bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination Therapy Composed of Surgery, Postoperative Radiotherapy, and Wound Self-management for Umbilical Keloids
Authors: Dohi Teruyuki , Kuribayashi Shigehiko , Aoki Masayo , Tosa Mamiko , Akaishi Satoshi , Ogawa Rei 
Published: April 2021

Background:
A universally accepted therapeutic strategy for umbilical keloids has not been determined. Our team has had considerable success with combination therapy composed of surgical excision followed by postoperative radiotherapy and steroid plaster/injection.

Methods:
All consecutive patients with umbilical keloids that developed from endoscopic surgical scars and underwent minimal-margin keloid excision followed by umbilicoplasty with a flap if needed, tension-reduction suturing, and postoperative radiotherapy in 2013–2017 in the keloid/scar-specialized clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School. The postsurgical radiotherapy regimen was 15 Gy administered in 2 fractions over 2 consecutive days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape or, if needed, steroid plaster. The primary study focus was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the growth of stiff red lesions in even small areas of the scar that was refractory to 2–6 months of steroid-plaster therapy.

Results:
The case series consisted of 34 patients with 34 lesions. Three lesions (8.8%) recurred. One recurrence was successfully treated by concomitant steroid plaster/injection. The other 2 cases were resistant to steroid injection and underwent reoperation without radiotherapy followed by 6 months of steroid-plaster therapy. None of the 3 cases recurred within 2 years of steroid plaster/injection completion or reoperation.

Conclusion:
Umbilical keloids can be successfully treated by customized treatment plans that involve appropriate surgical modalities (including umbilicoplasty, if required), postoperative radiotherapy (15 Gy/2 fractions/2 days), and wound/scar self-management with silicone tape and steroid plaster.
Mandibular Reconstruction with Free Fibula Flap for Medication-related Osteonecrosis of the Jaw in Patients with Multiple Myeloma
Authors: Kaoutzanis Christodoulos , Yu Jason W. , Lee Z-Hye , Davary Ashkan , Fleisher Kenneth E. , Levine Jamie P. 
Published: April 2021

Summary:
While bisphosphonates are the cornerstone for management of multiple myeloma, they are associated with medication-related osteonecrosis of the jaw (MRONJ). There are many controversies in the management of MRONJ in this patient population. In this article, we describe a representative case and, along with a literature review, we report the outcomes of our 3 cases with multiple myeloma who underwent mandible reconstruction with vascularized fibula bone grafts after segmental mandible resection for Stage 3 MRONJ over a 3-year period. All patients were male with a mean age of 59 years. All patients had undergone therapy with bisphosphonates and had no other identifiable cause of mandible osteonecrosis. All patients had pathologic mandible fractures associated with intraoral fistulae and exposed bone. Nonsurgical management was attempted in all patients. One patient also underwent debridement of the mandible without resolution of the disease. Mandible reconstruction with an osteocutaneous free fibula flap after segmental mandible resection was performed in all 3 cases without major complications or donor site morbidity. Different bacteria were isolated from the intraoperative tissue cultures in all cases. Computed tomographic imaging revealed bony union without hardware complications in all cases. Mean follow-up was 28 months. In conclusion, we demonstrated that patients with multiple myeloma and advanced MRONJ lesions of the mandible can be managed successfully and safely by segmental resection and reconstruction with vascularized fibula bone graft.
Artificial Intelligence in Plastic Surgery: Current Applications, Future Directions, and Ethical Implications
Authors: Jarvis Tyler , Thornburg Danielle , Rebecca Alanna M. , Teven Chad M. 
Published: April 2021

Background:
Artificial intelligence (AI) in healthcare delivery has become an important area of research due to the rapid progression of technology, which has allowed the growth of many processes historically reliant upon human input. AI has become particularly important in plastic surgery in a variety of settings. This article highlights current applications of AI in plastic surgery and discusses future implications. We further detail ethical issues that may arise in the implementation of AI in plastic surgery.

