bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Ischemic Complications with Direct-to-Implant versus Immediate Free Flap Reconstruction After Nipple Sparing Mastectomy: A Propensity-Score Matched Analysis
Authors: Abdou Salma A. , Sharif-Askary Banafsheh , Perez-Alvarez Idanis , Lavin Christopher V. , Bartholomew Alex J. , Sosin Michael , Tousimis Eleni , Fan Kenneth L. , Song David H.
Published: February 2023

Background:

Both direct-to-implant (DTI) and immediate free flap (FF) breast reconstruction following nipple sparing mastectomy (NSM) have been described in the literature. However, there is a paucity of comparative studies between these two techniques. Furthermore, existing studies do not control for factors influencing ischemic complications.

Methods:

A retrospective review of all NSMs performed at a single institution between January 2014 and January 2020 was performed. Immediate FF reconstructions were propensity score matched using probit regression to identify a comparable DTI cohort based on mastectomy weight, smoking, age, and history of prior radiotherapy. Primary outcomes of interest were 30-day ischemic complications.

Results:

108 NSMs performed in 79 patients were included. Average age was 45.7 ± 10.5 years old and mean BMI was 27.1 ± 4.8 kg/m2. There were 54 breasts in both the DTI group and the immediate FF group. Median mastectomy weight in the DTI group was 508 (264 IQR) grams as compared to 473 (303 IQR) in the FF group [(p=0.792). There was no significant difference in the rate of partial nipple-areola complex (NAC) necrosis in the DTI and FF groups (5.6 percent versus 3.7 percent, respectively; p=0.500) or mastectomy flap necrosis (5.6 percent versus 11.1 percent; p= 0.297). Both the DTI and FF groups had a total NAC necrosis rate of 1.9 percent (p= 0.752).

Conclusion:

Both DTI and immediate FF reconstruction can be safely offered to patients undergoing NSM while providing the benefit of a single reconstructive procedure.
“A Two-Flap Combination for Auricular elevation in Microtia Reconstruction”
Authors: Quang Ly Xuan , Linh Tran Ngoc Tuong , Ha Van Thi Hai , Quyen Le Van Vinh , Ngoc Tran Le Hong , Dung Nguyen Tan , Nga Nguyen Thi Thuy , Chen Yen-Chun , Hung Shih-Han , Dang Luong Huu
Published: February 2023

Objective:

The aims of this study were to describe and evaluate the effectiveness of combined flaps, a modification of Nagata's technique, for providing a reasonable projection for reconstructed auricles.

Method:

The authors modified Nagata's method for covering the cartilage block by introducing a new combined flap technique, including the temporoparietal skin flap and retroauricular flap. We compared the shape, size, and position of the reconstructed ear to the opposite ear, and we evaluated postoperative complications and patient satisfaction levels. We verified the effectiveness of the combined flap by assessing flap necrosis, skin color, thickness, hair in the auricular area and scars.

Results:

A total of 38 consecutive patients (39 ears) with microtia aged ranging from 6 to 34 years old were reconstructed using the modified method and followed for 33.6 months on average. The reconstructed auricle's shape was well defined, with 41.0% having good and 15.4% having excellent results. Most cases achieved good and acceptable levels in size, position, medial longitudinal axis angle and auriculo-cephalic angles, and 79.9% of patients/their families were satisfied. We observed no cases of flap necrosis or hypertrophic scarring, and there were low rates of flap complications, such as unmatched skin color (7.7%), unacceptable thickness (5.1%), or hair and stretch marks (10.3%).

Conclusion:

The modified method's reconstructed ear achieved stable projection, symmetrical appearance, and obvious anatomic landmarks with high patient satisfaction. The combined flap method showed certain advantages: high survival rate, less skin contrast, no hypertrophic scars, and fewer complications.

Clinical question/level of evidence:

Therapeutic, III
Free functional platysma transfer for restoration of spontaneous eye closure in facial paralysis: an analysis of anatomy, imaging, and clinical outcomes
Authors: Leckenby Jonathan I. , Patel Alap U. , Patel Swapnil , Rahman Akm A. , Haque Shameem , Grobbelaar AO
Published: February 2023

Background:

Facial palsy patients suffer an array of problems ranging from functional to psychological issues. With regard to the eye, lacrimation, lagophthalmos and the inability to spontaneously blink are the main symptoms and if left untreated can compromise the cornea and vision. This paper reports the outcomes of 23 free functional vascularized platysma transfers used for reanimation of the eye in unilateral facial paralysis.

Methods:

Data was collected prospectively for all patients undergoing reanimation of the paralyzed eye using free functional platysma transfer. The only exclusion criterium was that a minimum of a two-year follow up was required. Patients were assessed pre- and post-operatively and scored using the eFACE tool focusing on eye-symmetry with documentation of blink reflex.

Results:

A total of 26 free functional platysma transfer were completed between 2011 and 2018; three patients were excluded due to inadequate follow up. The mean age was 9.1 years (SD 7.1) and a ratio of 12 males to 11 females. Pre-operatively no patients had evidence of a blink reflex in comparison to 22 patients at two-year follow up. There was a statistically significant improvement in palpebral fissure (p < 0.001) and full eye closure (p < 0.001) scores at two-year follow up however, there was no statistically significant difference in gentle eye closure (p = 0.15).

