Annals of Plastic Surgery最新文献

Introduction: Medical tourism, commonly defined as the practice of traveling to another country for medical care, has increased in popularity over the past decade, particularly in aesthetic surgery where high costs lead patients to seek cheaper options abroad. Although patients may save money, inherent risks to medical tourism include truncated postoperative care and limited ability to evaluate providers. When complications arise, patients present to local institutions rather than to their original surgeons. Although literature describes complications from international tourism, less is known about domestic tourism. Although domestic centers may seem safer, medical tourists still face limitations that may affect the quality of their care. We hypothesize that similar limitations are present in both international and domestic medical tourism.

Methods: We performed a retrospective review of patients presenting to our institution for treatment from May 2015 to November 2025 with complications after elective aesthetic surgery. Patients were classified as international tourists if the surgery occurred outside the borders of the United States and domestic if travel was ≥200 miles away but within the United States. Data evaluated included demographics, procedure details, duration of stay, time to presentation, complications, and treatment.

Results: Forty-one patients met the inclusion criteria: 22 (56%) had surgeries domestically and 19 (46%) internationally. Miami and the Dominican Republic were the most common destinations. Domestic patients returned home sooner (5.9 vs 13.9 days, P < 0.05) and presented with complications earlier (18 vs 44 days, P < 0.05). No significant differences were found in procedures, complication type, or need for surgical treatment. Patients who stayed at their operative location ≤5 days postoperative were more likely to require inpatient admission (88.9% vs 36.4%, P < 0.05) and IV antibiotics (88.9% vs 27.3%, P < 0.05), regardless of if they traveled to domestic or international destinations.

Conclusion: Length of postoperative stay after medical tourism is correlated to a greater degree with complications requiring inpatient admission than surgical destination itself. Domestic tourism, often assumed to be safer than international, may carry similar risks, particularly if proper follow-up is lacking.

Introduction: Positional plagiocephaly is characterized by cranial asymmetry and can be the result of prolonged uneven pressure on the developing skull. Extrauterine causes include extended time in the supine position, one-sided feeding, or insufficient tummy time. Beyond cosmetic concerns, it can affect visual, auditory, dentofacial, and speech development. Following the "Back-to-Sleep Campaign," prevalence rose to 16% to 22.1% in 6-week-old infants (Iran J Child Neurol. 2022;16(2):85-92). Despite its extensive impact on development and finances, many caregivers and parents lack awareness, underscoring the need for improved education and prevention strategies.

Methods: In this 2-arm, partially blinded randomized controlled trial (June 2022 to April 2025) at UMass Memorial Medical Center, we compared standard care to an educational intervention for plagiocephaly prevention. The primary outcome was cephalic index (CI), measured at 2, 4, and 6 months, with higher values indicating greater deformity. Secondary outcomes included parent-reported adherence to prevention strategies. Group comparisons used unpaired t tests and difference-in-difference models.

Results: A total of 109 subjects were enrolled (intervention, 62; control, 47). The average CI differed significantly between groups at the 4-month mark (control, 89.84; intervention, 86.91; P = 0.05). Difference-in-difference analysis did not yield statistically significant results at any time point, but all intervention groups had a lower average CI. Survey data assessing parental adherence to plagiocephaly prevention behaviors showed a significant difference at 4 months (control, 15.87; intervention, 13.75; P = 0.03), with no significant differences at 2 or 6 months.

Conclusions: The intervention was associated with reduced cranial deformation, reaching statistical significance by 4 months. This correlated with better parental compliance, suggesting early education as an effective preventive strategy.

Background: Patients often use Google as a source of quick medical information, although the accuracy and clarity of search results can vary. ChatGPT has emerged as an alternative tool capable of providing conversational and potentially more reliable medical information. This study compares the readability, accuracy, and completeness of responses generated by ChatGPT with those obtained using Google for common patient questions regarding craniosynostosis and cleft palate.

Methods: The terms "Craniosynostosis" and "Cleft Palate" were entered into Google, and the top 10 associated questions for each-identified using the "People Also Ask" tool-were recorded. Each question was then entered into both Google and ChatGPT, and the responses from each were recorded. The ease of readability for each response was determined by the Flesch-Kincaid instrument. Blinded reviewers evaluated accuracy and completeness using a 3-point scale (1 = fully incorrect, 2 = partially incorrect, 3 = correct). Reviewer scores were averaged, and comparisons between platforms were evaluated using t tests.

Results: A total of 20 questions yielded 40 unique responses. For cleft palate queries, Google responses had significantly lower reading levels than ChatGPT (9.95 vs 13.22, P = 0.006). No significant difference in readability was observed for craniosynostosis responses (14.66 vs 14.73, P = 0.467). Across all questions, ChatGPT responses were significantly more complete (2.60 vs 1.86, P < 0.0001) and more accurate (2.78 vs 2.09, P < 0.0001) than Google responses. These differences persisted when each condition was analyzed separately.

Conclusion: ChatGPT provides more accurate and comprehensive information than Google for common patient questions about craniosynostosis without sacrificing readability. Patients can use this information to inform their future searches in order to obtain the most accurate information about their diagnoses. Further studies evaluating the information learned by patients from both search engines can help clinicians guide patients toward resources that best fit their individual care.

Learning objectives: After studying this article, the participant should be able to (1) understand how unique biological and developmental characteristics of children influence pediatric cancer treatment and how advancements in diagnostics and adjuvant therapy help tailor care, (2) describe treatment approaches to pediatric head and neck malignancies, and (3) understand how surgical resection integrates with multimodal systemic therapies.