Methods:
We conducted a systematic literature review of all electronically available publications in the PubMed, Scopus, and Web of Science databases as of February 5, 2020. All returned publications regarding the application of AI in plastic surgery were considered for inclusion.

Results:
Of the 89 novel articles returned, 14 satisfied inclusion and exclusion criteria. Articles procured from the references of those of the database search and those pertaining to historical and ethical implications were summarized when relevant.

Conclusions:
Numerous applications of AI exist in plastic surgery. Big data, machine learning, deep learning, natural language processing, and facial recognition are examples of AI-based technology that plastic surgeons may utilize to advance their surgical practice. Like any evolving technology, however, the use of AI in healthcare raises important ethical issues, including patient autonomy and informed consent, confidentiality, and appropriate data use. Such considerations are significant, as high ethical standards are key to appropriate and longstanding implementation of AI.
Cortical Thickness in Crouzon–Pfeiffer Syndrome: Findings in Relation to Primary Cranial Vault Expansion
Authors: Wilson Alexander T. , de Planque Catherine A. , Yang Sumin S. , Tasker Robert C. , van Veelen Marie-Lise C. , Dremmen Marjolein H.G. , Vrooman Henri A. , Mathijssen Irene M.J. 
Published: April 2021

Background:
Episodes of intracranial hypertension are associated with reductions in cerebral cortical thickness (CT) in syndromic craniosynostosis. Here we focus on Crouzon–Pfeiffer syndrome patients to measure CT and evaluate associations with type of primary cranial vault expansion and synostosis pattern.

Methods:
Records from 34 Crouzon–Pfeiffer patients were reviewed along with MRI data on CT and intracranial volume to examine associations. Patients were grouped according to initial cranial vault expansion (frontal/occipital). Data were analyzed by multiple linear regression controlled for age and brain volume to determine an association between global/lobar CT and vault expansion type. Synostosis pattern effect sizes on global/lobar CT were calculated as secondary outcomes.

Results:
Occipital expansion patients demonstrated 0.02 mm thicker cortex globally (P = 0.81) with regional findings, including: thicker cortex in frontal (0.02 mm, P = 0.77), parietal (0.06 mm, P = 0.44) and occipital (0.04 mm, P = 0.54) regions; and thinner cortex in temporal (−0.03 mm, P = 0.69), cingulate (−0.04 mm, P = 0.785), and, insula (−0.09 mm, P = 0.51) regions. Greatest effect sizes were observed between left lambdoid synostosis and the right cingulate (d = −1.00) and right lambdoid synostosis and the left cingulate (d = −1.23). Left and right coronal synostosis yielded effect sizes of d = −0.56 and d = −0.42 on respective frontal lobes.

Conclusions:
Both frontal and occipital primary cranial vault expansions correlate to similar regional CT in Crouzon–Pfeiffer patients. Lambdoid synostosis appears to be associated with cortical thinning, particularly in the cingulate gyri.
Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients
Authors: Moon Hyoung-Jin , Gao Zhan-Wei , Hu Zhi-Qi , Wang Hang , Wang Xiao-Jun 
Published: April 2021

Background:
Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study.

Methods:
We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions.

Results:
Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics.

Conclusions:
Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.
Perception of Breast Reconstruction among 10,299 Indian Women
Authors: Shanmugakrishnan R. Raja , Sabapathy S. Raja 
Published: April 2021

Background:
Less than 1% of women undergo breast reconstruction after mastectomy in India. To understand if the perception of breast reconstruction among Indian women is a contributing factor, a survey of 10,299 women was done.

Method:
In total, 10,299 women answered questions from a questionnaire with the help of social workers (10,005) and using the Surveymonkey App (294).

