The latest medical research on Plastic Surgery

Direct-to-implant breast reconstruction is a popular procedure since breast volume can be acquired immediately. Various evaluations have been utilized to achieve symmetry. We measured the weight and volume of mastectomy specimens and calculated the relationship between breast density and ptosis degree.

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A statistically significant relationship was found between higher breast density and a greater degree of ptosis. The outcome showed a significant trend across Group 1, 2 and 3 (p<0.05). In postoperative analysis, the nipple level discrepancy was less than 10 mm as follows: 100% in Group 1, 89.8% in Group 2, and 70.9% in Group 3, showing a progressive decreasing trend from Group 1 to Group 3 (p<0.05).

Direct-to-implant breast reconstruction is an attractive technique, offering predictable outcomes based on adequate measurements. The relationship between breast density and the degree of ptosis is a significant indicator in making intraoperative decisions. Breast density is an adjunctive index for achieving patients' expectations of symmetrical breasts.

Brachial plexus birth injuries (BPBI) occur as a result of a difficult delivery. External rotation of shoulder (ER) is usually one of the last movements which may recover. There is no consensus about the predicting factors for spontaneous recovery or the optimal timing for surgical treatment of ER in BPBI patients. The aim of our retrospective study was to describe spontaneous recovery of active ER and evaluate predicting factors for the recovery.

We screened 562 patients and identified a consecutive cohort of 103 BPBI patients, who had no active ER at the age of 3 months. We systematically collected clinical data on recovery. In addition, we assessed whether early recovery of elbow flexion, shoulder abduction or Narakas grade at 1 month predicts ER recovery.

Fifty-two (51%) patients spontaneously recovered ER, 44% of whom were recovered by the age of 1 year, 83% by 1.5 years, 92% by 2 years and 98% by 3 years. A breakpoint in the slope of the curve showing proportion of recovered patients occurred at 2 years of age. Recovery of active ER was significantly associated with early elbow flexion and Narakas grade at 1 month, but not with early active shoulder abduction.

Most spontaneous recovery of ER in patients with BPBI occurs until 2 years of age, which thus can be considered a meaningful follow-up period for spontaneous recovery of ER. This information should be considered when making decision about peripheral nerve transfer surgery to improve ER in BPBI.

Mandibular distraction osteogenesis (MDO) and pre-epiglottic baton plates (PEBP) are both effective for early management of upper airway obstruction (UAO) in infants with Robin sequence (RS), but have not been directly compared. The purpose of this study was to compare early airway, feeding and growth outcomes between these treatments.

This is a bicentric retrospective cohort study from 2015-2021 including infants with RS treated with MDO or PEBP before 6 months-of-age with pre- and post-treatment sleep studies and follow-up at least through age 1-year. The primary outcome was immediate post-intervention UAO, measured as obstructive apnea-hypopnea index (oAHI) or obstructive apnea index (oAI), as available. Latest follow-up sleep studies, feeding and growth characteristics were also assessed.

114 subjects were included: MDO, n=31 and PEBP, n=83. Pre-treatment UAO was similar between groups (p=0.61). PEBP was initiated at a younger age (median [IQR] 31 [14,53] vs. 41 [28,84] days-of-life, p<0.05). Significant reduction of oAHI/oAI was achieved in both groups, but greater with MDO (98%) compared to PEBP (94%, p<0.05). PEBP demonstrated better early feeding and growth outcomes compared to MDO, with fewer surgical feeding tubes (p<0.001) and more rapid early growth (p=0.038). When stratified by pre-intervention UAO, infants starting with moderate UAO experienced similar airway outcomes with both treatments (p=0.11), while those with severe UAO had greater resolution with MDO (p<0.001).

Both treatments effectively relieve moderate UAO in infants with RS, but MDO is more effective for infants with severe respiratory compromise.

The risk/benefit ratio of operating on the cleft nasal deformity in the period of mixed dentition remains debated. This study characterizes our 18-year experience with intermediate cleft rhinoplasties to add data and nuance to the discussion.

We performed a retrospective cohort study of patients who underwent intermediate cleft rhinoplasty from 2006 to 2023. Demographic information and operative details were collected. Primary outcomes were operative complications and need for subsequent rhinoplasty.

Three-hundred and forty-two patients undergoing 372 intermediate rhinoplasties were included: 150 (40.3%) with no graft/implant, 165 (44.4%) with iliac crest cartilage graft, 36 (9.7%) with ear cartilage, 19 (5.1%) with a resorbable plate, and 3 (0.8%) with nasal cartilage. Use of iliac crest graft predicted fewer subsequent rhinoplasties independent of age at surgery, age at most recent follow-up, sex, race, syndromic status, cleft severity, intranasal stenting duration, and surgeon (β=-0.234, p=0.012). Employment of a V-Y chondromucosal flap in the unilateral cleft lip group (β=-0.401, p=0.002) and placement of a columellar strut graft in the bilateral cleft lip group (β=-0.450, p=0.028) predicted fewer subsequent rhinoplasties. The proportion of rhinoplasties utilizing iliac crest grafts increased over time (r(372)=0.806, p<0.001). Most (55.0%) patients with follow-up beyond age 18 (n=60) did not require subsequent rhinoplasty.

Iliac crest cartilage grafting as a columellar strut in bilateral clefts and a chondromucosal V-Y advancement in unilateral clefts were associated with a decreased need for future rhinoplasty. Further work is needed to understand the risk/benefit ratio, surgical burden, and patient-reported outcomes of intermediate rhinoplasty.

Despite previous studies on auricle morphology, research on its biomechanical properties remains limited. This study aims to assess age- and gender-related variations in auricle strength in living humans.

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The study included 226 ears from 52 women and 61 men, aged 2-85 years. Age significantly influenced most anthropometric measurements, with males generally exhibiting larger ears. Resistance values increased with age, particularly in age groups over 35 and 50. Gender did not significantly affect resistance values. Positive correlations were found between auricle dimensions and resistance values, indicating increased resistance with increased auricle projection.

This study provides a comprehensive mechanical resistance map of the auricle, demonstrating age-related changes in stiffness and regional variations in mechanical properties. These findings are valuable for refining surgical techniques, tissue engineering, and potentially for forensic applications. Further research on diverse populations and standardization of measurement protocols are recommended.