Plastic and reconstructive surgery最新文献

Background: Lower body lift (LBL) after massive weight loss (MWL) is frequently complicated by seroma and wound dehiscence. The necessity of drains in LBL remains controversial, with limited robust evidence. This study retrospectively assessed whether omitting drains after MWL influences complication rates and outcomes in 1,002 patients.

Methods: Records of patients who underwent LBL from January 2011 to May 2024 were reviewed. Two groups were compared: with suction drainage and without drainage. Complications were evaluated individually and classified using Clavien-Dindo. Statistical analyses (univariate/multivariate) assessed links between drain use and complications, controlling for relevant covariates.

Results: Among 1,002 patients, 598 had no drains and 404 received suction drainage. The drain group experienced longer hospitalization (4.29 ± 1.55 vs. 2.41 ± 0.94 days, p<0.001) and operative time (179 vs. 152 minutes, p<0.001). Overall complication rates did not differ significantly. However, wound complications were more frequent with drains (24% vs. 17%, p<0.01). In multivariate analysis, drain use was not an independent risk factor for complications; only active smoking predicted higher risk.

Conclusions: Omitting drains in LBL after MWL was associated with similar overall complication rates but reduced wound complications and shorter hospital stays. These findings support the safety of drainless protocols in LBL surgery, suggesting they may improve outcomes and help reduce the postoperative treatment burden for patients.

Background: Choosing which procedure or combination of procedures is appropriate remains a daunting task for patients and surgeons alike. The goal of this study was to leverage machine learning models (MLMs) to find objective AI-derived parameters associated with improved cosmetic outcomes in patients undergoing aesthetic procedures.

Methods: A dataset from the American Society of Plastic Surgeons (ASPS) Before and After photos was compiled for facelift, browlift, and eyelid surgeries using non-consecutive, curated photographs of all available entries. Two MLMs were trained to detect perceived age and attractiveness using "in the wild" reference images. Pre- and post-operative photographs were used to generate scores before and after surgery per patient. Uni- and multi-variate odds ratio (OR) analyses were performed to interrogate procedures and demographic factors associated with improvements in age perception, attractiveness, and a composite aesthetic benefit score.

Results: 676 patients operated on by 65 surgeons from 22 different states/provinces in the USA and Canada were included in the analyses. 328 (48.5%), 172 (25.4%), 82 (12.1%), and 427 (63.2%) underwent facelift, necklift, browlift, or eyelid surgeries, respectively. On multivariate analysis [OR (CI), p-value] older perceived preoperative age was associated with a greater combined aesthetic benefit independent of procedure type [1.04 (1.02-1.06), p < 0.001]. The effects of surgery were found to be additive, with patients undergoing combined procedures (facelift+necklift+browlift+eyelid) demonstrating the greatest composite aesthetic benefit [11.34 (1.84-103.34), p < 0.05].

Conclusions: Machine learning can be used to more objectively assess aesthetic facial surgery using perceived age and attractiveness as novel preoperative markers. Perceived older preoperative age, decreased preoperative attractiveness, and increased number of concurrent procedures were associated improved cosmetic benefit. However, the interaction between perceived preoperative age and attractiveness demonstrated a complex, non-linear relationship when optimizing for postoperative aesthetic benefit.Clinical Question/Level of Evidence: Level III- Retrospective Multi-Center Cohort Study.

Background: The American Society of Plastic Surgeons (ASPS) created the Essentials of Leadership (EOL) program to foster leadership skills and networking among current and upcoming plastic surgery leaders. This study elucidates the program's impact on participants, its strengths and weaknesses, and the future of leadership in plastic surgery.

Methods: A qualitative descriptive design was employed, utilizing semi-structured interviews to explore the experiences of plastic surgeons who participated in the program. The data was analyzed inductively, and codes were reviewed to identify overarching themes.

Results: We interviewed 29 participants who completed EOL at an average of 8.3 years of practice, with an average of 15.5 years at the time of interview. Significant themes were identified, including motivations for joining, skills gained, and the program's impact. Many surgeons found themselves at a professional crossroads, seeking leadership skills and a broader network. Participants found that the following were most beneficial: 1) conflict resolution and negotiation, 2) understanding personality dynamics, and 3) effective meeting management. The program had a long-lasting impact on participants through two key outcomes: 1) enduring relationships and 2) increased confidence in pursuing career changes. Participants expressed hope that plastic surgery leaders will support greater leadership programming, increase diversity, and unite to innovate and protect their specialty.