Conclusions:

This is the first report of free functional platysma long-term outcomes in eye reanimation. The results demonstrate that successful restoration of the blink reflex can be achieved and full eye closure is obtainable following surgery.
Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor:Insights from a Five Year Follow-Up
Authors: Jozaghi Yelda , Chang Edward I , Clemens Mark W , Hanasono Matthew M , Klebuc Michael , Yu Peirong , Gaber A Osama , Selber Jesse C
Published: February 2023

This report provides a 5-year follow-up on the first reported simultaneous scalp, calvarium, kidney, and pancreas transplant. The previously published case report represented both the first composite calvarial-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation. Over the ensuing 5 years, the patient underwent a single episode of acute scalp rejection successfully managed with intravenous solumedrol, one resection of a basal cell carcinoma on the native scalp, and hardware removal and bony contouring. In addition, the patient developed seizures secondary to delayed, post-radiation cerebral necrosis requiring craniotomy and resection. His seizures were ultimately controlled. Currently, more than 5 years following his multi-organ transplant, the patient continues to have excellent allograft function and a very satisfactory aesthetic outcome, demonstrating that in certain cases, combined vascularized composite allotransplantation with solid organ transplant can be performed safely without compromising the solid organ transplant.
“Zygomatico-Orbital Artery: A Re-Evaluation of the Temporal Blood Vessels.”
Authors: Chen Chun-Lin , Zhou Yu-Hao , Luo Cheng-En , Wang Hai-Bin , Luo Sheng-Kang
Published: February 2023

Background:

The current anatomical description of the zygomatico-orbital artery (ZOA) is mainly based on cadaver head studies and do not accurately reflect the complete anatomical information of the ZOA.

Objective:

The purpose of this study was to reveal the anatomical characteristics of the ZOA and to provide an anatomical basis for relevant operations in the temporal area.

Methods:

Computed tomography (CT) scans and autopsies were performed on 78 cadaver heads perfused with lead oxide. Mimics software was used to construct a three-dimensional image based on the bilateral intertragic notches and the right inferior orbital margin for a detailed analysis of the ZOA.

Results:

The occurrence rate of ZOA in the 101 qualified hemisectioned cadaver heads was 86.14% (87/101). According to our observations, 52.87% (46/87) originated from the superficial temporal artery above the zygomatic arch, 26.44% (23/87) from the superficial temporal artery under the zygomatic arch, and 20.69% (18/87) from the frontal branch of the superficial temporal artery. The ZOA communicates with the deep and superficial arches of the supraorbital artery, transverse facial artery, and ophthalmic artery.

Conclusion:

This study describes the anatomical characteristics of the ZOA. Moreover, these findings may guide skin flap transplantation and prevent associated injection complications.
Supercharge End-to-Side Motor Transfer to a Long Nerve Graft to Enhance Motor Regeneration — An Experimental Rat Study
Authors: Zavala Abraham , Lu Johnny Chuieng-Yi , Chang Tommy Nai-Jen , Daniel Bassem W. , Chuang David Chwei-Chin
Published: February 2023

BACKGROUND

Long nerve grafts are prone to chronic denervation, often resulting in unsatisfactory clinical outcomes. We aim to investigate if supercharge end-to-side (SETS) motor nerve transfers to a long nerve graft can potentially enhance nerve regeneration and functional outcomes.

METHODS

A reversed long nerve graft was interposed between C6 and musculocutaneous nerve in 48 rats. The motor nerves near the C6 proximally and the musculocutaneous nerve distally were chosen for SETS transfer to the long nerve graft. There were four groups: (A) nerve graft only, (B) proximal SETS transfer, (C) distal SETS transfer, and (D) proximal and distal double SETS transfers. A grooming test was assessed at 4, 8, 12, and 16 weeks postoperatively. Biceps weight, compound action potential amplitude (CMAP), tetanic contraction force, as well as histomorphometric analysis of the musculocutaneous nerve were evaluated at 16 weeks.

RESULTS

Long nerve grafts that received SETS transfers (Groups B, C, and D) showed superior results compared to the control group. Proximal SETS transfer had significantly better outcomes than distal SETS transfer in electrodiagnostic parameters, while double SETS transfer had the highest axonal count and biceps CMAP.

CONCLUSIONS

SETS motor transfers to long nerve grafts can effectively improve functional outcome and optimize nerve graft regeneration to the target nerve.

CLINICAL RELEVANCE STATEMENT:

Long nerve grafts are often necessary in peripheral nerve injuries of the limb, and SETS transfer using motor branches in the vicinity of the nerve graft can enhance the nerve regeneration to achieve better functional outcome.
Intramuscular Nanofat Injection Promotes Inflammation-Induced Gastrocnemius Regeneration in Syngeneic Rat Sciatic Nerve Injury Model
Authors: Schilling Benjamin K. , Baker Jocelyn S. , Komatsu Chiaki , Turer David M. , Bengur Fuat Baris , Nerone W. Vincent , Qin Feng , Cottrill Adam R. , Kokai Lauren E. , Rubin J. Peter , Marra Kacey G.
Published: February 2023

Background:

Mechanical emulsification of adipose tissue to concentrate protein and stromal cell components (i.e., Nanofat) has gained considerable interest in clinical practice. While the regenerative potential of Nanofat has largely been used in aesthetic applications, these effects have considerable potential in reconstruction as well. Here, we investigated the therapeutic properties of Nanofat injected directly into the denervated gastrocnemius after a sciatic nerve injury in Lewis rats.

Methods:

Muscle denervation was induced by transecting and immediately repairing the sciatic nerve. Inguinal and subcutaneous adipose was harvested from donor rodents, processed into Nanofat, and then injected intramuscularly into the gastrocnemius. Gait analysis was performed weekly. Rodents were sacrificed at 9 and 12 weeks, upon which tetanic contraction force was measured, and gene expression, histology, and cytokine multiplexing were performed.

