Plastic and Reconstructive Surgery

BACKGROUND: The lack of specific tests and potential diagnostic inaccuracy may be behind the stunning figures of complex regional pain syndrome (CRPS) cases. The author tested the hypothesis that patients "diagnosed with" CRPS at referral could be assigned to recognized conditions and treated accordingly. METHODS: From January 2018 to April 2021, 225 consecutive patients attended the author's office having been diagnosed with and treated for CRPS for an average of 16±26 months...

Digital nerve lesions result in a loss of tactile sensation reflected by an anesthetic area (AA) at the radial or ulnar aspect of the respective digit. Yet, available tools to monitor the recovery of tactile sense have been criticized for their lack of validity. However, the precise quantification of AA dynamics by three-dimensional (3-D) imaging could serve as an accurate surrogate to monitor recovery following digital nerve repair.For validation, AAs were marked on digits of healthy volunteers to simulate the AA of an impaired cutaneous innervation...

INTRODUCTION: Hidradenitis suppurativa (HS) is a common chronical condition. It is often resistant to conservative treatment and requires a wide and aggressive surgical approach to avoid recurrence. A prospective study was compared comparing the outcomes of thoracodorsal artery perforator (TDAP) flap-based reconstruction and secondary intention closure (SIC) following wide local excision (WLE) of axillary HS. MATERIAL AND METHODS: A prospective study was conducted on sixty-eight patients suffering from stage III axillary HS...

BACKGROUND: Historically, prior failed reduction and certain radiographic indicators have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries. METHODS: A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital...

BACKGROUND: Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. METHODS: Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included...

OBJECTIVE: The aim of this study is to compare three surgical interventions to correct sagittal synostosis: frontobiparietal remodeling (FBR), extended strip craniotomy (ESC), and spring assisted correction (SAC), based on 3D photogrammetry and operation characteristics. METHODS: All patients diagnosed with non-syndromic sagittal synostosis, born between 1991 and 2019, who underwent FBR, ESC or SAC, and had at least one postoperative 3D photogrammetry image taken during one of six follow-up moments until the age of six, were considered for this study...

INTRODUCTION: The diagnosis and management of metopic craniosynostosis involves subjective decision-making at the point of care. The purpose of this work is to describe a quantitative severity metric and point-of-care user interface to aid clinicians in the management of metopic craniosynostosis and to provide a platform for future research through deep phenotyping. METHODS: Two machine-learning algorithms were developed that quantify the severity of craniosynostosis - a supervised model specific to metopic craniosynostosis (Metopic Severity Score) and an unsupervised model used for cranial morphology in general (Cranial Morphology Deviation)...

BACKGROUND: Small penile size is worrying for most men and leads to poor self-esteem, anxiety and depression. A penis can be enlarged in two ways: by increasing the length and by increasing the circumference. The purpose of this article is to present a new procedure of augmentation phalloplasty which combines these two parts in the same operation with a new technique to fill in the dead space created by the suspensory ligament division. METHODS: The lengthening of the penis is achieved with an inverted V-Y plasty followed by a division of the suspensory ligament of the penis all the way down the pubic symphysis...

BACKGROUND: The long-term effect of nasoalveolar molding (NAM) on patients with bilateral cleft lip and palate (BCLP) are unknown. We report clinical outcomes of facially-mature patients with complete BCLP who underwent NAM and gingivoperiosteoplasty (GPP). METHODS: A single-institution retrospective study of non-syndromic patients with complete BCLP who underwent NAM between 1991-2000 was performed. All study patients were followed to skeletal maturity, at which time a lateral cephalogram was obtained...

PURPOSE: Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility-terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy. METHODS: Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of surgeries were made between ATVs and UTVs...

BACKGROUND: There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, we developed a novel risk model for predicting dysphagia after tongue reconstruction. METHODS: This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical group across 31 cancer centers and university hospitals in Japan. A total of 532 patients (390 [73.3%] men and 142 [26.7%] women; median age at surgery: 60 years [range, 15-88 years]) who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included...

