Annals of Plastic Surgery最新文献

Background: Lower trapezius myocutaneous flap (LTMF) is widely used for reconstructing head and neck defects. However, a single LTMF, even after pre-transfer tissue expansion, is often insufficient to cover defects involving the bilateral neck and chest wall. This study presents our experience with the use of bilateral pre-expanded LTMFs for repairing extensive cervicothoracic defects.

Methods: A retrospective study was conducted of patients who underwent bilateral pre-expanded LTMF reconstruction between March 2013 and August 2024. Patient demographics, defect features, flap characteristics, and surgical outcome were recorded to assess the efficacy and safety of the procedure.

Results: Ten patients underwent reconstruction of bilateral pre-expanded LTMF reconstruction. The median age was 18 years (range, 5-41 years). The median defect size was 222.5 cm2 on the left (range, 85-390 cm2) and 246 cm2 on the right (range, 80-490 cm2). Tissue expansion lasted 3.5-9.5 months. The median flap size was 420 cm2 on the left (range, 150-660 cm2) and 477 cm2 on the right (range, 260-645 cm2). Fourteen flaps were transferred through subcutaneous tunnels, while 6 were transferred through an open wound between donor and recipient sites in a propeller fashion. The donor sites were closed primarily in all patients. Complete flap survival was achieved in 9 patients, while 1 patient experienced flap tip necrosis.

Conclusions: Bilateral pre-expanded LTMFs represent a reliable reconstructive option for cervicothoracic defects, providing satisfactory functional and aesthetic outcomes.

Background: This study evaluates the postoperative functional and quality-of-life outcomes associated with using the free noninnervated latissimus dorsi muscle flap in combination with transversus abdominis release (TAR) and retrorectus mesh for massive ventral hernia repair (VHR).

Methods: Eighteen patients who underwent VHR were reviewed. Patients were contacted at least 2 years postoperatively and assessed using standardized patient-reported outcome measures (PROMs), including visual analog scale (VAS) for pain, Short-Form Health Survey (SF-12), Hernia-Related Quality-of-Life Survey (HerQLes), and Carolinas Comfort Scale (CCS). Data were analyzed using t tests and linear regression models.

Results: Comorbidities included diabetes (27.8%), chronic obstructive pulmonary disease (5.6%), smoking (5.6%), and immunosuppression (16.7%). The mean clinic follow-up was 8.9 months, with no flap failures or hernia recurrences. Medical complications occurred in 3 patients, and 5 patients (27.8%) experienced 8 surgical complications. Two patients died of unrelated causes. Of 16 survivors, 8 (50%) completed phone surveys at a mean follow-up of 36.8 months. Increasing age was positively correlated with Physical Component Summary-12 (PCS-12; 0.70, P < 0.05) and HerQLes scores (1.94, P < 0.05) but negatively with CCS scores (-2.40, P < 0.05). Larger abdominal wall defects were associated with lower PCS-12 (-2.31, P < 0.05) and HerQLes scores (-6.40, P < 0.05), whereas CCS scores increased with defect size (8.20, P < 0.05). Higher body mass index (BMI) was linked to lower Mental Component Summary-12 (MCS-12; -1.60, P < 0.05).

Conclusions: Free LD flap is effective for repair of massive ventral hernias. Age positively impacted quality-of-life scores, whereas higher BMI and larger defects negatively influenced outcomes.

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.

Methods: A retrospective chart review of 2500 patients having undergone bilateral reduction mammoplasty at 5 institutions from 2010 to 2019 was performed to record pedicle selection, patient demographics, comorbidities, body mass index, patient measurements to determine patient selection for different pedicle techniques, and clinical outcomes associated with these techniques.