Results:
An estimated 48.8% of women were aware of breast reconstruction. Around 77.5% felt that women would feel depressed after mastectomy, and 76.5% said they would prefer breast reconstruction. Irrespective of age and financial status, most women preferred breast reconstruction after mastectomy. Autologous reconstruction (79.6%) was preferred to implant reconstruction (20.4%). An estimated 71.3% liked the idea of a DIEP flap. When explained that DIEP flap may take 6–8 hours of surgery and cost about US $3500, only 48.8% would go for a DIEP flap. For early breast cancers, women preferred breast conservation surgery (65.7%) to mastectomy and breast reconstruction (34.3%). Women felt that the best way to increase awareness of breast reconstruction would be by social media (47.8%) followed by word of mouth (16.4%), television (13.4%), newspapers (11.7%), and magazines (10.6%).

Conclusions:
Although the breast reconstruction rates are very low, women preferred breast reconstruction to mastectomy alone regardless of age and financial status. The surgical teams should devise strategies to assure woman that they can achieve reliable reconstruction at an affordable cost. Increasing experience and reduction of operation time would make autologous breast reconstruction affordable. This strategy could apply to most developing economies.
Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity
Authors: Sakamoto Yoshiaki , Miyamoyo Junpei , Kishi Kazuo 
Published: April 2021

Background:
It is generally accepted that the alar base on the cleft side in the cleft lip nose is displaced outward and downward; therefore, it is rotated inward and upward in almost all procedures for cleft lip closure. However, nostril narrowing and collapse of the lower lateral cartilage on the cleft side are sometimes experienced. In this retrospective study, we investigated whether the preoperative alar base on the cleft side is displaced outward and downward.

Methods:
This was a retrospective evaluation using preoperative frontal images obtained from patients with unilateral cleft lip (n = 245). The midcolumellar and subalare points were placed, and each ratio was analyzed and compared to those of age-matched controls (n = 40).

Results:
The subalare on the noncleft side and subnasale were displaced upward and outward. In contrast, the subalare on the cleft side was displaced downward and inward. The displacement of the subalare was greater on the noncleft than on the cleft side. There were no significant differences between male and female patients and between the left and right sides. Among the complete cleft lip and palate, incomplete cleft lip and palate, complete cleft lip and alveolus, incomplete cleft lip and alveolus, and microform cleft lip groups, the complete cleft lip and palate group showed the greatest displacement.

Conclusion:
The cleft alar base appeared to shift outward and downward because of an optical illusion, but in fact, both alar bases shifted; the alar base on the cleft side was displaced inward and downward, and the alar base on the noncleft side was displaced outward and upward.
Superficial Temporal Artery Pseudoaneurysm following Midface Thread-lift
Authors: Niimi Yosuke , Hayakawa Nami , Kamei Wataru , Hori Keijiro , Niimi Yu , Honda Takashi , Sakurai Hiroyuki 
Published: April 2021

Summary
Facial thread-lifting has been popular because of its ease and safety with short down time. However, many physicians perform the procedure in cosmetic clinics, which can result in several complications. This report describes the surgical treatment of iatrogenic superficial temporal artery pseudoaneurysm (STAP) following thread-lifting. A 27-year-old man developed a painless, pulsating soft mass in the pre-auricular region after undergoing a thread-lift in a private cosmetic clinic 3 months before being referred to the authors’ hospital. The mass was diagnosed as a STAP, using magnetic resonance imaging. The pseudoaneurysm was resected completely, and the superficial temporal artery was microsurgically reconstructed. Although there are some surgical procedures for treating STAP, such as surgical resection and embolization, the former is considered the first choice. Physicians should be trained before performing thread-lifting and must know the possibility of an iatrogenic STAP appearing after the procedure and the face and neck anatomy to prevent complications.
Volume Change of Muscle and Fat Portions of Latissimus Dorsi Myocutaneous Flap after Breast Reconstruction
Authors: Kang Chang Min , Shim Jeong Su , Park Sung Hwan , Jeong Young Ju , Seol Ki Ho , Kwak Sang Gyu 
Published: April 2021

Background:
Myocutaneous flaps are composed of muscle and fat portions, and exhibit volume changes with time. However, no consideration is generally given to volume changes of muscle and fat portions occurring in the flap. Therefore, we conducted this study to analyze the volume changes of muscle and fat portions of pedicled latissimus dorsi myocutaneous flaps over time.

