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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Autologous Fat Grafting for the Oral and Digital Complications of Systemic Sclerosis: Results of a Prospective Study.

Aesthetic Plastic Surgery

Systemic sclerosis is a connective tissue disease. Skin involvement of the mouth and hand may compromise function and quality of life. Autologous fat grafting has been described as a specific treatment of these clinical features. We report the results of our prospective study designed to treat and prevent skin complications in systemic sclerosis.

We treated 25 patients with mouth and/or hand involvement (microstomia, xerostomia, skin sclerosis, Raynaud's phenomenon and long-lasting digital ulcers) with autologous fat grafting, according to the Coleman's technique, around the mouth and/or at the base of each finger. The surgical procedures were repeated in each patient every 6 months for a total of two or three times. Clinical data were collected before the first surgery and again 6 months after each surgical procedure. Pain, skin thickness, saliva production and disability were assessed with validated tests.

Overall we performed 63 autologous fat grafting sessions (either on the mouth, on the hands or on both anatomical areas). Results at 6 moths after the last session included improvement of xerostomia evaluated with a sialogram, reduction of the skin tension around the mouth and, in the hands, reduction of the Raynaud phenomenon as well as skin thickness. Pain was reduced while the perception of disability improved. Digital ulcers healed completely in 8/9 patients.

Our results confirm the efficacy and safety of autologous fat grafting for the treatment of skin complications and digital ulcers due to systemic sclerosis. In addition, the patients' subjective well-being improved. Level of evidence V 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 .

Cephalic Malposition of the Lateral Crura and Parenthesis Deformity: A Cadaver Study in Caucasians.

Aesthetic Plastic Surgery

Improving the shape and contour of the nasal tip is a major goal in rhinoplasty. Extreme bulbosity and parenthesis deformity of the nasal tip are both frequently encountered. However, the underlying anatomical features that cause this kind of tip deformity are still not fully understood.

To evaluate the relation between the shape of the nasal tip and the anatomical position, orientation and shape of the lateral crura of the lower lateral cartilages and to estimate the incidence of cephalic malposition of lateral crura in Caucasian noses.

Nineteen Caucasian cadaver noses were studied, and the alar cartilages were measured and evaluated using a standardized method.

Fourteen of the total 38 lateral crura evaluated had cephalic malposition (long axis angle with the midline equal to or less than 30°). Of the nasal tips classified as having parenthesis deformity, 84.6% had cephalic malposition of lateral crura and 46.2% had convex lateral crura. Vertical orientation of the short axis of the lateral crura was no more common in noses with parenthesis deformity of the nasal tip than in other kinds of nasal tip.

The incidence of cephalic malposition of the lateral crura in this series of Caucasian noses was 36.8%. There was a statistically significant association between parenthesis deformity of the nasal tip and cephalic malposition of the lateral crura, as well as with convex shape of the lateral crura. No statistically significant association was found between the sagittal angle of the lateral crura and the type of nasal tip.

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 .

Evaluation of the Effect of Erector Spinae Plane Block in Patients Undergoing Belt Lipectomy Surgery.

Aesthetic Plastic Surgery

The interest in and demand for post-bariatric surgery have increased along with the increase in obesity surgery. Belt lipectomy, during which a circular correction is made in the center of the trunk, is the most commonly performed among these surgical techniques. Postoperative pain is an important problem due to the size of the surgical site and stretched closure. In this study, it was aimed to evaluate the intraoperative and postoperative narcotic analgesic consumption, postoperative analgesic requirement, postoperative visual analog scale (VAS) scores, postoperative nausea and vomiting (PONV), and the first mobilization time in patients with and without erector spinae plane block (ESPB).

The files of patients who had undergone belt lipectomy between 2016 and 2019 in our hospital were retrospectively reviewed. Patients who received ESPB were called group 1, and those who did not undergo ESPB were called group 2. Their demographic characteristics, intraoperative and postoperative narcotic and non-narcotic analgesic consumption, VAS scores, PONV, and the first mobilization times were recorded.

