Plastic Surgery Techniques Research Articles

Improving Surgical Treatment of Skin Burns to Reduce the Incidence of Pathologic Scarring

Background: In some parts of the world, the incidence of postburn pathologic scars reaches 16%. One should understand reconstructive surgery techniques and prioritize scar prevention during burn wound treatment. Inadequate wound management affects scar tissue formation and may cause pathologic scarring. Optimal timing of skin restoration operations reduces the risk of postoperative complications.Objective: To demonstrate that the surgical removal of fibrotic dermis and granulation tissue is feasible to reduce the incidence of pathologic scarring.Materials and methods: We studied treatment results in 57 patients with deep burns who were divided into 2 groups based on surgical treatment types before autologous skin grafting. Group 1 underwent total excision of granulation tissue, removal of fibrotic dermis, and excision of wound edges on day 27–31 after the injury. On day 22–28 postburn, group 2 had tangential excision of granulation tissue, removal of the upper skin layers only (the fibrotic dermis preserved), and then autologous skin grafting. The patients were followed up postoperatively at 1, 6, 12 months. During the examinations we assessed the formed scar tissue and perfusion of the burn injuries. Types and features of the scar tissue were identified by histologic examination of biopsy tissues.Results: We identified statistically significant differences between the analyzed patient groups based on the perfusion values measured by laser Doppler flowmetry and found a relationship between surgical approaches, wound perfusion, and the incidence of pathologic scarring.Conclusions: When early debridement is unfeasible, the preferred surgical approach for deep burns is a staged wound cleansing from necrotic tissue followed by total removal of granulation tissue and fibrotic dermis, and finally autologous skin grafting. This approach prevents pathologic scarring.

Tissue expansion techniques in reconstructive surgery: a 10-year bibliometric analysis.

Tissue expansion (TE) has attracted significant attention from researchers over the past decade. However, there are currently no bibliometric analyses in this field. We aimed to quantitatively and visually analyze the literature to explore the hotspots and frontiers in TE research. We extracted all the documents on this topic published from the Web of Science Core Citation (WOSCC) database between 2012 and 2021. CiteSpace (version 5.8 R3) and VOSviewer (version 1.6.18) were used to perform the visualization analysis. A total of 1,085 documents were included in the analysis. The publication trend fluctuated over time. The United States led the research, and Harvard University was the most productive institution. Plastic and Reconstructive Surgery published the largest number of documents and had the most citations. Kim JYS was the most prolific and most cited author. The high-frequency keywords were "complications", "breast reconstruction", "outcomes", "tissue expander", "mastectomy", and "acellular dermal matrix" (ADM). "Surgical site infection", "tissue expander/implant", "bilateral prophylactic mastectomy", and "activated controlled expansion" were the keywords with the strongest citation bursts until 2021. This study provided a complete analysis of the research on TE. The effect of ADM on the complication rates after breast reconstruction is the current hotspot of TE research in surgery. Patient-activated controlled expansion might be a promising future research direction for TE.

Hard and soft tissue regeneration of severe peri-implantitis defects with the laser-assisted peri-implant defect regeneration technique: 3-year results

