Annals of Plastic Surgery最新文献

Background: In 2019, the "Facts on Hand" direct-to-consumer advertising (DTCA) campaign, featuring former NFL quarterback John Elway, was launched to raise awareness of Dupuytren's contracture (DC) and its nonsurgical treatment options. Although DTCA has been shown to influence health care behavior in other specialties, its impact on treatment patterns for hand conditions remains unclear.

Methods: Google Trends was used to examine the influence of direct-to-consumer advertising (DTCA) on Internet-based information-seeking behavior related to DC. Changes in the proportion of surgical and nonsurgical management of DC were evaluated using 2016-2021 Medicare provider billing claims.

Results: Search interest in DC peaked during the campaign period, with breakout-level increases (>5000%) for terms such as "John Elway," "needle aponeurotomy," and "hand surgeon near me." Medicare data revealed regionally significant increases in CCH utilization, particularly in the Midwest (+10%) and Northeast (+5%), with corresponding declines in fasciectomy. Regional overlap between increased search activity and shifts in treatment patterns suggests a geographically reinforced campaign effect.

Conclusion: The "Facts on Hand" campaign was associated with increased public interest in DC and coincided with regionally specific shifts in treatment utilization. Although the campaign emphasized a nonsurgical option, breakout searches for terms such as "hand surgeon near me" and "Dupuytren's surgery" suggest that treatment-specific advertising may have encouraged broader engagement with treatment overall. These findings highlight the potential for DTCA to not only raise awareness of the condition itself but also prompt patients to seek specialist care.

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: High-voltage electrical burns of the extremities often result in deep tissue destruction with exposure of vital structures, necessitating free flap reconstruction. However, the optimal timing for reconstruction remains uncertain, particularly in the presence of evolving tissue viability.

Methods: This retrospective study included 23 patients with full-thickness high-voltage electrical burns involving the extremities who underwent free flap reconstruction. Patients were divided into two groups based on timing of flap coverage: early (<21 days) and delayed (>21 days, after at least 2 debridements). Outcomes assessed included flap survival, complications, reexploration rate, operative time, and hospital stay.

Results: The cohort was predominantly male (male-to-female ratio of 10:1) with an age range of 15 to 60 years. The upper limb was involved in 16 patients; and the lower limb, in 7. The overall flap survival rate was 87% (20/23). Flap failure occurred in 1 of 6 early cases and 2 of 17 delayed cases ( P = 1.00). Complications were more common in the early group (66.7%) compared to the delayed group (47.1%) but were not statistically significant ( P = 0.34). Four flaps required reexploration, with one successfully salvaged. Operative time and hospital stay were slightly longer in the delayed group but did not reach statistical significance.

Conclusion: Free flap reconstruction remains a reliable option for limb salvage in high-voltage electrical burns. A biologically timed approach-delaying reconstruction until tissue demarcation and vascular stability-may minimize complications while maintaining high flap survival rates.

Introduction: As more elderly patients pursue body contouring after massive weight loss, understanding their risk profiles is critical. Prior studies grouped complications together, but none have specifically examined pulmonary embolism (PE) in geriatric panniculectomy, despite reports of elevated PE risk in abdominoplasty and the predictive value of frailty.

Methods: The ACS NSQIP database (2005-2017) was queried for panniculectomy cases (CPT 15830). Patients 65 years or older were classified as geriatric. Demographics, comorbidities, and perioperative factors were compared between groups. Logistic regression identified predictors of PE and complications, with secondary analysis restricted to geriatric patients.

