Eplasty最新文献

Introduction: Regenerative peripheral nerve interfaces (RPNI) can be used to mitigate neuropathic pain resulting from nerve injury or neuroma formation following trauma, surgery, or amputation. Most of the current literature discusses the utility of RPNI for the treatment of neuropathic pain in the upper and lower extremities; however, RPNI can also improve neuropathic pain in non-extremity regions. Our objective was to characterize and describe patient cases of non-extremity RPNIs.

Methods: We retrospectively reviewed medical records of patients treated with RPNIs for non-extremity neuropathic pain by the senior author at a single institution between February 2020 and October 2023.

Cases: Seven patients were treated with RPNI in non-extremity regions. For 1 patient, RPNI was performed prophylactically following discovery of injured peripheral nerves during a surgery and the patient did not report any neuropathic pain in the related regions afterwards. Six patients presented with nerve pain in multiple regions, including the scalp, face, trunk, and groin, that began either after a trauma or previous surgery. The nerve pain of 5 patients completely resolved after the creation of an RPNI.

Discussion: The creation of an RPNI is relatively straightforward and can relieve or prevent peripheral nerve pain caused by injured nerves. While RPNIs have mainly been used for the treatment or prevention of neuromas in extremities, this case series demonstrates efficacy in non-extremity areas as well. Surgeons can, therefore, consider RPNI for patients who have neuropathic pain due to suspected nerve injury that has been refractory to other treatments.

A 55-year-old right-handed male presented acutely with inability to flex at the distal interphalangeal (DIP) joint of the right small finger after feeling a pop while moving heavy furniture. Avulsion of the flexor digitorum profundus (FDP) tendon at its insertion, or "jersey finger," was suspected. During operative exploration, the insertion on the distal phalanx was intact, and the rupture was noted proximally at the level of the lumbrical origin. There are cases in the literature describing attritional ruptures of the tendon proximally due to metacarpophalangeal or intercarpal arthrosis, but this is the first case of a closed, proximal tendon rupture due solely to trauma. Imaging may be helpful to diagnose the level of tendon rupture. We propose surgeons perform an A1 pulley incision to determine the level of rupture prior to planning the surgical exposure for tendon repair.

Background: Intraoperative expansion with air, as compared with saline, has been associated with fewer first-stage complications in 2-stage expander-implant breast reconstruction. However, longitudinal reconstructive outcomes, postoperative medication use indicating pain or discomfort, as well as patient-reported outcome measures after intraoperative air versus saline fill have not yet been investigated.

Methods: This is a retrospective cohort investigation of 69 patients who underwent 2-stage expander-implant prepectoral breast reconstruction with acellular dermal matrix in 2017 and 2018. Patients underwent intraoperative tissue expander (TE) fill with air or saline during stage 1 of reconstruction and underwent expander-implant exchange in stage 2. Air versus saline cohorts were compared with regards to time to definitive reconstruction and postoperative pain/opioid use.

Results: Of the 69 patients studied, 47 (68.1%) had tissue expanders filled with air and 22 (31.9%) filled with saline. In multivariable regression analysis, air-filled TEs were associated with significantly lower odds of requiring an opioid prescription refill (adjusted odds ratio [aOR] = 0.27; P = .009) and breast pain (aOR = 0.10; P < .001). The use of air instead of saline TEs also had no adverse impact on the length of time or number of office visits between stages.

Conclusions: Intraoperative air versus saline TE fill appears to impact longitudinal reconstructive outcomes in expander-implant based reconstruction. Our results demonstrated that air-filled TEs were associated with significantly lower odds of opioid refills and breast pain. Our study also indicates that timing and office visits between stages do not appear to be affected by TE fill medium.

Background: Injuries to the long thoracic nerve (LTN) and upper trunk of the brachial plexus (UTBP) can occur simultaneously and cause scapular winging and shoulder instability. The literature has not documented the concurrent occurrence of UTBP and LTN injuries in these patients. We show an upper trunk injury in patients whose preoperative electromyography (EMG) did not show injury to the UTBP.

Methods: We screened patients with traumatic brachial plexus injuries and associated nerve injuries and identified 50 patients (29 men and 21 women; 31 right side and 19 left side; mean age 34 years, range 16-63 years) with winged scapula and shoulder instability who had undergone neurolysis and decompression of the UTBP and LTN with the lead author and surgeon, R.K.N. We measured and compared the compound motor action potentials (CMAPs) of the upper limb nerves before and after neurolysis during intraoperative neurophysiological monitoring (IONM) and compared it with surgical outcomes.

Results: After surgery, IONM showed a significant increase in CMAPs for all 4 muscles: serratus anterior (295 ± 291 to 886 ± 937), supraspinatus (237 ± 216 to 618 ± 423), deltoid (344 ± 446 to 936 ± 1015), and biceps (492 ± 656 to 1109 ± 1230, P < .0001). The CMAPs of the 4 upper extremity (UE) muscles showed a positive correlation before and after surgery (R = 0.6, 0.28, 0.59, 0.57, respectively; P < .0001). Preoperatively, all patients had severe to moderate scapular winging and 15° - <170° in active range of motion (shoulder forward flexion and abduction). Scapular winging, shoulder flexion, and abduction improved significantly in 98% (n = 49) of the patients with a postoperative average of 168° ± 11° and 165° ± 16°, respectively, compared with the preoperative average of 127° ± 30° and 122° ± 29°, respectively, (P < .0001) with a mean follow-up of 1.3 years. Postoperatively, no patient experienced a worsening of their preoperative symptoms.

Conclusions: Our article presents the first documented occurrence of a long thoracic nerve injury coinciding with a brachial plexus upper trunk lesion in 50 patients with scapular winging whose preoperative EMG did not show injury to the UTBP. Neurolysis of the UTBP and LTN immediately increased the nerve conduction to the UE muscles evaluated intraoperatively.

