The latest medical research on Plastic Surgery

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about plastic surgery gathered by our medical AI research bot.

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Clinical Features of Skin Infection After Rhinoplasty with Only Absorbable Thread (Polydioxanone) in Oriental Traditional Medicine: A Case Series Study.

Aesthetic Plastic Surgery

Polydioxanone (PDO) is absorbable thread which is usually used for wound closure and face lifting. These days, PDO thread is used increasingly for aesthetic purposes such as correction of facial wrinkles, laxity and even rhinoplasty in many oriental traditional medicine clinics. As rhinoplasty with PDO thread increases, complications also increase. In this study, we will report on the clinical features of patients who got rhinoplasty using PDO thread.

From August 2018 to July 2019, seven patients (three males and four females) visited our clinic for complications after rhinoplasty with PDO thread. We checked ultrasonography and laboratory findings including wound cultures. We used conservative treatment using antibiotics and performed surgery on three patients.

Three patients experienced severe complications with open wounds, abscesses and skin necrosis. Four patients experienced mild complications including redness and thread exposure without open wounds. The location of infection included the nasal tip and inner lining. Six patients had a history of rhinoplasty before. On ultrasonography, abscess formation was seen around the implant inserted before. During the operation, PDO thread cannot be seen except in one patient.

PDO thread cannot be seen in radiologic findings and can cause severe infections like abscess formation with open wounds. In severe infections, massive debridement with the removal of the implant would be required. PDO thread is absorbed usually after six months; mild infection can be controlled by the conservative treatment. The best is not undergoing rhinoplasty with PDO thread for patients who had implants because of potential side effects.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Short-Scar Augmentation Mastopexy in Massive-Weight Loss Patients: Four-Step Surgical Principles for Reliable and Reproducible Results.

Aesthetic Plastic Surgery

Single-stage augmentation mastopexy is considered a challenging procedure, and its safety and efficacy remain controversial for breasts with grade-2 and grade-3 ptosis. In this paper, we report our experience in single-stage augmentation mastopexy with implants, using a short-scar technique, outlining the four-step principles of our technique which maximizes the cosmetic outcomes though being safe, reliable and reproducible.

Forty consecutive massive-weight loss (MWL) patients undergoing short-scar augmentation mastopexy with implants between September 2010 and August 2018 were retrospectively analysed. The preoperative evaluation and our four-step surgical principles are presented in detail. Breast shape analysis was performed separately by a blinded group of plastic surgeons and by the attending surgeon using a standardized evaluation method. Breast-Q was used to evaluate patients' satisfaction.

Patients' average age was 43 (range from 29 to 54). Among the 40 patients, 2 patients were rated as grade 1 (5%), 21 cases (52.5%) grade 2 and 17 (42.5%) grade 3 according to Pittsburgh Rating Scale. The average follow-up time was 40 months (ranging from 3 to 96 months). No major postoperative complications were experienced. Patients' satisfaction was high to very high.

Augmentation mastopexy with implant in the MWL population remains a challenging procedure, especially in Pittsburgh grade-3 breasts. A bilamellar approach using proper footprint reconstruction allows for very satisfying cosmetic results using the short-scar mastopexy pattern with a very low complication rate. Our four-step surgical principles are provided, which may aid in the surgical planning and execution of such demanding cases.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Association of Treatment Inequity and Ancestry With Pancreatic Ductal Adenocarcinoma Survival.

JAMA Surgery

Pancreatic ductal adenocarcinoma (PDAC) has a higher incidence and worse outcomes among black patients than white patients, potentially owing to a combination of socioeconomic, biological, and treatment differences. The role that these differences play remains unknown.

To determine the level of survival disparity between black and white patients in a modern PDAC cohort and whether treatment inequity is associated with such a disparity.

This cohort study used data on 278 936 patients with PDAC with database-defined race from the National Cancer Database from January 1, 2004, to December 31, 2015. The median follow-up for censored patients was 24 months. The National Cancer Database, comprising academic and community facilities, includes about 70% of new cancer diagnoses in the United States. Race-stratified receipt of therapy was the primary variable of interest. Multivariable analyses included additional demographic and clinical parameters. Data analysis was initially completed on November 30, 2018, and revised data analysis was completed on June 27, 2019.

Overall survival was the primary outcome, analyzed with Kaplan-Meier and multivariable Cox proportional hazards regression modeling.