The files of a total of 51 patients, including 23 patients in group 1 and 28 patients in group 2, were reviewed. It was determined that intraoperative and postoperative narcotic analgesic consumption (p < 0.005), PONV (p < 0.005), and the first mobilization time (p < 0.005) were significantly lower in group 1 compared with group 2.

The use of the ESP block in belt lipectomy surgeries significantly reduces intraoperative and postoperative narcotic analgesic consumption and pain scores.

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 .

Breast Augmentation Surgery: How Do We Do It? Results of a Joint Survey from European Association of Societies of Aesthetic Plastic Surgery.

Aesthetic Plastic Surgery

The purpose of this study was to evaluate the current perceptions, preferences, and practice of plastic surgeons in Europe regarding breast implant surgery after the controversy on macrotextured implants and BIA-ALCL and the voluntary recall of all biocell implants.

A survey comprising 15 questions about implant selection and postoperative routines associated with breast augmentation was sent to all society members of the EASAPS.

Out of 1473 correspondents, 416 completed the survey with response rate being 28.2%. Countries with less than ten respondents were not included in the analysis. A total of 359 respondents (24.4%) were included in the analysis. Twenty-one respondents (5.8%) had a clinical experience < 5 years, 43 (12%) had 5-10 years' experience, and 295 (82.2%) had > 10 years' experience. Regarding the type of implant, only 6.1% would use a macrotextured implant. Fourteen per cent of surgeons would recommend to change a biocell implant in any case, even without symptoms or problems (rupture, seroma, and capsular contracture), 99.7% would send the capsule for histopathological study (99.7%), 98.9% would perform bilateral implant replacement in case of a unilateral problem of rupture, contracture, or seroma, and 80.8% of respondents considered capsulectomy as a technique for managing capsular contracture degree III/IV.

The main conclusion is the heterogenicity of answers and practice, due to the lack of guidelines and scientific evidence on breast implants. Although 22 (6.1%) respondents would use a macrotextured implant (either round or anatomic), 71.6% of respondents considered that there is not enough information for removing macrotextured implants from the market and that they should be allowed to be used unrestrictedly or under close surveillance of the regulatory agencies.

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 .

"Radix Pillow" Constructs with Fascial Extension for Radix Augmentation in Primary Rhinoplasty.

Aesthetic Plastic Surgery

Temporalis fascia and diced cartilage, in varying combinations, are currently commonly employed for augmentation of the radix in rhinoplasty. Altho...

Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis.

JAMA Surgery

The expansion of Medicaid sought to fill gaps in insurance coverage among low-income Americans. Although coverage has improved, little is known about the relationship between Medicaid expansion and breast cancer stage at diagnosis.

To review the association of Medicaid expansion with breast cancer stage at diagnosis and the disparities associated with insurance status, age, and race/ethnicity.

This cohort study used data from the National Cancer Database to characterize the relationship between breast cancer stage and race/ethnicity, age, and insurance status. Data from 2007 to 2016 were obtained, and breast cancer stage trends were assessed. Additionally, preexpansion years (2012-2013) were compared with postexpansion years (2015-2016) to assess Medicaid expansion in 2014. Data were analyzed from August 12, 2019, to January 19, 2020. The cohort included a total of 1 796 902 patients with primary breast cancer who had private insurance, Medicare, or Medicaid or were uninsured across 45 states.

Percent change of uninsured patients with breast cancer and stage at diagnosis, stratified by insurance status, race/ethnicity, age, and state.

