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

Background: In effort to improve post-operative outcomes, enhanced recovery after surgery (ERAS) protocols have gained popularity. The objective of this systematic review was to assess the reporting and methodological quality of plastic surgery ERAS studies.

Methods: All plastic surgery ERAS implementation studies, published between January 1, 2020, to November 20, 2023, were included. The primary outcome was reporting quality based on "The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) checklist" (40 points). Secondary outcomes included methodology quality as per ERAS® Society endorsed guidelines (Breast 18 points; Head and Neck (H&N) 24 points).

Results: Fifty ERAS studies were included (breast reconstruction: 29, 58%; head and neck: 7, 14%; craniofacial: 6, 12%; aesthetic: 5, 10%; other: 3, 6%). Average reporting quality was 22.6/40 (56.7%). ERAS protocol elements least adhered to included: patient warming strategy (8/50, 16%), management of post-operative fluids (14/50, 28%), and post-discharge outcome tracking (14/50, 28%). Evaluation of breast methodological quality revealed average compliance of 9.2/18 (51.3%). The least complied with elements included preoperative computed tomography angiography (4/23, 17.4%), intraoperative warming (6/23, 26.1%), and post-operative wound management (2/23, 8.7%). For head and neck studies, average compliance was 9.1/23 (39.6%). The least complied with elements included pre-anesthesia pain medications (1/7, 14.3%), post-operative wound care (0/7, 0%), and urinary catheterization removal (1/7, 14.3%).

Conclusions: ERAS implementation studies in plastic surgery are highly variable, with overall low reporting and methodology quality. Plastic surgeons should be cautious when adopting published ERAS protocols that do not adhere to the recommended and official ERAS® Society guidelines.

Background: Profunda artery perforator (PAP) flap following cancer surgery has emerged as a relevant alternative for breast reconstruction but is mainly used in cases where the deep inferior epigastric perforator (DIEP) flap cannot be performed. The aim of this study was to compare the PAP and DIEP flaps' surgical and aesthetics outcomes in breast reconstruction.

Methods: Women who underwent breast reconstruction by DIEP or PAP flap at the Plastic Surgery Department of Georges Pompidou European University Hospital, Paris, France, between January 2012 and December 2020 were included. Patient's demographic characteristics, type, laterality, and timing of reconstruction were recorded. Operative times, length of hospital stay, general complications, and surgical complications were compared. The number of late surgical reoperations, their timing relative to the initial reconstructive procedure, and their purpose were also compared.

Results: A total of 677 patients were included, 559 of whom received DIEP flaps and 118 received PAP flaps. PAP flap patients were significantly younger, thinner, and had a smaller initial bra cup size than those who received DIEP (p < 0.001) Operative time was similar for both groups (p = 0.074). There was no difference in the number of early post-operative reoperations (p > 0.554) or late revisions (p > 0.403) between DIEP or PAP.

Conclusion: Provided that the technical and human resources are available, PAP flap is a valid technique, without increased risk of surgical complications and reoperations, or lengthening of operative time. The PAP flap should be considered a primary therapeutic option and not as an alternative to the DIEP flap.

Introduction: The management of malignant melanomas often involves performing a sentinel lymph node biopsy (SLNB) aided by imaging with lymphoscintigraphy. Whether lymphoscintigraphy should be performed on the same day as the SLNB operation (SD) or the day before (DB) surgery remains debated. This study aims to summarise existing evidence regarding the impact of the relative timings of lymphoscintigraphy and SLNB on clinical outcomes in melanoma.

Methods: A PRISMA-compliant search was conducted from inception to 28th May 2024. Data were collected on SLNB in melanoma patients who underwent either an SD or DB approach. The following outcomes were extracted from the articles: node identification, recurrence rate and survival outcomes. Pooled effects of outcomes were estimated using the DerSimonian and Laird random-effects model/generalised linear mixed model, where applicable.

