Anatomical considerations for thread-based brow lifting and wrinkle treatment

This review explores the anatomical considerations and technical aspects of thread lifting for the forehead and eyebrow, focusing on the relationships between vascular structures, muscular anatomy, and age-related changes in the forehead-eyebrow complex. It highlights the critical importance of understanding neurovascular pathways, particularly the supratrochlear and supraorbital vessels, as well as the appropriate thread placement techniques necessary for optimal outcomes. The review demonstrates that I-shaped threads, when placed beneath the frontalis muscle, provide a safer and equally effective alternative to traditional U-shaped designs. Additionally, the review emphasizes the significance of preoperative assessment, especially the evaluation of tissue mobility and adhesion patterns, in predicting procedural success. The review concludes that combining thread lifting with volumising monofilaments offers a comprehensive approach to rejuvenating the forehead-glabellar region, while minimizing the risk of complications. This study's clinical impact lies in its potential to enhance both the safety and efficacy of thread lifting procedures, offering practitioners a refined technique for esthetic rejuvenation of the forehead and eyebrow complex.

FK506 contributes to peripheral nerve regeneration by inhibiting neuroinflammatory responses and promoting neuron survival

JOURNAL/nrgr/04.03/01300535-202507000-00031/figure1/v/2024-09-09T124005Z/r/image-tiff FK506 (Tacrolimus) is a systemic immunosuppressant approved by the U.S. Food and Drug Administration. FK506 has been shown to promote peripheral nerve regeneration, however, its precise mechanism of action and its pathways remain unclear. In this study, we established a rat model of sciatic nerve injury and found that FK506 improved the morphology of the injured sciatic nerve, increased the numbers of motor and sensory neurons, reduced inflammatory responses, markedly improved the conduction function of the injured nerve, and promoted motor function recovery. These findings suggest that FK506 promotes peripheral nerve structure recovery and functional regeneration by reducing the intensity of inflammation after neuronal injury and increasing the number of surviving neurons.

Enhancing security in patient medical information exchange: A qualitative study

BACKGROUND

The digital transition has changed the practice of exchanging patient medical information between health professionals. Challenges include the involvement of multiple professionals with varying communication styles, the exponential growth of diverse data types, interoperability issues due to non-integrated tools, and heightened security risks stemming from the use of unsecured applications and personal devices. Here, we aimed to understand how to help health surgeons to better consider security during data exchange.

METHODS

We conducted a qualitative research with 20 interviews with surgeons working in wards of several French institutions. The verbatims were analyzed manually by two researchers using an iterative thematic approach, resulting in a framework to improve practitioners' security awareness.

RESULTS

Our findings emphasize the necessity of a multifaceted strategy, as a single secure application is not sufficient. Effective solutions require combining tailored digital tools with educational initiatives and institutional support. The proposed application must meet specific requirements; and simultaneously, hospitals must provide clear regulations, financial investment, and continuous support to reduce professional constraints.

CONCLUSION

This study underscores the need for a holistic approach, spanning education, institutional backing, and advanced technology, to enhance data security in healthcare. Future studies could extend our framework by considering other healthcare settings and patient perspectives.

Procedural Interventions for Hidradenitis Suppurativa

A variety of procedures may be employed for hidradenitis suppurativa, a chronic cutaneous condition that causes abscesses, nodules, and tunnels in skinfold areas. Intralesional steroid or incision and drainage are preferred for acutely inflamed discrete lesions, while deroofing or excision may be pursued for persistent or recurrent areas. Excision and deroofing may target individual lesions or complete regions that are more widely affected. Reconstructions may be considered after excisions based on operator and patient preference. Other procedures such as botulinum toxin injection, cryoinsufflation, and electrosurgical and laser-based modifications to deroofing and excisions have also been used successfully.

Cyanoacrylate glue as a novel skin substitute in periocular skin excisions: case series and literature review

OBJECTIVE

Despite the widespread use of cyanoacrylate glue (CA) as an alternative for wound closure, its potential as a sole skin substitute material in periocular skin surgery remains unexplored. The primary objective was to determine the viability of CA as a sole skin substitute in periocular skin surgery after excision.

DESIGN

Single-centre retrospective observational case series.

METHODS

All patients were treated at the McGill University Health Centre from August 2023 to November 2023, where CA served as the sole skin substitute material after periocular skin excision.

RESULTS

Three female and one male patient, with a mean age of 75 years, received treatment with CA after skin excision for both cancerous and benign skin lesions. Specifically, histopathology revealed 2 cases of basal cell carcinoma, 1 case of squamous cell carcinoma in situ, and 2 benign lesions. The skin defects after excision ranged from 4 × 3 mm to 15 × 30 mm. No complications were observed between CA graft insertion and final skin re-epithelization. Complete re-epithelization was achieved in all patients at final follow-up without evidence of excessive skin contraction.

CONCLUSIONS

This study presents a novel approach by using CA as a skin substitute material in periocular skin excisions. Its liquid form allows for easy application and conforms well to irregular wound surfaces. CA may offer economic advantages, including lower material cost and shorter surgical operating times, compared with traditional skin substitutes. Further research is needed to comprehensively evaluate CA's role as a skin substitute in periocular skin reconstruction.

Management of Forefoot Nonunions: A Brief Overview with Case Example

Forefoot nonunions present significant challenges in clinical practice due to their complex etiology and the essential role of the forefoot in weight-bearing and ambulation. Risk factors such as poor vascular supply, diabetes, smoking, poor nutritional status, non-compliance, and infection exacerbate the condition. Diagnosis primarily relies on clinical evaluation and imaging modalities. The effective management of forefoot nonunions requires a multifaceted approach that integrates accurate diagnosis, appropriate conservative or surgical treatment, and thorough postoperative care and long-term follow- up. Understanding the underlying causes and appropriately managing patient comorbidities can significantly enhance treatment outcomes and patients' quality of life.

Characterization of Fat Used for the Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty

Septorhinoplasty (SRP) is one of the most common aesthetic procedures worldwide. A thin or scarred soft tissue envelope, especially in the context of secondary SRP, can lead to unpredictable scarring, shrinkage, and discoloration of the skin. Other than the careful preparation of the soft tissue mantle, no gold standard exists to minimize the above-mentioned risks. Our aim was to create a thin "separation layer" between the nasal bridge (osseous and cartilaginous) and the skin envelope by autologous fat transfer with the addition of platelet-rich fibrin (PRF) to conceal small irregularities, to improve the quality of the skin soft tissue mantle, and to optimize the mobility of the skin. We report 21 patients who underwent SRP on a voluntary basis. All patients had either thin skin and/or revision SRP with scarring. Macroscopic fat harvested from the periumbilical or rib region was minced and purified. PRF was obtained by centrifugation of autologous whole blood samples and mixed with the fat to form a graft, which was then transferred to the nasal dorsum. Postoperative monitoring of graft survival included sonography and magnetic resonance imaging (MRI) of the nose. The harvested adipose tissue was also analyzed in vitro. In the postoperative follow-up after 1 year, survival of the adipose tissue was demonstrated in all patients by both sonography and MRI. The in vitro analysis showed interindividual differences in the quantity, size, and quality of the transplanted adipocytes. Camouflage of the nasal bridge by using adipose tissue was beneficial for the quality of the skin soft tissue mantle and hence represents a good alternative to known methods. Future aims include the ability to assess the quality of adipose tissue to be transplanted based on clinical parameters. Level of evidence: N/A.

Glomus tumor of the patellar tendon: a case report and review of the literature

BACKGROUND

A rare finding, the glomus tumor is made up of cells that resemble modified smooth muscle cells. It usually arises in the deep dermis of the palms and the wrists. However, it can still appear in atypical places such as the knee presenting with atypical symptoms.

CASE REPORT

This case report is about a 43-year-old previously healthy Middle Eastern male with a glomus tumor of the distal portion of the patellar tendon presenting as continuous dull pain of the right knee for the previous 2 years.

CONCLUSION

Glomus tumor, a mostly benign lesion usually found in subungual area in the hand, can be found in the knee as well. It can be diagnosed with magnetic resonance imaging, appearing bright on T2-weighted images with diffuse enhancement following gadolinium injection and as a well-defined dark lesion on T1-weighted images. Histological examination remains the only confirmatory diagnosis, showing sheets and clusters of homogeneous glomus cells encircling arteries.

