Annals of Plastic Surgery最新文献

Background: The bradykinin B2 receptor (B2R), a type of G protein-coupled receptor, exerts several beneficial biological effects on flaps. Accordingly, we investigated the role of the bradykinin B2R in the survival of perforator flaps.

Methods: In this study, a total of 50 male Sprague-Dawley rats were allocated equally into 2 groups: one receiving a bradykinin B2R blocker and the other serving as a control, with both groups undergoing flap procedures. Flap viability was assessed 7 days postoperatively by quantifying the surviving flap area. Blood perfusion within the flap was evaluated using laser Doppler imaging. The levels of Beclin-1, p62, and LC3-II/I were used to assess autophagy. The extent of flap angiogenesis was evaluated using immunohistochemistry and hematoxylin and eosin staining. Western blotting revealed the expression levels of vascular endothelial growth factor (VEGF) and the apoptotic index. Moreover, superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were used to evaluate oxidative stress. This study used a nitric oxide (NO) assay kit to determine NO production.

Results: The bradykinin B2R blocker group exhibited significantly reduced flap survival areas (blocker group: 64.7 ± 3.36%; control group: 85.6 ± 3.35%; P < 0.01), diminished blood perfusion (blocker group: 389.8 ± 7.92; control group: 491.8 ± 5.81; P < 0.05), and decreased neovascularization (blocker group: 20.13 ± 1.58; control group: 52.17 ± 1.49; P < 0.05). Compared to the control group, the bradykinin B2R blocker group also demonstrated lower SOD activity, NO content, and VEGF expression, and increased MDA levels (all P < 0.05). Rats treated with the bradykinin B2R blocker exhibited higher levels of autophagy and apoptosis than those observed in the control group.

Conclusion: According to our research, the bradykinin B2R protects multiterritory perforator flaps through diverse molecular pathways, which involve inhibiting apoptosis, combating oxidation, modulating autophagy, and fostering angiogenesis to improve the blood supply to the flap.

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: 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.

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.

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.