Methods:
Sixteen patients who underwent breast reconstruction using a latissimus dorsi myocutaneous flap between 2009 and 2017 were enrolled in this study. Using their postoperative computed tomography scan data, we measured the volume of muscle and fat portions of the flap, and performed a statistical analysis of volume changes over time. We also measured the volume of latissimus dorsi muscle on the opposite side and compared the difference in muscle volume.

Results:
The volume of the muscle portion of latissimus dorsi myocutaneous flap decreased by approximately 24%, from 6 months to postoperative year 2; from the third year, it shrank with a decrease rate similar to that of normal muscle. The fat portion of the flap showed no regular volume changes.

Conclusions:
Atrophy of the muscle portion is the primary cause of volume change of latissimus dorsi myocutaneous flaps over time. it is necessary to understand the difference in the volume change patterns of the muscle and fat. To maintain a long-term satisfactory result, it is better to make the maximum possible use of the relatively stable fat portion rather than the muscle portion.
Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision: A Prospective, Multi-centered, Double-blinded Study
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Jenwitheesuk Kamonwan , Eua-angkanakul Kant , Winaikosol Kengkart , Punyavong Pattama , Wongkietkachorn Nuttapone , Wongkietkachorn Supawich , Salyapongse A. Neil 
Published: April 2021

Background:
During burn excision, the clinical judgment whether to excise or not excise the area with indeterminate burn depth is difficult. Indocyanine green angiography (ICGA) has been reported to provide high accuracy in diagnosing indeterminate burns. This study aims to evaluate the complete wound closures in both short-term and long-term outcomes after using ICGA precise marking to guide indeterminate burn excision.

Methods:
This was a prospective, multi-centered, double-blinded, experimental study. The participants were admitted to the hospital with indeterminate burn wounds. ICGA precise marking was performed. The deep second-degree burn was painted, excised, and subsequently covered with skin grafts and measured on day 5. The superficial burns were measured on day 21. All wounds were followed-up at two months.

Results:
Thirty indeterminate burn sites were included in this study. Using ICGA precise marking, the overall rate of short-term complete wound closure, which combined superficial and deep burns, was found to be as high as 96.7% (29/30). The long-term complete wound closures at two months confirmed the short-term result and yielded 100.0% of complete wound closure. The complete wound closures between the short-term and long-term measurements were not significantly different (P > 0.999).

Conclusions:
Using ICGA precise marking to guide indeterminate burn excision resulted in an excellent rate of complete wound closure and an insignificant difference between short-term and long-term wound outcomes. ICGA is a competent method to aid decision-making in burn surgery of the indeterminate area.
Nipple–Areola Complex Reconstruction Using a Skin Graft and Nipple Sharing after Wise-pattern Central Lumpectomy
Authors: Schwartz Jean-Claude D. 
Published: April 2021

Summary
Patients with central breast cancers historically underwent mastectomy, as the aesthetic implications of removing the nipple–areola complex and central breast tissue left disfiguring defects after breast conservation. The introduction of oncoplastic techniques allowed for central lumpectomies in ptotic patients, as the excess skin and gland could be mobilized centrally to fill the defect and even immediately reconstruct a nipple and areola. These reconstructions used excess skin on the Wise pattern vertical limbs to create a nipple, or on a “neopedicle” where both the areola and nipple were reconstructed and then mobilized superiorly into position as would be performed for a conventional mastopexy or reduction. These techniques importantly allowed for the immediate reconstruction of a nipple and areola in patients who often imminently required radiotherapy and where subsequent surgery would be challenging. Here we describe another option for immediate nipple and areola reconstruction in these patients—nipple sharing and a skin graft—a well-established approach in post-mastectomy patients but never previously described for patients undergoing breast conservation.
Relationship between angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and COVID-19 incidence or severe disease
Authors: Tse Gary , Zhou Jiandong , Lee Sharen , Wong Wing Tak , Li Xintao , Liu Tong , Cao Zhidong , Zeng Daniel Dajun , Wai Abraham K.C. , Wong Ian Chi Kei , Cheung Bernard Man Yung , Zhang Qingpeng 
Published: April 2021

