Eplasty最新文献

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.

Background: Chat Generative Pretrained Transformer (ChatGPT), a newly developed pretrained artificial intelligence (AI) chatbot, is able to interpret and respond to user-generated questions. As such, many questions have been raised about its potential uses and limitations. While preliminary literature suggests that ChatGPT can be used in medicine as a research assistant and patient consultant, its reliability in providing original and accurate information is still unknown. Therefore, the purpose of this project was to conduct a review on the utility of ChatGPT in plastic surgery.

Methods: On August 25, 2023, a thorough literature search was conducted on PubMed. Papers involving ChatGPT and medical research were included. Papers that were not written in English were excluded. Related papers were evaluated and synthesized into 3 information domains: generating original research topics, summarizing and extracting information from medical literature and databases, and conducting patient consultation.

Results: Out of 57 initial papers, 8 met inclusion criteria. An additional 2 were added based on the references of relevant papers, bringing the total number to 10. ChatGPT can be useful in helping clinicians brainstorm and gain a general understanding of the literature landscape. However, its inability to give patient-specific information and act as a reliable source of information limit its use in patient consultation.

Conclusion: ChatGPT can be a useful tool in the conception of and execution of literature searches and research information retrieval (with increased reliability when queries are specific); however, the technology is currently not reliable enough to be implemented in a clinical setting.

Background: A common postoperative challenge following implant-based breast reconstruction surgery is lateral or inferior displacement of the implant, which ultimately requires surgical intervention to shape the pocket for improved symmetry. Capsulorrhaphy is traditionally performed with smooth sutures, but the use of barbed sutures has proven to be more efficient and effective in other plastic surgery procedures. This study aimed to demonstrate the safety and efficacy of barbed sutures for breast reconstruction implant capsulorrhaphy.

Methods: A retrospective cohort study was performed including all consecutive patients who underwent capsulorrhaphy by the senior author utilizing barbed sutures and, for comparison, another colleague utilizing smooth sutures from the years 2018-2021.

Results: Twenty-eight patients were identified who underwent barbed suture capsulorrhaphy (a total of 36 breasts operated on), which was compared with 20 patients who had smooth suture capsulorrhaphy (a total of 34 breasts operated on). The average ages of the barbed and smooth suture cohorts were 55 and 53 years old (P = 1.00), respectively. The average BMI of the barbed and smooth suture cohorts were 26.7 and 25.0 kg/m² (P = .15), respectively. The reoperation rates for both groups were similar at 5%. Overall complication rate was 13.9% in the barbed suture group and 8.8% in the smooth suture group, which was not statistically significant (P = .71). Patients with barbed sutures did not have an increased risk of complications compared with those who received smooth sutures (OR 1.67 (0.37-7.59), P = .51).

Conclusions: In conclusion, performing implant-based breast reconstruction capsulorrhaphy with barbed sutures is a safe and effective procedure as compared with smooth sutures.

This case report describes the surgical management of a severe mentosternal contracture in a 49-year-old woman in Ghana, West Africa, secondary to an acid burn injury. With limited resources, the treatment involved scar excision and full-thickness skin grafting in a single operation performed solely under local anesthetic infiltration, with no use of oral, inhaled, or parenteral anesthetic or sedating agents. As we were unable to find any documented cases performed under only local anesthesia, this case highlights a simplified reconstructive and anesthetic approach to managing complex, disabling burn contractures in low-income countries, particularly where advanced reconstructive options and monitored anesthesia care are not readily available.

Background: There are a variety of ways to surgically manage patients with scaphoid waist fractures. The purpose of this study is to compare the rate of union achieved with a nitinol compression staple versus that of a headless compression screw in the treatment of scaphoid waist fractures.

Methods: We performed a retrospective review of patients with middle-third scaphoid fractures treated surgically. Patients were stratified into 2 groups based on fixation device: a nitinol compression staple or headless compression screw (HCS). Primary outcome was radiographic union. Secondary outcomes included time from surgery to union, development of avascular necrosis (AVN), complication rate, and need for revision.

Results: Forty-one patients were included in the final analysis. The median follow-up time was 5.7 months. Twenty patients were treated with staples, 21 with HCS. Thirty-seven patients achieved union. All who failed to unite were treated with HCS. Eight patients had postoperative complications, including postoperative AVN, all of whom were in the HCS cohort. This treatment group had a higher rate of revision surgery as well. Staples required less time to achieve union and fewer weeks of immobilization. Postoperative scapholunate angles were similar between the groups.

Conclusions: Fixation of scaphoid waist fracture with nitinol compression staples is at least as likely to achieve union as fixation with HCS in patients without prior surgical intervention. This treatment also demonstrated equivalent or better secondary outcomes, including postoperative AVN, complication and revision rates, time to union, and weeks immobilized.