Results:

Intramuscular injection of Nanofat significantly increased maximum tetanic force generation at 9 and 12 weeks. The forces of the Nanofat-injected gastrocnemii were better correlated to their contralateral gastrocnemii relative to controls. Muscle repair-associated inflammatory gene expressions were significantly upregulated in Nanofat-injected gastrocnemii. Cytokines IL-1β, IL-18, VEGF, GC-MSF, and TIMP-1 were significantly higher in Nanofat-injected gastrocnemii relative to control gastrocnemii, and the tetanic force was linearly and significantly correlated to IL-1β and IL-18, and their interacting effects.

Conclusions:

Intramuscular injection of emulsified adipose tissue (Nanofat significantly increased gastrocnemii contraction force after sciatic nerve injury, with prolonged reconstructive inflammation via CD68, iNOS, IL-1β, and IL-18 all being potential mechanisms for this recovery. This application could potentially increase the therapeutic breadth of Nanofat to include muscular recovery after nerve injury.
Facial Expansion: A Blueprint for Coverage
Authors: Cohen Joshua M. , Zide Barry M.
Published: February 2023

The benefits of tissue expansion go unrealized if flap design and coverage concepts do not exist in pre-operative thinking. Without proper analysis, the surgeon will likely burden the patient with more expanders than necessary. Tissue coverage needs can be simplified in forms of triangles and rectangles to determine expanded tissue advancement. Single or double back cuts allow usage of all the expanded tissue. Furthermore, early subtotal excisions, especially in children less than four months old, can reduce the number of expanders required.

With methods presented herein, the face can be resurfaced with better color and less distortion. Eyebrows should be maintained and positioned by keeping the lower frontalis muscles intact. Cheeks can be covered with a large “Schrudde” design and color can be improved by using upper neck skin preferentially over lower neck harvest. Laser hair removal allows larger swaths of forehead to be covered by hair-bearing scalp tissue. Prior incisional delay can expedite success with no tissue loss. The results speak for themselves when surfaces are covered with large, expanded flaps which are expeditiously harvested
“Gender and Ethnic Diversity in Plastic Surgery: Temporal Trends Among Speakers at National and Regional Plastic Surgery Conferences”
Authors: Landford Wilmina , Marquez Jocellie , Ngaage Ledibabari Mildred , Rathi Sourish , Stewart Talia , Hill John , Huston Tara , Broderick Kristen , Aliu Oluseyi
Published: February 2023

Introduction:

Scientific leadership among women and underrepresented minorities is lacking in plastic surgery. It is unknown whether the underrepresentation of women and ethnic minorities extends into academic conferences. We evaluated the temporal trends of female and ethnic minority representation at plastic surgery conferences in the United States.

Methods:

A retrospective analysis of all presentations from seven national and regional plastic surgery meetings between 2014-2018 was conducted. Gender, ethnicity, and academic rank of the first authors were determined by analyzing pronouns, institutional biographies, and accompanying images identified in online searches.

Results:

A total of 4180 abstracts were presented by 3452 first authors. The majority of first authors were of European descent (53%), male (65%), and most commonly a resident physician (42%). Women were found to have a greater representation at plastic surgery conferences than in the plastic surgery workforce (34% vs 17%, p<0.0001). Similarly, relative to AAMC demographics, individuals of Asian descent were overrepresented as first authors (27% vs 12%, p<0.0001) whereas first authors of European descent were less prevalent (53% vs 64%, p<0.0001). When compared to national plastic surgery conferences, regional conferences had a greater proportion first authors of European descent (51% vs 58%, p<0.0001) but a lower proportion of first authors of East Asian descent (21% vs 16%, p=0.0001). Ethnic representation remained persistently low with first authors of South Asian descent decreasingly represented (2014: 10% to 2018: 6%, p=0.0062).

Conclusion:

Collectively, we present multi-level data that shows a promising trend of increased female representation at national meetings. However, there appears to be a decline in ethnic diversity.
‘Comparison of the Effects of Skin Microneedling with Cupping Therapy and Microneedling Alone: An Experimental Study’’
Authors: Pasinlioğlu Burak , Çenetoğlu İbrahim Seyhan , Karasu Oğuzhan , Özkoçer Süheyla Esra , Elmas Çiğdem
Published: February 2023

Background

Microneedling promotes percutaneous collagen induction; cupping therapy creates negative pressure and leads to increased blood flow in the applied area. The addition of cupping therapy to microneedling is thought to contribute positively to microneedling’s effects. This study was carried out to investigate the histological effects of adding cupping therapy to microneedling.

Methods:

Thirty Wistar rats were divided into five groups, with six rats in each group. One control group and four experimental groups were formed, which are defined as follows: C group, control; Mi group, single-session microneedling applied to the dorsal trunk; MiCu group, 15-minute cupping therapy added to the single-session microneedling; 3Mi group, microneedling applied over a total of three sessions at 3-week intervals; and 3MiCu group, microneedling with cupping therapy applied over a total of three sessions at 3-week intervals. Each animal was sacrificed at the end of the fourth week following the last treatment, and skin samples were evaluated histologically with hematoxylin-and-eosin stain and type-1 and 3 collagen antibody immunostaining.

Results

The addition of cupping therapy to microneedling increased the thickness of the epidermis and dermis. A significant increase in type-1 collagen immunostaining and the type-1/type-3 collagen ratio was seen only in the Mi group. Cupping therapy did not generate a significant difference in type-1 collagen immunostaining. No treatment was found to produce a significant increase in type-3 collagen immunostaining.

