Annals of Plastic Surgery最新文献

Objective: The impact of suture materials on surgical site infections (SSIs) has been well documented in various surgical fields; however, it has not been thoroughly examined in oral oncological surgery with free-flap reconstruction. This study aimed to evaluate the incidence of oral SSIs associated with the use of monofilament and braided sutures for flap fixation.

Methods: A retrospective chart review of patients who underwent oral oncological resection with free-flap reconstruction was conducted between May 2020 and April 2024. Either monofilament (4-0 PDS® II or Monodiox®) or braided (3-0 Vicryl®) suture was used for flap suturing. The primary outcome was the incidence of oral SSIs, defined according to the guidelines of the United States Centers for Disease Control and Prevention. Multivariable logistic regression and inverse probability of treatment weighting based on propensity scores were used to estimate the risk differences.

Results: Of 209 eligible patients, 58 experienced oral SSIs, resulting in an incidence of 27.8%. Monofilament sutures were used in 174 patients and braided sutures in 35. The incidence of oral SSIs was higher in the braided suture group (42.9%) than in the monofilament suture group (24.7%). Analysis using propensity scores revealed a significantly higher risk of oral SSIs associated with braided sutures than with monofilament sutures, with a 18.5% risk difference (95% confidence interval, 2.1%-34.9%; P = 0.027).

Conclusions: Braided sutures may pose an increased risk of SSIs in oral oncological surgeries with free-flap reconstructions. Monofilament sutures are recommended for reconstructions, especially of the floor of the mouth.

Background: Surgical treatment of comminuted and multiple facial fractures is challenging, as identifying the bone anatomy and restoring the alignment are complicated. To overcome the difficulties, 3D-printed "jigsaw puzzle" has been innovated to improve the surgical outcome. This study aimed to demonstrate the feasibility of 3D-printed model in facial fracture restoration procedures.

Materials and methods: Patients with traumatic craniomaxillofacial fractures treated at a single institution were enrolled in this study. The exclusion criteria included the presence of mandibular fractures, greenstick fractures, isolated fractures, and revision cases. Fine-cut (1-mm thick) computed tomography images of each patient were assembled into a 3D model for preoperative planning. Major fragments were segmented in virtual surgical planning, printed out with a 3D printer as "jigsaw puzzle" pieces, and assembled with plates and screws as in surgical rehearsals. We further matched our study group with a control group of patients who underwent the corresponding procedures to compare operative time.

Results: Nine patients with craniomaxillofacial fractures were included in the study, including 2 patients with zygomaticomaxillary complex fractures and 7 patients with multiple fractures. No remarkable postoperative complications, such as enophthalmus or optic nerve injury, that require additional or revision surgery were noted. The mean operative time was 391 and 435 minutes in the study and control groups, respectively. The t test results were not statistically significant.

Conclusions: Surgeons can perform comprehensive preoperative planning, simulation, and obtain a real-time reference for facial bone reduction by using the 3D-printed "jigsaw puzzle" in multiple complicated craniomaxillofacial fractures.

Introduction: YouTube has become a popular source of health information, including plastic surgery. Given the platform's wide reach and potential influence on patient decisions, this study aimed to assess the quality of information available on YouTube for African audiences seeking plastic surgery procedures.

Methods: This cross-sectional study extracted data from YouTube videos on plastic surgery relevant to Africa. A search strategy identified videos in English using keywords. The first 50 results for each term were included, with duplicates removed. Next, the metadata of videos published from inception to June 9, 2024, were extracted. Two reviewers independently assessed videos using standardized tools to evaluate reliability (modified DISCERN and JAMA criteria) and engagement (likes-to-views ratio [LVR] and comments-to-views ratio [CVR]). The Mann-Whitney U test was used for unadjusted bivariable comparisons. Then ordinal logistic and beta regression analyses were used to evaluate the primary (modified DISCERN and JAMA scores) and secondary (LVR and CVR) outcomes, with a statistical significance level set at 0.05.

Results: Eight hundred ninety-seven plastic surgery videos were analyzed, and 3.9% were published by African entities. Large subscriber count (coefficient = -6.9e-8, 95% confidence interval [CI] [-1.13e-7, -2.9e-8], P = 0.001), African-authored (coefficient = -0.85, 95% CI [-1.44, -0.25], P = 0.005), and advertising (coefficient = -1.01, 95% CI [-1.63, -0.57], P < 0.001) videos had lower modified DISCERN scores. Advertising videos equally had lower JAMA scores (coefficient = -1.29, 95% CI [-1.83, -0.74], P < 0.001). Academic videos had lower LVR (coefficient = -0.48, 95% CI [-0.66, -0.30], P < 0.001), whereas independent videos had higher LVR (coefficient = 0.40, 95% CI [0.26, 0.54], P < 0.001). Academic videos had lower CVR (coefficient = -0.40, 95% CI [-0.67, -0.13], P = 0.003), whereas videos with other purposes had higher CVR (coefficient = 0.37, 95% CI [0.10, 0.64], P = 0.007).