Results: Of 11,708 cases, 1005 (9%) were geriatric (mean age, 69 ± 3.7 years). Geriatric patients had higher rates of hypertension, insulin-dependent diabetes, dyspnea at rest, and poor functional status (all P < 0.001). Pulmonary embolism occurred in 8 of 1005 geriatric patients (0.8%) compared with 32 of 10,703 nongeriatric patients (0.3%) ( P = 0.01). On multivariable analysis, geriatric age independently conferred a 3-fold increase in PE risk (aOR, 3.1; 95% CI, 1.34-7.1; P < 0.01). Within the geriatric cohort, obesity (aOR, 1.6; P < 0.01), dyspnea at rest (aOR, 1.6; P = 0.05), poor functional status (aOR, 2.0; P = 0.04), antihypertensive use (aOR, 1.7; P = 0.02), and inpatient surgery (aOR, 2.7; P < 0.001) independently predicted complications.

Conclusions: Geriatric patients undergoing panniculectomy face significantly higher PE risk, echoing abdominoplasty data showing delayed venous thromboembolism. Surgical morbidity appears driven by comorbidities and physiologic reserve rather than age alone. These findings underscore the importance of careful preoperative risk stratification and support the need for prospective evaluation of perioperative thromboprophylaxis strategies in elderly patients.

Background: Skin-reducing mastectomy (SRM) represents a surgical option that provides patients with ptotic breasts the advantage of undergoing simultaneous nipple-preserving mastopexy in conjunction with mastectomy. Nonetheless, existing data, primarily derived from single-center studies, are characterized by limited patient cohorts. Therefore, this study examines the complications associated with SRM.

Methods: We conducted a systematic review of MEDLINE and Embase to evaluate outcomes of skin-reducing mastectomies, following PRISMA guidelines. Search terms included "cancer," "mastectomy," "mastopexy," and "nipple." We included studies detailing surgical techniques of nipple-preserving, skin-reducing mastectomy and its complications, excluding those with nipple grafting. Complications assessed were necrosis of the nipple-areola complex, infection, wound dehiscence, seroma, hematoma, fat necrosis, implant loss, and skin flap necrosis, analyzed using a random-effects model meta-analysis.

Results: Twenty-eight studies included for data extraction. The review examined 1201 breasts from 716 patients who underwent skin-reducing mastectomy. Mean age was 47.45 ± 5.6 years. Mean BMI was 27.29 ± 2.45 kg/m 2 . Mean mastectomy weight was 633.78 ± 125.64 g. Mean implant size was 472.3 ± 125.67 cc. 45.87% of patients underwent SRM for therapeutic indications. 23.97% (CI = 17.40%, 31.15%) of all patients reported complications. The most common complication was necrosis of the nipple-areola complex (6.55%, CI = 3.84%, 9.78%). Reoperation rate for any complication was 6.76% (CI = 3.46%, 10.83%).

Conclusions: Systematic review and meta-analysis of outcomes for SRM demonstrates that nipple areolar necrosis is the most prevalent complication in this population. This finding underscores the necessity to examine various factors that may enhance outcomes for individuals in this cohort.

Abstract: Anterior palatal fistulae (APFs) present a considerable challenge following cleft palate repair, particularly when involving the alveolus and the anterior half of the hard palate. These defects are notoriously difficult to close due to limited local tissue availability, scarring, restricted flap mobility, and altered vascularity, all contributing to high recurrence rates. This study evaluates the effectiveness of the buccal sulcus myomucosal flap (BSMF) as a practical and reliable option for APF closure. A retrospective review of 132 patients treated between January 2021 and December 2023 was conducted. All patients underwent nasal layer closure with turn-in flaps, followed by measurement of the residual defect and harvest of a BSMF of appropriate size. Of the cohort, 59 patients (44.7%) presented with primary fistulae while 73 (55.3%) had recurrent defects. The overall recurrence rate following repair was 10.4%, with similar rates observed in primary and recurrent cases. The technique consistently achieved tension-free closure even in large anterior defects extending into the alveolus, with minimal donor site morbidity. Its technical simplicity and cost-effectiveness further enhance its applicability, particularly in resource-constrained and high-volume settings. The BSMF offers a reproducible, effective solution for managing anterior palatal fistulae and warrants broader consideration in cleft care algorithms.