Conclusions

Cupping therapy can be added to microneedling therapy and used to increase certain desired effects on skin.
Micronized cellular adipose matrix (MCAM) promotes the therapeutic effect of an artificial nerve conduit in peripheral nerve gap injury
Authors: Sawai Seiji , Sowa Yoshihiro , Kishida Tsunao , Inokawa Hitoshi , Inafuku Naoki , Tsuchida Shinji , Oda Ryo , Fujiwara Hiroyoshi , Mazda Osam , Yoshimura Kotaro , Takahashi Kenji
Published: February 2023

Introduction:

The stromal vascular fraction (SVF) isolated from adipose tissue has been shown to be beneficial for treating peripheral nerve injuries. Micronized cellular adipose matrix (MCAM) is a SVF-rich micronized fat tissue obtained by a series of simple mechanical processes. The aim of this study is to assess the therapeutic effect of MCAM for peripheral nerve injury.

Methods:

Microscopic evaluation of the cell phenotype and functions was performed to determine the adipose-derived stem cell (ADSC) content of the MCAM. An ANC filled with MCAM was implanted into a sciatic nerve defect in immunodeficient mice. Comparisons of this treatment with an autograft, an ANC filled with SVF cells, and an ANC alone were made based on electrophysiologic characteristics, sciatic function index, histological analyses of regenerated nerve fiber and myelination using electron microscopy, and the preventive effect on innervated muscle atrophy.

Results:

MCAM contained many cells with a phenotype and differentiation potency similar to ADSCs. The implantation experiment indicated that MCAM enhanced the efficiency of functional and structural recovery, while preventing atrophy of the innervated muscle. These effects were significantly improved than in the control group (ANC only) and comparable to those in the SVF group, whereas the improvement did not reach the same level of autograft group.

Conclusion:

Injection of MCAM into an ANC accelerated nerve regeneration compared with use of an ANC alone and this effect, which indicate that MCAM is a promising transplant material for treatment of peripheral nerve injury and an alternative to use of SVF cells.
E2F1- deficient adipose-derived stem cells improve skin wound closure in mice by upregulating paracrine expression of VEGF and TGF-β1
Authors: Yi Zhen , Wu Yiping , Zhang Qi , Xiao Hui , Yang Changchun , Hou Kai , Zeng Ning , Qin Gangjian , Wu Min
Published: February 2023

Background:

Wound healing is a widespread health problem that imposes a financial burden on health systems. Cell therapy with genetically modified ADSCs is a promising strategy for dysregulated wound repair. E2F transcription factor 1 is a bidirectional regulator of cytokines. Here, we aimed to investigate the impact and potential mechanism of E2F1–/– ADSCs in promoting the wound healing process.

Methods:

Forty-five C57BL/6 mice (SPF, male) with 10 mm full-thickness wound were randomly treated with subcutaneous injection of 2 x 106 wild type (WT) ADSCs, 2 z 106 E2F1–/– ADSCs or PBS. The wound closure rate was monitored at day 0, 3, 7, 10, and 14 post-treatment. The collagen synthesis, angiogenesis, and wound contraction were calculated by Masson, IHC and IF staining (CD31, KI67), WB (α-SMA, collagen I, VEGF, and TGF-β1) separately at day 14. In vitro, the conditioned media (CM) of WT ADSCs and E2F1–/– ADSCs were collected to evaluate the impact on proliferation, migration, and angiogenesis.

Results:

In vivo, the E2F1–/– ADSCs group exhibited increased healing rate, proliferating vessels, and collagen synthesis compared to control at day 14 (P <0.05). Moreover, E2F1–/– ADSCs showed enhanced VEGF and TGF-β1 expression in the wound site and CM, and the CM from E2F1–/– ADSCs promoted the proliferation, migration, and tube formation of co-cultured cells in vitro (P < 0.05).

Conclusions:

The E2F1–/– ADSCs exhibited a strong paracrine ability to improve the vascularization process and collagen deposition, thereby accelerating the wound healing in the rodent model.
Avascular fat grafts show lower volume retention but higher hypoxia, angiogenesis, adipocyte proliferation, and macrophage infiltration than vascularized adipocutaneous flaps in an in vivo pilot mouse study Fat grafting vs. flap transfer in mice
Authors: Thomas Benjamin , Warszawski Jan , Falkner Florian , Bleichert Sonja , Haug Valentin , Bigdeli Amir K. , Schulte Matthias , Hoffmann Sabrina HL. , Garvalov Boyan K. , Schreiber Caroline , Takamiya Masanari , Sleeman Jonathan P. , Schmidt Volker J. , Kneser Ulrich , Pichler Bernd J. , Dimmler Arno , Thiele Wilko
Published: February 2023

Background:

Over 137,000 breast reconstructions are performed annually by ASPS member surgeons in the US alone. Vascularized flap transfer and avascular fat grafting each account for over 33,000 annual autologous reconstructions, respectively. And although autologous approaches yield superior long-term functional and aesthetic outcomes, clinical and experimental observations of both techniques suggest considerable biologic differences with diverging effects on locoregional tumor control. However, parallel small animal models to compare their inherent proliferative, angiogenic, metabolic, and immunogenic influences in vivo are lacking. Therefore, we standardized existing flap transfer and fat grafting models in immunocompetent mice to reduce experimental bias, guarantee comparability, and lay the methodological foundation for an in vivo model of autologous breast reconstruction combinable with orthotopic mammary tumor implantations.