Conclusions: This study underscores a potential disparity in the quality of online plastic surgery information based on video sources and purposes.

Background: The inferior alveolar nerve (IAN), a crucial branch of the trigeminal nerve, innervates the mandible. Precise knowledge of IAN positioning ensures surgical safety.

Methods: This cross-sectional study analyzed head and neck computed tomography scans from Maharaj Nakorn Chiang Mai Hospital. Inclusion criteria comprised dentate adults. Exclusion criteria included mandibular trauma/pathology or prior surgery. The study aimed to determine IAN positioning relative to key surgical landmarks: the first molar, lingula, and mental foramen.

Results: A total of 450 Thai mandibles (900 hemimandibles) with a mean age of 36 years (58.2% male) were included. No significant differences were observed in IAN positioning relative to the first molar between the left and right sides in superior and inferior landmarks. However, the buccal distance was significantly closer on the left. The lingula distance was higher on the left, whereas that to the mental foramen was lower.

Conclusion: Surgical implications suggest maintaining a 15-mm distance from the lower mandibular border during osteotomy and upper plate placement, restricting horizontal cuts within this 15-mm range from the lingula, and ensuring screws do not extend more than 7 mm from the buccal surface. This study provides valuable guidance for minimizing the risk of iatrogenic injury to the IAN.

Background: Surgical delay is any surgical intervention performed 7-14 days before flap elevation, separating part of flap from its vascular bed and aiming to decrease flap necrosis. However, delay surgery needs to be planned and performed as a separate surgical operation. Quercetin is a flavonoid with anti-inflammatory, and vasodilator effects. This study compares the effects of quercetin and surgical delay on flap survival.

Materials and methods: The study included 32 male Wistar rats divided into four groups: control group (group 1), surgical delay group (group 2), quercetin group (group 3), and both surgical delay and quercetin group (group 4). All dorsal skin island flaps were elevated based on deep circumflex iliac artery and 7 days were selected as waiting period after flap elevation, 50 mg/kg (0.5 mL) intraperitoneal quercetin administration period, and surgical delay period. Macroscopically flap necrosis rates were calculated and histopathological examination was performed to evaluate number of vessels, vessel lumen diameters, inflammation, epidermal damage, and dermal fibrosis scores. All rats were euthanized.

Results: Flap necrosis rates, inflammation, epidermal damage, and dermal fibrosis scores of group 3 and 4 were found to be lower than group 1 and 2 (P < 0.05). Vascular lumen diameter of group 2, 3, and 4 were found to be higher than group 1 (P < 0.05) but no statistically significant difference was found for this parameter between group 2, 3, and 4 (P > 0.05). The number of vessels were found to be higher in group 2, group 3, and group 4 compared with group 1, but this difference was not to be found statistically significant (P = 0.534).

Conclusions: This study shows that quercetin application is more effective in reducing flap necrosis rates and anti-inflammatory effect than surgical delay and also has superior effect in terms of vasodilation.

Purpose: Well-designed pilot trials are essential in determining feasibility prior to initiating definitive randomized controlled trials (RCTs) and their implementation into clinical practice. The primary outcome of this study was to identify the number of pilot or feasibility studies in Plastic Surgery that progressed to a definitive RCT. Secondary outcomes included a) number of pilot studies expressing feasibility statements and outcomes and b) reporting quality.

Methods: MEDLINE, Embase, Web of Science, and clinicaltrials.gov were searched for all pilot RCTs and definitive RCTs in plastic surgery between 2012-2023. Pilot trials were matched to definitive RCTs by keyword, author, and citation report. Feasibility outcomes were presented using descriptive statistics. Reporting quality was evaluated using the Consolidated Standards of Reporting Trials 2010 randomized pilot and feasibility trials extension.

Results: Among 11,540 and 6035 citations screened in 2 separate literature searches, 171 pilot studies and 779 definitive RCTS were included, respectively. Ten (5.8%) pilot studies were associated with a completed RCT, 4 (2.3%) were in progress, and 2 (1.2%) were stopped. For studies that did not progress to a definitive RCT, "inadequate funding" (n = 11, 41.4%) was the most cited reason followed by "insufficient efficacy to justify study progression" (n = 5, 17.3%). The average reporting adherence to the Consolidated Standards of Reporting Trials items was 65.6% (SD 16). Fifty (29.2%) pilot RCTs reported a feasibility statement and 30 (17.5%) reported feasibility outcomes.

Conclusions: Few pilot trials in plastic surgery progressed to a definitive RCT, and most did not present feasibility statements or outcomes. Pilot studies should precede RCTs and include clear feasibility statements and outcomes.

Background: Plagiocephaly, wherein infants' head exhibits a diagonal asymmetry, is currently diagnosed based on physicians' subjective judgment. Discrepancies between physician and parent perspectives may result in dissatisfaction with treatment outcomes. This problem highlights the need for an objective assessment system aligning with physician-made clinical diagnoses.