The cohort included 278 936 patients (137 121 women and 141 815 men; mean [SD] age, 68.72 [11.57] years); after excluding patients from other racial categories, 243 820 of the 278 936 patients (87.4%) were white and 35 116 of the 278 936 patients (12.6%) were black. Unadjusted median overall survival was longer for white patients than for black patients (6.6 vs 6.0 months; P < .001). Black patients presented at younger ages than white patients (15 819 of 35 116 [45.0%] vs 83 846 of 243 820 [34.4%] younger than 65 years; P < .001) and with more advanced disease (20 853 of 31 600 [66.0%] vs 135 317 of 220 224 [61.4%] with stage III or IV disease; P < .001). Black patients received fewer surgical procedures than white patients for potentially resectable stage II disease (4226 of 8097 [52.2%] vs 39 214 of 65 124 [60.2%]; P < .001) and slightly less chemotherapy for advanced disease (2756 of 4067 [67.8%] vs 17 296 of 25 227 [68.6%] for stage III disease [P = .001]; 8208 of 16 104 [51.0%] vs 58 603 of 105 616 [55.5%] for stage IV disease [P < .001]). Decreased survival for black patients persisted in multivariable modeling controlled for sociodemographic parameters (hazard ratio, 1.04 [95% CI, 1.02-1.05]). Conversely, modeling that controlled specifically for clinical parameters such as disease stage and treatment revealed a modest survival advantage (hazard ratio, 0.94 [95% CI, 0.93-0.96]) among black patients. Resection was the factor most strongly associated with overall survival (hazard ratio, 0.39 [95% CI, 0.38-0.39]).

Black patients with PDAC present at younger ages and with more advanced disease than white patients, suggesting that differences in tumor biology may exist. Black patients receive less treatment stage for stage and fewer surgical procedures for resectable cancers than white patients; these findings may be only partly associated with socioeconomic differences. When disease stage and treatment were controlled for, black patients had no decrease in survival.

Association of High Mortality With Postoperative Myocardial Infarction After Major Vascular Surgery Despite Use of Evidence-Based Therapies.

JAMA Surgery

Patients undergoing vascular surgery are at high risk of postoperative myocardial infarction (POMI). Postoperative myocardial infarction is independently associated with significant risk of in-hospital mortality.

To examine the association of patient and procedural characteristics with the risk of POMI after vascular surgery and determine the association of evidence-based therapies with longer-term outcomes.

A retrospective cohort study of prospectively collected data within a statewide quality improvement collaborative database between January 2012 and December 2017. Patient demographics, comorbid conditions, and perioperative medications were captured. Patients were grouped according to occurrence of POMI. Univariate analysis and logistic regression were used to identify factors associated with POMI. The collaborative collects data from private and academic hospitals in Michigan. Patients undergoing major vascular surgery, defined as endovascular aortic aneurysm repair, open abdominal aortic aneurysm, peripheral bypass, carotid endarterectomy, or carotid artery stenting were included. Analysis began December 2018.

The presence of a POMI and 1-year mortality.

Of 26 231 patients identified, 16 989 (65.8%) were men and the overall mean (SD) age was 69.35 (9.89) years. A total of 410 individuals (1.6%) experienced a POMI. Factors associated with higher rates of POMI were age (odds ratio [OR], 1.032 [95% CI, 1.019-1.045]; P < .001), diabetes (OR, 1.514 [95% CI, 1.201-1.907]; P < .001), congestive heart failure (OR, 1.519 [95% CI, 1.163-1.983]; P = .002), valvular disease (OR, 1.447 [95% CI, 1.024-2.046]; P = .04), coronary artery disease (OR, 1.381 [95% CI, 1.058-1.803]; P = .02), and preoperative P2Y12 antagonist use (OR, 1.37 [95% CI, 1.08-1.725]; P = .009). Procedurally, open abdominal aortic aneurysm (OR, 4.53 [95% CI, 2.73-7.517]; P < .001) and peripheral bypass (OR, 2.375 [95% CI, 1.818-3.102]; P < .001) were associated with the highest risk of POMI. After POMI, patients were discharged and received evidence-based therapy with high fidelity, including β-blockade (296 [82.7%]) and antiplatelet therapy (336 [95.7%]). A high portion of patients with POMI were dead at 1 year compared with patients without POMI (113 [37.42%] vs 993 [5.05%]; χ2 = 589.3; P < .001).

