Annals of Plastic Surgery最新文献

Introduction: Giant basal cell carcinoma (GBCC) is a rare and aggressive subtype of basal cell carcinoma (BCC), characterized by a diameter of ≥5 cm and a potential for deep tissue invasion. This study aimed to present our experience with the surgical management of GBCC in the maxillofacial region, focusing on resection and immediate reconstruction strategies.

Methods: We conducted a retrospective analysis of 5926 patients with BCC in the maxillofacial region from 2010 to 2020, with a specific emphasis on 32 patients diagnosed with GBCC. Associations between patient and tumor characteristics were analyzed, treatment approaches evaluated, and clinical outcomes assessed.

Results: The cohort comprised 20 males (62.5%) and 12 females (37.5%) ( P > 0.05), with a median age of 71 years (range: 40-86 years). The median time from tumor onset to presentation was 4 years (range: 2-7 years). A total of 24 GBCCs (75%) developed de novo, whereas 8 (25%) were recurrent BCCs ( P < 0.05). The median tumor diameter was 8 cm (range: 5-15 cm), with local invasiveness extending to cartilage in 31.25% of cases, facial muscles in 29.41%, neural tissues in 21.87%, and bone in 18.75%. Surgical resections included orbital exenteration (3 cases, 9.38%), total parotidectomy (2 cases, 6.25%), partial maxillectomy (2 cases, 6.25%), frontal craniofacial resection (2 cases, 6.25%), partial petrosectomy with mastoidectomy (1 case, 3.13%), and near-total rhinectomy (1 case, 3.13%). For reconstruction, a skin graft was used in 3 patients (9.38%), local skin flaps in 15 (46.88%), locoregional flaps in 10 (31.25%), and free flaps in 4 (12.5%). The 5-year overall survival, disease-free survival, and disease-specific survival for the cohort were 87.5%, 93.75%, and 96.88%, respectively.

Conclusions: Our findings suggest that a single-stage procedure featuring aggressive surgical resection and reconstruction achieves low complication rates, excellent oncologic control, and acceptable cosmetic outcomes.

Introduction: Soft tissue reconstruction in the distal lower extremities is challenging because of the inherent vulnerability of tendons, bones, and implants to being easily exposed, and scanty local tissue makes it more complicated. Local flaps that avoid the donor-site morbidity and the need of microsurgery gain popularity among the treatment choices. This study aims to compare the outcomes of 2 common local flaps: adipofascial flaps and muscle flaps in distal lower leg reconstruction.

Materials and methods: From November 2019 to November 2023, the patients with distal lower leg defects undergoing perforator-based adipofascial flaps or muscle flaps were included and reviewed. The patient demographics, injury characteristics, outcomes, and complications were evaluated.

Results: A total of 32 patients were included in the study of which, 17 received perforator-based adipofascial flaps, and 15 received muscle flaps. The backgrounds of the 2 groups were similar, except that the patients in the adipofascial flap group were older and had more comorbidities. All flaps survived except for one muscle flap that failed. The flap survival, infection rates, and donor-site complications were comparable in both groups; however, the adipofascial flap group had less daily drainage volume and seemed to have a shorter hospital stay, although the difference was not significant (8.06 ± 3.33 days vs 11.93 ± 7.63 days, P = 0.085).

Conclusions: For distal lower leg reconstruction, the adipofascial flaps are comparable to the muscle flaps but avoid the functional impairment. If available, the adipofascial flap can be considered as a prior treatment option, even for patients with implant exposure.