Extended Reality Technologies for Visualization in DIEP Flap Breast Reconstruction: A Systematic Review

BackgroundDeep inferior epigastric artery perforator (DIEP) flap breast reconstruction is the gold standard for autologous breast reconstruction but is complex due to variable vascular anatomy. Traditional imaging modalities like computed tomography angiography (CTA) provide two-dimensional visualization, which can limit spatial understanding. Extended reality (XR) technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) offer immersive three-dimensional visualization that may enhance surgical planning and intraoperative guidance. This systematic review synthesizes current evidence regarding XR applications in DIEP flap breast reconstruction.MethodsA systematic review was conducted following PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched for original research articles reporting clinical use of XR technologies in DIEP flap breast reconstruction. Data on study characteristics, XR technologies used, outcomes, and key findings were extracted and analyzed.ResultsThirteen studies involving 265 patients met inclusion criteria. Seven studies utilized AR, six used VR, and none focused on MR. XR technologies were associated with improved accuracy in perforator identification, reduced operating times, and enhanced surgical planning. Identified limitations included soft tissue deformation affecting intraoperative application, ergonomic issues with headsets, and technological constraints such as processing power and network.ConclusionXR technologies show significant potential in improving preoperative planning and intraoperative guidance in DIEP flap breast reconstruction. While preliminary results are promising, further large-scale studies are needed to establish efficacy, address limitations, and facilitate integration into clinical practice.

[Reconstruction of breast burn sequelae in young girls through tissue expansion starting in the prepubertal phase]

INTRODUCTION

Burns on the thorax are common in children. When these burns are deep and extensive in girls, they pose a risk of aesthetic and functional sequelae due to impaired breast growth. The management of these sequelae can be initiated as early as the prepubertal phase, with an initial stage involving the replacement of the scarred skin with healthy skin by using tissue expansion.

METHODS

We present our protocol for skin resurfacing of the breast areas through tissue expansion initiated in the prepubertal stage. We describe the indications (related to the patient, related to their burn, and other associated burns). We detail the preoperative planning and the operative technique, including the placement of expanders and the type of flap used. We illustrate this with clinical cases.

RESULTS

Between January 2018 and December 2023, six patients were followed in a multidisciplinary consultation for thoracic burn sequelae. Their initial burn occurred at an average age of 4.6 years, with the affected body surface ranging from 15 to 31%. All underwent early skin grafting. The sequelae affected at least two quadrants, involving both breasts in all cases. Treatment with tissue expansion began at an average age of 8.6 years, with one to three protocols per patient. A total of 24 expansion implants were placed, sometimes combined with other reconstructive surgeries. These were primarily placed in the supramammary region to position scars in the inframammary folds, and advancement flaps were used whenever possible to reduce scarred skin surface. Complications included prostheses protrusion without exposition, skin necrosis, and limited surgical revisions. All patients were able to complete their treatment without major therapeutic failure.

CONCLUSION

Skin resurfacing of burned breast areas through tissue expansion before breast development offers many advantages. It allows either the natural growth of an undamaged gland or the gradual reconstruction of breast volume during puberty. This therapeutic strategy, when used under appropriate indications, helps to reduce the early aesthetic and psychological impact of breast burn sequelae in young girls.

Management of hypertensive leg ulcers: A French national survey

BACKGROUND

Hypertensive leg ulcers (HLUs) are superficial, rapidly spreading, necrotic ulcers that are frequently resistant to standard local wound care. The available literature on HLU management is relatively poor. This survey-based study aimed to evaluate the management of HLUs in France.

METHODS

A questionnaire was sent in December 2019 to all members of the Angiodermatology Group of the French Society of Dermatology. The questionnaire collected information about physicians and their department, and about their management of HLUs, including examinations and specific and non-specific topical and systemic treatments.

RESULTS

Forty-four physicians responded. The most frequently performed examinations were lower-limb arterial Doppler (88.6%), ankle-brachial pressure index tests (83.7%) and venous Doppler (60.5%). Blood sampling for autoimmunity testing was requested by 27.3% of physicians and skin biopsy by 20.5%. The most frequently used first-line therapy was skin grafting (97.7%). Other treatments included topical steroids (58.1%), negative-pressure therapy (15.9%), electrostimulation (15.9%), auto-haemotherapy (14.0%), and iloprost (11.4%). The mechanism of action of electrostimulation is not very clear. Its main benefit lies in controlling the pain of HLU. Iloprost appears to be an interesting vasodilator although it has not been validated to date. An additional antiplatelet agent was proposed by 19.0% of the physicians and modification of anticoagulant treatment (use of a vitamin K antagonist in addition to direct oral anticoagulants) was proposed by 19.5% of physicians.

DISCUSSION

The survey results showed that HLU evaluation involved searching for associated peripheral arterial disease and that HLU management in France was disparate. Skin grafting was the sole consensual treatment and was generally used as a first-line option. Other treatments require further evaluation. Management disparities could be reduced by the drafting and publication of a consensus guideline to harmonise HLU management.

Intraoperative Predictors of Salvage in Infected Breast Implants: A Retrospective Study

BACKGROUND

Infectious complications associated with implant-based breast reconstruction (IBBR) can be devastating and may lead to reconstructive failure. Although there are known demographic risk factors for reconstructive failure, few studies have identified intraoperative findings that predict failure after attempted salvage.

OBJECTIVES

The objective of this study was to identify intraoperative findings in infected breasts that might be predictive of implant failure.

METHODS

In total, 837 patients undergoing IBBR between January 2017 and July 2023 were included. Intraoperative records of patients who developed a major infection were reviewed. Reconstructive salvage denoted any intervention not resulting in explantation. Failure denoted explantation.

RESULTS

Of 837 patients, 8% developed a major infection (n = 71). Within this group, 8% had successful treatment with intravenous antibiotics alone, 38% were salvaged after operative intervention, 28.2% failed without salvage attempt, and 25.4% underwent salvage attempt but ultimately failed. Overall, the rate of reconstructive failure was 53.5% and the rate of implant salvage was 46.5%. A total of 51% of patients returning to operating room were found to have unincorporated acellular dermal matrix (ADM). Seventy-eight percent of patients undergoing intervention had a positive culture, most commonly methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Serratia, Enterobacter, Pseudomonas or Proteus. Unincorporated ADM was significantly associated with reconstructive failure (odds ratio 5.4, P = .003). Serratia infection, hematoma, and gram-negative infection were associated with implant failure, but these findings did not achieve statistical significance.

CONCLUSIONS

Presence of unincorporated ADM was associated with eventual implant failure. Surgeons should be aware that this finding may portend poor outcomes for patients. These results may be helpful to intraoperative decision-making.

LEVEL OF EVIDENCE: 4 (THERAPEUTIC)

Risk factors for complications of tissue expansion: An updated systematic review and meta-analysis

BACKGROUND

This study aimed to summarize risk factors for complications of tissue expansion using a meta-analysis of cohort studies.

METHODS

PubMed, Embase, and Cochrane Library were searched from January 1985 to January 2025 for retrospective cohort studies investigating at least one potential risk factor for complications of tissue expansion. The quality of individual studies was assessed using the Newcastle-Ottawa scale. We conducted meta-analysis with risk ratios calculated for complication event rates.

RESULTS

This review included 19 studies involving 1,673 participants. Two distinct subgroups (children only, adults and children) were identified. Strong evidence indicated that lower limb (relative ratio, 1.73; 95% confidence interval, 1.27-2.37), burn (relative ratio, 1.45, 95% confidence interval, 1.07-1.95), and myelomeningocele (relative ratio, 1.82; 95% confidence interval, 1.22-2.70) were the risk factors for premature removal of expansion in both children and adults.

CONCLUSION

This review identified lower limb, burn, and myelomeningocele are risk factors for complications of tissue expansion. Identifying modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.

