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

Introduction: The frontal appearance of ears, usually overlooked in facial aesthetics, has gained increasing attention among Asians. However, a consensus on the ideal cranioauricular angle is currently lacking. This study aims to investigate the ideal cranioauricular angle as perceived by the Asian population through a questionnaire-based survey.

Methods: A survey was conducted among a diverse population of varying backgrounds by distributing questionnaires manually. The participants were requested to evaluate a series of images depicting typical Asian facial features, with ears digitally manipulated to demonstrate distinct cranioauricular angles. Demographic information, including age, gender, occupation, their own face and ear type, and history or interest in otoplasty for aesthetic purposes, was recorded.

Results: A total of 632 responses were recorded. The cranioauricular angle of 30 degrees received the highest scores from respondents, regardless of gender and face shape (P<0.0001), which corresponded to an upper width facial ratio of 0.79-0.82 and a lower facial width ratio of 0.67-0.70. Subgroup analysis revealed ideal angle lies between 30 and 40 degrees, with slight differences when stratified by age, gender, or occupation. Auricles that are excessively protruded or concealed were not preferred. Among respondents with a slender face, 20.5% expressed interest in otoplasty, compared to 15.27% among those with a broader face.

Conclusion: This study provides an in-depth insight into the optimal cranioauricular angle based on gender and facial shape. The ear with a cranioauricular angle of 30 degrees is the preferred option among participants in the survey. These findings offer valuable guidance for surgical planning and outcome assessment in cosmetic otoplasty.

This study aimed to evaluate the potential use of artificial dermal grafts in the lower eyelid following surgical resection of basal cell carcinoma (BCC), focusing on the degree of scar contracture. Postoperative changes were assessed using four quantitative and two qualitative parameters. Anthropometric analysis revealed no statistically significant differences across the four quantitative measures. Furthermore, no new cases of ectropion or scleral show were observed after grafting. These findings suggest that artificial dermal grafting may be a viable option following surgical excision of BCCs on the lower eyelids, without inducing significant eyelid retraction.

Background: Microtia is a common congenital craniofacial malformation, with concha-type microtia presenting unique challenges due to the relatively large residual auricle tissue and flexible surgical methods. The authors employed triangular flaps combined with full-thickness skin graft technique for treating concha-type microtia, achieving marked treatment effects.

Method: Thirty-five patients with unilateral concha-type microtia were enrolled in this study from January 2023 to June 2024. All patients underwent reconstruction using the triangular flaps combined with full-thickness skin graft method. Pre-and postoperative data regarding the auricles were precisely measured and statistically analyzed, and patient satisfaction along with postsurgery complications were monitored.

Results: Overall, 35 patients were followed-up for 3 to 13 months. The mean preoperative length, width, and perimeter of the affected auricle were 4.79±0.28, 2.44±0.24, and 9.10±0.54 cm. The mean immediate postoperative length, width, and perimeter of the affected auricle were 5.35±0.30, 2.85±0.25, and 10.16±0.54 cm. Significant differences were observed when comparing immediate postoperative and last follow-up results to preoperative measurement (P<0.05). No significant difference was observed in the dimensions of the postoperative auricle compared to that of the unaffected side. All patients expressed satisfaction with the treatment effect and no complications were reported.

Conclusion: The method using triangular skin flaps combined with full-thickness skin graft proved to be a remarkable approach for concha-type microtia, maximizing the utilization of the residual auricle, simplifying the treatment procedures, and yielding satisfactory repair outcomes.

Background: Over the 27 years following the first report of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), significant changes have been made in breast implant surgery trends. This study aimed to determine breast implant selection changes among European plastic surgeons.

Methods: The European Association of Plastic Surgeons (EURAPS) promoted a digital survey to 31 national plastic surgery societies across Europe, which spread it to their members. The survey included 37 questions covering demographics, BIA-ALCL perception, current clinical practices, implant selection considerations, and satisfaction with information from health authorities and scientific societies. Anonymous responses were collected from February to April 2024.

Results: A total of 904 surgeons from 33 countries participated, 41.5% reported that BIA-ALCL concerns affected patient decisions. Awareness of BIA-ALCL was high (97.2%), with more than 85% approving the quality of information from European scientific societies. The awareness influenced implant texture preferences in both aesthetic and reconstructive breast surgery (p<0.001), in the first with a notable drop in the use of macrotextured implants from 32.6% to 1.8%, while the use of smooth implants (ISO 14607:2018) increased from 11.3% to 44.6%. Similar trends were observed in reconstructive surgery regarding implant texture, but 33.1% of surgeons considered performing autologous reconstruction more often than using implants. Surgeons who encountered BIA-ALCL were more prone to using smooth implants. The recognized causal relationship between implant texture and BIA-ALCL is the main explanation to these changes.