PurposeThis retrospective cohort study evaluates the regeneration of severe peri-implantitis deficiencies treated with the laser-assisted peri-implant defect regeneration (LAPIDER) approach within a 3-year follow-up.MethodsTwenty-four implants with severe peri-implantitis in 18 patients were treated according to the LAPIDER technique. In contrast to classic techniques for reconstructive peri-implantitis surgery with a marginal incision, a buccal split-flap preparation avoiding papillae separation was used. After a coronal flap elevation and a laser-assisted peri-implant defect cleaning, connective tissue and autogenous bone grafting was performed. Primary outcomes were the changes of the marginal bone levels (MBL) and the buccal bone thickness. Secondary outcomes included implant survival, peri-implant probing depths (PPD), bleeding on probing (BOP), recession, width of keratinized mucosa (KMW), thickness of keratinized mucosa (KMT), soft tissue esthetics (PES), and implant success.ResultsMBL improved interproximal by 3.10 ± 2.02 mm (p < 0.001), buccal by 3.49 ± 2.89 mm (p < 0.001), and lingual by 1.46 ± 1.98 mm (p = 0.003); buccal bone thickness by 0.55 ± 0.60 mm (p = 0.005), and 1.01 ± 1.25 mm (p = 0.001) at 1 and 3 mm below reference level. Two implants were removed; 22 implants were still in function at a mean follow-up of 36 months. PPD changed from 5.05 ± 1.39 to 3.08 ± 0.71 mm (p < 0.001); recession was reduced from 2.07 ± 1.70 to 0.91 ± 1.13 mm (p = 0.001); KMW increased from 2.91 ± 1.81 to 4.18 ± 1.67 mm (p = 0.006); KMT improved from 1.73 ± 0.50 to 2.44 ± 0.43 mm (p < 0.001); PES changed from 7.7 ± 2.8 to 10.7 ± 1.9 (p < 0.001). 45.8% to 54.2% of the implants met the criteria of implant success.ConclusionsThe favorable results document the proof of principle for the regeneration of severe peri-implant hard and soft tissue deficiencies by the LAPIDER treatment approach.

Application of Trapezoid Orbital Septum Membrane Flap in Double-Eyelid Blepharoplasty.

For a long time, to achieve the natural shape of double-eyelid crease, multiple techniques of double-eyelid plastic surgery have been developed. We describe the trapezoid orbital septum membrane flap in blepharoplasty to achieve a dynamic double-eyelid crease and avoid a depressed static scar. The authors developed a trapezoid orbital septum membrane flap in double-eyelid blepharoplasty. The flap base is fixed on the pretarsal plate with the distal end of the flap positioned between the superior and inferior edges of the incision. Layer-by-layer contraposition suturing is then performed. One hundred ninety-one cases of double-eyelid blepharoplasty were performed by a senior surgeon using the trapezoid orbital septum flap method. Patients were followed for 6 to 17 months. Twelve cases were revised secondarily. Patients were satisfied with the palpebral folds, which showed a dynamic crease followed with movements of the eyelids. The authors introduce a trapezoid orbital septum flap in upper eyelid blepharoplasty. The flap relies on the elasticity of the orbital septum flap as the levator aponeurosis extension segment to produce a natural crease without a depressed static scar.

Evaluation of Patient Satisfaction Following the Grafting of Autologous Fat Tissue Obtained by VASER-Assisted Liposuction

Aim: Autologous fat transplantation, also known as fat grafting or fat injection, is an increasingly popular technique in reconstructive surgery with minimal complications and low morbidity rates. The aim of this study is to evaluate the satisfaction of patients after the injection of autologous adipose tissue obtained by the Vibration Amplification of Sound Energy at Resonance (VASER)-assisted lipoplasty method due to aesthetic concerns or deformity. Materials and Methods: The study includes 20 patients who underwent VASER-liposuction-guided autologous fat injection between 2014 and 2021 in a single center. Patients were invited for follow-up approximately three years after the surgical intervention, and patient satisfaction and complications were evaluated with a semi-structured questionnaire. Results: Patient and surgeon satisfaction received the highest score at discharge. Sensory changes and tissue stiffening were found to be the most common complications. Overall satisfaction and scar healing were identified as the parameters with the highest score. Conclusion: VASER- assisted liposuction and autologous fat transplantation is a technique associated with high patient satisfaction and minimal complications. The method is an ideal technique for whole body contouring and facial operations.

Management of soft tissue defects of the thumb

Hand surgery has undergone substantial changes in recent years, especially for reconstructive surgery techniques. We discuss the management of soft tissue defects of the thumb, discussing indications, and operative pearls and pitfalls. We cover non-operative treatment and local advancement flaps for small distal soft tissue defects and pedicled flaps for more significant defects. We also discuss composite vascularized free flaps such as second-toe neurocutaneous flaps and partial hallux transfer for compound defects or total amputations. This article aims to provide hand surgeons with an update on reconstructing an injured thumb.