Dual-energy CT angiography-Guided vascularised free thoracodorsal artery lateral branch chimeric flaps for complex maxillofacial defect repair: An anatomical and clinical study

A modified thoracodorsal artery lateral branch (TDAL) chimeric flap was developed using dual-energy computed tomography (CT) angiography data of perforators to explore the anatomical characteristics and postoperative outcomes of TDAL flaps in complex maxillofacial defect repair. TDAL flaps were harvested from patients with locally advanced oral cancer. Preoperative perforator detection was performed with dual-energy CT angiography. Anatomical data were collected, and patients' perioperative recovery details and complications were recorded. Upper extremity function and quality of life (QoL) data were compared to control data from a paired anterolateral thigh (ALT) flap group. Seventy-six patients survived without major complications. The length of the vascular pedicle was 8.97 ± 1.34 cm, and the diameter of the supplying artery was 1.60 ± 0.48 mm. In the first 3 months postoperatively, the TDAL group showed improved QoL. However, upper extremity function and QoL did not differ significantly between the TDAL and ALT groups at 6, 9, and 12 months postoperatively. A two-dimensional map of the perforation distribution was drawn based on the statistical distribution of perforations. TDAL can be designed as a long spindle-shaped or multi-leaf chimeric flap based on the perforator distribution map. This flap can be used as an alternative to repair large oral and maxillofacial defects.

Silicone particles in breast implant capsules: A retrospective single-center study evaluating silicone bleeding

INTRODUCTION

Breast implants consist of a silicone elastomer shell filled with either silicone gel or saline solution. As per the Food and Drug Administration (FDA), breast implants offer safety and efficacy but pose short and long-term risks, including capsular contractures, silicone leakage, and discoveries of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant Illness (BII).

OBJECTIVE

This study aims to estimate the amount of silicone particles that leak from breast implants and deposit in the peri-prosthetic capsules of implants used in Belgium and investigate the various factors that may affect the magnitude of silicone leakage.

MATERIALS AND METHODS

From a monocentric registry from the plastic and reconstructive surgery department of University Hospital Brugmann, thirty-nine capsules' slides were analyzed retrospectively using NDPView2 software. Silicone particles were counted and measured based on their largest diameter. The capsule surface area and its thickness were measured to calculate particle's density and total number of particles in each capsule.

RESULTS

Silicone particles were detected in 32 (82%) out of 39 capsules, with significant higher densities observed in silicone implants compared to saline implants (P=0.027). Overall average density was 66 particle/mm3. The density of silicone particles increased significantly with prolonged implantation duration (P<0.001). Particle's density tended to differ between different implants' textures and brands.

CONCLUSION

Silicone particles were found in capsules of both saline and silicone implants. Silicone generates primarily from the silicone gel. Implants texture, brand, and duration of implantation are factors that influence silicone bleeding. Addressing silicone leakage is crucial for enhancing implant safety and patient well-being.

Outcomes of temporalis muscle-based facial reanimation surgery: A systematic review and meta-analysis

Background

Despite the encouraging findings of temporalis muscle-based facial reanimation surgery without the need for nerve grafting, there is a need for comprehensive evaluation of the impact of temporalis-based facial reanimation surgery on key outcome measures.

Methods

Comprehensive search in Medline and Embase databases were carried out up to 25 February 2023. The articles that examined facial reanimation surgery using the temporalis muscle were included in this study. Postoperative changes in smile excursion and the angle of the mouth while smiling were pooled using the DerSimonian and Laird random-effects model. Narrative synthesis was conducted for other outcomes including assessments of spontaneous smile, subjective evaluation of facial symmetry using validated rating tools, functional outcomes, aesthetic outcomes and patient-reported outcomes owing to heterogeneity in reporting of the outcomes.

Results

Twenty-four studies were included in the analysis. Conflicting evidence was demonstrated regarding emotional smile outcomes and its definition. The pooled changes in smile excursion postsurgery were 7.06 mm (95% CI: 3.73-10.40, P < 0.001; I2 = 0%) and the angle of the mouth were 11.76° (95% CI: 8.80-14.71, P < 0.001; I2 = 0%). Significant improvement was reported across the validated rating scales of symmetry, functional outcomes, aesthetic outcomes and patient-reported outcomes whereas the superiority compared to other procedures remained inconclusive.

Conclusion

Overall, temporalis-based facial reanimation surgery is a promising option for addressing the negative effects of facial nerve paralysis on the patients' quality of life. This study highlights the uncertainty surrounding the technique and need for further studies.

[Prophylactic breast surgery: The role of DIEP (Deep Inferior Epigastric)]

In France, breast cancer is the most common cancer among women, with 5 to 10% of cases being genetic. Frequently involved genes include BRCA1 and BRCA2, PALB2, TP53, CDH1, and PTEN, among others. Approximately, two in 1000 women carry a BRCA1 or BRCA2 gene mutation. The National Cancer Institute (INCa) provides guidelines for screening and risk-reduction treatments. Prophylactic surgery, including bilateral mastectomy, is a preventive option for high-risk women. Immediate breast reconstruction (IBR), particularly using the DIEP flap technique, helps mitigate the psychological impact of mastectomy, and is part of the gold standard to be offered to patients. This technique uses excess of skin and fat from the lower abdomen and requires micro-surgical skills. Despite logistical challenges, this method is favored for its durability and natural outcome. INCa and other organizations are working to improve access and information for these treatments.

Novel digital measurement system for predicting surgical outcomes in patients with primary non-syndromic craniosynostosis

Objective

With the aim of further optimizing the care of patients with primary non-syndromic craniosynostosis, we describe a novel and clinically feasible measurement method to predict postoperative outcomes and provide an analysis of quality of life.

Design

76 patients with primary non-syndromic craniosynostosis were treated by one surgeon. 47 healthy patients without craniosynostosis formed the control group. All patients had an age between 3 months and 18 years.Based on manual measurement using callipers, x-ray-imaging and 3-D-photographs of the head, various detailed symmetry and aesthetic indices were collected using a novel digital measurement tool that was integrated into a clinically established programme. These are compared with a healthy control group without craniosynostosis. In addition, perioperative data, a clinical visual assessment of the scars and quality of life were evaluated using a standardised questionnaire.

Results

Individual values show statistically significant deviations from the control group preoperatively and immediately postoperatively, which are typical for the respective form of craniosynostosis. Overall, there were good results in terms of symmetry, aesthetics and satisfaction. Interestingly, the quality of life of operated patients tended to be rated better overall than in the control group.

Conclusion

The detailed measurement technique presented is easy to use and enables an individual, efficient and internationally comparable assessment of the pre- and postoperative findings of patients with primary non-syndromic craniosynostosis. The additional survey of quality of life provides a valuable contribution to the analysis of affected patients.

Sensory preservation in reduction mammoplasty using the nipple-areola complex-carrying pedicle technique for gigantomastia: A systematic review and meta-analysis

Background

Gigantomastia is a disabling condition characterized by excess breast tissue. Historically, free nipple graft (FNG) has been preferred, prioritizing the nipple-areola complex (NAC) vascularity. The NAC-carrying pedicle technique, which is most commonly used in case of hypertrophy of the breast, has been suggested as a viable alternative for gigantomastia according to recent evidence, with reduced rates of NAC necrosis and improved outcomes. Nevertheless, a detailed outcome evaluation of the technique in terms of sensory preservation is currently lacking. Therefore, this systematic review and meta-analysis aimed to assess the risk of sensory loss associated with the NAC-carrying pedicle technique in cases of gigantomastia.

Methods

Following the PRISMA guidelines, a literature search identified studies reporting postoperative sensitivity with the NAC-carrying pedicle technique in resections exceeding 1000 g of adipo-glandular tissue. Then, a proportion meta-analysis was conducted to assess the pooled rate of sensation loss through the NAC-carrying pedicle technique.

Results

Seventeen studies (843 patients, 1685 breasts) met the inclusion criteria. The meta-analysis revealed an exceptionally low risk of sensory loss with the NAC-carrying pedicle technique (1.3%; 95% confidence interval: 0.7-2.0), without significant statistical heterogeneity.

Conclusion

This study provides the first comprehensive evaluation of sensory preservation with the NAC-carrying pedicle technique in gigantomastia. The NAC-carrying pedicle technique emerges as the first choice, offering safety and favorable functional outcomes. Surgical caution remains crucial with the option to switch to FNG as required, ensuring patient safety and procedure success. Further research on the impact of different NAC-carrying pedicle techniques on sensory preservation is warranted.

