Annals of Plastic Surgery最新文献

Introduction: American Cleft Palate and Craniofacial Association (ACPA) teams consist of trained professionals collaborating in an interdisciplinary approach to optimize outcomes for patients with cleft palate. Orthodontic care is essential to correct dental malocclusion, guide maxillary growth, enhance surgical outcomes, and improve oral function and aesthetics. Although ACPA approval requires an orthodontist in the multidisciplinary team, the methods of delivering orthodontic care remain unclear. This project aims to elucidate how orthodontic care is integrated into ACPA teams.

Methods: A list of ACPA teams (n = 204) and reported orthodontists (n = 374) was obtained from the ACPA directory. Teams outside the US. and duplicate listings were excluded. Each team's website was reviewed to identify orthodontists, care delivery types (university/hospital, private practice, mixed, not listed), and orthodontic craniofacial fellowship status. Team geographic distribution was compared across the 4 US Centers for Disease Control and Prevention (CDC) Census regions: West, Midwest, South, and Northeast.

Results: Among 184 ACPA-approved teams, only 46.7% listed an orthodontist on their public websites, despite guidelines requiring orthodontic inclusion. The most common care model was university/hospital-based (25%), followed by private practice (18.5%), with variation across teams (P < 0.001). Only 16.3% of teams included a craniofacial fellowship-trained orthodontist, whereas over half did not report training status. Private practice teams were less likely to include a fellowship-trained orthodontist compared to university/hospital-based teams (OR, 0.086; P < 0.001). Most teams had 1 to 2 orthodontists (mean, 1.84), with no difference by region or care model. Regionally, the South had the highest proportion of teams (33.2%) and orthodontists (33.2%), whereas the Northeast had the fewest. Fellowship-trained orthodontists were most common in the South but showed no regional difference (P = 0.989).

Discussion: Orthodontists are inconsistently represented across ACPA teams with limited public reporting and low rates of fellowship training. Variation in care delivery models and regional access highlights structural gaps in interdisciplinary cleft care. Standardizing orthodontic integration and increasing fellowship training may improve the consistency and equity of craniofacial care nationwide.

Abstract: Outreach medical programs refer to medical or surgical care initiatives provided by volunteer teams typically from higher income countries and last from a few days to 8 weeks. To appreciate the development and empowerment of the onsite team, the use of "Sustainable Health Programs" (SHP) has become the preferred terminology at Global Smile Foundation. This study aims to review the challenges faced with implementing SHPs and propose a framework with the goal of implementing successful and sustainable programs. The cornerstone of such success is forging long-term, bidirectional partnerships with local healthcare teams, empowering them not only with clinical skills but also with the ability to mobilize resources independently. A SHP's success is gauged by how well it strengthens the local system to carry the mission forward long after the international team departs.

Introduction: Lower eyelid blepharoplasty is performed via transconjunctival and subciliary approaches. In the subciliary approach, we have compared 2 methods: biplanar flaps versus a composite flap, with the goal of improved short-term recovery.

Materials and methods: Preoperative and 6-day postoperative 2-dimensional patient photographs were reviewed from each patient assigned to 1 of the 2 groups. Two blinded surgeons who neither performed the procedure nor were aware of the technique used reviewed the postoperative pictures from each patient and scored the results based on the Modified Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) Questionnaire.

Results: Forty-one patients (82 eyes) underwent subciliary lower blepharoplasty in the stated time frame. The primary outcome of the modified SPREE survey showed that patients who underwent the composite technique had an average edema score of 1.06 (from a 1-4 increasing severity scale) compared to 1.52 scored on patients with the biplanar technique (P < 0.00228). For ecchymosis, patients who underwent the composite technique had an average score of 0.25 (from a 0-3 increasing severity scale) compared to 0.60 scored on patients with the biplanar technique (P < 0.04444).

Conclusions: Composite flaps were shown to have a statistically significant decreased Modified SPREE score compared to biplanar flaps.

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/m2. 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.

Purpose: Open access publishing models are common in plastic surgery. We aim to quantify the financial investment required to support open access publishing for plastic surgery students during both medical school and residency training.

Methods: Peer-reviewed PubMed journal articles from plastic and reconstructive surgery-related journals published by current PGY-2 through PGY-6 integrated plastic surgery residents were divided into publications during medical school and publications during. Article-processing charges (APCs) for analyzed articles were collected online. Subgroup analyses by institutional NIH funding were conducted.

Results: A total of 2904 unique publications published by 606 PGY-2-PGY-6 integrated plastic surgery residents during medical school and 1109 publications from 245 PGY-5 and PGY-6 residents during residency were extracted. For medical school publications, each individual had a median (interquartile range [IQR]) of 4 (2-7) publications; 20.4% of their publications had a mandatory APC with a mean (SD) APC of $2140 (727) per project. The percent APC increased over time (correlation = 0.09). For residency publications, each student had a median (IQR) of 3 (2-7) publications; 23.6% of each resident's publications required an APC, with an average APC of $2140 ± $765 (mean ± SD) per project. Publications affiliated with a top 25 NIH-funded medical institution had a lower rate of open access publishing with an APC (17.8% vs 22.9%) but higher average impact factor (1.86 vs 2.03).