Purpose: The purpose of this analysis is to highlight trends in Medicare reimbursement rates in recent years and examine any regional differences in reimbursements that may exist over the past decade.

Methods: The CMS Physician and Other Practitioners database was used to extract the top 20 plastic surgery HCPCS codes in 2022 by volume. The Medicare Physician Fee Schedule Database was then used to analyze trends in reimbursements for these procedure codes from 2012 to 2025. Dollar amounts were inflation adjusted to 2025 estimates based on consumer price index (CPI) values.

Results: From 2012 to 2025, the mean overall reimbursement rate for plastic surgery procedures fell 34.2% from $373.21 to $245.65, with a 14.9% decrease in MP RVU * GPCI. A majority of codes analyzed were integumentary procedures. Nevada (40.4%, $408.26-$243.40) and Wyoming (39.0%, $396.83-$241.89) had the most dramatic decreases in reimbursement rate, whereas Massachusetts (30.5%, $378.12-$262.86) and New York (30.7%, $392.55-$272.15) had the smallest decreases in reimbursement rate. The West had the largest decrease in reimbursement rate (36.6%, $411.44-$260.66).

Conclusion: Medicare reimbursement rates for plastic surgery are decreasing nationally, most drastically in the West region. These trends may have important indications for shaping practice and fair compensation for services.

Abstract: Skin redundancy after massive weight loss often requires body contouring procedures such as abdominoplasty and mastopexy. Bariatric patients may face higher complication risks due to nutritional deficiencies. However, with proper management, including stable body weight and adequate nutritional status, these risks may be mitigated. In addition, glucagon-like peptide-1 (GLP-1) receptor agonists have recently emerged as a rising trend for nonbariatric weight loss, but their impact on surgical outcomes remains underexplored. Between January 2015 and August 2025, 101 consecutive weight-loss patients undergoing synchronous full abdominoplasty and mastopexy with a superomedial pedicle were prospectively enrolled. Forty-nine patients had undergone bariatric surgery, whereas 52 achieved weight loss without bariatric surgery, including 14 patients using GLP-1 receptor agonists (liraglutide or tirzepatide). Demographic characteristics, weight loss parameters, serum albumin levels, operative details, and complications (classified by Clavien-Dindo) were recorded. There were no significant differences between groups in age or BMI. The bariatric group demonstrated significantly greater absolute and percentage weight loss, although serum albumin levels were slightly lower compared to nonbariatric patients. The overall complication rate was 8.9%, with no life-threatening events (Clavien-Dindo grades IV and V). Complication rates did not differ significantly between bariatric and nonbariatric patients. Notably, no complications occurred in patients who lost weight with GLP-1 analogs. In conclusion, synchronous abdominoplasty and mastopexy can be performed safely in bariatric patients who maintain stable body weight for at least 6 months and have serum albumin level of >3.5 g/dL. The increasing use of GLP-1 analogs in nonbariatric weight-loss patients represents an important emerging trend that warrants further investigation in the context of body contouring surgery.

Abstract: Breasts hold multifaceted significance in modern society, encompassing elements of motherhood, sexuality, and female identity. Diseases of the breast can thus result in uniquely complex decision making, particularly in the case of malignancy when mastectomy is indicated. Patient narratives reveal the profound impact of breast loss on self-perception, femininity, and community belonging. Although post-mastectomy breast reconstruction is empirically well supported, intersecting societal pressures and surgeon biases may challenge the autonomy of patients deciding on reconstructive options.This article critically examines various factors involved in decision-making in breast reconstruction following mastectomy, highlighting the significance of patient autonomy. We excavate the historical, sociocultural, and economic influences that may have tilted the current balance in favor of breast reconstruction. While considering the benefits of this shift, we examine the potential existing biases that may influence patient decisions. We emphasize that autonomy is a central ethical consideration in navigating complex reconstructive decisions and promoting patient-centered care. We hope that our work will contribute to a broader discussion on the value placed on breasts and reinforce the agency breast cancer survivors have in decision making.