Eplasty最新文献

Background: The treatment of complex wounds remains a challenging aspect of reconstructive surgery, given their diverse nature and the frequent need for high-level surgical procedures. Standard treatment with flap coverage can achieve many goals; however, it is not without difficulties, including technical complexity, extended recovery times, donor site morbidity, and vascular complications, particularly in non-optimized patients. Acellular extracellular matrices, such as porcine urinary bladder matrices, have emerged as an alternative approach to support wound healing without the risks of high-level reconstruction. Urinary bladder matrix provides an extracellular matrix scaffold that supports intrinsic tissue regeneration mechanisms, allowing for stable, well-vascularized wound bed formation.

Methods: This retrospective case series examines the outcomes of urinary bladder matrix for the treatment of complex wounds in 21 patients deemed high-risk or unfavorable candidates for surgical management with local or free flap techniques. The patients were treated by 2 surgeons at 2 separate level 1 trauma centers from October 2019 through June 2022. Urinary bladder matrix was the primary wound management modality with serial wound debridement, matrix reapplication, and subsequent wound care tailored to each patient until definitive, stable coverage.

Results: In all cases, urinary bladder matrix facilitated soft tissue remodeling, permitting complete wound re-epithelization or preparation for skin grafting and/or flap coverage. Four patients' wounds re-epithelized on their own, while 17 patients received subsequent skin graft. In 2 of these cases, the initial split-thickness skin graft failed, requiring a second skin graft and or/flap coverage.

Conclusions: Our results demonstrate that urinary bladder matrix facilitates definitive soft tissue reconstruction and can be a valuable adjunct to wound repair, providing a simpler, less morbid treatment option for patients with various comorbidities and injury mechanisms.

Although the first choice of vascular access for hemodialysis is still the creation of an arteriovenous fistula, the increasing number of vascular access creations in Japan, as well as the inability of percutaneous transluminal angioplasty to effectively restore patency in stenotic and obstructed native vascular accesses, has resulted in an increase in the rate of arteriovenous grafting for hemodialysis. However, for patients with infected wounds, using a prosthetic graft is generally contraindicated because of the risk of the spread of infection. In such cases, options tend to be limited to less frequently used or novel methods of vascular hemodialysis access, such as basilic vein transposition and autologous vein transplantation. Herein, we report 3 successful cases of arteriovenous grafting using an autologous saphenous vein. Careful preoperative evaluation of the vascular anatomy is necessary to effectively determine the best option for vascular access in such patients.

Background: Patients undergoing facial plastic surgery are increasingly using artificial intelligence (AI) to visualize expected postoperative results. However, AI training models' variations and lack of proper surgical photography in training sets may result in inaccurate simulations and unrealistic patient expectations. This study aimed to determine if AI-generated images can deliver realistic expectations and be useful in a surgical context.

Methods: The authors used AI platforms Midjourney (Midjourney, Inc), Leonardo (Canva), and Stable Diffusion (Stability AI) to generate otoplasty, genioplasty, rhinoplasty, and platysmaplasty images. Board-certified plastic surgeons and residents assessed these images based on 11 metrics that were grouped into 2 criteria: realism and clinical value. Analysis of variance and Tukey Honestly Significant Difference post-hoc analysis tests were used for data analysis.

Results: Performance for each metric was reported as mean ± SD. Midjourney outperformed Stable Diffusion significantly in realism (3.57 ± 0.58 vs 2.90 ± 0.65; P < .01), while no significant differences in clinical value were observed between the AI models (P = .38). Leonardo outperformed Stable Diffusion significantly in size and volume accuracy (3.83 ± 0.24 vs 3.00 ± 0.36; P = .02). Stable Diffusion underperformed significantly in anatomical correctness, age simulation, and texture mapping (most P values were less than .01). All 3 AI models consistently underperformed in healing and scarring prediction. The uncanny valley effect was also observed by the evaluators.