Despite high rates of discharge with evidence-based therapies, the long-term burden of POMI is substantial, with a high mortality rate in the following year. Patients with diabetes mellitus, coronary artery disease, congestive heart failure, and valvular disease warrant additional consideration in the preoperative period. Further, aggressive strategies to treat patients who experience a POMI are needed to reduce the risk of postoperative mortality.

Noncontact Phased-Array Ultrasound Facilitates Acute Wound Healing in Mice.

Plastic and Reconstructive Surgery

We developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array (PA) technology (NLFU-PA). It may aid wound healing because it is likely to associate with lower risks of infection and heat-induced pain than conventional ultrasound methods. We hypothesized that the microdeformation it induces accelerates wound epithelialization. This was tested in mice. Its effects on key wound-healing processes, namely, angiogenesis, collagen accumulation, and angiogenesis-related gene transcription, were also examined.

Immediately post-wounding, bilateral acute wounds in C57BL/6J mice were NLFU- and sham-stimulated for 1 hour/day for three consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as percent change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (n=5-6/timepoint) and subjected to histopathology with H-E and Masson's trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis.

Compared to sham-treated wounds, NLFU-PA-treated wounds exhibited significantly accelerated epithelialization (65±27% vs. 30±26% closure), angiogenesis (4.6±1.7% vs. 2.2±1.0% CD31+ area), and collagen deposition (44±14% vs. 28±13% collagen density) on days 5, 2, and 5, respectively (all P<0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively.

Our NLFU-PA device improved the wound-healing rate. This associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. NLFU-PA devices may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.

Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up.

Plastic and Reconstructive Surgery

In recent years, microneedling has been increasingly used to treat a number of dermatologic conditions, including scars. Microneedling has been shown to promote neocollagenesis via mechanical disruption of the epidermis and dermis. The creation of multiple microchannels by needle penetration physically disrupts the compact collagen bundles while inducing new collagen and elastin synthesis and deposition within the fibrotic dermis. The latest microneedling devices are motorized and have improved the ability to more precisely and effectively treat scars. While initial studies have demonstrated improvement of (mostly) atrophic scars with microneedling, the number of patients evaluated have been relatively small and the devices and treatment protocols utilized as well as post-treatment follow-up have varied widely. Through this prospective observational study, we describe the results of microneedling on a consecutive series of 120 patients with a variety of scars. Clinical outcomes and adverse effects were evaluated over a 12 month period after treatment.

One hundred twenty consecutive patients (SPT I-VI) with facial and non-facial scars from a variety of etiologic sources (acne, trauma, surgery) were treated using a mechanical microneedling device. Treatments were delivered at monthly intervals by the same operator using a motorized microneedling device with 2.5-3mm needle depths. No additional treatments (topical or intralesional) were applied. Representative clinical photographs were obtained at baseline, prior to each treatment, and 1, 3, 6, and 12 months after treatment. Two assessors blinded to treatment protocol rated clinical improvement of scars on a 5-point scale (0= no change, 1= 1-25% improvement, 2= 26-50% improvement, 3=51-75% improvement, 4= 76-100% improvement). Side effects were monitored and tabulated.

Patients received 1 to 6 consecutive monthly microneedling treatments. All scars improved at least 50% after an average of 2.5 treatments. Over 80% of patients had 50-75% improvement and 65% of patients demonstrated over 75% improvement. No significant clinical differences were observed in treatment responses of facial scars versus non-facial scars. Similarly, no significant clinical differences were seen between responses of atrophic acne scars and traumatic or surgical scars. Side effects were limited to transient erythema and edema. Rare purpura formation and herpes simplex reactivation were experienced. No scar worsening nor long-term adverse sequelae were observed.

The clinical results obtained in this study support the use of microneedling for various facial and non-facial scars across a broad range of skin phototypes with minimal risk of adverse effects. Further studies will help to establish standardized protocols to optimize treatment outcomes for different scar types.

The Alignment of the Nose in Rhinoplasty: Fix Down Concept.

Plastic and Reconstructive Surgery

The current literature on rhinoplasty mainly focusses on the nasal profile (sagittal plane); however, the nose is a 3-dimensional structure, and alignment of the nose in consideration of other aspects is important to achieve an aesthetic result. The author aimed to introduce the fix down concept which includes fix down technique and the adjunct maneuvers for achieving alignment of the nose in 3 anatomical planes and improving the results of rhinoplasty in terms of symmetry.