Methods:

Autologous groin flaps (n=25) and syngeneic fat grafts (n=39) were transferred in 8-week-old female BALB/c-mice. Viable adipocytes were tracked via Hoechst-Calcein-DiI-staining (n=2/group) and postoperative graft versus flap volumes were compared via longitudinal MRI (n=3/group) on days 1, 11, 21, and 31. Proliferation indices, microvessel densities, tissue hypoxia, and macrophage infiltrates (graded 0-3) were compared via Ki67-, CD31-, pimonidazole-, and H&E-staining on days 5, 10, 15, 20, and 30 (n=4/group/timepoint).

Results:

Viable adipocytes were present in both transferred tissue types. Fat graft volume retentions plateaued at 42.7±1.2% versus 81.8±4.0% of flaps on day 31 (p<0.001). Contrary to flaps, fat grafts initially contained more hypoxic cells (D5: 15.192±1.249 vs. 1.157±192, p<0.001), followed by higher proliferation (D15: 25.2±1.0% vs. 0.0±0.0%, p<0.001) and higher microvessel numbers per high-power field (D30: 307.0±13.2 vs. 178.0±10.6, p<0.001), accompanied by higher-graded macrophage infiltrates (3 vs. 2, p<0.01).

Conclusions:

Vascularized flaps and avascular lipofilling were compared in experimental mice in vivo. This comparative pilot study suggests differences in recipient site volume retention, adipocyte proliferation, angiogenesis, hypoxia, and macrophage recruitment.
How Minimally Invasive Treatments Can Render a Subsequent Facelift More Difficult.
Authors: Skouras George , Skouras Athanasios , Skoura Elena
Published: February 2023

Background:

Minimally invasive antiaging procedures are often misused or overused, creating difficulties when the patient later decides to have a facelift.

The goal of this study was to examine the most common problems that the senior surgeon faces in his facelifts because of these non-invasive interventions and to demonstrate the ways he uses to solve them.

Methods:

A review of rhytidectomy cases from 2012 to 2017 performed by the senior author was conducted. All patients who had had any type of minimally invasive procedure before they had a facelift with the senior author were included in the study.

The aim of our study was to examine the author’s facelifts regarding the problems created by minimally invasive interventions that the patient had undergone in the past.

Results:

During the 5-year study period, the author performed 552 face lifts. By analyzing these patients, we found that 207 of them had previously undergone one or more minimally invasive procedures, in an effort delay or avoid a facelift.

The problems frequently encountered by the senior author in these patients were the following:

1) Cheek fat atrophy because of previous energy-based treatments.

2)Significant scar tissue formation because of previous energy-based treatments or thread lifting

3) Large volume injectables.

In all the abovementioned cases, the surgeon had to modify his basic surgical plan accordingly.

Conclusion:

Plastic surgeons today must be perfectly trained to evaluate and solve any of the problems caused during a facelift by misused or overused minimally-invasive treatments performed in the past.
Immediate post-mastectomy implant-based breast reconstruction: an outpatient procedure?
Authors: Keane Alexandra M. , Keane Grace C. , Skolnick Gary B. , Chi David , Ebersole Trina D. , Myckatyn Terence M. , Tenenbaum Marissa M.
Published: February 2023

Background:

Coronavirus disease 2019 (COVID-19) poses unique challenges for breast reconstruction. At our institution, COVID-19 postoperative protocols mandated patients undergoing immediate prosthetic breast reconstruction transition from 23-hour postoperative observation to same-day discharge. We sought to compare complications and hospital costs between these groups.

Methods:

A retrospective study of consecutive patients who underwent immediate prosthetic breast reconstruction from March 2019 - April 2021 at an academic hospital was performed. Before mid-March 2020, patients were admitted postoperatively for observation; after mid-March 2020, patients were discharged same day. Postoperative complications at 48 hours, 30 days, and 90 days and hospital costs were compared.

Results:

There were 238 patients included (119 outpatient, 119 observation). Across all time points, total complications, major complications, categorical complications (wound healing, seroma, hematoma, infection, implant exposure), and reconstructive failures were low and not statistically different between groups. There were no differences in 30-day hospital readmission/reoperation rates (7.6% outpatient vs 9.2% observation, p=0.640). No patient or surgical factors predicted major complication or hematoma by 48 hours or infection by 90 days. At 90 days, radiation history (p=0.002) and smoking (p<0.001) were significant predictors of major complications. Average patient-care costs outside of surgery-specific costs were significantly lower for outpatients ($1,509 vs $4,045, p<0.001).

Conclusions:

Complications after immediate prosthetic breast reconstruction are low. Outpatient surgery is safe, harboring no increased risk of complications. Furthermore, outpatient care is more cost-effective. Therefore, surgeons should consider outpatient management of these patients to minimize COVID-19 exposures and reduce resource consumption, all while maintaining excellent surgical care.
Mid Cheek Lift via the Facial Soft Tissue Spaces
Authors: Wong Chin-Ho , Hsieh Michael Ku Hung , Mendelson Bryan
Published: February 2023

The mid cheek lift is one of the most effective procedures to rejuvenate the aging mid face. However, it is a technically demanding procedure with the risk of complications, such as scleral show and ectropion. In 2015, we published our mid-cheek lift technique and outcomes. In this Video+ article, we present refinements and nuances of our surgical technique, emphasizing technical aspects of this procedure that has enabled us to perform the surgery safely and effectively. The key concept of our approach is to minimize the trauma associated with surgical access, by dissection through the facial soft tissue spaces that are the gliding planes of the mid cheek. This minimizes post-operative bleeding and scarring that are the main contributor to the dreaded post-operative contracture related complications. To effectively mobilize the mid cheek, precise sharp release of specific mid cheek retaining ligaments separating these facial soft tissue spaces is performed. Conservative skin excision is emphasized along with routine canthopexy for lower lid support
Assessment of facial and cranial symmetry after one-piece fronto-orbital advancement with distraction for isolated unilateral coronal synostosis
Authors: Park Hojin , Min Jaechung , Choi Jong Woo , Ra Young Shin
Published: February 2023

Background:

The surgical correction of unilateral coronal synostosis (UCS) aims to achieve a long-standing facial and cranial symmetry. We hypothesized that endocranial morphology correction achieved by one-piece fronto-orbital advancement with distraction osteogenesis (FODO) could alleviate facial asymmetry because endocranial morphology is thought to be its major determinant. Thus, this study aimed to quantitatively analyze the changes in supraorbital and midfacial symmetry after FODO.