Conclusions: Certain AI models outperformed others in generating the images, with evaluator opinions varying on their realism and clinical value. Some images reasonably depicted the target area and the expected outcome; however, many images displayed inappropriate postsurgical outcomes or provoked the uncanny valley effect with their lack of realism. The authors stress the need for AI improvement to produce better pre- and postoperative images, and plan for further research comparing AI-generated visuals with actual surgical results.

Scalp lacerations represent a significant portion of traumatic wounds treated in emergency settings, presenting unique challenges due to the scalp's high vascularity and tension on closure. This study explores primary closure techniques for scalp defects, focusing on sutures, staples, and the hair apposition technique (HAT). Given the cosmetic and psychological implications of hair loss associated with scalp laceration repairs, effective closure methods are paramount. This systematic review evaluates the efficacy of sutures, staples, and HAT in minimizing hair loss and enhancing cosmetic outcomes. Out of an initial 21530 literature sources, 7 studies were included in this analysis, selected through a comprehensive screening process. Findings suggest that while traditional methods like sutures and staples are widely used, HAT shows promise in reducing complications and preserving hair. The study underscores the importance of selecting appropriate closure techniques to optimize patient satisfaction and overall care quality.

Background: The reconstruction of soft tissue near the heel area is challenging, especially after wheel-spoke injuries. Different varieties of the reverse sural artery flap technique are routinely used in complex locoregional areas for reconstructive surgery.

Methods: This study proposes an innovative surgical method involving the use of a rotation-advancement fasciocutaneous flap based on peroneal artery perforators. In this study, 30 patients with soft-tissue defects in the lower third of the leg, including defects in the ankle and heel areas, were treated with this flap.

Results: The study included 19 women and 11 men. The mean age of the patients was 27.60 years. The most common cause of the defect was wheel-spoke injury due to a road traffic accident. In the authors' experience, the flap survival rate was approximately 100%. Four patients had only marginal necrosis of the distal tip, and 2 patients had minor wound infections; these patients were managed cautiously until their healing was complete.

Conclusions: For distal leg reconstruction, the authors recommend the UAD flap over the traditional sural flap because of its lower donor-site morbidity and better aesthetic appearance.

Background: Wound reconstruction involving exposed critical structures, especially in medically complex patients and in those who are at high risk of loss to follow-up, presents a unique challenge to surgeons. The use of acellular dermal matrix (ADM) has augmented our ability to address these wounds safely and with minimal morbidity. A piscine ADM, the Kerecis Omega3 Wound, has shown promise in the treatment of chronic wounds and burns. In this study, we describe the use of the Omega3 Wound in reconstruction of upper extremity wounds, including those with exposed critical structures.

Methods: From 2019 to 2021, 11 consecutive patients with upper extremity wounds, including 9 with exposed critical structures, were queried. Clinical data was tabulated to evaluate outcomes.

Results: Etiology of the wounds included burns, trauma, infection, and oncologic resection. Wound surface area was 150 ± 42 cm². Time to incorporation of the Omega3 Wound was 2 weeks, and the vital structures of previously critical wounds were covered with granulation tissue. Clinically and histologically, the ADM became granulation tissue once incorporated. The average time from application to discharge was 6 days, with 3 patients discharged on the day of application. Skin grafting was subsequently performed at an outpatient surgical center, with 3 weeks as the average time to skin grafting.

Conclusions: The Omega3 Wound allows for complete biologic integration and vascularized wound coverage that accepts a skin graft. Patients can be discharged after application and managed at outpatient facilities. This ADM is safe and well tolerated by patients (including those who are diabetic and immunocompromised) for coverage of upper extremity wounds with exposed critical structures.

Background: The fascia lata autograft is a versatile material utilized in a wide variety of soft tissue reconstructive procedures. Our case highlights an instance in which harvesting fascia lata resulted in a symptomatic vastus lateralis muscle herniation at the donor site that required 2 surgical revisions.

Methods: In this case, a patient developed a thigh muscle hernia at a fascia lata graft donor site. The hernia required a secondary surgical reconstruction utilizing a mesh underlay for the fascial defect repair.

Results: There has been no recurrence of the hernia 1 year after reconstruction, and the patient is able to ambulate normally and with minimal pain.