Results: A total of 9 studies met the inclusion criteria. Six studies (n = 10, 216) compared SD and DB approach outcomes, while 3 studies (n = 153) compared SD and DB SLNB within the same patient cohort. In the former, no significant difference was found in positivity rates between SD and DB groups (RR 1.03, 95% CI 0.94-1.13, p = 0.475), and recurrence rates were comparable (RR 0.90, 95% CI 0.75-1.07, p = 0.233). SD approach was associated with significantly shorter hospital stays and lower costs, but conflicting results were observed in survival outcomes. In the latter studies, all 3 reported discrepancies between the results of the SD and DB approaches.

Conclusion: Current evidence is insufficient to provide a definitive answer. Further research is warranted to conclusively evaluate the impact of SLNB timing on melanoma outcomes and patient care.

Background: Previous computed tomography studies have reported that the superior mesenteric artery is often located ventrally to the superior mesenteric vein; however, the precise location of the peripheral jejunal arteriovenous system is unknown. This study investigated the arteriovenous positioning of the free jejunal flaps during reconstructive surgery.

Methods: This retrospective cohort study included 78 patients who underwent free jejunal flap reconstruction between June 2021 and May 2023. The positions of the jejunal artery and vein were classified into 6 patterns (A-F) based on the photographs taken during the flap harvest. Statistical analysis was performed to examine the location of the artery (ventral vs. dorsal) and its orientation along the oral-anal axis in relation to the vein.

Results: The jejunal arteries were most commonly located on the oral and ventral sides of the vein (type A, 48.6%) when the mesentery of the jejunal flap is positioned toward the front, with the left and right sides corresponding to the oral and anorectal sides, respectively. Notably, 62.1% of the arteries were located on the oral side and 71.6% on the ventral side. The recipient arteries used for vascular anastomosis were predominantly the superior thyroid artery (44.6%) and transverse cervical artery (50.0%), while the internal jugular vein (85.1%) was the most commonly used vein.

Conclusion: The position of the jejunal arteriovenous system is important for optimizing anastomotic techniques and ensuring safe surgical outcomes. Understanding vascular anatomy patterns can help prevent vessel misplacement and allow for more reliable and accurate anastomosis procedures.

Background: Autogenous fat grafting (AFG) has become a common procedure to optimize aesthetic results in breast augmentation (BA). However, complications or outcomes in reoperative BA remain unclear. This study compared the outcomes or risk factors in reoperative BA with AFG and without AFG.

Objectives: To assess outcomes from AFG in a large series of patients undergoing reoperative BA.

Methods: We identified a retrospective cohort of patients who underwent secondary BA, and then established 2 groups that did and did not receive AFG. Charts were reviewed for complications or reoperations. The primary outcome was complications (identified clinically or via imaging), and regression logistic analysis was used to evaluate risk factors including age, body mass index, smoking, implant surface/volume, and previous pocket.

Results: Overall, 293 patients were included (age: 41 ±9.4 years, follow-up: 70.4±30.7 months). In the AFG group (n = 111), 27.9% had at least 1 complication, most frequently capsular contracture; 12% had a previous submuscular pocket (43% presented animation deformities). In the non-AFG group (n = 182), 29.6% had at least 1 complication. No significant difference was observed between groups for total complications (p = 0.750) or reoperation (p = 0.665). AFG itself was independently associated with increased risk of altered imaging results (p = 0.002; OR = 2.92), predominantly oil cysts. In the AFG group, animation was completely resolved.

Conclusions: Despite extensive AFG research, previous reoperative BA studies are limited and have not analyzed complications or long-term outcomes. AFG provides adequate tissue thickness to allow for a more superficial pocket, thus resolving animation issues. Our results indicate that AFG is a reliable technique that permits satisfactory outcomes and does not increase overall complication or reoperation rates compared to the procedures without AFG.

Background: Orbital exenteration is a severe and disabling surgical procedure that involves the removal of all orbital contents. Effective reconstruction is crucial to managing the resulting defects. This study aims to propose a reconstructive algorithm utilizing free flaps derived from the lateral circumflex femoral artery (LCFA) system for orbital exenteration defects, based on our clinical experience.

Patients and methods: Patients who underwent orbital exenteration and subsequent reconstruction using LCFA-based free flaps between January 2013 and January 2022 were included in this study.