Abstract: We aimed to evaluate the feasibility and effectiveness of customized 3-dimensional (3D)-printed finger splints in the treatment of mallet fingers. We categorized 21 patients into those who received the traditional finger splint (group A) and those treated with a customized 3D-printed finger splint (group B). We retrospectively analyzed the functional outcomes and patient satisfaction in the 2 groups. During the follow-up period, 3 patients in group A failed treatment, of which 2 underwent extended immobilization and one 1 transferred to surgery. All 3 patents in group B who failed treatment received extended immobilization and did not require transfer to surgery. In patient satisfaction assessments, group B patients scored better in dimension and comfort than did group A patients. Customized 3D-printed finger splints provided a more comfortable and fitting treatment option for mallet finger. Although they did not result in a significant difference in treatment success rate, these splints significantly improved patient compliance with treatment and wearing.

Background: Rates of recurrence, metastases, and mortality for squamous cell carcinoma (SCC) of the upper limb have not been clearly defined.

Objective: We aimed to characterize these tumors and assess the long-term outcomes, comparing with current literature.

Methods and materials: A retrospective review was performed on 100 consecutive primary cutaneous upper limb SCCs managed surgically by a single hand surgeon between 2012 and 2019. Data collection included patient demographics and tumor factors from the electronic patient records.

Results: One hundred SCCs were identified in 93 patients. Sixty-six percent of patients were male, and the median age was 80 years. Median follow-up was 25 months. Ninety-seven percent of cases were completely excised. The local recurrence rate was 1%, 2% presented with metastases, 4% developed metastases during follow-up, and the mortality related to SCC was 3% with a 33% overall mortality rate.

Conclusions: SCCs of the upper limb behave in a similar manner to those located elsewhere. The local recurrence, metastases, and mortality rates were all low, as such the majority of upper limb SCCs can be managed effectively with a single, low morbidity procedure.Deep margin clearance can be particularly challenging to achieve and an acceptable margin should be considered on an individual basis.

Background: Diabetic foot ulcer (DFU) is one of the most dreaded complications of diabetes mellitus and is associated with a high risk of lower limb amputation and mortality. Because the efficacy of conventional treatments for DFUs is often limited, regenerative medicine therapy, such as growth factors and stem cells, may provide a solution to chronic wound healing. In this study, we compared several kinds of regenerative therapy for treating DFUs in terms of efficacy.

Methods: We systemically searched relevant studies on PubMed, Cochrane Library, and EMBASE. Randomized clinical trials on conventional treatment combined with platelet-rich plasma (PRP), epidermal growth factor (EGF), or stem cell therapy, compared with conventional treatment alone in patients with DFUs, were included in this study.

Results: A total of 1454 patients from 23 randomized controlled trials (RCTs) were included in the network meta-analysis. In terms of the number of completely healed ulcers, no significant difference was noted between PRP, stem cell therapy, and EGF group. We also performed surface under the cumulative ranking curve analyses to predict the rank of each intervention by the number of completely healed ulcers. The predicted ranking was as follows: stem cell, PRP, EGF, and the control group (conventional treatment alone). Furthermore, when we compared the mean of the wound healing time of DFUs among these four interventions, we found that the PRP group achieved significantly earlier ulcer healing than the stem cell, EGF, and control groups. No significant difference was observed in the time needed for wound healing between the stem cell and EGF groups. Funnel plot analysis demonstrated no publication bias.

Conclusions: PRP combined with conventional treatment significantly accelerates wound healing for DFUs. The mean wound healing time was similar between the stem cell and EGF groups. However, additional reviews of rigorous, large, well-designed RCTs are warranted for further validation of our findings.

Background: Surgery plus radiotherapy is associated with fewer recurrences after keloid treatment. However, the side effects of radiotherapy are of concern. Superficial radiation therapy has a low energy, targets the skin, and spares deeper structures, making it ideal for keloid treatment. Many studies have reported good outcomes after surgery combined with superficial radiation therapy. This study provided data on Taiwanese patients who underwent keloid excision with simple primary closure and superficial radiation therapy.