Oncological outcome of patients treated surgically with oncoplastic breast surgery: a single centre analysis

Background: Oncoplastic breast surgery is a well-established approach that aims to maintain the quality of life by using plastic surgery techniques without compromising the oncological outcome. This study aimed to demonstrate the effective oncoplastic surgical practice with low rates of perioperative complication and high patient reported outcome.Methods: A prospective observational and systematic review comprised of 50 patients with T1- T3 and T4B lesions treated with Level I and Level II oncoplastic breast surgery techniques in a single centre. Patient demography, procedure and outcome data were collected. The patient satisfaction and quality of life were assessed using Breast Q Module questionnaire.Results: The greatest number of cases were seen in the age group 30-40 years with T2 lesions with next T4B lesions in the same age group. Three patients (6%) experienced complication requiring intervention, and all patients had margins free of tumour. Patient satisfaction scores were higher in the postoperative period.Conclusions: Our study even though has a smaller number of patients and less duration of study period showed a good result with regards to the patient reported outcomes.

Radial Flap in Reconstructions of the Hand - Case Series Study

Abstract Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2×3.1cm to 9×13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

Postburn Reconstruction of the Face and Neck.

After studying this article, the participant should be able to: 1. Understand the cardinal principles in the management of postburn deformities in the face and neck. 2. Understand reconstruction of specific subsites in the face and neck affected by burn contracture. 3. Acquire knowledge about the various techniques of burn reconstruction of the face and neck. 4. Grasp technical nuances and select appropriate surgical options for individual cases. Postburn contractures in the face and neck region are multifactorial in origin and difficult to prevent in extensive burns. Facial burns lead to distortion of anatomical landmarks, causing aesthetic, functional, and psychological problems. Each subunit of the face is unique in structure; thus, the surgeon needs to adjust the timing of surgery and the technique according to region and the severity of contracture. Contracture of one unit, especially that of the neck and forehead, can exaggerate the contracture in neighboring subunits. The role of these extrinsic influences must be considered while sequencing surgical procedures. The burn surgeon must be adept in all reconstructive surgery techniques from skin grafting to tissue expanders to microsurgery to obtain the best outcomes. Surgery must be followed up with long-term physical therapy and psychological rehabilitation to help burn survivors with head and neck contractures to integrate back into society.

Keller Funnel Efficacy in "No Touch" Breast Augmentation and Reconstruction: A Systematic Review.

A systematic review of PubMed, Embase, the Cochrane database, and Google Scholar was performed between 2005 and 2021. All clinical-based, retrospective and prospective studies utilizing the Keller funnel method for breast implant insertion were selected. Six studies were identified for evaluation: five were retrospective cohorts and one was a prospective trial. No randomized controlled trials were found. Outcomes reported included lower rates of capsular contracture (RR, 0.42; P = 0.0006; 95% CI, 0.25-0.69), shorter incision lengths (35.5 ± 2.1 mm), less insertion time (mean = 6 seconds), and decreased complications, and one paper reported ultimately greater patient satisfaction with outcomes (BREAST-Q Score: 92%). This review suggests that the Keller funnel is a useful method for no-touch breast augmentation and reconstruction surgery. The Keller funnel reduces subsequent capsular contracture rate, surgical time, and incision length and allows for easier insertion. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.

ANTI-RECURRENCE PLASTIC FOR ANTERIOR ABDOMINAL WALL HERNIAS

Summary. The purpose of the study is to find new methods of surgical treatment of hernias, aimed at reducing the frequency of recurrences.&#x0D; Research materials and methods. The paper analyzes the results of examination and surgical treatment of abdominal hernias in 39 patients.&#x0D; Research results. An analysis of the surgical treatment of patients with abdominal hernia using the author’s technique of anti-recurrence plastic surgery by applying a semi-purse suture to the terminal areas of the line of sutures on the aponeurosis was carried out.&#x0D; Conclusions. The use of our method of antirelapse plastic surgery is pathogenetically justified and does not have a negative effect on the course of the postoperative period in operated patients.