Background: This paper reviews the signs and symptoms of recurrent or persistent carpal tunnel syndrome and examines some of the causes of failed primary carpal tunnel release.

Methods: A retrospective review of the surgical findings and outcomes of 29 consecutive patients who underwent 30 revision carpal tunnel operations was performed. Patient outcomes were recorded at a minimum of 1 year postoperatively.

Results: Thirty hands in 29 consecutive patients underwent a second operation by a single surgeon. The average time interval from the first carpal tunnel release to the revision surgery was 5.7 years. Twenty-three patients experienced recurrent symptoms, and 7 had persistent symptoms. On preoperative examination, 77% demonstrated abductor pollicis brevis muscle weakness, 67% demonstrated a positive Phalen sign, and 63% demonstrated ring finger "sensory splitting." Incomplete release of the transverse carpal ligament and circumferential fibrosis were the most common intraoperative findings, totaling 20 cases each; intact antebrachial fascia (8 cases), volar subluxation of the median nerve (5 cases), compression of the median nerve by palmaris longus (4 cases), flexor tenosynovitis (4 cases), and aberrant anatomy (1 case) were also observed. Nine patients (34%) had complete resolution of symptoms after the revision carpal tunnel release. Fifteen patients (58%) had improvement in symptoms, and 2 patients did not report improvement.

Conclusions: We have found the Phalen sign, comparison of the strength of the abductor pollicis brevis muscle, and subjective "splitting" of the ring finger sensation to be the most helpful findings in establishing the diagnosis. Persistent carpal tunnel syndrome is almost always secondary to incomplete division of the transverse carpal ligament.

Background: Dermal substrates (DS) are native skin substitutes applied to facilitate wound healing in burn patients, either as definite treatment or to prepare wound beds for grafting. Our study aimed to characterize wound healing after DS application among pediatric patients with deep partial-thickness burns.

Methods: We retrospectively reviewed patients <18 years old at our American Burn Association-verified pediatric burn center from 2015-2023 who underwent burn excision and application of either DS alone or DS with subsequent autografting. All patients were treated with a single DS containing fetal bovine dermal repair scaffold. We collected demographic data, injury details, operative procedures, and postoperative wound complications. We compared patients with χ² and Fisher exact tests.

Results: Among 205 patients, 84.4% healed with treatment with DS alone and 15.6% required autografting after DS application. Median age at DS application was 3.0 years. Most patients were male (60.0%) and White (63.9%). Patients most commonly had scald (47.8%) or flame burns (32.2%). Median total body surface area burned was 6.0% (IQR 3.0%, 10.3%). Patients needing autografting after DS placement healed a median of 50% (IQR 28.1%, 77.5%) of their original wound surface area after DS application. Complications were overall low in both groups. Patients who only required DS had lower rates of wound infection (2.9% vs 12.5%, P = .029) and scar contracture compared with those who required subsequent autografting (5.8% vs 15.6%, P = .045).

Conclusions: Children with deep partial-thickness burn injuries treated with DS alone had a high proportion of wound healing and low rates of complications. Although some patients may require subsequent autografting after DS application, the proportion of the wound requiring autografting was half of the size of the original wound. Our findings can help surgeons counsel pediatric burn patients and their families about expectations following DS application for deep partial-thickness burns.

Background: Primary breast augmentation remains the most frequently performed aesthetic surgery worldwide. Advances in this surgery have been incredible, not only from a surgical technique point of view but also since the appearance of new technologies and the better understanding of the interactions between the patient, the breast implant, the usual bacterial flora, and surgical maneuvers. However, there are still several instances of surgical procedure or postoperative medical indications that differ remarkably from one surgeon to another and may even be totally opposite. Due to the lack of a clinical practice guide for performing a primary augmentation mastoplasty, it is important to compare surgeon's procedures and decisions with scientific evidence.

Methods: An anonymous survey composed of 25 multiple choice questions was designed to assess current practice in primary breast augmentation among active members of the Argentinian Society of Plastic Surgery. In January 2020, it was distributed via email. The results of the surveys were compiled by 2 independent reviewers and contrasted with current medical evidence.

Results: A total of 146 surveys were completed by members of the Argentinian Society of Plastic Surgery.

Conclusion: Many differences were found in the behavior of the surgeons surveyed, as well as a lack of correlation between the evidence based on medicine and the usual medical practices or indications. These results should serve as the basis for the realization of a clinical practice guide from a scientific society of plastic surgeons.

Background: Intraoperative techniques to maximize control are crucial to achieving an aesthetic result in cosmetic breast surgery with implants. The authors describe their experience with the use of polydioxanone (PDO) internal support matrix in a high volume of primary augmentation, primary mastopexy augmentation, and revision augmentation cases.

Methods: A high-volume (n = 522) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to June 2023. All patients received smooth-shelled silicone gel breast implant augmentation surgeries with PDO mesh as an adjunct. Each case used at least 1 sheet of PDO mesh, with a small set (n = 9) receiving 2 sheets. Patients were followed (range 6-37 months), with 6 months minimum follow-up to assess outcomes.

Results: PDO mesh is associated with decreased malposition in primary augmentation with smooth implants and improved scarring in primary and revision augmentations involving a mastopexy. Augmentations performed with PDO mesh as an adjunct allowed for the use of larger implant volumes with less concern over poor soft tissue stores and compromised skin quality to hold the weight of the implant.

Conclusions: PDO mesh is a safe and effective adjunct to smooth silicone gel implants to obtain greater pocket control and optimal aesthetic results in cosmetic breast surgeries.