[Vascularized composite allografts in France: An update]

Vascularized composite allografts (VCA) encompass the face, upper limb, trachea, penis, abdominal wall, and, more recently, uterus transplants. They offer unique reconstructive possibilities to overcome the limitations of traditional reconstructive techniques. Unlike solid organ transplants (heart, liver, kidney, lung, etc.), VCA is not generally performed in a life-threatening situation but aims to improve quality of life, at the cost of a major constraint to its expansion: the need for lifelong immunosuppressive treatment. Nevertheless, VCA is considered one of the five most important innovations of the modern era of the discipline, and a worldwide survey of plastic surgeons has confirmed that significant changes in reconstructive surgery will be related to VCA in the future. France pioneered this type of transplantation by successfully performing the first VCA (unilateral hand transplant), the first double hand transplant, the first face transplant, the first face retransplant, and the first bilateral shoulder and arm transplant, and continues to demonstrate unprecedented surgical prowess. This activity continues to expand across the country, with active VCA programs notably in the upper limb, face, uterus and penis. This article aims to provide an update on the clinical advances made in France in the field of composite tissue allografts.

Identifying key genes, miRNAs, and pathways in keloid formation: A bioinformatics and experimental study

Keloids represent a challenging clinical problem because of their unpredictable and often refractory nature to treatment. This study aimed to identify the key changes in gene expression in the formation of keloid and provide potential biomarker candidates for clinical treatment and drug target discovery. Keloids and normal skin samples were analyzed for gene expression, and datasets from the Gene Expression Omnibus database were also analyzed. Differentially expressed genes (DEGs) were identified and analyzed using bioinformatics techniques, including gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses. A protein-protein interaction network of the DEGs was created using the Search Tool for the Retrieval of Interacting Genes database. The gene set enrichment analysis was performed on keloid and normal skin tissue from clinical samples. The enriched functions and pathways identified included collagen-containing extracellular matrix (ECM), ECM, and external encapsulating structure. Ten hub genes were identified, along with one differentially expressed microRNA, miR-22-5p. miRNA target gene prediction was performed using miRPathDB 2.0 and Targetscan database. Among the hub genes, RUNX2, IGF1, EGF, and PPARGC1A were predicted targets of miR-22-5p. Validation at the tissue level highlighted RUNX2 as a crucial DEG in keloid tissue. These findings shed light on the molecular mechanisms of keloid formation and offer candidate therapeutic targets, suggesting that modulation of the miR-22-5p/RUNX2 axis may be a promising avenue for keloid diagnosis and treatment, thus laying a foundation for improved clinical management of keloid disorders.

Treatment of skin lesions related to pseudoxanthoma elasticum in plastic surgery

BACKGROUND

Pseudoxanthoma elasticum (PXE) is a hereditary disorder of connective tissue characterized by progressive calcification and fragmentation of elastic fibers, which primarily affects the skin, retinal and arterial walls. Skin damage takes the form of yellow papules that can merge to create a cutaneous fold. This is accompanied by an excess of skin on the different sides of the neck and in the largest folds. These changes to the skin have a significant aesthetic, functional and psychological impact, especially among women.

PATIENTS AND METHODS

We evaluated the treatment options in all patients with PXE of our University-Hospital. This group contains people who have been hospitalized for the assessment of their disease and applicants for surgical correction. The goal of the surgery was not the total removal of the lesions but instead a decrease in their size and a tightening of the skin.

RESULTS

In total, 250 patients were seen between 2007 and 2022. Surgical treatment was advised for 29 women and 1 man. The main interventions were based on standard techniques such as cervico-facial facelifts, brachioplasties and cruroplasties. The results obtained during postoperative follow-up consultations were rated satisfactory to very good, both aesthetically and functionally. There were no postoperative complications recorded: neither bruising nor scarring issues. Patients with PXE heal as normal.

CONCLUSION

Surgical treatment for excess skin observed during PXE is poorly described. Yet, these excesses can be removed when they become troublesome by making use of and adapting the traditional methods of plastic surgery for tightening of the skin.

Breast sensibility after reconstruction: Comparison of different methods

BACKGROUND AND OBJECTIVES

Sensibility of the breast area is a key factor in quality-of-life evaluation after breast reconstruction (BR). Breast sensation can be assessed using numerous tools that are already largely described in the literature, including the Semmes Weinstein filaments which remain the most frequently used. Although different reconstruction techniques are available, post-BR sensitivity is rarely described. The aim of this study was to evaluate post-BR sensibility of the breast according to each reconstruction technique.

MATERIAL AND METHODS

Fifteen patients were included in each group, i.e. 90 patients in total: before BR, Latissimus Dorsi (LD) flap with implant, LD flap with fat grafting, exclusive fat grafting, Deep Inferior Epigastric Perforator (DIEP) flap, implant. A single evaluator assessed the sensibility with Semmes Weinstein filaments testing 7 zones on both sides. The native breast was considered as control. Various potential confounding factors were collected.

RESULTS

Patients who benefited from BR with fat grafting alone had a significantly better sensation of the reconstructed breast compared to the other groups (DIEP flap (P<0.0001), LD flap+implant (P=0.0013), LD flap with fat grafting (P=0.0073), implant (P=0.00315)). Comparing those results to the ones obtained in the group before reconstruction, only the fat grafting and DIEP flap groups showed a difference, the fat grafting group (P=0.0061) had higher sensibility whereas DIEP flaps were less sensitive (P=0.00233).

CONCLUSION

We compared mammary sensibility depending on the BR technique used. Our study is the first comparing breast sensitivity among all major breast reconstruction methods. Fat grafting resulted in better breast sensitivity in delayed breast reconstruction than implant or flap-based BR.

Comparison of the Outcomes of Perforator-Based Adipofascial Flaps and Local Muscle Flaps in Distal Lower Extremity Reconstruction: A Retrospective Study

INTRODUCTION

Soft tissue reconstruction in the distal lower extremities is challenging because of the inherent vulnerability of tendons, bones, and implants to being easily exposed, and scanty local tissue makes it more complicated. Local flaps that avoid the donor-site morbidity and the need of microsurgery gain popularity among the treatment choices. This study aims to compare the outcomes of 2 common local flaps: adipofascial flaps and muscle flaps in distal lower leg reconstruction.

MATERIALS AND METHODS

From November 2019 to November 2023, the patients with distal lower leg defects undergoing perforator-based adipofascial flaps or muscle flaps were included and reviewed. The patient demographics, injury characteristics, outcomes, and complications were evaluated.

RESULTS

A total of 32 patients were included in the study of which, 17 received perforator-based adipofascial flaps, and 15 received muscle flaps. The backgrounds of the 2 groups were similar, except that the patients in the adipofascial flap group were older and had more comorbidities. All flaps survived except for one muscle flap that failed. The flap survival, infection rates, and donor-site complications were comparable in both groups; however, the adipofascial flap group had less daily drainage volume and seemed to have a shorter hospital stay, although the difference was not significant (8.06 ± 3.33 days vs 11.93 ± 7.63 days, P = 0.085).

CONCLUSIONS

For distal lower leg reconstruction, the adipofascial flaps are comparable to the muscle flaps but avoid the functional impairment. If available, the adipofascial flap can be considered as a prior treatment option, even for patients with implant exposure.

The Initial Exploration of Polidocanol Sclerotherapy for the Treatment of Axillary Osmidrosis: A Retrospective Study

BACKGROUND

Axillary osmidrosis (AO) is a strong, unpleasant odor that originates from the apocrine axillary glands. Treatments of AO include surgical treatment and nonsurgical treatment. The surgical procedure yields effective results with a low recurrence rate but requires a longer recovery time and has more postoperative complications. Nonsurgical treatments are minimally invasive and safe, but short-term recurrence may occur in some cases.

OBJECTIVE

Polidocanol sclerotherapy was first described for management of AO. This retrospective study explored the clinical efficacy in relieving symptom of AO assessed by AO severity using the axillary osmidrosis grading system and safety of polidocanol sclerotherapy in treating AO.

PATIENTS AND METHODS

This retrospective study included 25 patients with AO single-site study, with 12 patients receiving polidocanol (1%) sclerotherapy (the polidocanol group) and 13 receiving botulinum toxin A (BTX-A) injection (the BTX-A group). The short-term efficacy (7 days after injection), the long-term efficacy (6 months after injection), the recurrence rate, and complications were compared between the 2 groups. A p-value of <0.05 was considered statistically significant.