Conclusion: Efforts in BIA-ALCL education have heightened surgeons' awareness, improved patient communication, and influenced clinical practices toward safer choices.

Background: Few studies have been conducted on direct-to-implant (DTI) breast reconstruction failure, and consistent conclusions are lacking. Thus, this study aimed to comprehensively analyze the risk factors of reconstruction failure.

Methods: Patients who underwent DTI breast reconstruction after mastectomy at a single center between July 18, 2014, and January 13, 2020, were retrospectively included in this study. Two algorithms, random forest and logistic regression, were employed to construct models that analyzed the complications and risk factors of reconstruction failure. Subsequently, a multicenter external validation was performed for both models.

Results: There were 538 patients in the model construction group and 91 patients in the multicenter external validation group, with 23 and 5 reconstruction failure outcomes, respectively. Random forest analysis revealed that infection and wound dehiscence were the most significant factors leading to reconstruction failure. Multivariate logistic regression analysis indicated that body mass index (BMI), infection, and wound dehiscence were correlated with reconstruction failure. The risk of failure was 3.35% higher in overweight (BMI > 24 kg/m²) patients, 9.6% higher in patients with infection, and 42.5% higher in patients with wound dehiscence than that in the control group. The internal validation receiver operating characteristic (ROC) value for the random forest model was 0.990, whereas the external validation ROC was 0.736. The internal and external validation ROC values for the logistic regression model were 0.995 and 0.826, respectively.

Conclusion: Wound dehiscence and infection were the most significant risk factors for DTI breast reconstruction failure, and preoperative weight control was also important.

Background: Skin graft is frequently used for donor site closure after osteocutaneous fibula free flap (OCFFF) harvest when primary closure is not possible. Partial skin graft loss requiring wound care is a common complication. The purposes of this prospective study were to investigate the perforator anatomy for local propeller or tonearm flap closure and compare the outcomes to those of skin graft closure.

Methods: All patients undergoing OCFFF for head and neck reconstruction from February 2022 to October 2023 were considered for the tonearm flap. Intraoperative perforator anatomy was prospectively recorded. Surgical techniques and criteria for tonearm flap reconstruction were described. A minimum follow-up period of 6 months was required. Outcome measures included the rate of flap success and wound complications.

Results: Forty consecutive patients were included. The tonearm flap was not possible in 16 patients (40%) due to unfavorable perforator anatomy and 2 patients underwent primary closure. All successful tonearm flaps were eccentrically designed on a proximal lower leg perforator, located 13.5 ± 1.99 cm from the fibular head. Most proximal perforators were musculocutaneous through the soleus muscle (n = 20, 90.9%), whereas the rest were septocutaneous (n = 2, 9.1%), originating from the peroneal artery. Three patients experienced distal partial flap loss; one required an additional skin graft. Only half of the skin graft cohort (n = 99, 50.8%) achieved complete skin graft take. The average skin graft loss was 34.3%, and wound care was required for an average period of 51.6±52.8 days.

Conclusions: The study findings demonstrate that local tonearm flaps, when anatomically feasible, can be successfully performed with superior outcomes compared to skin graft closures.

Introduction: Orthoplastic surgery, which combines orthopedic and plastic surgery principles, plays a crucial role in the treatment of open fractures of the lower limb. Clinical Practice Guidelines (CPGs) are valuable tools for standardizing and improving patient care.

Objective: To assess the availability and quality of international CPGs for orthoplastic treatment of open fractures of the lower limb. A secondary objective was to provide a detailed analysis of the specific recommendations by comparing them among different CPGs.

Methods: A systematic review was conducted in 2023 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines across major medical databases and gray literature. Inclusion criteria focused on guidelines specific to orthoplastic surgery for lower limb open fractures. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, a widely accepted instrument for guideline assessment, was utilized to evaluate the methodological rigor and transparency of the selected guidelines.

Results: Three orthoplasty CPGs have been identified, 2 of which were judged reliable according to the AGREE II methodology. Orthoplastic recommendations are no more than 7 per CPG. Consistent agreement was observed on the timing of debridement, the importance of early fixation, and definitive coverage.

Conclusion: CPGs are critical to set up clinical pathways that are safe and evidence-based. Only 3 international CPGs address orthoplastic treatment of open lower limb fractures, 2 of which are judged reliable according to methodology. Therefore, it becomes essential to develop and disseminate high-quality, evidence-based guidelines, which are critical to improving patient outcomes and standardizing clinical practice worldwide.