Mechanical Stress Improves Fat Graft Survival by Promoting Adipose-Derived Stem Cells Proliferation.

Cell-assisted lipotransfer (CAL), defined as co-transplantation of aspirated fat with enrichment of adipose-derived stem cells (ASCs), is a novel technique for cosmetic and reconstructive surgery to overcome the low survival rate of traditional fat grafting. However, clinically approved techniques for increasing the potency of ASCs in CAL have not been developed yet. As a more clinically applicable method, we used mechanical stress to reinforce the potency of ASCs. Mechanical stress was applied to the inguinal fat pad by needling. Morphological and cellular changes in adipose tissues were examined by flow cytometric analysis 1, 3, 5, and 7 days after the procedure. The proliferation and adipogenesis potencies of ASCs were evaluated. CAL with ASCs treated with mechanical stress or sham control were performed, and engraftment was determined at 4 weeks post-operation. Flow cytometry analysis revealed that mechanical stress significantly increased the number as well as the frequency of ASC proliferation in fat. Proliferation assays and adipocyte-specific marker gene analysis revealed that mechanical stress promoted proliferation potential but did not affect the differentiation capacity of ASCs. Moreover, CAL with cells derived from mechanical stress-treated fat increased the engraftment. Our results indicate that mechanical stress may be a simple method for improving the efficacy of CAL by enhancing the proliferation potency of ASCs.

The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery-A review.

The lateral tarsal strip is one of the basic surgical techniques in ophthalmic plastic surgery. It is used in many indications, predominantly in ectropion repair. Even though there are alternatives, it is probably one of the most popular techniques in ophthalmic plastic surgery. The lateral tarsal strip is also part of bigger surgical procedures (such as midface lifting, entropion surgery, reconstruction surgery, or a part of some surgical approaches to the orbit). The aim of this review is to assess the most common ways of usage of the lateral tarsal strip, to cover its alternatives, and to discuss the future of this technique. We have search PubMed and Web of Science and went through articles about lateral tarsal strip. We have also searched for other techniques that used the lateral tarsal strip and included these articles in our review. We have analyzed the major articles and made a review about the topic. As a natural part of many advanced surgical techniques and as a major surgical technique for lower eyelid ectropion repair, the lateral tarsal strip remains an important part of modern ophthalmic plastic surgery.

Diseño de póntico ovoide mediante contorno gingival. Reporte de dos casos clínicos.

Dentro de los problemas más frecuentes que presentan los pacientes que han sido sometidos a extracciones, principalmente en zonas que representan un gran compromiso estético, se encuentran los colapsos en la región anterior maxilar, tratamientos realizados sin una adecuada planeación del caso, ocasionan defectos muy importantes en la arquitectura periodontal del proceso alveolar. Existen técnicas protésicas y periodontales, mediante las cuales se pueden solucionar este tipo de situaciones. La utilización del póntico ovoide en combinación con algunas técnicas de cirugía plástica periodontal, son principalmente utilizadas en la rehabilitación de pacientes, logrando resultados estéticos y funcionales satisfactorios. El objetivo fue mostrar dos casos clínicos en los que se utilizaron ambas técnicas; en el primer caso clínico se realizó una prótesis parcial fija de tres unidades cerámicas sin metal In-Ceram, mediante la técnica de póntico ovoide. En el segundo caso, se hizo una prótesis tipo Maryland de polímero cerámico optimizado, reforzado con fibra de vidrio con póntico ovoide en combinación con un injerto de tejido conectivo subepitelial para la reconstrucción de la arquitectura periodontal del proceso alveolar en la zona del diente ausente. De esta manera, se logra un alto grado de naturalidad, estética y funcionalidad en la apariencia de los pónticos de la prótesis.