Between March 2017 and December 2017, a total of 102 patients (78 female, 24 male), (13 revision, 89 primary cases) underwent septorhinoplasty with the fix down concept. The noses were evaluated in coronal, sagittal, and axial planes and classified according to their deformities.

The functional and aesthetic results were satisfactory for the patients, examiners, and surgeon. No revisions were necessary during the follow-up period. In addition to the fix down technique; ethmoid bone grafting (16 patients); fix up technique (8 patients); dissection of the levator alaeque nasi muscle (14 patients); plication of this muscle (4 patients); superior based transposition flap (39 patients); rim grafts (17 patients); mucosa grafts (12 patients); double layer grafts (9 patients); maxillary deepening (5 patients); maxillary augmentation with cartilage/bone grafts (21 patients); and supratip onlay grafts (7 patients) were employed as adjunctive maneuvers to achieve symmetry in the frontal, base, and profile views.

The presented fix down concept will help to provide 3-dimensional symmetric noses for rhinosurgeons.

Chondrogenesis of adipose-derived stem cells on irradiated cartilage.

Plastic and Reconstructive Surgery

Irradiated allogeneic costal cartilage (IACC) is an alternative option of cartilage graft in patients with insufficient autologous cartilage. However, complications can occur during long-term follow-up. This study investigated whether Tutoplast-processed cartilage (TC), one of the IACC acts as a scaffold for adipose-derived stem cells (ASCs) and whether the treated ASCs on TC can differentiate into cartilage.

Human ASCs were cultured and differentiated into chondrocytes in an in vitro setting. Next, ASCs seeded on TC were cultured in chondrogenic media, and observed using a scanning electron microscope. Three types of TC, including TC itself, undifferentiated ASC-TC (UA-TC), and chondrogenic differentiated ASC-TC (CA-TC) were implanted subcutaneously into nude mice. At postoperative weeks 2 and 4, all kinds of TC were harvested, and gross, histologic, and gene expression analyses were performed.

Human ASCs subjected to in vitro three-dimensional culture differentiated into chondrocytes and expressed the COL2A1 and ACAN genes. ASCs seeded on TC were differentiated into chondrocytes in chondrogenic media. In the CA-TC group, the chondrogenic-differentiated cells attached to the surface of the TC were maintained during the follow-up and were distinct from the existing TC. Moreover, the CA-TC group had higher expressions of cartilage-specific genes than did the UA-TC group.

ASCs seeded on TC underwent chondrogenic differentiation, generating new cartilage, which was maintained after implantation without critical complications. The findings are clinically valuable in terms of overcoming the limitations of IACC, and broaden the surgical options for treatments requiring cartilage.

Bone Tissue Engineering in the Growing Calvarium Using Dipyridamole-Coated 3D Printed Bioceramic Scaffolds: Construct Optimization and Effects to Cranial Suture Patency.

Plastic and Reconstructive Surgery

3D-printed bioceramic (3DBC) scaffolds composed of beta-tricalcium phosphate (β-TCP) delivering the osteogenic agent dipyridamole (DIPY) can heal critically-sized calvarial defects in skeletally mature translational models. However, this construct has yet to be applied to growing craniofacial models. In this study, we implanted 3DBC/DIPY scaffolds in a growing calvaria animal model and evaluated bone growth as a function of geometric scaffold design and DIPY concentration. Potential adverse effects on the growing suture were also evaluated.

Bilateral calvarial defects (10 mm) were created in 5-week-old (~1.1 kg) New Zealand White rabbits (n = 16 analyzed). 3DBC scaffolds were constructed in quadrant form composed of varying pore dimensions (220μm, 330μm, 500μm). Each scaffold was collagen coated and soaked in varying concentrations of DIPY (100μM, 1000μM, 10,000μM). Controls comprised empty defects. Animals were euthanized 8-weeks post-operatively. Calvaria were analyzed using micro-computed tomography (microCT), 3D reconstruction, and non-decalcified histologic sectioning.

Scaffold-induced bone growth was statistically greater than bone growth in empty defects (p=0.02). Large scaffold pores, 500μm, coated in 1,000μM DIPY yielded the most bone growth and lowest degree of scaffold presence within defect. Histology showed vascularized woven and lamellar bone along with initial formation of vascular canals within the scaffold lattice. MicroCT and histologic analysis revealed patent calvarial sutures without evidence of ectopic bone formation across all DIPY concentrations.