Results: A total of 44 patients underwent orbital exenteration, followed by LCFA free flap reconstruction. The choice of reconstructive technique depended on defect type and dura mater exposure, adhering to the proposed algorithm. The procedures included 20 standard ALT (Anterolateral thigh) flaps, 13 chimeric ALT flaps, 1 SALT chimeric flap with skin grafting, 7 SALT flaps with skin grafting, and 3 buried SALT flaps. Complications were recorded in 10 cases at the recipient site and 2 cases at the donor site.

Conclusion: Orbital exenteration presents significant challenges both surgically and reconstructively, with a high risk of local recurrence and postoperative mortality. The reconstruction algorithm using LCFA-based free flaps, as proposed in this study, may guide surgeons in selecting the most appropriate technique, tailored to the specific defect and considering postoperative treatments such as adjuvant radiotherapy.

Objectives: To introduce a novel technique using the buried-guided suture method for suspending the alar crus to correct nostril exposure in East Asians and to investigate its safety and efficacy.

Methods: Patients with ptotic alar crus and nostril exposure at our clinic were enrolled between December 2011 and December 2023. Via an intranasal incision, the excess skin on the inner side of the nostrils was excised. The alar crus was suspended to the periosteum of the piriform aperture using non-absorbable sutures. Changes in the exposed area of the nostrils and distance of alar crus elevation were statistically analyzed before and after surgery. Satisfaction rate was assessed using a four-point visual analog scale.

Results: A total of 35 patients were included, with an average follow-up duration of 15 ± 6 months. Post-operatively, the mean exposed area of the nostrils was significantly reduced compared to the preoperative area (9.14 ± 1.93 mm² vs. 20.97 ± 2.64 mm², P < 0.05). The mean height of the alar crus relative to the base of the columella showed significant improvement post-operatively (+1.08 ± 0.32 mm vs. -1.82 ± 0.32 mm, P < 0.05). Overall, 91.4% (32/35) patients expressed satisfaction with the outcomes.

Conclusions: The buried-guided suture method for suspending the alar crus combined with excision of the inner nasal skin is a safe and effective surgical procedure for correcting nostril exposure.

Background: Vascularized lymph node transfer (VLNT) is traditionally performed in patients with advanced-stage lymphedema. To enhance and promote the physiological effects of VLNT, lymphatic system transfer (LYST) was developed. In this technique, lymph nodes and a portion of their corresponding afferent lymphatic vessels are transferred to stimulate lymphangiogenesis. This study presented our experience, pearls, and pitfalls of using superficial circumflex iliac artery perforator LYST.

Methods: A retrospective review of patients treated with LYST for lymphedema treatment from July 2018 to March 2022 was included. Patient characteristics, perioperative data, and long-term outcomes were analyzed.

Results: Eight patients with unilateral lower-extremity lymphedema underwent LYST. The mean follow-up duration was 39.0 (24.0-60.0) months. The mean improvement in the excess volume percentage compared to the unaffected limb was 11.2% (100% improvement to 0% worsening) at the last follow-up, with statistical significance (p < 0.001). The incidence of cellulitis decreased with statistical significance (p = 0.025).

Conclusion: A long-term study on using LYST flaps in lymphedema treatment has not been previously performed. This study showed that the LYST procedure provides reliable and effective long-term outcomes in treating patients with advanced-stage lymphedema.

Experts have widely discussed rhinophyma treatment, proposing and testing various therapies over the years. The aim of this retrospective study was to compare the aesthetic outcomes of patients undergoing the cold blade technique at the Department of Plastic Surgery and ablative fractional carbon dioxide (CO₂) laser treatment at the Department of Dermatology at Zealand University Hospital. We assessed rhinophyma severity using the RHISI scale with pre-and post-operative photographs evaluated by senior consultants from each department, who were blinded to the treatment method. Additionally, the patients completed a questionnaire to gauge their satisfaction and willingness to recommend the procedure. Cosmetic outcomes were deemed excellent or good (75% for surgery and 71% for CO₂-laser) in both treatment methods. Only one patient answered with moderate satisfaction. Therefore, we recommend both methods as possible treatment options.