RESULTS

The short-term efficacies of polidocanol sclerotherapy and BTX-A injection were 100% and 69.2%, which was not clinically significant (p > .05), whereas their long-term efficacies were 100% and 46.2%, respectively (p < .05). The recurrence rates in the polidocanol and BTX-A groups were 25.0% and 84.6%, respectively (p < .05). The complications did not differ significantly between the 2 groups (p > .05). Although the short-term efficacy and complications were comparable between the 2 groups, the long-term efficacy of polidocanol sclerotherapy was superior to BTX-A injection. The polidocanol group has a lower recurrence rate than the BTX-A group.

CONCLUSION

Polidocanol sclerotherapy may provide an effective and safe treatment with longer efficacy compared to toxin, which is an effective and safe option for AO treatment.

A systematic review of sustainability practices in plastic surgery

AIM

There is an urgent need to mitigate the environmental impact of surgery, with surgery representing a major contributor to carbon emissions. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used to facilitate the attainment of net zero targets.

METHODOLOGY

Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search was performed using MEDLINE, EMBASE and Cochrane Library databases (PROSPERO registration number CRD42023446104). Studies pertaining to sustainability practices in plastic surgery were included.

RESULTS

An initial search yielded 1083 studies, of which 15 met inclusion criteria. The studies were analysed for data on waste, carbon footprint and cost reduction. Hand surgery was the leading subspecialty with initiatives to tackle waste, such as using procedure-specific surgical packs of the Wide-Awake Local Anaesthesia No Tourniquet technique, while also considering surgeons' preferences. Other initiatives were implemented in craniofacial, skin cancer and breast surgery. Successful recycling initiatives were reported with a monthly average of 39.6 tonnes of waste redirected to be recycled per month. Five studies, from skin and hand surgery, demonstrated a simultaneous benefit through reduction in cost by individualising sustainability practices for specific procedures. The average carbon footprint per procedure, of the included studies reporting emissions, was 22.7 kgCO2-eq.

CONCLUSION

This systematic review demonstrated the necessity of an agile approach towards implementing sustainability practices, tailoring sustainability strategies to the requirements of each surgical procedure. The development of standardised outcome sets to evaluate the best practices in sustainability was emphasised.

Left nasal reconstruction using a concha cartilage for loss of substance post human bite: A case report

INTRODUCTION AND IMPORTANCE

Conchal cartilage is recommended for correction of substance loss of the nose. Transfixing nose substance loss presents an anatomical, functional, and aesthetic restoration challenge. The rate of complications associated with concha cartilage harvesting using a retroauricular approach is low.

CASE PRESENTATION

A 24-year-old presented with nose damage and loss of transfixing substance after being intentionally assaulted and injured (human bite during a fight). He underwent a nose wing reconstruction using a composite transplant from the auricular cartilage. Post-operative recovery was uneventful. Nonetheless, a minor disparity existed between the flap and the natural nasal wing.

CLINICAL DISCUSSION

The three-dimensional anatomy of the nasal wing makes the aesthetic reconstruction of the transfixing loss of substance of the entire unit very difficult to achieve, especially when the reconstructed wing will be constantly confronted and compared to the contralateral wing. Concha cartilage is recommended for correction of cleft nasal deformities of trauma. Morbidities at the donor site have been reported in aesthetic rhinoplasty cases.

CONCLUSION

The composite nose graft, which consists of a cartilaginous graft and a nasolabial flap, is still a straightforward option for reconstructing the nose wing in a remote location. Nasal reconstruction using a concha cartilage, restore the anatomically deficient structures with satisfactory aesthetic and easy to shape. The conchal cartilage is minimally invasive when harvesting, repair for large defect and conforms naturally to the curvature of the nasal wing.

Interdomal ligament of the nose: Clarifying the anatomy through a cadaveric study

BACKGROUND

Over the years, the anatomical description of the nasal ligaments has been revisited several times. Although several authors have studied the structures supporting the nasal tip, there is a lack of literature that consistently describes the anatomy of the interdomal ligament. This study analyzed the anatomical variations of the interdomal ligament by describing the possible shapes and dimensions and confirming its ligamentous nature histologically.

METHODS

Twenty-five fresh cadaver noses of Caucasian descent, without signs of previous nasal surgery were dissected using an open approach. The interdomal ligament was identified, isolated, measured, and sent for histological examination. The statistical analysis was conducted using Prism9.

RESULTS

The average area of the interdomal ligaments of the whole cohort was 0.39±0.22 cm2. The mean ligament depth was 0.16±0.05 cm, and the mean interdomal distance was 1.38±0.32 cm. Overall, 58.3% of the ligaments showed a fusiform shape and the rest showed a trapezoidal shape. A correlation between the interdomal distance and length of the ligament was demonstrated with r=[0.7536]. The histological analysis of the interdomal ligament displayed a "fibrous-connective nature of the structure compatible with a ligament."

CONCLUSIONS

This study confirmed the ligamentous nature of the interdomal ligament and demonstrated its consistent presence in 24 cadavers, with the depth from the dome ranging from 0.10 to 0.24 cm. The data demonstrated that this ligament may have a fusiform or trapezoidal shape with a mean area of 0.39±0.22 cm2. Furthermore, a correlation exists between the major base of the ligament and the interdomal distance, with a ratio of 1.633.

Hidradenitis Suppurativa Surgery Complication Rates Among Patients With Obesity or Diabetes or Who Smoke: A Review

Importance

Surgery is frequently required for hidradenitis suppurativa (HS) treatment, but the impact of common comorbidities such as obesity, diabetes, and smoking on outcomes has been sparsely studied.

Observations

A total of 12 studies met final inclusion criteria for investigating complication rates associated with at least 1 comorbidity. Complication rates were associated with obesity in 3 of 10 studies. Obesity was modestly associated with dehiscence and readmission for flap reconstruction, debridement, and skin-grafting techniques in one study, dehiscence in a second, and delayed wound healing in another. One of 5 studies that reported complication rates in patients with diabetes found increased hospital readmissions for debridement (deroofing or excision without flap/graft) and flap reconstruction. No studies evaluating smoking found increased associated risks.

Conclusions and Relevance

This review highlights a greater need for consistent analysis and reporting of the surgical outcomes among patients with HS and certain comorbidities. Further rigorous clinical trials are needed to validate these findings and improve access to surgery in this patient population.

Periumbilical Fascioplasty Improves Postabdominoplasty Umbilical Perfusion: An Approach to Reducing Umbilical Necrosis

Abdominoplasty represents one of the most recognized operations performed by plastic surgeons. Despite its long history and ubiquity, the procedure retains a largely individualistic component, affected by a surgeon's artistry as much as by known clinical approaches. Consequently, complication incidence reporting has been variable, particularly that of umbilical dehiscence. This study aims to demonstrate the incorporation of periumbilical fascioplasty to reliably limit umbilical necrosis, particularly in cases where maximal rectus plication is desired. We present a series of 30 patients who underwent abdominoplasty at a single center under 1 surgeon between 2021 and 2024. Abdominoplasties were performed in standard fashion. Following extensive midline abdominal wall plication, the umbilicus is identified deep within the plication. Periumbilical fascioplasty is then performed by incising the anterior rectus fascia circumferential to the position of the umbilicus, releasing any adherences to the underlying rectus muscle, and suturing the imbricated anterior rectus fascial segment onto the anteriorly exposed fascia, thereby anteriorly transposing the base of the umbilicus. This further eliminates the compression caused by the vertical vector of traditional midline plication while simultaneously displacing the umbilical base anteriorly. Abdominal skin is then transposed, and the umbilicus is externalized in the desired fashion. This approach resulted in 0 cases of umbilical skin necrosis and dehiscence. Although approximately 15 additional minutes are required in this process, the reduced need for follow-up corrective surgery should be considered. In applying this protocol, a surgeon may be more confident that they may achieve maximum midline plication while improving umbilical survivability metrics.