This study included a total of 1 796 902 women. Between 2012 and 2016, 71 235 (4.0%) were uninsured or had Medicaid. Among all races/ethnicities, in expansion states, there was a reduction in uninsured patients from 22.6% (4771 of 21 127) to 13.5% (2999 of 22 150) (P < .001), and in nonexpansion states, there was a reduction from 36.5% (5431 of 14 870) to 35.6% (4663 of 13 088) (P = .12). Across all races, there was a reduction in advanced-stage disease from 21.8% (4603 of 21 127) to 19.3% (4280 of 22 150) (P < .001) in expansion states compared with 24.2% (3604 of 14 870) to 23.5% (3072 of 13 088) (P = .14) in nonexpansion states. In African American patients, incidence of advanced disease decreased from 24.6% (1017 of 4136) to 21.6% (920 of 4259) (P < .001) in expansion states and remained at approximately 27% (27.4% [1220 of 4453] to 27.5% [1078 of 3924]; P = .94) in nonexpansion states. Further analysis suggested that the improvement was associated with a reduction in stage 3 diagnoses.

In this cohort study, expansion of Medicaid was associated with a reduced number of uninsured patients and a reduced incidence of advanced-stage breast cancer. African American patients and patients younger than 50 years experienced particular benefit. These data suggest that increasing access to health care resources may alter the distribution of breast cancer stage at diagnosis.

Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic.

JAMA Surgery

Smoking quitline programs effectively promote smoking cessation in outpatient primary care settings.

To examine the factors associated with smoking quitline engagement and smoking cessation among patients undergoing thoracic surgery who consented to a quitline electronic referral.

A retrospective cohort study was conducted from January 1, 2014, to December 31, 2018, among 111 active smoking patients referred to the quitline from a thoracic surgery outpatient clinic visit. Patients were divided into operative and nonoperative cohorts.

Primary outcomes were engagement rates in the quitline program and successful smoking cessation. Secondary outcomes were self-reported point prevalence abstinence at 1 month and 6 months after the smoking quit date.

Of 111 patients (62 men; mean [SD] age, 61.8 [11.2] years) who had a quitline referral, 58 (52%) underwent surgery, and 32 of these 58 patients (55%) participated in the program. Of the 53 nonoperative patients (48%), 24 (45%) participated in the program. In the operative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (21 of 32 [66%] vs 16 of 6 [62%]; P = .79) or in point prevalence abstinence at 1 month (23 of 32 [72%] vs 14 of 25 [56%]; P = .27) or 6 months (14 of 28 [50%] vs 6 of 18 [33%]; P = .36). Similarly, in the nonoperative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (8 of 24 [33%] vs 11 of 29 [38%]; P = .78) or in point prevalence abstinence at 1 month (7 of 24 [29%] vs 8 of 27 [30%]; P = .99) or 6 months (6 of 23 [26%] vs 6 of 25 [24%]; P = .99). Regardless of quitline participation, operative patients had a 1.8-fold higher proportion of successful smoking cessation compared with nonoperative patients (37 of 58 [64%] vs 19 of 53 [36%]; P = .004) as well as a 2.2-fold higher proportion of 1-month point prevalence abstinence (37 of 57 [65%] vs 15 of 51 [29%]; P < .001) and a 1.8-fold higher proportion of 6-month point prevalence abstinence (20 of 45 [44%] vs 12 of 48 [25%]; P = .05). Having surgery doubled the odds of smoking cessation (odds ratio, 2.44; 95% CI, 1.06-5.64; P = .04) and quitline engagement tripled the odds of remaining smoke free at 6 months (odds ratio, 3.57; 95% CI, 1.03-12.38; P = .04).

Patients undergoing thoracic surgery were nearly twice as likely to quit smoking as those who did not have an operation, and smoking quitline participation further augmented point prevalence abstinence. Improved smoking cessation rates, even among nonoperative patients, were associated with appropriate outpatient counseling and intervention.

The Latest Evolution in Virtual Surgical Planning: Customized Reconstruction Plates in Free Fibula Flap Mandibular Reconstruction.

Plastic and Reconstructive Surgery

Virtual surgical planning (VSP) has contributed to technical advancements in free fibula flap mandible reconstruction. We present the largest comparative study on the latest modification of this technology: the use of patient-specific, preoperatively customized reconstruction plates for fixation.