Results: A total of 1186 patients had inferior pedicle technique, 65 had superior pedicle technique, 807 had superomedial pedicle technique, 148 had free nipple graft, and the remainder were not specified. A total of 1899 reduction mammaplasties were closed with wise-pattern skin closure, and 189 were circumvertical. Demographics were similar across groups except for higher age ( P < 0.001), BMI ( P < 0.001), and ASA score ( P < 0.001) in the free nipple graft cohort. Superomedial pedicle was used most frequently with lower sternal notch to nipple (SNN) distance, whereas inferior pedicle was performed most frequently with higher SNN distance. Inferior pedicle was most commonly employed for obesity class I-III patients, and free nipple graft was only used for obese patients. On linear regression, superior pedicle reduction (coefficient = -195.2, P = 0.001) was significantly associated with lower resection weights, whereas free nipple grafting was associated with a higher resection weight (coefficient = 752.8, P < 0.001). On univariate analysis, inferior pedicle technique was associated with higher dehiscence, delayed wound healing, and overall complication rates than other techniques ( P < 0.001). Regression analysis demonstrated only age and BMI as independent risk factors for overall complications.

Conclusions: Inferior pedicle reduction remains the most popular pedicle design followed by superomedial pedicle, with wise-pattern closure the most common skin closure type. SNN distance was the most impactful physical exam metric used to choose pedicles. Inferior pedicle and free nipple graft were used most commonly for obese patients, whereas superior reduction was associated with lower resection weights and BMI. Inferior pedicle technique was associated with increased wound healing complications, yet regression analysis implicated only BMI and smoking as statistically significant in this regard. Superomedial technique performed well across different BMI classifications.

Background: Reduction mammaplasty is an effective treatment for symptomatic macromastia but is associated with postoperative complications, such as hematoma, seroma, and infection. Tranexamic acid (TXA) has been shown to reduce blood loss and hematoma formation across surgical specialties, whereas the efficacy of adjunctive topical agents like Arista, a microporous polysaccharide hemostat, remains uncertain in breast surgery. This study evaluates whether combining TXA with Arista confers additional benefit in reducing postoperative complications following reduction mammaplasty.

Methods: A retrospective cohort study was conducted on patients undergoing bilateral reduction mammaplasty at a single institution from January 1, 2020, to April 1, 2025. Patients were divided into 3 groups: those receiving both IV TXA and topical Arista (n = 120), TXA alone (n = 133), and neither agent (control, n = 211). The primary outcome was hematoma incidence, stratified into major (requiring reoperation) and minor. Secondary outcomes included seroma, infection, and delayed wound healing. Statistical analyses included ANOVA and chi-squared tests with significance set at P < 0.05.

Results: A total of 464 patients were included in this study; 120 consecutive breast reduction patients received both Arista and TXA, 133 patients received TXA only, and 211 controls received neither. Combined use of TXA and Arista resulted in the lowest total hematoma rate (2.5%), compared to TXA alone (3.8%) and control (10.0%; P < 0.05). Major hematoma rates were significantly reduced in both treatment groups compared to control but did not differ significantly between TXA (2.3%) and TXA + Arista (1.7%). Infection rates were lowest in the combination group (0.8%) versus TXA alone (6.8%) and control (2.8%; P < 0.05). Delayed wound healing was also reduced with combined treatment (1.7%) compared to TXA alone (16.5%) and control (11.4%; P < 0.0005). Seroma rates and estimated blood loss showed no significant differences across groups.

Conclusions: IV TXA significantly reduces postoperative hematoma rates following reduction mammaplasty, with the addition of Arista providing a modest incremental benefit. Although TXA remains the primary agent for hematoma prophylaxis, Arista may be selectively useful in patients contraindicated for TXA. Further prospective studies are warranted.

Background: Neurogenic thoracic outlet syndrome (nTOS) results from compression of the brachial plexus and can lead to debilitating symptoms such as pain, paresthesia, and motor weakness. This study aimed to compare outcomes between patients undergoing rib-sparing scalenectomy (RSS) and those receiving first rib resection (FRR).

Methods: The TrinetX Collaborative Network was queried for patients who underwent surgical treatment of nTOS. Adult patients with a diagnosis of nTOS who underwent either RSS or FRR between 2013 and 2025 were included. Patients were identified using Current Procedural Terminology codes and matched 1:1 via propensity score matching based on age, sex, and comorbidities. One-year outcomes including postoperative hand pain, hematoma, and reintervention rates were compared using risk differences, odds ratios, and Kaplan-Meier analysis.

