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

Background: Nose deviation deformities pose a complex cosmetic and functional problem. The most common surgical intervention to manage such deformities is septorhinoplasty, typically performed by a plastic surgeon or a rhinologist. This study investigated the effect of a combined operation by a plastic surgeon and rhinologist, comparing them with those operations performed singlehandedly by a plastic surgeon.

Methods: From January 2017 to January 2022, 99 patients with deviated noses were treated. Fifty-nine underwent the combined operation, whereas 40 underwent surgery performed by a plastic surgeon. In the combined operation group, the rhinologist performed endonasal septoplasty and turbinoplasty, while the plastic surgeon performed open rhinoplasty, osteotomies, caudal septal deviation correction, camouflage procedure, esthetic enhancement, and dorsal augmentation. Subsequently, the rhinologist checked the airway and applied a nasal tamponade. Treatment outcomes were evaluated using the Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) questionnaire and incidence of postoperative complications.

Results: Of the 79 patients who responded to the RHINO questionnaire, 33 underwent an operation by a plastic surgeon, whereas 46 underwent the combined operation. All cases showed improved scores on the RHINO questionnaire postoperatively, with significantly higher scores in the combined group (p = 0.032). Furthermore, the combined group showed more significant improvements in function-related questions, despite longer total operation durations. The overall complication rate was 10.1%.

Conclusion: A combined surgical correction for deviated nose by a plastic surgeon and rhinologist could provide better subjective outcomes, especially in functional outcomes.

Background: The long-term stability of allograft or native bone in facial vascularized composite allograft (fVCA) recipients is unclear. This study quantified long-term bone volume changes in facial transplants.

Methods: Computed tomography scans of eight fVCA recipients (2011-2023) were analyzed with Materialise Mimics. Native bone (soft tissue-only VCAs, n=4) and allotransplanted bone (n=4) were compared. Median bone volumes were assessed for significance using the WilcoxonRanked-Sum Test.

Results: Mean follow-up was 10 years (range 5-13). A significant median decrease in both mandibular (-6520 mm³; p=0.0078) and maxillary (-3548 mm³; p=0.0078) bone volumes was seen in all patients, irrespective of bone origin. Median bone volume loss was -9.92% in the bony allograft cohort and -22.60% in the soft tissue-only cohort, respectively. The histopathological analysis of the limited samples (n=2) showed physiological bone even after ten years.

Conclusion: Patients with allotransplanted bone showed less pronounced volume loss compared to those with native bone receiving soft tissue-only allografts. This finding suggests that allotransplanted vascularized bone in fVCAs may not be a primary target of chronic rejection processes that compromise bone volume stability and functionality. Bone volume changes are likely influenced by multiple factors, such as tooth loss, nutrition, chronic immunosuppression (e.g., steroids), mechanical stress/load, varying bone remodeling rates, and other medical comorbidities. Further research is needed to clarify the factors affecting bone volume and remodeling after fVCA.

Background: Reduction mammaplasties are among the plastic surgery procedures with the highest rates of patient satisfaction. However, the loss of postoperative sensation in the breast and nipple-areolar complex remains a concern. In light of increasing interest in nerve-preservation techniques, we sought to investigate the relationship between retained sensation with overall satisfaction in reduction mammaplasty in current literature.

Methods: The authors systematically reviewed all studies that reported postoperative sensation and satisfaction in patients who underwent reduction mammaplasty, using the MEDLINE, Embase, Cochrane, CINAHL, and Scopus databases in October 2023. Studies were evaluated for methodological quality using an NIH Quality Assessment Tool. Meta-analyses of proportions were conducted.

Results: A total of 48 studies met the eligibility criteria. The median quality assessment score was 8/10. For 28 studies eligible for statistical analysis, random effects pooled proportion for patients that retained preoperative sensation was 0.78 (95% CI: 0.67-0.87), and for patients that report postoperative satisfaction was 0.94 (95% CI: 0.91-0.97). Overall, the studies reported a relatively wide range of sensation outcomes with consistently high satisfaction scores.

Conclusion: The results of this systematic review suggest that other surgical factors (e.g., relief of macromastia symptoms, aesthetic appearance) play a greater role in patient satisfaction compared to sensation retention in reduction mammaplasty. Wide variability in assessment methodologies for both sensation and satisfaction was noted. Standardizing and objectifying measurement techniques, particularly for sensation, will help further characterize the relationship between sensation and satisfaction in future studies.

Background: There is currently no consensus on the efficacy of operative reinnervation at the time of post-mastectomy reconstruction. This review compares postoperative sensation between innervated and non-innervated flaps in breast reconstruction through systematic review and meta-analysis.

Methods: EMBASE, Ovid, and CENTRAL were searched from inception to December 6, 2023. The primary outcome was level of sensation postoperatively. Secondary outcomes included presence of sensation, breast-related complications, operative time, and quality of life. Meta-analysis was conducted using mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and odds radio (OR) for dichotomous outcomes. Quality of evidence was appraised using RoB-2/ROBINS-I. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations.

Results: Twenty-eight studies were included; studies were observational studies except one randomized controlled trial. Common flaps were deep inferior epigastric perforator (11/28, 39.3%) and transversus rectus abdominis muscle (9/28, 32.1%). Innervated flaps were significantly associated with improved level of postoperative sensation (SMD: -0.94, 95% CI: [-1.35; -0.53], I²: 78%, p < 0.01), presence of postoperative sensation (OR: 11.4, 95% CI: [5.09; 24.5], I²: 0%, p < 0.01), and improved postoperative BREAST-Q scores (MD: 8.11, 95% CI: [4.33; 11.89], I²: 27%, p < 0.01). However, certainty of evidence was low/very low for all outcomes. Most studies had moderate risk of bias (56.5%). There were no statistically significant differences in breast-related complications or operative time.