Conclusions: Use of a fascia lata autograft can result in debilitating donor-site morbidity in certain patients. Prompt reconstruction of residual fascial defects at the time of graft harvest is ideal. However, in this patient, reconstruction with a prosthetic mesh reinforcement several years after symptomatic herniation led to significant improvement in quality of life. Cases of lateral thigh pain with associated bulge also benefit from early magnetic resonance imaging or ultrasound imaging to diagnose fascia defects or distinguish other etiologies.

Background: Breast reduction is one of the most common plastic surgeries, with more than 40000 procedures performed in the United States annually. As breast reductions remove a portion of the breast and distort the anatomy, plastic surgeons need to be mindful of the possibility of breast cancer. In this study, we sought to review the available literature on breast cancer workup for patients undergoing reduction mammoplasties.

Methods: We queried the PubMed (National Institutes of Health) and Embase (Elsevier) databases to identify studies discussing breast cancer workup before breast reduction via preoperative imaging and/or at the time of surgery via histopathologic evaluation of breast specimens. Two individual reviewers screened the titles and abstracts for relevance. We extracted data on the outcomes of preoperative imaging and histopathologic evaluation of breast reduction specimens.

Results: Twenty-three articles published between 1996 and 2022 met the inclusion/exclusion criteria. Two studies evaluated only the role of preoperative imaging and reported a biopsy rate of 3.7% to 5.1% based on imaging findings. Three studies discussed only the role of histopathologic evaluation without mentioning the preoperative imaging requirements from the patients. For the remaining 18 studies, the rate of incidental breast cancer from breast reduction specimens was 0.0% to 2.0%. All studies recommended universal histopathologic evaluation of breast specimens.

Conclusions: In this review, we found unanimous recommendations for performing histopathologic evaluation of breast reduction samples, consistent with the 2022 American Society of Plastic Surgeons clinical practice guideline. Further research is still required to determine the optimal preoperative imaging approach for breast reduction.

Background: Patients with Pierre Robin Sequence (PRS) treated with mandibular distraction (MD) frequently suffer from a cleft palate (CP). There are no standard practices surrounding the need for admission to a pediatric intensive care unit (PICU) following CP repair in these patients. This study will investigate the frequency of airway events following CP repair in this subset of patients.

Methods: A retrospective chart review of all patients with PRS treated with MD that also required CP repair surgery at the authors' institution from 2012 to 2022 was performed. Intraoperative and postoperative analgesic usage, preoperative and postoperative respiratory status, presence of a concomitant operation, comorbid anomalies, as well as age and weight at CP repair were recorded. Our primary outcomes included length of stay following CP repair, presence of airway events perioperatively/postoperatively, and admission status following CP repair.

Results: Twenty-nine patients underwent MD during this period, of which 13 patients also underwent repair of a CP. The average length of stay following CP repair was 2.3 days. Only 2 airway events were noted, and only 3 patients were admitted to the PICU following repair. Presence of comorbid musculoskeletal and neurologic abnormalities was associated with postoperative PICU admission.Remaining intubated following CP repair was associated with increased analgesic usage intraoperatively. A longer duration of intubation following MD was associated with PICU admission and remaining intubated following CP repair.

Conclusions: Overall, it appears that admission to the floor following CP repair in PRS patients with a history of MD is generally safe.

Burn injuries resulting from domestic explosions involving liquefied petroleum gas present complex challenges in clinical management. We present 3 cases of patients with severe burn injuries, highlighting diverse presentations and complications encountered during their treatment. Despite significant morbidity, all patients demonstrated favorable outcomes, emphasizing the importance of comprehensive management strategies. Challenges included inhalation injury, microbial infections, thromboembolic complications, and acute kidney injury. Aggressive treatment modalities, including bronchoscopy-guided therapy, targeted antimicrobial therapy, and vigilant infection control, effectively addressed these complications. Multidisciplinary collaboration and adherence to evidence-based guidelines optimized outcomes. Continued research and innovation are needed to further enhance care and improve long-term outcomes for patients with severe burns.