A retrospective chart review was performed on all patients undergoing mandibular reconstruction with virtually planned free fibula flaps at a single institution between 2008 and 2018. Patient demographics, perioperative characteristics and postoperative outcomes were reviewed. Reconstructions utilizing traditional fixation methods were compared to those utilizing pre-fabricated, patient-specific reconstruction plates.

A total of 126 patients (mean age 48.5 ± 20.3 years; 61.1% male) underwent mandibular reconstruction with free fibula flap. Mean follow-up time was 23.5 months. A customized plate was used in 43.7% of cases. Reconstructions with patient-specific plates had significantly shorter total operative times compared to non-customized fixation methods (643.0 vs. 741.7 minutes, p=0.001). Hardware complications occurred in 11.1% of patients, with a trend towards a lower rate in the customized plate group (5.5% vs. 15.5%, p=0.091). Multivariate regression showed that the use of customized plates was a significant independent predictor of less overall complications (p=0.03), shorter operative time (p=0.014), and shorter length of stay (p=0.001).

Compared to traditional fixation methods, patient-specific plates are associated with less complications, shorter operative times, and reduced length of stay. The use of customized reconstruction plates increases efficiency and represents the latest technological innovation in mandibular reconstruction.

Long-term Outcomes of Spring-Assisted Surgery for Sagittal Craniosynostosis.

Plastic and Reconstructive Surgery

Spring-assisted surgery (SAS) is an accepted alternative to cranial vault remodeling (CVR) for treatment of sagittal craniosynostosis. The long-term safety and efficacy profiles of SAS have not been established.

This study is a retrospective exam of all patients treated with SAS (n=175) or CVR (n=50) for sagittal craniosynostosis at our institution from 2003-2017. Data collected includes demographic and operative parameters, pre- and post-operative cephalic indices, and complications. Whitaker grades were assigned blindly by a craniofacial surgeon not involved in patients' care.

The mean age at surgery was significantly lower for the SAS compared with CVR group (4.6 vs 22.2 months, p<0.001). Even when combining spring placement with spring removal operations, total surgical time (71.1 vs 173.5 min), blood loss (25.0 vs 111.2 mL) and hospital stays (41.5 vs 90.0 hrs.) were significantly lower for the SAS cohort vs the CVR group (p<0.001 for all). There were no differences in infection, re-operation rate, or headaches between the groups. The percent improvement in cephalic index (CI) was not significantly different at 1- (p=0.13), 2- (p=0.99), and 6- (p=0.86) years post-operatively. At 12 years post-operatively the SAS group had persistently improved CI (75.7 vs 70.7 pre-op). Those receiving SAS had significantly better Whitaker scores indicating lesser need for revisionary surgery, compared with the CVR group (p=0.006).

Compared with our CVR technique, SAS requires less OR time with less blood loss, but has equivalent long term cephalic indices and subjectively better shape outcomes.

"Advantages of a Fixation-Free Technique for Open Retromuscular Ventral Hernia Repair".

Plastic and Reconstructive Surgery

In open retromuscular ventral hernia repair (RVHR), fixation-free mesh placement is increasingly prevalent and may minimize pain; the main concern with adoption of this technique is short-term technical failure and hernia recurrence. This study compares outcomes following mechanical mesh fixation (i.e. sutures, staples, tacks) versus fixation-free mesh placement.

Adults who underwent open, elective, RVHR of ≤ 15 cm width with permanent synthetic mesh placement in a clean wound were identified in the Americas Hernia Society Quality Collaborative (AHSQC) database. Propensity score matching was used to compare patients who received mechanical mesh fixation to those who received fixation-free mesh placement. Thirty-day hernia recurrence was the primary outcome, with secondary outcomes of 30-day hospital length of stay (LOS) and 30-day rates of readmission, reoperation, wound events, pain, and abdominal wall function. Long-term outcomes of 1- and 2-year composite recurrence along with 3-year cumulative composite recurrence were also evaluated.