Conclusion: The EOL program provides time for reflection, relationship building, and leadership development. Participants walk away with practical skills, meaningful connections, and renewed purpose, demonstrating the program's critical role as a catalyst for career advancement and long-term leadership in plastic surgery.

Mentorship is a cornerstone of surgical education, fostering professional growth, research productivity, and career guidance. In plastic surgery, mentorship profoundly impacts career choices and professional development, yet structured one-on-one programs are notably limited. Challenges such as time constraints, mismatched expectations, and disparities in representation often hinder traditional mentorship models. To address these issues, we developed a computational algorithm to facilitate team-based mentorship in plastic surgery. This algorithm utilizes a weighted Jaccard similarity index and recursive stability optimization to optimize compatibility among participants by aligning career goals, clinical interests, and mentorship priorities. A survey of 171 Professional Resource Opportunities in Plastic and Reconstructive Surgery Education and Leadership (PROPEL) members informed the pilot matching process, resulting in 36 teams with a median pooled similarity score of 0.823. Our approach offers distinct advantages, including equitable opportunity, scalability, and reduced administrative burden. Future efforts should focus on integrating qualitative feedback, evaluating long-term outcomes, and exploring advanced technologies such as natural language processing to refine the model further.

Background: Secondary lymphedema is a common, debilitating consequence of oncologic surgery that leads to irreversible skin and subcutaneous fibrosis. No topical anti-fibrotic therapy currently exists. We previously showed that systemic rosiglitazone, a peroxisome proliferator-activated receptor-γ (PPARγ) agonist, promotes adipogenesis and reduces fibrosis in experimental lymphedema, but systemic toxicity limits its use.

Methods: A murine tail model of secondary lymphedema was used to compare systemic and topical rosiglitazone. scRNA-seq data was initially used to justify interrogation of rosiglitazone as a therapeutic compound. A novel topical formulation was developed and tested in murine skin ex vivo. Outcomes included fibrosis, adipogenesis, and systemic toxicity, evaluated by histology, immunofluorescence, and bone marrow adiposity.

Results: Systemic rosiglitazone reduced fibrosis, increased anti-fibrotic adiponectin expression, and reduced infiltration of CD4⁺ T cells into lymphedematous tissue. Topical rosiglitazone reproduced these anti-fibrotic and pro-adipogenic effects locally, increased epidermal and dermal adiponectin expression, achieved full dermal penetration, and avoided systemic effects such as bone marrow adipogenesis.

Conclusions: Topical rosiglitazone is a novel, safe, and clinically translatable strategy to mitigate cutaneous fibrosis in secondary lymphedema. By repurposing an FDA-approved drug with localized delivery, this approach may offer reconstructive surgeons the first noninvasive pharmacologic option to address this irreversible complication.

Clinical relevance statement: Fibrosis is the most challenging aspect of lymphedema, as it permanently alters tissue quality and limits patient quality of life. Our topical rosiglitazone formulation reduces fibrosis and enhances adipose tissue, offering a novel strategy to improve tissue quality and surgical outcomes.

Background: Oncoplastic breast reconstruction (OP), combining tumor resection with volume reduction and soft tissue rearrangement, benefits women undergoing breast conservation surgery by both alleviating macromastia symptoms and enhancing symmetry, shape, and cosmesis. This study compared oncoplastic breast reconstruction with standard bilateral breast reduction (BBR) across three domains: (1) clinical safety profile, (2) patient-reported outcomes, and (3) aesthetic results.

Methods: A single-surgeon, single-institution retrospective review was conducted on patients who underwent OP or BBR from April 2022 to May 2025. Demographics, clinical data, BREAST-Q surveys, and aesthetic outcomes were collected via electronic medical record. Statistical analyses included univariate testing and minimal ANCOVA.