Mechanical Stretch Induced Skin Regeneration: Molecular and Cellular Mechanism in Skin Soft Tissue Expansion.

Skin soft tissue expansion is one of the most basic and commonly used techniques in plastic surgery to obtain excess skin for a variety of medical uses. However, skin soft tissue expansion is faced with many problems, such as long treatment process, poor skin quality, high retraction rate, and complications. Therefore, a deeper understanding of the mechanisms of skin soft tissue expansion is needed. The key to skin soft tissue expansion lies in the mechanical stretch applied to the skin by an inflatable expander. Mechanical stimulation activates multiple signaling pathways through cellular adhesion molecules and regulates gene expression profiles in cells. Meanwhile, various types of cells contribute to skin expansion, including keratinocytes, dermal fibroblasts, and mesenchymal stem cells, which are also regulated by mechanical stretch. This article reviews the molecular and cellular mechanisms of skin regeneration induced by mechanical stretch during skin soft tissue expansion.

Autologous Fat Grafting in the Upper Extremity: Defining New Indications.

Background:Autologous fat grafting is a commonly used technique in plastic surgery that can also be applied broadly in hand surgery. We present a case series to demonstrate the diverse indications for fat grafting in hand surgery.Methods:We retrospectively reviewed cases of fat grafting in the upper extremity in 2020. Cases representing a unique application of fat grafting were identified. Patient data, including demographics, diagnoses, preoperative and postoperative assessments, complications, patient satisfaction, and surgical operative reports, were recorded.Results:Five patients representing distinct indications for autologous fat grafting in the upper extremity were identified. Indications included hand rejuvenation (20.0%), burn/scar management (20.0%), tenolysis (20.0%), revision nerve decompression (20.0%), and carpometacarpal joint arthritis (20.0%). Average patient age was 60.4 years (range, 42–71). Average volume of fat injected was 15.2 ml (range, 1–37 ml). No major complications were noted (0.0%). All patients expressed satisfaction with their overall result with good functional outcomes (100%).Conclusions:Autologous fat grafting can be applied broadly in hand surgery. Indications for fat grafting in hand surgery include hand rejuvenation, burn/scar management, tenolysis, revision nerve decompression, and thumb carpometacarpal arthritis. Hand surgeons can easily incorporate fat grafting into their daily practice. Current literature supports fat grafting as a viable technique in hand surgery with lower-level studies.

602 Using Plastic Surgery Techniques in Abdominal Wall Surgery

Abstract Complex Abdominal Wall Hernias (CAWH) present a huge challenge to surgeons and patients often requiring Abdominal Wall Reconstruction (AWR). AWR aims to restore abdominal wall anatomy, improve function, and reduce the risk of future herniation. Plastic surgery techniques can be used including primary closure, skin grafts, flaps, tissue expansion and small bite, small stitch technique. Below are two cases where some of these techniques were utilised. Case 1 LC is a 65 y/o female with CAWH. Her gastric band became infected requiring a laparotomy for perforation of gastroesophageal junction. She subsequently had primary open repair of abdominal hernia using Permacol. It became infected requiring 5 debridements and application of a VAC device. Her hernia was a Ventral Hernia Working Group (VHWG) grade 3 at 10cm×16cm. Her CAWH was repaired using a Rives-Stoppa technique and a Surgimend mesh. The epigastric component of her wound was closed using a superiorly based local rhomboid flap and a Prevena VAC dressing. Case 2 KH is a 37 y/o female with a para-ileal conduit skin granuloma that was painful and refractory to other treatments such as silver nitrate and steroid topical treatments. She had excision of the area of granulation and her wound was closed using a local advancement flap taking account of previous scars raised and a prevena VAC dressing. Discussion CAWH requiring AWR is a complex operation benefiting from plastic surgical specialists. Plastic surgical techniques can help with closure of the abdominal wall and reduce complication rates including wound infections and incisional hernia.