Methods:

We included 27 UCS patients who underwent FODO between May 2008 and November 2019. The supraorbital, midfacial, and orbital symmetry ratios and the endocranial and midface angles were measured using computed tomography images.

Results:

The mean follow-up period was 3.7±1.9 years. The supraorbital shape became symmetric after FODO, as the supraorbital distance ratio changed from 0.88±0.04 to 0.98±0.03 (p<0.001). The endocranial angulation improved from 167.5±5.0° to 174.4±3.4° (p<0.001), and the midface angulation decreased from 6.6±2.2° to 2.6±1.9° (p<0.001). In the long-term follow-up period (5.9 years) analysis, the endocranial angle experienced a slight relapse (- 1.4± 0.9 %) and the supraorbital symmetry noticed a -2.0±3.9 % relapse. The midface angle continued to improve over the follow-up periods, but it was not statistically significant (p=0.121).

Conclusions:

Our observations indicate that FODO produced satisfactory outcomes in correcting supraorbital retrusion and midface asymmetry. In addition, FODO may allow anterior cranial base remodeling and help relieve the midface and skull base angulation. Therefore, FODO can be a good therapeutic strategy for correcting supraorbital and facial asymmetry in patients with UCS.
“Impact of the COVID-19 Pandemic on Manuscript Submission by Women to Plastic and Reconstructive Surgery”
Authors: Blum Jessica D , Rohrich Rod J. , Taylor Jesse A
Published: February 2023

Introduction:

The COVID-19 pandemic has had far-reaching consequences, occasionally amplifying pre-existing disparities. This study examines the impact of COVID-19 on Plastic and Reconstructive Surgery (PRS) manuscript submissions by female authors.

Methods:

All manuscripts submitted to PRS during the months of March and April 2018 through 2021 were examined. Gender of the first, corresponding, and senior authors was confirmed using https://gender-api.com/, the country of the author was abstracted, and appropriate statistical comparisons were made.

Results:

There were 2,512 submissions to PRS during the study periods, with a statistically significant increase observed between 2019 and 2020 (Figure 2, p = 0.008). Despite this significant increase, the proportion of publications by female corresponding and senior authors decreased significantly with the onset of the pandemic (p < 0.001 for both). This decrease was mirrored by a significant increase in the proportion of male senior and corresponding author publications (p < 0.001 for both) and female first author publications (p = 0.002).

Conclusions:

Despite a significant increase in overall submissions to PRS during the COVID-19 pandemic, the proportion submitted by senior and corresponding female authors declined. While causality cannot be determined by our methodology, our findings suggest a disproportionate burden on senior female authors during the pandemic with unclear academic repercussions.
Seeing Cleft Lip from a New Angle: Crowdsourcing to Determine Whether Scar Severity or Lip Angle Matters More to the General Public
Authors: Sescleifer Anne M. , Francoisse Caitlin A. , Osborn Tamara A. , Rector Jeffrey D. , Lin Alexander Y.
Published: February 2023

Purpose:

Modern cleft lip surgery aims to restore symmetry and create a level, normal-appearing Cupid bow. However, families’ concerns often center on the degree of scarring. We hypothesized that the lip angle would be less influential than scar severity in layperson ratings.

Methods:

We received IRB approval for modifying patients' postoperative photos to create systematic variations displaying different levels of scarring and lip angle. Each child’s resulting composite images were presented in pairs to internet raters using Amazon Mechanical Turk. Users selected the simulated postoperative result they felt most normal. The Bradley-Terry (BT) model was used to determine raters’ preferences between different levels of scarring and lip angle.

Results:

Four children with primary unilateral cleft lip repair had their postoperative photos modified, mean age 1.4 years (mean followup 1.0 years). Twelve-hundred crowdsourced pairwise ratings were collected for each patient (4,800 combined ratings). For all 4 children, raters preferred images with more severe scarring than those with a greater lip angle, suggesting uneven lip angle has a more negative effect on perceived appearance.

Conclusion:

Online crowdsourcing postoperative lip angle had a significantly greater influence on ratings of normal appearance than does the severity of scarring. Although patients may ask about scars more often, clinically, this study suggests perceptions of a cleft lip repair result may be more likely influenced by the angle of the cleft lip repair.
“Intramuscular gluteoplasty: a comparative study between different incisional access.”
Authors: Ramos da Silva Cláudio G. , Guimarães Fernando S. , Aboudib José H. , Morales Pedro J.
Published: February 2023

Background:

Silicone implants have been used to improve volume and body contour in buttocks for almost 45 years. Although the intramuscular plane continues to be the gold standard, surgeons still diverge on the best incision technique: using a vertical incision, and thus without the preservation of the intergluteal groove, or preserving this area through a triangular dissection. The goal of this research study is to evaluate and compare these techniques of intramuscular augmentation gluteoplasty.

Methods:

Two randomized groups were formed with fifty-three patients in each group. One of the groups underwent intramuscular gluteoplasty with a vertical incision in the intergluteal groove, and therefore without the preservation of said intergluteal groove (group A). The other group performed intramuscular gluteoplasty using a triangular dissection, thus preserving the intergluteal groove (group B). The groups were compared in relation to the incidence of complications (dehiscence, hematoma, seroma and infection).