Methods: Infant heads were modeled using 3-dimensional scanning techniques. We developed a craniofacial asymmetric index (CAI) based on 10 height planes of heads with varying weight. CAI and traditional craniofacial vault asymmetry index (CVAI) of 10 infants undergoing helmet therapy were compared with 11 craniofacial surgeons' judgment. The Pearson correlation coefficient and Bland-Altman plot were used to determine the correlations and agreement between physicians' judgment and the aforementioned assessment methods. The adjusted intraclass correlation coefficient was calculated to evaluate the reliability of between-physician agreement.

Results: All 10 infants were divided into the following 3 severity groups: severe, moderate, and mild groups based on craniofacial surgeons' judgment. Notably in CAI, front/back halves of skull and multiangular weighting factors were evaluated. The evaluation revealed perfect alignment in severity classification between the CAI and physicians' judgment, whereas both the CVAI score and MATLAB analysis show varying degrees of difference, 6 and 4 distinct results, respectively. Coefficients of the correlations of physician-assigned scores with the MATLAB analysis, CVAI score, and CAI score were 0.500, 0.833, and 1.000, respectively. Furthermore, Bland-Altman plots revealed the best agreement between CAI and physician-assigned scores.

Conclusions: CAI closely aligns with the subjective judgment of craniofacial surgeons' assessing the severity of plagiocephaly in infants.

Objective: Lower extremity trauma significantly impacts patients' lives, requiring a nuanced approach to evaluate outcomes beyond clinical measures. The LIMB-Q, a patient-reported outcome measure (PROM), assesses the multifaceted impacts of lower extremity trauma, including physical and emotional dimensions, from the patient's perspective. This study validates the German version of the LIMB-Q.

Methods: We relied on the translation of the LIMB-Q that had followed the International Society for Pharmacoeconomics and Outcomes Research best practice guidelines. Sixty patients who had undergone reconstructive surgery or amputation of the lower limb completed the LIMB-Q, Lower Extremity Functional Scale (LEFS), and Short Form Health Survey (SF-36). Internal consistency of the German LIMB-Q was determined by Cronbach's alpha, and reliability was assessed using the intraclass correlation coefficient. Construct validity was analyzed using Pearson correlation coefficients between the LIMB-Q, LEFS, and SF-36.

Results: Validation involved 60 patients. Internal consistency in a test-retest subset of 5 patients was good to excellent (α: 0.891 to 0.965). The intraclass correlation coefficient for these scales ranged from 0.821 to 1. The LIMB-Q domains significantly correlated with the corresponding domains of the SF-36 and LEFS, confirming excellent construct validity.

Conclusions: The German version of the LIMB-Q is conceptually equivalent to the original English version. It is a reliable and valid PROM for assessing physical and psychological impairments in patients who have undergone lower extremity reconstructive surgery or amputation.

Introduction: Acute kidney injury (AKI) is common in severe burns with high mortality. Previous studies confirmed the renal replacement therapy (RRT) as an effective strategy in burn patients. However, the optimal timing of RRT initiation with AKI is rarely investigated.

Methods: We conducted a single-center, retrospective cohort study at a large burn center in Chongqing, China, from 2010 to 2020. Patients were grouped into early (initiated at Kidney Disease: Improving Global Outcomes stage 1 or 2 of AKI) and delayed RRT (initiated at Kidney Disease: Improving Global Outcomes stage 3 of AKI). The primary outcome was in-hospital mortality. The secondary outcomes included renal function recovery, length of stay, and RRT-related complications.

Results: Of the included 79 patients, 42 and 37 were in early and delayed RRT group, respectively. The mean burn area was 68.82%. The in-hospital mortality tended to be higher in the early group (42.86%) than in the delayed group (29.73%, P = 0.227), although the difference was not statistically significant. The rate of partial remission of renal function at 48 hours after RRT discontinuation was significantly higher in the delayed group (78.26%) than early group (36.84%, P = 0.003). Furthermore, multivariable Cox and logistic regression analysis found that interval from AKI occurrence to RRT initiation was protective factors for 90-day mortality (hazard ratio 0.514, 95% confidence interval 0.349-0.756, P = 0.001), but fluid overload, acute respiratory distress syndrome, and multiple organ dysfunction syndrome were risk factors for mortality. Subgroup analysis revealed that patients with stage 1 or 2 AKI who received RRT within 24 hours after AKI had the lowest survival rate. In contrast, patients with stage 3 AKI who received RRT beyond 24 hours after AKI had the highest survival rate. The delayed group had higher rate of bleeding and lower rate of catheter-related infection than the early group.

Conclusions: Delayed initiation of RRT seemed to have similar survival benefits to early RRT initiation in burn patients with AKI, needing further confirmation by large randomized clinical study in future.