Journal of plastic, reconstructive & aesthetic surgery : JPRAS最新文献

Background: Although intraoperative electrical nerve stimulation appears to be a promising neuroenhancing adjunct to peripheral nerve repair, insight into its effects on nerve regeneration is essential to advocate its application in clinical settings.

Objective: This study examined whether electrical stimulation during microsurgical repair of peripheral nerve injury results in enhanced nerve regeneration compared to suture repair alone in experimental animals.

Methods: A systematic search in Embase, MEDLINE, Web of Science, and Google Scholar databases was performed from inception to March 22, 2024. The search included animal studies assessing outcomes following peripheral nerve repair with and without intraoperative electrical stimulation. Outcomes were subdivided into 4 categories: motor function, sensory function, electrophysiology, and histology. We calculated standardized mean differences and combined these using random effects models to estimate the overall effect. The risk of bias was assessed using the SYRCLE tool.

Results: From 3615 references, 21 articles were included. Thirteen studies evaluated motor functional outcomes and showed that electrical stimulation improved functional index, muscle mass, muscle force, footstep accuracy, footprint, and joint angle measures. Six studies examined sensory function and found that electrical stimulation improved mechanical algesimetry. Nine studies assessed electrophysiology outcomes. Although conduction velocity did not differ between the groups, electrical stimulation resulted in a higher amplitude and lower latency. Twenty studies evaluated the histological outcomes and demonstrated increased axon count and myelin thickness, whereas axon diameter and G-ratio did not differ.

Discussion: The results suggest that intraoperative electrical stimulation following peripheral nerve repair accelerates and improves nerve regeneration compared with nerve repair alone.

Systematic review registration: PROSPERO CRD42023455066.

Introduction: Targeted muscle reinnervation (TMR) in amputee patients is a surgical intervention that has shown promise in improving pain and functional outcomes. However, limited research exists regarding its effects on midterm mental health and the quality of life in amputees.

Methods: A chart review was conducted for 46 patients (53 limbs) who underwent TMR. Patients were contacted after at least 1 year and assessed for mental health and quality of life using standardized patient-reported outcome measures (PROMs), including the patient health questionnaire-9 (PHQ-9), posttraumatic stress disorder (PTSD) checklist-specific (PCL-S), Nottingham health profile (NHP), and quality of life scale (QOLS). Data were analyzed using t-tests and linear regression models.

Results: Patients reported significant improvements in residual limb pain, with median preoperative numerical rating scale (NRS) scores of 8 improving to 1 post-operatively (p < 0.05). Mental health PROMs were administered at a mean of 693.6 + 411.6 days following TMR. Mean PHQ-9, PCL-S, NHP, and QOLS scores were 7.5 ± 5.6, 32.6 ± 13.2, 39.1 ± 26.3, and 74.4 ± 21.1, respectively. There was a high prevalence of mental health disorders, with 55% of the patients exhibiting PHQ-9 scores indicating mild depression, while 25% screened positive for PTSD. Linear regression showed a significant positive correlation (p < 0.05) between post-operative NRS and PHQ-9 (depression) scores.

Conclusion: Although TMR effectively reduces residual pain in amputees, its effect on mental health and quality of life is limited. High rates of depression and PTSD remain prevalent in this population. High NRS scores correlate with increased depression scores.

Background: Our study sought answers on the reliability and sensitivity of landmark and 3D surface-based methods in detecting facial asymmetry.

Methods: Asymmetry analysis was performed using anatomical landmarks and surfaces from data obtained with a 3D scanner, and the amount of deviation was calculated according to the opposite half of the face. Resting, eyebrow-raising, eye closure, showing teeth, and whistling facial expressions were evaluated. The intraclass correlation coefficient (ICC) was used to calculate the method's reliability, and sensitivity in detecting asymmetry was tested by comparing healthy subjects and patients with the unpaired t-test. Seventeen patients and 20 healthy volunteers were analyzed.

Results: Intraobserver and interobserver agreement of surface-based analysis ranged from high to excellent in healthy and facial paralysis individuals (ICC 0.77 to 0.99), while landmark-based analyses ranged from moderate to high agreement (ICC 0.60 to 0.91). Furthermore, for the sensitivity in detecting asymmetry, while the landmark-based system could detect statistically significant differences in 2 (eyebrow-raising and showing teeth) of 5 facial expressions (sensitivity = 0.4), the 3D system could detect differences in 5 of 5 (sensitivity = 1) (p < 0.05).

Conclusion: The 3D surface-based analysis method is more sensitive and reliable than the landmark-based method in determining facial asymmetry.