Secondary cleft lip rhinoplasty. Our experience of two decades

Patients who underwent cleft lip surgery in childhood may develop nasal malformation later in life. Various procedures have been described to correct these malformations. This study aims to describe our surgical approach and assess the morphometric outcomes of secondary cleft-lip rhinoplasty performed at the plastic surgery department in Marseille between 2002 and 2022. We conducted an analysis of surgical procedures and nasal morphometrics results by measuring pre- and postoperative images. Both surgical procedures and nasal morphometric analyses have been performed. This study included 43 patients, with 70% presenting unilateral cleft lip and 30% bilateral cleft-lip. An open approach was performed in 90% of cases. Regarding the surgical steps, a tip rhinoplasty, tip reinforcement, and crus lateral reinforcement by cartilage grafting was performed in 98%, 96%, and 32% of cases. A septal extension graft, a columellar strut, and a "tongue in groove" technique were performed in 54%, 33%, and 4% of cases, respectively, to reinforce the tip. Cartilage harvested from the nasal septum, ribs, and ear was utilized in 44%, 23%, and 20% of cases. An osteotomy, septoplasty associated with a spreader-flap, alar base reduction, and alar to triangular cartilage fixation were performed in 67%, 79%, 16%, and 16% of cases. All pre- and postoperative nasal morphometrics measurements have demonstrated a statistical significant improvement in nasal morphology following surgery. An open approach rhinoplasty, facilitating alar cartilage dissection and reinforcement by septal, rib, or ear cartilage is crucial to preserve postoperative outcomes. Our technique enables favorable mid-term results on secondary cleft-lip rhinoplasty.

Wise Versus Vertical Mastopexy Pattern Skin-reducing Mastectomy With Immediate Breast Reconstruction: Systematic Review and Meta-analysis

Background

This study compares postoperative outcomes of Wise and vertical mastopexy pattern skin-reducing/skin-sparing masctomy, hypothesizing that incision choice affects cosmetic outcomes and complication rates.

Methods

A systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, MEDLINE, Embase, Web of Science, and StarPlus Library. Included studies documented skin-sparing mastectomy using Wise or vertical mastopexy patterns with immediate reconstruction. The primary outcome is total mastectomy flap necrosis. The secondary outcomes are major/minor necrosis, infection, hematoma, seroma, and wound complications. Bayesian and frequentist generalized linear mixed models were used for the meta-analysis, including studies with 0 events.

Results

Sixty-six studies were identified, with 39 included in the meta-analysis, comprising 1954 patients and 2311 breast reconstruction cases. The Wise group had a higher rate of mastectomy flap necrosis (14.2%; 95% confidence interval: 10%-20%; I² = 83%) compared with the vertical group (7.8%; 95% confidence interval: 5%-12%; I² = 0%) (P < 0.05). No significant differences were found in other domains. Subgroup analysis favored vertical mastopexy for wound-related complications (P = 0.04).

Conclusions

The Wise pattern shows significantly higher mastectomy flap necrosis than the vertical pattern. However, there were no significant differences in major necrosis, minor necrosis, infection, hematoma, or seroma. Future studies should focus on larger, high-quality randomized controlled trials to better understand the impact of incision techniques on postoperative outcomes.

Time to reconsider the use of synthetic mesh in immediate prepectoral implant-based breast reconstruction: Impact of their use on short-term outcomes

BACKGROUND

Breast reconstruction practices, predominantly implant-based, have evolved, with meshes aiding in overcoming traditional limitations. However, data comparing mesh-assisted prepectoral reconstruction with implants alone are lacking. This study aimed to assess whether synthetic meshes in prepectoral reconstruction impact postoperative complications.

MATERIAL AND METHODS

We retrospectively studied 238 prepectoral immediate implant-based breast reconstructions (IBBR) in 211 patients from 2020 to 2022. Our primary endpoint was the 90-day revision surgery rate comparing mesh and non-mesh groups. Secondary endpoints included postoperative complications: seroma formation, skin necrosis, implant exposure, hematomas, surgical site infections, and implant loss. We conducted univariate and multivariate analyses to assess complications and risk factors for postoperative revision in the entire cohort.

RESULTS

There was a statistically significant higher rate of revision surgery in the mesh group (22 % vs. 9.0 %, p = 0.022) and more early complications in the mesh group, although there was no significant difference between the two groups. During the study period, the number of immediate IBBR significantly increased, reflecting expanded surgical indications that were no longer dependent on potential adjuvant treatments. and practices have changed. The multivariate analysis revealed no specific evidence of mesh use affecting surgical revision. However, it identified implant volume as a significant factor increasing the risk of revision surgery (p = 0.01).

CONCLUSION

This study underscores a significant practice shift: standardizing surgical techniques, particularly reducing mesh usage, did not lead to higher revision surgery rates. These findings suggest that the non-mesh assisted prepectoral approach is a valid technique.

Neonatal Limb Compartment Syndrome: A Comprehensive Review

PURPOSE

Neonatal limb compartment syndrome (NLCS) is a rare and potentially limb-threatening condition defined as an increased pressure within a confined limb compartment. Clinicians may fail to distinguish NLCS from other mimicking conditions. Misdiagnosis is possible due to a low index of suspicion for this condition, which may delay appropriate and urgent treatment. A comprehensive review of the available literature was performed to explore common themes in NLCS and identify gaps in the evidence to guide future studies.

METHODS

A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French. Studies were selected by two independent reviewers who extracted descriptive data including the delivery history and complications, the timing of diagnosis, the location of the lesion, and the management strategy.

RESULTS

A total of 43 reports describing 86 cases of neonatal compartment syndrome were published between 1980 and 2021. The male-to-female ratio was 6:7. Compartment syndrome was mainly located in the upper extremity (95.3%). Clinical features including swelling (41%), sentinel skin lesion (94.2%), extremity cyanosis (89.5%), and necrotic fingers (7%) were observed. The treatment strategy was either surgical decompression (32.6%) or nonsurgical management (68.6%). Sequelae occurred at a rate of 16.6%, 81.3%, and 75.9% after early fasciotomy (< 24 hours), late fasciotomy, and nonsurgical management, respectively.

CONCLUSIONS

Sentinel skin lesions and flaccid paralysis are the most observed clinical features and represent key clues for diagnosis. Neither radiography, Doppler ultrasound, nor magnetic resonance imaging has demonstrated any advantage in guiding the appropriate management of NLCS and may delay appropriate treatment. Despite nonsurgical management and late fasciotomy (> 24 hours) being the most described treatments, the lowest rate of sequelae was observed when decompression was performed within the first 24 hours.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Squamous cell carcinoma in rare case of Huriez Syndrome: The role of distant flaps

Context

Huriez syndrome is a rare de rmatological condition characterized by severe sclerotic and atrophic changes in the extremities (hands and feet) and an increased tendency to develop squamous cell carcinomas, with no established gold standard for the surgical treatment of these patients, who are difficult to manage due to the inability to perform reconstructions using local flaps.

Clinical Case

We report the case of a patient with severe Huriez syndrome who had developed SCC in both the hands and foot over time. After multiple surgeries at other centers, all resulting in recurrences, we planned wide excisions followed by reconstruction using distant flaps. The postoperative course for both reconstructive procedures was complication-free. Follow-up revealed not only an excellent reconstructive outcome but also highlighted the untapped potential of the flap in managing this condition: thanks to its independent vascularization, the flap remained unaffected by the surrounding diseased skin and significantly improved the scaly, atrophic appearance of the affected areas.

Discussion

Huriez syndrome is a dermatological condition characterized by a predisposition to developing squamous cell carcinomas. In these patients, it is essential to plan wide excisions that ensure oncological radicality. The reconstruction must be carefully planned, and microvascular flaps can be prioritized.

Conclusion

The radial forearm flap has proven effective for reconstruction in individuals with SCC associated with Huriez syndrome. The skin of the flap not only remained unaffected by the surrounding pathology but also induced a previously undescribed benefit on the diseased skin. This oncological-reconstructive approach could become the gold standard in treating these patients.

Expanding Global Surgery Services to Include Reduction Mammaplasty Procedures

Background

Global surgery is a multidisciplinary field that aims to deliver equitable and improved surgical services. Surgical care has been previously considered to play a limited role in the global burden of disease, in part due to its complexity and associated expense. A functional health system mandates high-quality, accessible, and timely surgical care.

Methods

Literature was reviewed on the role of plastic and reconstructive surgery in global surgery programs, reduction mammaplasty, and quality of life (QoL). Definitions of emergency and essential surgical care were explored to understand which surgical procedures are included in these programs. Reduction mammaplasty is the most researched aesthetic surgery procedure when considering QoL.