A 3:1 propensity score match was performed on 299 fixation-free patients identifying 897 mechanical fixation patients, with a mean BMI of 31 kg/m and mean age of 57.5 years. There was no difference in 30-day recurrence between mechanical fixation and fixation-free approaches (0.2% vs 0%; P = 1). Median LOS was longer for patients undergoing mechanical fixation (4 vs 3 days; P = 0.002). In the mechanical fixation group, pain scores were higher (worse pain; 46 vs 44; P = 0.001), and abdominal wall function scores were lower (worse function; 47 vs 60; P = 0.003), with no differences in rates of hospital readmission, reoperation, or wound events. There were no differences in long-term outcomes of 1- and 2-year composite recurrence, or 3-year cumulative composite recurrence.

With regards to short-term technical durability, fixation-free mesh placement in open RVHR is an acceptable alternative to mechanical fixation for hernia defects of ≤ 15 cm.

Facial asymmetry in Unilateral Condylar Hyperplasia: comparing treatment for active versus burnt out disease.

Plastic and Reconstructive Surgery

Facial asymmetry due to unilateral condylar hyperplasia (UCH) requires treatment to address facial and occlusal imbalances. There is no definitive evidence to suggest that a single intervention strategy (during either active condylar overgrowth or the burnt-out phase) results in better / more symmetric correction. This study sought to quantify pre- and post-operative facial asymmetry in UCH patients comparing treatment for active versus burnt out disease.

Pre- and post-operative three-dimensional (3D) photographs were obtained. Images were compared to unaffected controls as a standard for normal facial symmetry. Facial asymmetry was assessed using root mean squared deviation (RMSD). Paired student's t-tests were performed to compare the RMSDs of pre- and post-operative images between the UCH groups and against controls.

Forty patients were included (11 active, 9 burnt-out, and 20 controls) and 60 3D images were evaluated. Pre-operatively, patients in the burnt-out group had worse asymmetry than those with active UCH (p = 0.011). Both groups demonstrated significantly improved symmetry post-operatively (active; p = 0.0069 and burnt out; p = 1.74E-4). However, burnt out patients remained with some residual asymmetry (p = 4.75E-4), while their active counterparts showed no significant difference compared to unaffected controls (p = 0.089).

Patients with end-stage UCH have more severe facial asymmetry that is more difficult to normalize, compared to earlier intervention during active UCH. These findings suggest that, if possible, corrective intervention is preferable during active UCH.

Free Lateral Forearm Flap in Head and Neck Reconstruction: An Attractive Alternative to the Radial Forearm Flap.

Plastic and Reconstructive Surgery

The lateral forearm flap (LFF), a thin, fasciocutaneous flap harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery, is an attractive alternative to the radial forearm flap. We hypothesized that the LFF is a safe and effective flap for head and neck reconstruction.

We conducted a retrospective review of all LFF reconstructions performed between 2016 and 2018. Patient demographics, defect characteristics, adjuvant therapies, and post-operative complications were recorded. Swallowing and diet were assessed in patients undergoing intra-oral reconstruction. The DASH questionnaire was completed prospectively pre- and post-operatively. Flap and pedicle dimensions were recorded.

Twenty-five LFF reconstructions were performed; 23 were for intra-oral defects. There were no partial or complete flap losses, one venous thrombosis, and one hematoma requiring reoperation. Pre- and post-operative DASH scores were equivalent (p=0.78). In the intra-oral cohort, 22 patients (96%) resumed an oral diet following reconstruction. The average pedicle length was 11.8cm (range: 9-16 cm), skin paddle length and width were 6.6cm (range: 4-12cm) and 4.7cm (range: 4-12cm), respectively, arterial diameter was 1.5mm (range: 1.4-2.5mm), and venous diameter was 2.8mm (range: 2.4-3.6mm). All donor sites were closed primarily; one superficial dehiscence was reported.

Contrary to historical reports about the free LFF, we found that it provides an excellent alternative to the radial forearm flap in head and neck reconstruction. The LFF is a thin, pliable fasciocutaneous flap with excellent pedicle length, and the donor site can be closed primarily with minimal morbidity.