Results: Among 180 patients, 116 (64.4%) received BBR and 64 (35.6%) OP. BBR patients were younger and had greater resection weights (p<0.05). OP patients had higher BMI and ASA class (p<0.05). Wise pattern incision was utilized in all BBR and 97% of OP cases. While minor wound breakdown was statistically more frequent in the oncoplastic cohort, major complication rates were comparable between the two cohorts. Both cohorts showed significantly higher post-op BREAST-Q scores in psychosocial, sexual, and physical well-being, in addition to satisfaction with breasts, controlling for age and BMI. Comparing aesthetic scores between 10 patients of each group, BBR was slightly favored, though by less than 0.5 Likert scale in all six domains.

Conclusions: OP provides significant QoL improvement with comparable major safety profile and aesthetic outcomes to BBR, further supporting its role as a favorable reconstructive option when lumpectomy is indicated.

Background: Traumatic optic neuropathy (TON) can result in irreversible blindness. A consensus is not currently available on the superior treatment modality for TON. This study evaluates the literature to determine the superior treatment modality and the impact of time to treatment on outcomes.

Methods: A systematic search was conducted following Preferred Reporting for Systematic Reviews and Meta-Analysis guidelines. Random effects models were used to pool relative risk from RCTs, Peto odds ratios from sparse controlled nonrandomized studies, and arcsine transformed crude rates of the outcomes from uncontrolled case series and case reports.

Results: There were 51 studies were included in our quantitative synthesis. Low-quality evidence suggests systemic corticosteroids increase the rates of improved visual acuity when compared with observation alone in adolescents and adults (Peto OR 2.7 (1.5; 4.9); NNT 4 (2;9)). Early (< 24 hours from trauma) versus delayed (within 7 days) prednisolone administration does not result in greater rates of improved visual acuity in children (Peto OR 2.8 (0.3; 29.0)). When surgery is performed, early surgery results in greater rates of improvement in visual acuity than later surgery in adults and children (Peto OR 6.0 (1.9; 19.4) NNT 2 (5;1)).

Conclusions: Systemic corticosteroids were superior to observation alone, but surgical decompression did not significantly improve visual acuity when compared to systemic therapy. The results of this review suggest that medical management and surgical intervention have therapeutic value in the resolution of TON; however, in the instance of neuropathy that is refractory to medical management in the setting of injuries with deformities that warrant surgical repair, the pursuit of intervention within a week from injury may prove useful. Further contributions of high-level evidence are required to substantiate case-by-case treatment algorithms.

Background: Improvements in mastectomy techniques have led to increased adoption of single-stage direct-to-implant (DTI) breast reconstruction, yet whether it functions as a true "one-and-done" pathway remains uncertain.. This study evaluates reoperation rates for prepectoral DTI versus two-stage implant-based breast reconstruction (IBBR).

Methods: A retrospective review was conducted of all prepectoral breast reconstructions from 2017-2024. Data collected included demographics, operative characteristics, and complications. Complications were categorized as major (readmission/reoperation), minor (managed outpatient), or aesthetic.

Results: A total of 552 breasts (333 patients) were included: 229 DTI and 323 two-stage reconstructions. DTI patients had lower BMI (23.8 vs. 26 kg/m²,p<0.05), lower mastectomy weights (561.1g vs. 653.4g,p<0.05), and more prophylactic mastectomies (59.4% vs. 33.7%, p<0.05). Major complications were significantly lower in DTI (7.0% vs. 19.8%, p<0.05), as were minor complications (21.0% vs. 30.7%,p<0.05). Aesthetic revisions were more common in DTI (15.3% vs. 5.3%,p<0.05), predominantly for fat grafting. Across the reconstructive course, the mean number of surgeries per breast was 1.2 for DTI vs. 2.3 for two-stage (p<0.05).

Conclusions: Prepectoral DTI reconstruction can result in significantly fewer complications and total operations compared to two-stage IBBR. Although aesthetic reoperations were more common in DTI, they were minor and elective. To our knowledge, this is the first and largest prepectoral-only study evaluating revision burden, providing plane-specific data to guide operative planning and patient counseling. Patients can be counseled that DTI reconstruction offers a safe and aesthetically favorable option, with a reduced total number of surgeries and lower complication rates compared to traditional two-stage reconstruction.