Results:

7.5% of patients in group A presented dehiscence and 1.9% seroma. In group B however, 28.3% of patients presented dehiscence and 7.5% seroma and dehiscence during the first 21 days after surgery. No patient had hematoma or infection in either group.

Conclusions:

In the comparison between the groups of patients, the technique with a vertical incision in the intergluteal groove showed a lower number of surgical wounds, dehiscences and seromas when compared to the technique that preserves the intergluteal groove.
Hybrid Augmentation Mastopexy with Composite Reverse Inferior Muscular Sling: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar in a Single-Stage Procedure
Authors: Munhoz Alexandre Mendonça , Marques Neto Ary de Azevedo , Maximiliano João
Published: February 2023

Augmentation mastopexy (AM) is a challenging procedure, and complications include implant displacement and visibility. These deformities can be addressed, but the stability of the smooth implant surface and patients with poor soft-tissue coverage may present limitations. This article describes a surgical technique for AM using a composite reverse inferior muscle sling associated with autogenous fat grafting.

Objectives:

To assess outcomes from primary AM procedures using the present technique in a cohort of patients operated on by a single surgeon.

Methods:

Forty-five patients (90 breasts) with a mean age of 37.7±7.2 years underwent hybrid composite reverse inferior muscular sling AM to treat ptosis (grade II–III). An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive subsequent fat grafting and divided into three zones. Three-dimensional imaging from the Divina scanner system was used to evaluate lower pole (LP) stretch and intermammary distance (IMD).

Results:

The average implant volume was 265 cc (range: 175–335 cc). Patients received an average volume of 115.34cc of AFG / breast (86.2–145.2 cc); the average fat volumes in zones I-II and III were 80.1 (61.6–95.2 cc) and 39.3 (25.2–47.3 cc), respectively. Five cases of complications were observed in 3 patients (6.6%): minor dehiscence in 2 (4.4%) and nipple-areola asymmetry in 1 (2.2%) over a mean follow-up period of 38 (6–49) months. At 12 months, the average values for nipple-inframammary fold were 85.8 mm and 86.4 mm for right and left sides, respectively. The LP stretched 11.51% (9.9 mm) and 9.8% (8.5 mm) on the right and left sides, respectively (p <0.0001), between 10 days and 1 year postoperative. IMD was reduced by an average of 49.9% (25.1 mm) (p <0.001) between the preoperative value and 1 year after surgery.

Conclusions:

Advances in AM and hybrid composite reverse inferior muscular sling have led to improved aesthetic results for patients with breast ptosis and poor tissue coverage. Fat grafting and recognizing cleavage zones are still important to obtain satisfactory results. Our data show this procedure offers a good alternative for AM candidates, providing an adequate smooth surface for implant stabilization.
Pregnancy Associated Breast Changes after Nipple Sparing Mastectomy”
Authors: Aschen Seth Z. , Paik Kristine C. , Swistel Alexander S. , Talmor Mia
Published: February 2023

Background:

Women of reproductive age are chronically underrepresented in breast cancer studies. Recent studies suggest that almost 40% of patients diagnosed with breast cancer, who are of reproductive age, want to have children after completing treatment. In this study, we evaluate patients of reproductive age who have undergone nipple sparing mastectomy (NSM) and implant-based reconstruction. We compare those who have become pregnant and those who have not, with respect to clinical and radiologic changes that are reported on follow-up.

Methods:

Any patient 45 years of age or younger at the time of NSM was defined to be of reproductive age and selected for evaluation and followed prospectively. The presence or absence of breast exam changes in the setting of pregnancy after NSM were recorded.

Results:

35 patients became pregnant after NSM and 159 patients did not become pregnant after NSM. Of those who became pregnant, nearly half reported some clinical change just prior to, or immediately after delivery. These included color change and discharge at the residual nipple areolar complex, and palpable nodularity elsewhere. For those with palpable changes, an ultrasound was performed and hypoechoic lesions with variable vascularity were identified. For those who went on to excision, lactational hyperplasia was the most common diagnosis.

Conclusions:

Ultrasound is an appropriate first line investigation of changes which can include hyperplasia of remaining ductal and glandular tissue. Patients who became pregnant after NSM commonly had clinical breast exam changes, however the majority of these changes are found to be benign on further evaluation.
A Systematic Review of Efficacy and Complications of High Definition Liposuction
Authors: Willet Jake W. , Alvaro Anton I. , Ibrahim Abdullah K. , Javed Muhammad U.
Published: February 2023

Background:

Traditionally liposuction is performed on the deeper layer of fat. However, in 1983 Illouz described a liposuction technique targeting the superficial layer of fat. High definition liposuction (HDL) is an advanced technique of liposuction that generates a desirable profile of anatomical area whilst promoting skin retraction. Although the safety profile of basic or traditional liposuction has been extensively studied, data relevant to HDL is limited. A systematic review to determine the effectiveness and complications was conducted.

Method:

Across the 21 articles included in the synthesis, a total of 6964 patients underwent HDL procedures. Of the cases where gender was reported, 44% were females (n=1241) and 56% males (n=1556). The average age of patients was 38 years (range 15 -76) and BMI was 25kg/m2 (range 18-38).

Results:

An overall complication rate of 14.4% (n=994) was calculated, with only 0.2% (n=13) of complications classified as major. Transient Hyperpigmentation was the most frequently reported complication affecting 3.8% (n=260) patients, followed by seroma 3.3% (n=231) and transient soft tissue fibrosis 2.7% (n=185). Despite an absence of uniform reporting, satisfaction rates of 92.6% (n= 1497) were reported.