Background:
Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may be associated with higher susceptibility of COVID-19 infection and adverse outcomes. We compared ACEI/ARB use and COVID-19 positivity in a case–control design, and severity in COVID-19 positive patients.

Methods:
Consecutive patients who attended Hong Kong's public hospitals or outpatient clinics between 1 January and 28 July 2020 for COVID-19 real time-PCR (RT-PCR) tests were included. Baseline demographics, past comorbidities, laboratory tests and use of different medications were compared between COVID-19 positive and negative patients. Severe endpoints for COVID-19 positive patients were 28-day mortality, need for intensive care admission or intubation.

Results:
This study included 213 788 patients (COVID-19 positive: n = 2774 patients; negative: n = 211 014). In total, 162 COVID-19 positive patients (5.83%) met the severity outcome. The use of ACEI/ARB was significantly higher amongst cases than controls (n = 156/2774, 5.62 vs. n = 6708/211014, 3.17%; P < 0.0001). Significant univariate predictors of COVID-19 positivity and severe COVID-19 disease were older age, higher Charlson score, comorbidities, use of ACEI/ARB, antidiabetic, lipid-lowering, anticoagulant and antiplatelet drugs and laboratory tests (odds ratio >1, P < 0.05). The relationship between the use of ACEI/ARB and COVID-19 positivity or severe disease remained significant after multivariable adjustment. No significant differences in COVID-19 positivity or disease severity between ACEI and ARB use were observed (P > 0.05).

Conclusion:
There was a significant relationship between ACEI/ARB use and COVID-19 positivity and severe disease after adjusting for significant confounders.
Analysis of Immune Cells on Donor Corneal Endothelium After Corneal Transplantation Using the HRT-Rostock Cornea Module
Authors: Okumura Naoki , Velumani Thenmozhi , Hadiya Farhath , Padmanaban Vasanthi , Komori Yuya , Hanada Naoya , Hirono Taisuke , Srinivas Sangly P. , Koizumi Noriko , Padmanabhan Prema 
Published: April 2021

Purpose:
The aim of this study was to investigate the immune cells on corneal endothelium of the graft in patients who underwent penetrating keratoplasty (PK), Descemet-stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK).

Methods:
A total of 43 eyes of 43 patients who underwent PK (17 eyes), DSEK (13 eyes), and DMEK (13 eyes) and who did not show any sign of graft rejection were recruited for the study. Patients who underwent cataract surgery (26 eyes) served as controls. Immune cells on the corneal endothelium were examined with laser in vivo confocal microscopy. The associations between the corneal endothelial cell density, type of keratoplasty, aqueous flare, repeated keratoplasty, and time after surgery versus the density of immune cells were investigated.

Results:
In vivo confocal microscopy visualized similar numbers of immune cells on the corneal endothelium in the PK, DSEK, and DMEK groups, whereas no immune cells were observed in any of the control patients. The numbers of immune cells tended to be higher in regraft eyes in the PK group (P = 0.00221) and in the DSEK group (P = 0.168) than those in the primary graft eyes. No significant association was found between the density of immune cells and corneal endothelial cell density in the PK, DSEK, and DMEK groups.

Conclusions:
Immune cells were observed to a similar extent in the eyes of PK, DSEK, and DMEK subjects even in the absence of any clinical sign of immune rejection. A further prospective longitudinal study will evaluate the effect of immune cells on long-term graft survival and the risk for graft rejection.