Methods: We retrospectively collected data from patients who underwent keloid excision with postoperative radiotherapy at our hospital. All patients underwent keloid excision and primary wound closure without Z-plasty or a local flap. Subsequently, patients underwent 2 or 3 fractions of superficial radiation therapy (SRT) on postoperative days 0, 1, and 2 (in 3 fractions). We collected data on the patients' preoperative Vancouver Scar Scale (VSS), 2-month follow-up VSS score, recurrence, and side effects.

Results: In total, 16 keloids in 12 patients were treated with excision, primary closure, and superficial radiation therapy. The mean preoperative VSS was 8.69 ± 1.79, whereas the mean 2-month postoperative VSS was 3.56 ± 0.70. Most of the keloids were followed up for more than 6 months. No keloid recurrence was observed. A side effect of radiotherapy is hyperpigmentation of the skin surrounding the surgical scar.

Conclusions: Keloid excision with primary closure combined with postoperative SRT leads to a good outcome with no recurrence and a shorter incision wound that satisfies patients and reduces the complications of hyperpigmentation.

Introduction: Soft tissue defects in the distal limbs are common after traumatic injury. Repairing such defects is challenging because of the lack of adjacent soft tissue for direct closure or use of a local flap, and functional and aesthetic issues are more prominent in the hands and feet. Thin, unbulky free tissue transfer is ideal for achieving functional and aesthetically pleasing reconstructions. This study reports the use of free superficial circumflex iliac artery perforator (SCIP) flap to reconstruct posttraumatic distal limb defect.

Patients and methods: Thirteen patients with distal limb defects following traumatic injury underwent microsurgical reconstruction with SCIP flap between 2017 and 2022. The defects were located in the upper extremities in 8 patients and lower extremities in 5 patients. Flap thinning was performed to minimize bulkiness, thus restoring functionality and an aesthetically satisfactory appearance.

Results: The patients' average age was 39.8 ± 15.3 years. The average flap size was 13.5 ± 3.4 × 6.7 ± 1.5 cm, and the average pedicle length was 5.2 ± 1.3 cm. Two flaps failed because of unsalvageable venous thrombosis, whereas 2 flaps had salvageable vessel thrombosis. Other flaps survived without major complications. During the average follow-up duration of 7.4± 4.8 months, the functional and aesthetic outcomes were satisfactory after an average of 1 ± 1.2 times of flap revisions.

Conclusions: With a thin skin paddle, SCIP flap is an available option for posttraumatic distal limb defect reconstruction without much effort of further revisions.

Background: Repair of the abdominal fascia at the time of abdominoplasty is a valuable method to improve the contour of the abdomen. However, this maneuver has been linked to an increased risk of venous thromboembolism (VTE). This review was undertaken to evaluate the evidence.

Methods: An electronic literature review was conducted to identify publications on the subject of abdominal fascial repair during abdominoplasty and VTE risk. Key words included abdominoplasty, fascial plication, intra-abdominal pressure, and venous thrombosis.

Results: Three large clinical studies were identified. One retrospective study using matched comparisons reported nearly identical VTE rates for patients treated with and without abdominal fascial plication (1.5% vs 1.7%). Another retrospective study reported significantly more VTEs (2.3%) in abdominoplasty patients undergoing fascial repair compared with panniculectomy patients who did not undergo fascial plication (0.36%). The author also recommended a modified Caprini score, adding fascial repair as a risk factor. Only 1 prospective study reported a large number of consecutive plastic surgery outpatients evaluated with Doppler ultrasound. This group included 188 abdominoplasty patients, all treated with fascial plication and without muscle paralysis. Only 1 VTE was diagnosed on the day after abdominoplasty (0.5%).

Discussion: Retrospective studies are susceptible to confounders and confirmation bias. Caprini scores do not have a scientific foundation. Chemoprophylaxis increases the risk of bleeding without reducing the risk of VTE.

Conclusions: The best available evidence supports performing a fascial repair. An effective and safe alternative to Caprini scores and chemoprophylaxis is avoidance of muscle paralysis and early detection of VTEs using ultrasound screening.