) compared to the <31-year age group. However, no statistically significant relationship was found with minor or major complication rates in senior groups with age ≥ 60 years. In adjusted models, age was not an independent predictor of minor or major complications; instead, diabetes (minor; odds ratio, 1.80; 95% confidence interval, 1.04-3.07; P = 0.03) and smoking (major; odds ratio, 2.16; 95% confidence interval, 1.12-3.98; P = 0.02) were associated with increased risk.

Conclusion: Older patients show higher unadjusted morbidity after reduction mammaplasty, but age itself is not an independent risk factor once comorbidities are considered. Preoperative counseling and optimization should prioritize diabetes, hypertension, and smoking over rigid age thresholds.

Background: The quantification of phantom limb pain (PLP) is challenging due to the heterogeneity of patient experiences. This study evaluated the use period prevalence questionnaires in assessing PLP in patients with lower limb osseointegrated implant (OI) prostheses.

Methods: The study included patients who received single-stage lower limb OI prostheses at our institution. Period prevalence questionnaires included questions regarding frequency and duration of PLP prior to OI implantation and in the last year postoperatively. The frequency of PLP was assessed by asking participants how often they experienced PLP pain. The duration of each episode was evaluated by asking how long the PLP pain lasted. Nerve reconstruction procedures included targeted muscle reinnervation (TMR) or combined TMRpni.

Results: A total of 11 patients completed the questionnaire (7 transtibial and 4 transfemoral). The median age was 52 years, and the median BMI was 29.7 kg/m2. Of the 11 patients, 8 underwent nerve reconstruction (72%): 5 with combined TMRpni and 2 with TMR. Six patients reported a reduction of PLP episodes (54%), whereas the remaining 5 patients experienced the same frequency of PLP. Statistical analysis revealed a significant reduction in PLP frequency from preop to postoperative time points (median, 4 vs 3; P = 0.016). For PLP duration, 5 patients reported shorter episodes (45.5%), 5 patients reported the same duration (45.5%), and 1 patient experienced a longer duration (9%). There was no significant difference in duration between preoperative and postoperative assessments. When examining the total scores, there was a significant reduction of PLP from preoperative to postoperative time points (median, 6 vs 5; P = 0.048).

Conclusions: We introduced a novel method to assess PLP using period prevalence instead of pain intensity. OI prostheses, with or without nerve reconstruction, significantly reduced PLP frequency and combined frequency-duration measures. Future work will validate the period prevalence survey against established PLP instruments.

Introduction: Medical tourism, commonly defined as the practice of traveling to another country for medical care, has increased in popularity over the past decade, particularly in aesthetic surgery where high costs lead patients to seek cheaper options abroad. Although patients may save money, inherent risks to medical tourism include truncated postoperative care and limited ability to evaluate providers. When complications arise, patients present to local institutions rather than to their original surgeons. Although literature describes complications from international tourism, less is known about domestic tourism. Although domestic centers may seem safer, medical tourists still face limitations that may affect the quality of their care. We hypothesize that similar limitations are present in both international and domestic medical tourism.

Methods: We performed a retrospective review of patients presenting to our institution for treatment from May 2015 to November 2025 with complications after elective aesthetic surgery. Patients were classified as international tourists if the surgery occurred outside the borders of the United States and domestic if travel was ≥200 miles away but within the United States. Data evaluated included demographics, procedure details, duration of stay, time to presentation, complications, and treatment.

Results: Forty-one patients met the inclusion criteria: 22 (56%) had surgeries domestically and 19 (46%) internationally. Miami and the Dominican Republic were the most common destinations. Domestic patients returned home sooner (5.9 vs 13.9 days, P < 0.05) and presented with complications earlier (18 vs 44 days, P < 0.05). No significant differences were found in procedures, complication type, or need for surgical treatment. Patients who stayed at their operative location ≤5 days postoperative were more likely to require inpatient admission (88.9% vs 36.4%, P < 0.05) and IV antibiotics (88.9% vs 27.3%, P < 0.05), regardless of if they traveled to domestic or international destinations.

Conclusion: Length of postoperative stay after medical tourism is correlated to a greater degree with complications requiring inpatient admission than surgical destination itself. Domestic tourism, often assumed to be safer than international, may carry similar risks, particularly if proper follow-up is lacking.