Background: The authors' previous research suggested the hypothesis that aesthetic surgery in general has a positive impact on quality of life (QoL). This prospective study aimed to investigate the indication-specific effect on QoL in patients undergoing transaxillary endoscopic breast augmentation.

Methods: Seventy-seven patients underwent aesthetic breast augmentation. Fifty patients met the inclusion criteria. All of them answered one set of the questionnaires preoperatively, and the follow-up set at 6 months postoperatively. The testing instruments included a self-developed indication-specific questionnaire and five standardised and validated questionnaires with German norm data available: Questions on Life Satisfaction, Modules (FLZ^M, German version), the Freiburg Personality Inventory-Revised (FPI-R), the Rosenberg Self-Esteem Scale (SRES), the Patient Health Questionnaire (PHQ-4) and the Breast-Q | Augmentation.

Results: Our self-developed indication-specific questionnaire shows high satisfaction with the postoperative results. The FLZ^M demonstrated significant improvements in the module life in general (p < 0.001), 'hobbies' (p < 0.001), 'health' (p = 0.04), 'family life' (p = 0.03) and 'partner relationship/sexuality' (p < 0.001). Moreover, the FPI-R revealed a significant improvement in emotional stability (p < 0.001). Moreover, the PHQ-4 showed a significant reduction in overall psychological distress (p < 0.001). Further, Breast-Q indicated a significant increase in psychological (p < 0.001) and sexual well-being (p < 0.001).

Conclusion: Transaxillary endoscopic breast augmentation has a significant impact on QoL and sexuality. The surgery leads to a higher satisfaction not only with the result of intervention and the outer appearance specifically, but also with life and the state of health generally. It improves emotional stability. Therefore, the authors' hypothesis in a previous research was confirmed for this specific indication prospectively.

Background: Nasal cutaneous tumors impact appearance and function, affecting the patients' well-being. This study compares the outcomes of second intention healing, where wounds heal naturally, with flap transfer in nasal defect repair after tumor resection to evaluate its viability as an alternative.

Methods: In this multi-center study, 80 patients who underwent second intention healing and 70 patients who received flap transfer after nasal tumor resection between July 2018 and June 2023 were included. Patient demographics, tumor characteristics, operative details, and wound healing time were collected. Scar outcomes were evaluated at 6 months postoperation using the Vancouver scar scale and visual analog scale.

Results: The second intention healing group showed significantly better outcomes compared to the flap transfer group. The Vancouver scar scale score was lower in the second intention group (3.51 ± 0.22 vs. 3.98 ± 0.68, P = 0.02), indicating better scar quality. Superior outcomes were observed in vascularity, pigmentation, and pliability on the observer patient and observer scar assessment scale (POSAS) scale. Patients reported better color, irregularity, and higher satisfaction with wound care experience. The overall patient satisfaction score was significantly higher in the second intention group (7.59 ± 0.24 vs. 7.16 ± 0.10, P = 0.02).

Conclusion: This cohort study suggests that second intention healing is associated with higher patient satisfaction in nasal cutaneous tumor surgery compared to flap transfer. These findings support the possibility of using second intention healing as an alternative in nasal cutaneous tumor treatment. Further research is needed to validate these results.

Background: The aim of the study was to evaluate the accessibility and localization of spinal accessory and suprascapular nerves in the suprascapular region in healthy volunteers using ultrasonography.

Methods: One hundred healthy volunteers were included and the location of the spinal accessory nerve (SAN) and suprascapular nerve (SSN) was assessed in the right suprascapular region.

Findings: Seventy men and 30 women, (mean age 40.37 years; mean BMI 23.44 kg/m²) participated in the study. Mean distance of SAN from the vertebral spinous process and medial border of the scapula was 3.80 and 0.7 cm, respectively. Mean depth of SAN from the skin was 2.67 cm. The mean distance of SSN from the spine was 7 cm and mean depth of SSN from the skin was 3.28 cm. In overweight and obese individuals, the distance of SAN from the skin and vertebral spinous process and distance of SSN from the vertebral spine increased significantly. According to gender, there was no statistically significant difference in the location of SSN and SAN; however, the distance of SSN from the vertebral spine was significantly increased with increasing age.

Interpretation: The SSN and SAN in the suprascapular region can be consistently and reliably mapped using ultrasound. These data can also help in surface markings of both the nerves, which reduces the operating time and risk of iatrogenic injury.