Conclusions: Operative reinnervation in breast reconstruction is significantly associated with improved level and presence of postoperative sensation and BREAST-Q scores without significant increase in breast-related complications/operative time. More high-quality studies are required to improve the certainty of outcomes.

Background: Patients with facial nerve palsy often experience lagophthalmos (incomplete eye closure), which can lead to exposure keratitis. The Bionic Lid Implant for Natural Eye Closure (BLINC) is a medical device designed to mimic the more natural blink kinetics than traditional lid loading techniques.

Aims: This study aimed to evaluate potential factors that might influence the design of the BLINC device and willingness of participant to undergo the implant placement surgery.

Methods: Patients attending a multidisciplinary facial nerve clinic were invited to complete a survey addressing patient acceptance of the BLINC device implantation.

Results: Seventy-two patients were mailed the survey, of which 50 returned completed surveys (69%). The most important factor identified by participants was the device function (81% ranked as very important) and the least important factor was cost (16% ranked as very important). Median acceptable device function time was 5 years (range 1-10 years). Ten participants (20%) indicated willingness to be the first to trial BLINC. Women were more likely to rate visual appearance as important (OR 3.32, CI 1.14-9.62, p = 0.028), and less likely to rate user friendliness as important (OR 0.16, CI 0.04-0.52, p = 0.0021). Older participants were more likely to rate the length of recovery period as important (OR 1.04, CI 1.01-1.08, p = 0.006). Participants with complete eye closure were less likely to be willing to trial the implant (OR 0.08, CI 0.00-0.53, p = 0.006, whilst patients with eye irritation were more willing to trial the implant (OR 7.20, CI 1.12-142, p = 0.036).

Conclusion: Certain patient demographics impact patient aesthetic and functional preferences and the willingness to trial the BLINC device.

Background: Malignant neoplasms of the parotid gland (MPG) are clinically challenging due to aggressive growth and metastasis. Despite tumor resection being the primary treatment, there is a paucity of studies on postsurgical outcomes and preoperative risk factors for MPG.

Materials and methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent MPG surgery between 2008 and 2021. 30-day postoperative outcomes and risk factors predisposing to the occurrence of complications were assessed.

Results: The study population included 3052 patients, the majority of whom were males (n = 1842; 60%) and White (n = 2017; 66%). The average age was 63 ± 16 years. The most common comorbidities were obesity (n = 1182; 39%) and hypertension (n = 1533; 50%). Surgical procedures were performed predominantly in the inpatient setting (n = 1773; 58%) by ENT surgeons (n = 2767; 91%). Overall, complications were reported in 6.8% (n = 209) of patients. Inpatient setting (p < 0.001), renal failure (p < 0.001), smoking (p = 0.012), as well as increased creatinine (p < 0.001) and blood urea nitrogen (BUN) levels (p = 0.001) were identified as risk factors for complications. In addition, concurrent microsurgical procedures such as flap surgery and/or nerve grafting significantly increased the risk of postoperative adverse events (p < 0.001).

Conclusions: Our analysis revealed that complication rates were associated with high creatinine and BUN levels, inpatient surgery, renal failure, higher American Society of Anesthesiology classes, and smoking. We also found that concurrent microsurgical procedures were predictive factors for complications. These findings can inform patient counseling, preoperative planning, and risk stratification.

Background: The aim of this study was to investigate the impact of exosomes derived from adipose-derived stem cells (ASCs) on complications arising from hyaluronic acid (HA) filler injections.

Methods: An HA hydrogel blended with adipose stem cell-derived exosomes was prepared and administered to the inguinal fat pads of 16 C57BL/6J mice. The control group received only HA filler (HA group), and the study group was treated with a combination of HA filler and exosomes (exoHA group). Biopsy was performed 1 week and 1, 2, 3, and 6 months after the injections. The effects were assessed using hematoxylin and eosin and Masson's trichrome staining for histological examination, immunohistochemistry for collagen type I and Vascular Endothelial Growth Factor (VEGF), RNA sequencing, and quantitative real-time polymerase chain reaction (PCR) (Il6, Ifng, Hif1a, Acta2, Col1a1).

Results: RNA sequencing revealed significant downregulation of the hypoxia (false discovery rate [FDR] q = 0.007), inflammatory response (FDR q = 0.009), TNFα signaling via NFκB (FDR q = 0.007), and IL6 JAK-STAT signaling (FDR q = 0.009) gene sets in the exoHA group. Quantitative PCR demonstrated a decrease in expression of proinflammatory cytokines (Il6, P < 0.05; Hif1a, P < 0.05) and fibrosis markers (Acta2, P < 0.05; Col1a1, P < 0.05) within the exoHA group, indicating reduced inflammation and fibrosis. Compared to the exoHA group, the HA group exhibited a thicker and more irregular capsules surrounding the HA filler after 6 months.

Conclusion: The addition of ASC-derived exosomes to HA fillers significantly reduces inflammation and accelerates collagen capsule maturation, indicating a promising strategy to mitigate the formation of HA filler-related nodules.