Results: There were a total of 5359 patients meeting the inclusion criteria, with 4352 (81.2%) patients in the FRR cohort and 1007 (18.8%) patients in the RSS cohort. After matching, 973 patients were included in each group. The incidence rates of postoperative pain (3.7% FRR vs 3.2% RSS) and hematoma (1.85% vs 2.05%) were similar between groups (P > 0.05). Reintervention rates were also comparable for both FRR (7.8%) and RSS (7.6%). Kaplan-Meier analysis showed no significant difference in 1-year reintervention-free survival (FRR: 89.4% vs RSS: 89.5%, P > 0.05).

Conclusion: In this large, matched cohort, rib-sparing scalenectomy and first rib resection yielded comparable 1-year outcomes for nTOS. Given the similar complication and reintervention rates, RSS may serve as an effective, less invasive alternative to FRR in select patients.

Abstract: In 1948, Dr Jerome P. Webster-"father of plastic surgery education" and founding member of the American Board of Plastic Surgery-taught plastic surgery to 13 Chinese surgeons through the American Bureau for Medical Aid to China (ABMAC). Founded in 1937, the ABMAC worked with the Chinese government to transfer medical knowledge and supplies from the United States. The founding of the ABMAC in 1937 coincided with the second Sino-Japanese War and increased American aid to China following Pearl Harbor. Webster's course featured lectures on wound healing, surgical management of burns, and defects of the face. Reading assignments included techniques such as neck-tubed pedicles and Webster's own articles on war wounds of lips and cheeks and ear deformities. After 4 weeks of lectures, dog surgeries, and cadaver dissections, Webster and students operated at 2 Shanghai hospitals, including the National Defense Medical Center Hospital where they treated combat-injured soldiers. In correspondence, one student wrote that he later "carried out a number of rather minor operations using the technique and methods" taught by Webster, viewing his Shanghai experience as an incentive to study plastic surgery. Many of Webster's students proceeded to found plastic surgery departments in their corresponding hospitals, establishing a lasting legacy of this educational exchange. Through a review of the Jerome P. Webster Papers available at Columbia University including lecture materials and correspondence, this article examines Webster's contributions to plastic surgery education in China and its impact on Sino-American medical exchange. It ultimately highlights a lesser-known aspect of the history of plastic surgery, as well as Webster's role in shaping plastic surgery in China.

Abstract: Plastic and reconstructive surgeons must stay current on the care of facial palsy. The time constraints of a busy surgical schedule may prevent them from continuing their professional development. Due to limited learning opportunities or a shortage of experts, surgeons in resource-poor or low-income locations may be unable to provide their patients with the latest procedures. Our webinar masterclass series brought together a distinguished faculty of facial palsy surgeons from around the world to address knowledge gaps in facial palsy management. Doctors and other healthcare workers who treat facial palsy may benefit from this. Our educational theories included experiential learning, connectivism, and constructivism to improve the experience.The 3-session series, publicized on social media and surgical networks, attracted 1338 participants from 42 countries. Live sessions with international experts involved active debates on surgical procedures, patient care strategies, and emerging technologies. All interested colleagues received free world-class surgical education from this multinational collaboration. After careful discussion and postwebinar feedback, we concluded the following: (1) Global collaboration enhances surgical knowledge and skills, (2) accessibility for equitable education, (3) real-time debates for evidence-based decision-making, and (4) a multidisciplinary approach for optimal patient outcomes, and (5) it embraces telemedicine to shape patient care and education. This webinar series showcases the innovative power of virtual education for facial palsy surgery, bringing together experts in one place for the first time. Sharing worldwide expertise in reconstructive plastic surgery can enhance surgical standards, improve patient outcomes, and increase access to education. We strongly recommend using this paradigm to improve surgical training availability and creativity in future initiatives.