Conclusion:

There is a high demand for HDL surgery globally and this systematic review illustrates the safety and efficacy of HDL. Major complication rates across the entirety of the literature reviewed were 0.2%, with minor complications seen in 14.2% across the 6964 cases reported. High patient satisfaction of 92.6% from HDL procedures was achieved, indicating efficacy of this procedure.
How the Lifting Amount in an Endoscopic Brow Lift is Influenced by Supraorbital Nerve Tension and Gliding-Layer Mobility of the Brow: A Cadaveric Study
Authors: Kim Sang-Hyun , Kim In-Beom , Choi Yeop
Published: February 2023

Background:

Sensory nerve tension and gliding-layer mobility in the brow may be significant factors affecting postoperative brow level in an endoscopic brow lift, yet have rarely been studied.

Methods:

To investigate the effects of sensory nerve tension and gliding-layer mobility, the following measurements were performed alongside the endoscopic brow lift in 50 fresh cadaveric hemifaces: amount of brow elevation, critical lifting amount (as sensory nerves became tense), laxity of sensory nerve courses, and mobility of brow-gliding layers. The sensory nerve situations in the subperiosteal and subgaleal dissections were also observed.

Results:

Supraorbital nerve tension limited the cephalic advancement of the forehead flap. The mean elevation of the brow was 5.8±1 mm (range, 3.5–8.6 mm). The mean critical lifting amount was 5.3±1.1 mm (range, 4.0–7.3 mm). The mean amount of laxity in the supraorbital nerve (the permissible amount of lift) was 4.1±0.9 mm (range, 2.5–5.5 mm). The galeal fat pad was responsible for 60% of brow mobility. The sensory nerve was more protected in a subgaleal dissection in the brow and inferior forehead, and in a subperiosteal dissection in the middle and upper forehead.

Conclusion

Cephalic movement of the forehead flap is limited by supraorbital nerve tension. The permitted lifting amount varies from 2.5–5.5 mm.

2. Gliding-layer mobility in the brow offsets the postoperative amount of cephalic advancement of the forehead flap.

3. Consideration of supraorbital nerve tension and gliding-layer mobility is recommended to obtain an optimal brow level in endoscopic brow lifts.
A new understanding and a minimalist approach for rhinoplasty.
Authors: Dogan Teoman
Published: February 2023

In this paper a new understanding and minimalist rhinoplasty approach is presented. This technique has many novelties and is aiming to simplify, make the operation more predictable and corrects primary deformities with a 20 steps procedure.
Co-administration of autologous concentrated growth factor (CGF) increases skin thickness and area during tissue expansion: a randomized clinical trial
Authors: Tan Poh-Ching , Zhang Pei-Qi , Zhou Shuang-Bai , He Ji-Zhou , Qian Jia , Huang Ru-Lin , Zhang Zhi-Yue , Cheng Chen , Li Qing-Feng , Xie Yun
Published: February 2023

Background:

Mechanical stretching of the skin, in terms of tissue expansion, could generate additional skin, but it is limited by the intrinsic growth capacity. Here, we conducted on autologous concentrated growth factor (CGF) to promote skin regeneration by increasing skin thickness and area during tissue expansion.

Methods:

A single-center, randomized controlled trial (registered with ClinicalTrials.gov [NCT03406143]) was conducted from 2016 to 2019. Participants undergoing skin expansion received either CGF or saline via intradermal injection on the expanded skin (0.02 ml/cm 2), for a total of three treatments at 4-week intervals. The primary endpoint was the expanded skin thickness at 12 weeks, which was measured by ultrasound. The secondary endpoints included the skin thickness at 4 and 8 weeks and the surface area, expansion index (EI), and skin texture score of the expanded skin at 12 weeks. Safety assessments, such as infection symptoms and nodule formation, were assessed at 24 weeks.

Results:

In total, 26 patients were enrolled and assigned to the CGF group or the control group. Compared with the control group, the CGF group had significantly increased skin thickness at 8 (control: 1.1 ± 0.1 mm, CGF: 1.4 ± 0.1 mm; -0.6 mm to 0.0 mm, p = 0.047) and 12 weeks (control: 1.0 ± 0.1 mm, CGF: 1.3 ± 0.1 mm; -0.6 mm to 0.0 mm, p = 0.047). Compared with the baseline thickness (control: 1.6 ± 0.1 mm, CGF: 1.5 ± 0.1 mm; -0.3 mm to 0.5 mm, p=0.987), skin thickness was sustained in the CGF group at 8 weeks posttreatment (-0.1 mm to 0.3 mm, p = 0.711) but decreased in the control group (0.3 mm to 0.7 mm, p＜0.001). At 12 weeks, the CGF group showed greater increases in surface area (control: 77.7 ± 18.5 cm 2, CGF: 135.0 ± 15.7 cm 2; 7.2 cm 2 to 107.4 cm 2, p = 0.027) and EI (control: 0.9 ± 0.1, CGF: 1.4 ± 0.2; 0.0 to 0.8, p=0.030) than the control group. Additionally, CGF-treated skin showed an improvement in texture (CGF: grade 3: 2 [15.8%], grade 2: 4 [30.7%]; control: grade 3: 0 [0.0%], grade 2: 3 [23.0%]). No severe adverse events occurred.

Conclusion:

CGF treatment increases skin thickness and area during tissue expansion, as represents a safe and effective strategy for managing skin expansion.

Evidence Rating:

Therapeutic Studies, Level II