Results

The surgical conditions treated by plastic surgeons comprise a large proportion of the global surgical disease burden and disproportionately affect individuals in low- to middle-income countries. Over time, reconstructive surgery has gained equivalence to other surgical fields, partly due to a broader understanding of health; the need for psychological well-being; and the fact that some aesthetic surgery procedures are now considered reconstructive, such as a reduction mammaplasty. Essential surgery comprises low-cost, basic surgical procedures that prevent disability or life-threatening complications and may be performed at the district hospital level. Reconstructive plastic surgery improves QoL in multiple domains, including reduction mammaplasties.

Conclusions

The cost-effectiveness and QoL improvements of reduction mammaplasty have been elucidated; therefore, this can make a real difference for many patients in developing countries. Consideration should be given to expanding the essential surgical care package to include reduction mammaplasty.

Clinical Perspectives on the Pathophysiology of Facial Synkinesis: A Narrative Review

Importance

Facial synkinesis refers to pathologic cocontraction and baseline hypertonicity of muscles innervated by the facial nerve, commonly attributed to the aberrant regeneration of nerve fibers following injury. The pathomechanism and optimal treatment of facial synkinesis remain unclear. The goal of this review is to highlight current understanding of the epidemiology, pathophysiology, clinical presentation, assessment, and treatment of facial synkinesis.

Observations

Research into the epidemiology and risk factors of facial synkinesis is limited due to a lack of large databases tracking patients with facial palsy, inherent selection bias, and the wide range of symptom severity. Misguided nerve regeneration, polyneuronal innervation, and cortical changes are implicated in the development of synkinesis, and a better understanding of these mechanisms is required to develop new treatments. The clinical presentation of facial synkinesis varies considerably among patients, and important prognostic questions regarding timing of onset and progression of symptoms remain incompletely answered. Current management options for facial synkinesis include noninvasive modalities, chemodenervation, myectomy, and selective neurectomy. Potential new treatments for facial synkinesis are being investigated in animal models, but few have been tested in humans.

Conclusions and Relevance

The treatment of facial synkinesis is currently hindered by limitations in clinical research and understanding of pathomechanism. Current studies predominantly yield level 4 evidence or lower. The development of large datasets of patients with facial palsy and the translation of basic science evidence to humans will facilitate the advancement of new treatments.

Fat embolism following fat grafting: A systematic review of reported cases

Background

This systematic review aims to consolidate and analyze reported cases of fat embolism following fat grafting, focusing on patient demographics, procedural characteristics, clinical features, diagnostic methods, management strategies, and outcomes.

Methods

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted across multiple databases, including PubMed, Google Scholar, Cochrane, Embase, MEDLINE, and Scopus, up to January 31, 2024. Inclusion criteria encompassed case presentations diagnosing fat embolism or fat embolism syndrome post-fat grafting in patients over the age of 18 years. Data were extracted using EndNote® X21.

Results

From 1051 identified studies, 71 met inclusion criteria, encompassing 137 patients. The mean patient age was 36.22 years, with 90.5 % being female. Liposuction was the predominant fat harvesting method. Ocular signs were the most common presentation (50.8 %), followed by neurological (42.2 %) and cardiopulmonary (32.0 %) symptoms. Diagnostic methods varied, including imaging and histopathology. Supportive care was the primary management strategy. The overall mortality rate was 34.3 %, with 88.6 % of survivors experiencing permanent sequelae.

Discussion

This study acknowledges several limitations in evidence, including heterogeneity, recall bias, language limitations, and potential publication bias due to studies with worse outcomes. Fat embolism following fat grafting, though rare, can lead to significant morbidity and mortality. Early recognition and prompt management are crucial. This review highlights the need for standardized diagnostic and treatment protocols to improve patient outcomes in fat grafting procedures.

Other

This study received no external funding and was previously registered with the Prospective International Register of Systematic Reviews (PROSPERO).

A Cross-Disciplinary Study of Facial Asymmetry in a Pre-Hispanic Mesoamerican Sculpture: Some Cultural and Rheumatological Insights

BACKGROUND/HISTORICAL PERSPECTIVE

Facial asymmetry has been recognized and represented in Mesoamerican and South American pre-Hispanic cultures.

SUMMARY

This study aims to describe and contextualize an ancient pre-Hispanic stone face carving from the Early Postclassic Period (1200-1500 AD) discovered during excavations for the construction of what is now the National Rehabilitation Institute in Mexico City. The remarkable facial asymmetry of the artifact, suggesting facial paralysis, is a focal point for an interdisciplinary study combining bioarchaeology, anthropology, paleopathology, and rheumatology.

CONCLUSIONS

Although most causes of facial paralysis are idiopathic and pre-Hispanic Mesoamerican populations may have had a higher incidence of infections that could be the leading triggering cause, the potential connection between facial paralysis and rheumatic diseases in pre-Hispanic or pre-Columbian contexts is still a topic of ongoing investigation. This task remains highly relevant for rheumatologists who have traced the history and evolution of rheumatic diseases.

FUTURE RESEARCH

To understand the potential causes of disabilities in ancient societies, a comprehensive, holistic, and transdisciplinary approach is needed, including evidence-based reviews to analyze the relationship between facial paralysis and rheumatic diseases.

Subfascial Transaxillary Breast Augmentation: Critical Evaluation of a 25-Year Review of 1015 Consecutive Cases

BACKGROUND

Subfascial (SF) pocket breast augmentation (BA) has gained popularity, whereas the transaxillary approach (TAA) offers the benefit of an inconspicuous scar. Previous reports on both techniques involved limited follow-up/samples, and few clinical studies specifically address surgical technique and outcomes following primary and secondary BA. The purpose of this study was to assess outcomes from the SF TAA technique in a large series of patients who underwent primary and secondary BA.

METHODS

A retrospective cohort of patients who underwent BA between 1999 and 2024 was identified. The primary outcome was occurrence of incision and implant/pocket complications. Regression logistic analysis evaluated risk factors including age, body mass index, smoking, implant surface/volume, and fat grafting.

RESULTS

The cohort contained 1015 patients (mean age, 28.5 ± 7.3 years), and the average follow-up was 77.6 ± 38.6 months. In primary BA, 212 patients (23.4%) experienced at least 1 complication, most frequently capsular contracture. More complications were seen in secondary BA ( P = 0.016). Multivariate regression identified body mass index less than 18.5 kg/m 2 as a significant risk factor for incision complications, whereas textured surface (OR, 2.70; P < 0.001) and implant volume greater than 350 cc (OR, 2.79; P < 0.001) were risk factors for implant/pocket complications.

CONCLUSIONS

Despite extensive research on BA procedures, studies on SF TAA procedures are limited and have not analyzed long-term outcomes following primary/reoperative operations. These results demonstrate that SF TAA is a reliable technique, and the data are compatible with other studies using different BA approaches. Knowledge of the axillary and pectoralis fascia anatomy allows surgeons to safely implement the SF TAA technique and minimize risk.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Population comparison of facial soft tissue thickness

The thickness of the face's soft tissue has been widely measured through different populations around the world. In this study, we gathered and compared multiple measurements including our study group. We set the variables and included studies in which only females with normal values of BMI, age from 18 to 30years old were studied, and we included research with more than 10 study participants. We gathered 32 various studies and tested them with Kruskal-Wallis's test in RStudio. Statistical significance in tissue thickness was not confirmed when compared with the results of studies of different populations, which may indicate a greater importance in the bony mass in facial identification.

Are All Alginate Dressings Equivalent?

Alginate dressings are widely used in wound treatment for their healing and hemostatic properties and their capacity to drain exudate. However, a clear understanding of the heterogeneity within this class of dressings is lacking. Numerous sources of variability exist between alginate dressings: their composition (% of calcium alginate relative to other components), the ratio of D-Mannuronic and L-Guluronic acids in the alginate fraction, their purity (presence of toxic contaminants), and the shape of their fibers (surface and thickness). These parameters affect the performance and safety of alginate dressings, which may thus not be interchangeable in clinical practice. Therefore, clinicians must be aware of these differences to ensure optimal treatment and avoid complications or suboptimal healing. The objective of this study was to compare six alginate dressings to conclude or not on their equivalence. The results obtained demonstrate considerable variability between alginate dressings in the assessed characteristics: composition, Ca2+ release, level of cytotoxicity, fiber shape, draining capacity, and their resistance to traction. Algostéril, the only pure calcium alginate rich in G, releases a specific dose of Ca2+ and is the only non-cytotoxic dressing. With its multilobed fibers that are statistically the thickest, it provides the best draining capacity and greatest resistance to traction. These results demonstrate that alginate dressings are not equivalent. Each dressing is distinct, and consequently the clinical performance of one cannot be transposed to the others. Therefore, each alginate dressing should demonstrate its own efficacy, in a given indication, through a clinical trial.