BACKGROUND: Body contouring is a common procedure, but it is worth attention due to concerns for a variety of complications, and even potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning models. METHODS: The National Inpatient Sample (NIS) database from 2015 to 2017 was queried to identify patients undergoing body contouring...

BACKGROUND: This study aimed to compare the effects of total maxillary setback osteotomy (TMSO) and anterior maxillary segmental osteotomy (AMSO) on nasolabial morphology. METHODS: This retrospective clinical trial enrolled 130 patients undergoing maxillary surgery using TMSO or AMSO. Ten nasolabial-related parameters and nasal airway volume were measured pre-operatively and post-operatively. The soft tissue digital model was reconstructed using Geomagic Studio and Dolphin image 11...

BACKGROUND: Submucous cleft palate (SMCP) is a particular subtype of cleft deformity with the optimal surgical timing and technique still under debate. This study aimed to identify potential prognostic factors for the speech outcome of patients with SMCP and provide evidence for further management strategy optimization. METHODS: We reviewed patients with nonsyndromic SMCP who received either Furlow palatoplasty (FP) or posterior pharyngeal flap (PPF) between 2008 and 2021 in a tertiary hospital-based cleft center...

Many patients seeking orthognathic jaw surgery also experience nasal obstruction. Currently transoral functional rhinoplasty techniques include septoplasty and inferior turbinate reduction, which are performed through the mouth following maxillary downfracture. Although powerful, these interventions do not treat dynamic nasal sidewall collapse. Here we describe a novel transoral alar batten (TAB) graft. Using the maxillary vestibular approach, septal cartilage is harvested and delivered from the maxillary vestibule into the nasal alar-sidewall junction through a small tunnel...

BACKGROUND: Vascularized lymph node transfer (VLNT) has proven to be a valuable treatment for patients affected by advanced stages of lymphedema. Although a spontaneous neo-lymphangiogenesis has been advocated to explain the positive effects of VLNT, there is still a lack of supportive biological evidence. The aim of the paper was to demonstrate the post-operative formation of new lymphatic vessels using histological skin sections from the lymphedematous limb. MATERIALS AND METHODS: All patients diagnosed with extremities' lymphedema who had undergone gastroepiploic vascularized lymph node flap (GE-VLN) between January 2016 and December 2018 were identified...

Long-term enophthalmos is a common orbital fracture sequela. Various autografts and alloplastic materials have been studied in post-traumatic enophthalmos repair. However, the expanded polytetrafluoroethylene (ePTFE) implantation in late enophthalmos repair has scarcely been reported. Herein, we report novel use of ePTFE for late post-traumatic enophthalmos (PTE) repair. This retrospective study included patients with post-traumatic long-term enophthalmos who underwent hand-carved ePTFE intraorbital implantation for enophthalmos correction...

BACKGROUND: Frontofacial surgery (FFS) creates a communication between the cranial and nasal cavities and is associated with significant infection risk. After a cluster of infections affecting patients undergoing FFS a root cause analysis of index cases was undertaken but no specifically remedial causes identified. Basic principles incorporating known risk factors for the prevention of surgical site infection were then applied to the creation of a peri-operative management protocol. This study analyses infection rates before and after its implementation...

Ear framework handcraft simulation using costal cartilage models is crucially important for ear reconstruction surgery education. Fabricating proper models mechanically and structurally comparable to their native counterparts is an unmet challenge. Herein, the authors developed structure and mechanical performance bio-mimetic costal cartilage models used for practicing and simulating handcraft of ear framework. High-tensile silicone and three-dimensional techniques were utilized to fabricate bio-mimetic models...

BACKGROUND: Prenatal diagnosis of cleft palate (CP) is challenging. The current study's objective was to investigate if prenatal alveolar cleft width is associated with the likelihood of a cleft of the secondary palate in unilateral cleft lip (CL). METHODS: The authors reviewed 2D US images in fetuses with unilateral CL from 1/2012-2/2016. Images of the fetal face were obtained with a linear and/or curved probe in the axial and coronal planes. Measurements of the alveolar ridge gap were taken by the senior radiologist...