Summary: Pediatric head and neck malignancies require a tailored, multidisciplinary management approach that considers the unique biological, developmental, and long-term implications in this vulnerable population. This comprehensive review provides a disease-specific overview of the most common pediatric head and neck cancers. Current evidence-based surgical and nonsurgical treatment strategies are summarized, and recent advancements in diagnostic imaging, minimally invasive techniques, and adjuvant therapies are discussed for each cancer type commonly incurred within the pediatric population. The integration of multi-agent chemotherapy, radiation therapy, and targeted therapeutic modalities with precise surgical intervention has reshaped treatment paradigms and led to improved survival outcomes while minimizing long-term patient morbidity. Emphasis is placed on the importance of early diagnosis, prompt initiation of treatment, and vigilant long-term follow-up to monitor patients for both recurrence and treatment-related complications. Ultimately, this review serves as a practical guide to clinicians, reinforcing the critical role of a coordinated, interdisciplinary team-including pediatric oncologists, surgeons, radiologists, pathologists, and allied specialists-in optimizing care and enhancing quality of life for children with head and neck malignancies.

Introduction: Symptomatic neuroma develops in 5%-25% of individuals receiving an amputation. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have emerged as effective interventions for neuroma treatment, and interest in prophylactic use is growing. However, no national consensus exists on implementation. This study aimed to identify surgeon characteristics associated with peripheral nerve intervention, referral patterns, and barriers to broader adoption of prophylactic TMR/RPNI.

Methods: A REDCap survey was administered to 3628 physicians; 303 responded. Participants were members of the American Society for Surgery of the Hand (ASSH) or the Musculoskeletal Tumor Society (MSTS). Physicians were queried on training background, procedural utilization, timing of intervention, and perceived barriers to performance or referral.

Results: Surgeons performing peripheral nerve surgery were more likely to be in practice for 10 years or less (P < 0.001), work as an academic surgeon (P < 0.001), and be trained in plastic surgery (P < 0.001). Among the 142 physicians performing peripheral nerve surgery, 86% perform either TMR or RPNI for prophylaxis and 51% stated the effect was comparable for treatment or prophylaxis. There were no differences in utilization of prophylactic procedures based on time in practice (P = 0.42), practice setting (P = 0.14), or surgical specialty (P = 0.36). Forty-two percent of nerve surgeons stated that not being consulted by the primary team was a consistent barrier. Of 89 amputation-only surgeons, 38% refer to TMR/RPNI, with higher referral rates in the academic setting (P < 0.001).

Conclusions: TMR and RPNI are increasingly adopted for treatment and prophylaxis of neuroma. However, referral rates remain low and are limited by coordination challenges and inconsistent consultation pathways. There appears to be a growing proportion of surgeons strategically employing these techniques prophylactically regardless of years in practice or practice setting, possibly due to the increasing body of evidence at single-site studies. These findings highlight the need for broader interdisciplinary awareness, streamlined referral pathways, and continued efforts to translate emerging evidence into clinical practice.

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.

Abstract: To keep pace with the advancements of technology, training models must also adapt, prioritizing safety, efficiency, and accessibility. Simulation-based training has emerged as a powerful tool to address these demands, offering structured, safe environments where junior cleft providers can build procedural confidence and sharpen their technical skills. The Comprehensive Cleft Care Workshop was established to provide sustainable, targeted solutions to challenges faced by cleft providers in their local contexts, by focusing on capacity building. As evidenced by measurable improvements in procedural confidence, long-term satisfaction, and clinical impact, this model represents a scalable and sustainable solution to global cleft care challenges.

Learning objectives: After studying this article, the participant should be able to (1) understand the incidence and trends of pediatric head and neck cancer; (2) identify the common tumors that present in the head and neck region; (3) describe the risk factors and pathogenesis associated with these malignancies, to identify children at risk; and (4) describe and understand the common presentations of these tumors to gain confidence in diagnosing these patients early in practice.

Summary: Pediatric head and neck malignancies are rare; however, their incidence is rising rapidly, with an incidence of 3.29 diagnoses per 100,000 person-years. These malignancies often present with nonspecific symptoms distinct from adults, making early diagnosis more challenging. Recognizing early symptoms in children is essential to improve treatment and long-term outcomes. This review discusses the incidence, pathogenesis, classification, and presentation of the common pediatric head and neck malignancies, including lymphoma, soft tissue sarcoma, thyroid carcinoma, salivary gland malignancies, bone malignancies, nasopharyngeal carcinoma, and melanoma.

Learning objectives: After studying this article, the participant should be able to (1) gather appropriate history and perform relevant physical exam maneuvers for head and neck complaints, (2) relate presenting complaints to differential diagnoses, (3) describe the appropriate workup for various head and neck complaints and presentations, and (4) perform clinical staging of head and neck tumors according to current guidelines.

Summary: Pediatric head and neck cancers are rare and complex, but plastic surgeons may play a crucial role in the multidisciplinary and multifaceted workup of a suspected malignancy. These cancers present unique diagnostic and therapeutic challenges given the unique anatomy, physiology, and developmental considerations in children compared to their adult counterparts. A comprehensive workup for pediatric head and neck malignancies is essential, starting with taking a thorough history and physical exam, followed by a well-considered and wide differential diagnosis. Appropriate imaging modalities and biopsy techniques are pivotal in obtaining an accurate diagnosis. Tumor and site-specific staging seek to provide essential information for guiding treatment planning. Plastic surgeons, therefore, must be informed and well versed in their evaluation and workup to best optimize patient outcomes.

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.