Conclusions: Students publishing in plastic surgery journals require financial investment for open access fees. Institutions should ensure that they have adequate resources to support trainee publishing.

Background: Although the indications for the dangle protocol following lower extremity free flap reconstruction (LEFFR) are well established, significant heterogeneity in the postoperative day (POD) of protocol initiation is observed in clinical practice. This study aims to evaluate the outcomes associated with different initiation times of the dangle protocol following LEFFR.

Methods: A retrospective chart review included adult patients who underwent LEFFR at a level 1 trauma center from January 2016 to December 2022. Patients were grouped according to initiation of extremity dangling: early (POD 4-6) versus late (POD 7-8). The primary outcome was flap failure. Secondary outcomes were postoperative and dangle-related complications, including rate of flap take-back, partial necrosis, venous congestion, ischemia, hematoma, seroma, wound dehiscence, infection, and pulmonary embolism.

Results: A total of 103 patients (mean age, 43.5 ± 14.5 years) were included: 46 in the early group and 57 in the late group. No significant difference in flap failure was observed between groups (4.3% vs 1.8%, P = 0.585). The early group displayed a significant reduction in average hospital LOS (21.5 vs 25 days, P = 0.010). The rate of flap take-back, partial necrosis, venous congestion, ischemia, hematoma, seroma, infection, and pulmonary embolism did not differ significantly between groups.

Conclusion: Our results suggest that early initiation of the dangle protocol may decrease hospital LOS without adversely affecting flap outcomes. Future prospective studies are needed to provide additional evidence to determine the optimal timing of dangle protocol initiation.

Background: Traction neurectomy (TN) remains the standard of care for digital nerve management in partial and ray digital amputations but is associated with both neuroma formation and chronic postoperative pain. The purpose of this study is to evaluate if digital nerve coaptation (DNC) is associated with lower postoperative pain and complication rates compared to standard TN. We hypothesize that patients undergoing digital amputations with DNC will demonstrate lower postoperative complications, reduced rates of persistent pain, and fewer reoperations for nerve-related pain.

Materials and methods: A retrospective cohort study was conducted, analyzing 95 patients who underwent partial or ray amputation at a single institution from 2019 to 2024. Patients were stratified by nerve management technique: DNC (n = 26) vs TN (n = 69). Primary outcomes included postoperative pain scores and complication rates including neuroma formation, infection, wound dehiscence, persistent pain, and functional stiffness. Pain scores were assessed using the Neuropathic Pain Scale (NPS, 0-100) and a numerical pain rating scale (NPRS, 0-10). Of the 95 patients, 48 (TN = 33, DNC = 15) were successfully contacted for postoperative pain assessment. Statistical comparisons were made using independent t tests, Mann-Whitney U tests, and chi-square analyses, with significance set at P < 0.05.

Results: Patients with a digit amputation that underwent DNC experienced a lower percentage of complications compared to traction neurectomy (26.9% vs 55.1%, P = 0.030). Furthermore, although not statistically significant, patients undergoing DNC reported lower average NPS (36.1 vs 43.8, P = 0.263) and NPRS (3.79 vs 4.20, P = 0.590) scores compared to neurectomy alone. This trend of decreased pain scores reported by patients who received DNC was true regardless of whether the amputation was due to acute injury or other causes. Similarly, patients described reduced pain at all amputation levels except the middle phalanx.

Conclusions: These data indicate a positive observable outcome when comparing patients' postoperative pain and rate of complications with DNC vs TN at the time of amputation. Though a larger sample size is needed to solidify these results, these findings do suggest that DNC is a potentially superior alternative for nerve management in digital amputations, with the potential to improve long-term pain control and patient outcomes.

Background: Conventional facelift surgery may fail to adequately address submandibular gland ptosis (SMGP), prompting recommendations for partial gland resection. Alternatively, the extended SMAS technique involves a more extensive SMAS-platysma dissection, providing lower facial and neck rejuvenation while preserving the submandibular glands. This study aims to quantify the effect of the extended SMAS technique on SMGP.

Methods: This retrospective cohort study analyzed 53 patients who underwent extended SMAS facelift surgery over a 10-year period in the senior author's practice. Photographic analysis was used to quantify SMGP correction and cervicomental angle (CMA) improvement.

Results: All patients were available at a mean follow-up of 8.4 months (range: 1-34 months). Mean SMGP decreased from 8.9 mm preoperatively (range: 0-23 mm) to 0.1 mm postoperatively (range: 0-3.9 mm), with an average improvement of 8.01 mm (P < 0.001). The mean CMA improved from 152° (range: 100-180°) to 121° (range: 92-156°), with a mean change of 30.8° (P < 0.001). Two patients (3.8%) were dissatisfied, and 3 (5.7%) required office revisions.

Conclusion: The extended SMAS facelift technique effectively controls SMGP, nearly eliminating submandibular gland visibility on postoperative photographic analysis while enhancing neck angularity. This improvement may result from the thorough release of the cervical and parotid retaining ligaments as well as the platysma-auricular ligament. This level of SMAS-platysma flap mobilization may have a more effective sling-like effect on the contents of the digastric triangle, potentially obviating the need for submandibular gland resection.