We present an effective pediatric bone tissue engineering scaffold design and dipyridamole concentration which is effective in augmentation of calvarial bone generation while preserving cranial suture patency.

The KS-Pexy: a novel method to manage horizontal lower eyelid laxity.

Plastic and Reconstructive Surgery

Patients with horizontal lower lid laxity undergoing lower lid blepharoplasty are at a high risk for lid malposition. Prophylactic correction of horizontal lower lid laxity during blepharoplasty may alleviate this risk. Here, we describe a novel lower lid blepharoplasty technique, the KS-Pexy, for correcting horizontal lower lid laxity.

All cases of KS-Pexy between September 2009 - June 2018 from an aesthetic practice were reviewed retrospectively. All patients were diagnosed with horizontal lower lid laxity and requested lower lid blepharoplasty for aesthetic concerns. Patient demographics, clinical presentation, procedure details, and intraoperative findings were analyzed.

62 patients underwent KS-Pexy by the senior author. The average follow-up was 41.1 months, ranging from 2-107 months. Thirteen patients had a negative vector, 54 patients received a KS-Pexy in combination with another facial procedure, and 14 patients had their KS-Pexy as a secondary procedure. The overall success rate was 96.8%. The complication profile was: chemosis (27.4%), new onset dry eyes persisting longer than 8 weeks (6.5%), temporary lower eyelid malposition (4.8%), lower eyelid malposition requiring surgical intervention (3.2%), poor scar quality (1.6%), lower lid abscess (1.6%), transient conjunctivitis (1.6%), lateral fat compartment swelling (1.6%), canthopexy dehiscence (1.6%), hordeolum (1.6%) and temporary V2 paresthesia (1.6%).

The KS-Pexy is an effective means to treat horizontal eyelid laxity prophylactically in patients requesting lower eyelid blepharoplasty for aesthetic reasons.

A Study on the Effective Ratio of Fat to Stromal Vascular Fraction for Cell-Assisted Lipotransfer.

Aesthetic Plastic Surgery

Fat grafting, used for soft tissue augmentation during aesthetic or reconstructive plastic surgery, has disadvantages of low efficiency and unpredictable resorption rate. As an alternative, cell-assisted lipotransfer (CAL) is widely used because of its simplicity and low fat resorption rate. However, relevant studies on optimal CAL parameters are still lacking. Here, we aimed to identify the most effective ratio of fat to stromal vascular fraction (SVF) for CAL.

We designed two experimental paradigms. The first involved four groups of mice, each group injected with varying ratios of fat and SVF purified from different amounts of fat from a fixed amount of harvested fat. The second experiment involved four groups of mice, each injected with varying amounts of SVF mixed with a fixed amount of fat tissue. The amount of surviving fat in both experiments was compared 8 weeks after fat transplantation.

In the first experiment, the group injected with only fat, without consuming any of the harvested fat for SVF purification, showed the greatest mean volume and weight. In the second experiment, groups with 1:1 or more ratio of fat to SVF showed greater volume and weight than the group without SVF. Notably, a ratio of 1:1 did not give significantly different results than higher ratios.

Thus, when a limited amount of fat tissue is available, using all of it for grafting is the most effective. However, if an adequate amount is available, using a fat-to-SVF ratio of 1:1 is the most efficient.

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Anchor-Line Abdominoplasty with Scarpa Fascia Preservation in Postbariatric Patients: A Comparative Randomized Study.

Aesthetic Plastic Surgery

The number of bariatric surgeries for the treatment of morbid obesity has increased, and there is growing demand for postbariatric abdominoplasty. The aim of this study was to evaluate the impacts of Scarpa's fascia preservation on total drainage volume, time to drain removal, and seroma formation in anchor-line abdominoplasty.

A total of 42 postbariatric patients were randomly assigned to two groups and underwent anchor-line abdominoplasty. Scarpa's fascia was not preserved during abdominoplasty in one group (n = 21) but was preserved in the other group (n = 21). A suction drain was left in place until the drainage volume was less than 30 ml/24 h. Seroma formation was assessed by abdominal ultrasound on the twentieth postoperative day; only fluid collections greater than 30 ml were considered seromas.

The time to drain removal was shorter, and the total drainage volume was lower in the fascial preservation group than in the fascial dissection group. However, no difference in the seroma formation rate was observed between the groups.

Scarpa's fascia preservation decreased the drainage volume and the time to drain removal but not the rate of seroma formation.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.