Pediatric cervical Intravascular Papillary Endothelial hyperplasia (IPEH): A case report of an unusual presentation

Intravascular Papillary Endothelial hyperplasia (IPEH) are benign vascular lesions rarely described in the pediatric population. We present here the case and the management of a 11-year-old child with a lateral neck mass. The diagnosis of IPEH can be challenging for the clinician and the radiologist as it may mimic other pathologic entities. The definite management consists of surgical excision and immune-histopathological examination to establish a diagnosis.

Software-assisted bone thickness evaluation in patients with syndromic craniosynostosis undergoing Le Fort III osteotomy: a technical note

The aim of this study was to assess the value of the use of software for the preoperative evaluation of cranial bone thickness in syndromic patients undergoing Le Fort III osteotomy. Four patients were evaluated preoperatively to determine whether they were eligible for distraction osteogenesis. Data from the computed tomography scans was evaluated using advanced reverse engineering tools to determine the temporal bone thickness. Three patients showed adequate values for the positioning of a rigid external distractor device (average thickness values >3.5 mm), while one patient showed insufficient bone thickness (average value <2.5 mm) and therefore underwent midface advancement according to the traditional technique. Adequate midface advancement was obtained in the three patients who underwent distraction osteogenesis. No complications related to the rigid external distractor were observed. A shorter skeletal advancement was obtained in the patient who underwent Le Fort III osteotomy according to the traditional technique. A cerebrospinal fluid fistula was observed after the removal of the plates, requiring surgical repair. Software evaluation of the cranial bone thickness is a useful tool in the surgical planning of Le Fort III osteotomy in patients affected by syndromic craniosynostosis.

[Vastus lateralis muscle fascia reconstruction with absorbable mesh plate for the anterolateral thigh flap donor site : Muscle herniation prevention]

INTRODUCTION

The anterolateral thigh flap is sometimes harvested with a portion of the quadriceps muscle fascia, which can lead to muscle hernias or adhesions at the donor site. Studies report an 11 to 32% incidence of muscle hernias and an 8 to 26% incidence of persistent weakness at the donor site. There is no data in the scientific literature presenting a surgical technique for the prevention of muscle hernias at the donor site of the anterolateral thigh flap. The objective of our study is to describe our technique for placing a synthetic mesh when closure of the fascia is not possible during the harvesting of an anterolateral thigh flap, in order to reduce the risk of postoperative muscle hernias and to analyze its benefits.

MATERIALS AND METHODS

As part of a prospective study, we present here our technique for reconstructing the fascia by placing a non-resorbable synthetic mesh.

RESULTS

Twenty-two patients underwent the placement of a mesh for the reconstruction of the fascial defect, which averaged 9.6cm. One year after the procedure, none of the patients presented with a muscle hernia or adhesions at the donor site.

DISCUSSION

According to studies, muscle hernias and scar adhesions occur in 11 to 32% of cases and are both unsightly and disabling for patients. Although it is difficult to quantify the benefit in terms of muscle strength, fascia reconstruction effectively prevents this type of complication. When the defect is greater than 8cm, we believe it is essential to reconstruct the fascia during harvesting to prevent the occurrence of hernia or adhesion at the donor site. While not affecting limb function, muscle hernia is at least aesthetically bothersome and should be systematically prevented.

CONCLUSION

Reconstruction of the muscle fascia at the donor site of the anterolateral thigh flap with a non-resorbable synthetic mesh, in cases of a defect greater than 8cm, prevents the occurrence of muscle hernias and adhesions, which can lead to aesthetic and functional complications.

Factors affecting anastomosis failure in microvascular fibula flap reconstruction of the maxillofacial region: a systematic review and meta-analysis

This systematic review and meta-analysis evaluates the contributory factors and failure rates in anastomosis during microvascular fibula flap reconstruction in maxillomandibular regions. A comprehensive search strategy was employed across databases including MEDLINE, Web of Science, EMBASE, Scopus, Cochrane's CENTRAL, as well as grey literature sources, and manual searches of noteworthy journals, covering studies from inception up to April 2023. The inclusion criteria targeted retrospective or prospective cohort and clinical studies that investigated functional and dental rehabilitation outcomes in human subjects undergoing maxillofacial reconstruction using microvascular fibula flaps. Exclusion criteria encompassed case-control studies, alternative reconstruction method research, and animal-based investigations. The study's findings revealed a cumulative vascular failure rate of 6%. Subsequent analysis delineated the primary causes of this failure, attributing 3% to venous thrombosis, 1% to arterial thrombosis, and less than 1% to blood vessel compression due to hematoma. However, notable heterogeneity across the studies indicates substantial variability in vascular failure rates reported. These results of our review and meta-analysis underscore the intricate factors impacting anastomosis success, such as anastomosis technique, recipient vessel quality, the choice between couplers.

Quality and Reliability of 2D and 3D Clinical Photographs in Plastic Surgery: A Scoping Review

BACKGROUND

Clinical photography is a critical tool in plastic surgery practice. The primary aim of this scoping review was to assess the quality and reliability of various 2D and 3D photography modalities in plastic surgery.

METHODS

The databases, MEDLINE via PubMed, Embase via Elsevier, and Scopus via Elsevier, were searched from inception to March 15, 2023, for any papers focused on evaluation of quality and/or reliability of photography in plastic surgery-related applications. Data regarding general article characteristics, study characteristics, participants, and study results were extracted by two reviewers and qualitatively synthesized.

RESULTS

A total of 17 studies published from 1999 to 2023 were eligible for inclusion in the final analysis. Thirteen (76.5%) were cross-sectional and four (23.5%) were cohort studies. Photographed locations included craniomaxillofacial and oral (n = 11, 64.7%), scars (n = 3, 17.6%), breast and torso (n = 2, 11.8%), and wounds (n = 1, 5.9%). Assessed photographic modalities were found to be on par or better than comparators in almost all applicable cases (n = 13/14, 92.9%).

CONCLUSIONS

Multiple photographic modalities were found to have adequate quality and reliability. 3D photography was found to be a superior imaging modality for craniomaxillofacial and oral applications. For scar and wound assessment and images of the breast and torso region, 2D photography was sufficient. Overall, 2D photography using smartphone devices is sufficient for reliable and quality images in most clinical settings. With continued advances in technology, the ability to capture clinical images will undoubtedly improve, and there is a need for future studies to assess and compare these modalities.

LEVEL OF EVIDENCE III

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 .

Nonsurgical Rhinoplasty: Histopathological Effects of Dermal Fillers on Nasal Cartilage in a Rabbit Model

Nonsurgical rhinoplasty has emerged as a preferred nasal aesthetic treatment due to its safety, predictability, and high patient satisfaction. It utilizes dermal fillers, primarily hyaluronic acid (HA), to enhance nasal profiles and correct defects. However, limited data exist on the effects of HA-containing dermal fillers on nasal cartilage. This study aimed to evaluate these effects histopathologically. Sixteen New Zealand white rabbits were divided into two groups (A and B). Group A's right lateral cartilages (AR) received 0.1 mL of VYC-20L filler, while the left (AL) received isotonic saline. Group B's right lateral cartilages (BR) received 0.1 mL of VYC-25L filler, with the left (BL) serving as the control. After 90 days, the rabbits were sacrificed, and cartilage samples were analyzed histopathologically for cartilage thickness, chondrocyte nucleus loss, inflammation, fibrosis, giant cells, granulation tissue, abscess, and necrosis. Statistical significance was set at p < 0.05. Significant differences were found between groups for chondrocyte nucleus loss, fibrosis, and giant cells (p = 0.005, 0.018, <0.001, respectively). No difference was observed in cartilage thickness between AR and BR (p = 0.918). Chondrocyte nucleus loss was present in AR and BR but absent in AL and BL. Giant cells were detected in all VYC-20L and VYC-25L samples. Chronic inflammation and fibrosis varied but were not statistically significant. No abscess or necrosis was observed. This study demonstrated the histopathological effects of VYC-20L and VYC-25L on nasal cartilage using a rabbit model. Further studies with larger samples and diverse fillers are recommended.