O056 Achieving optimal clinical outcomes in autologous fat grafting (AFG): a systematic review of processing techniques

Abstract Introduction AFG is an increasingly popular technique in reconstructive and cosmetic surgery but significant variability in long-term graft retention continues to be a limitation. This results in unreliable clinical outcomes and revision procedures. There is no consensus on the optimal methodology of graft processing. This systematic review identifies the latest evidence base supporting different processing techniques. Methods A systematic literature search was conducted using PubMed, SCOPUS, and the Cochrane electronic databases. Studies comparing AFG processing techniques and reporting long-term patient outcomes (≥3 months) were identified. Data collected included the technical aspects of techniques, cohort characteristics, complication rates, volume retention. Systematic assessment of study quality was also performed. Results Twenty-four studies (2928 patients) providing at least level three evidence were included. Processing techniques evaluated included centrifugation, decantation, washing, filtration, gauze rolling, as well as commercial devices and ASC enrichment methods. There was variable reporting of complications and volume retention rates. Complications were infrequent; palpable cysts (0–18%), cellulitis (0–8%) and fat necrosis (0–36.4%) were the most commonly reported. No significant differences in long-term volume retention between techniques were found in AFG in the breast. In head and neck patients, greater volume retention were documented in ASC enrichment (64.8–95.8%) and commercial devices (41.2%) compared to centrifugation (31.8–76%). Conclusion The quality of AFG research has improved significantly in recent years but has heterogeneity in reporting outcomes. ASC (adipose derived stem/stromal cells) enrichment methods and commercial devices results in superior long-term volume retention in facial but not breast fat grafting. Take-home message Adipose derived stem/stromal cell enrichment methods and commercial devices have superior long term volume retention in facial but not breast autologous fat grafting [level of evidence II]. Randomised control trials are necessary to identify if certain processing methods are superior to others in volume retention and complication rates.

Activating Parkin-dependent mitophagy alleviates oxidative stress, apoptosis, and promotes random-pattern skin flaps survival

The random-pattern skin flap is a crucial technique in reconstructive surgery and flap necrosis caused by ischemia/reperfusion injury is a major postoperative complication. Herein, we investigated the mechanism of mitophagy induced by Melatonin (ML) and its effect on the survival of skin flaps. Our results demonstrated that ML could activate mitophagy, ameliorate oxidative stress and alleviate apoptosis in Tert-Butyl hydroperoxide solution (TBHP)-stimulated human umbilical vein endothelial cells in vitro. Inhibiting ML-induced mitophagy considerably abolished its protective effects. Moreover, knockdown of Parkin by siRNA inhibited ML-induced mitophagy, and subsequently exacerbated oxidative stress and apoptosis. Further study demonstrated that inhibition of AMPK reversed these protective effects of ML and downregulated the expression of TFEB. In the vivo study, ML effectively promoted flap survival by activating mitophagy and subsequently ameliorating oxidative stress and mitigating apoptosis. These results established that ML is a potent agent capable for increasing random-pattern skin flap survival by activating Parkin-dependent mitophagy through the AMPK-TFEB signaling pathway.

The integrity or deficiency of the soft tissue envelope predicates the 10 decisions for reconstruction of the mangled hand

Combined upper extremity injuries involving both bone and soft tissue destruction are commonly referred to as “mangled hands”. These injuries often involve a twisting or crushing mechanism or are the result of a high energy trauma, and their reconstruction requires a knowledge of both advanced orthopedic and plastic surgery techniques – the epitome of an orthoplastic approach. In this review, we outline 10 decisions and technical steps to optimize the outcomes in these complex injuries. Specifically, we discuss why the integrity of the soft tissue envelope, or lack thereof, predicates our algorithm with regard to limb salvage and reconstruction. • Initial evaluation of the mangling hand injury should focus on cataloguing injuries and identifying ischemia. • Projecting the likely function of the hand in 2 years can assist with the decision for amputation or reconstruction. • A quality, systematic debridement under tourniquet sets the stage for successful future reconstruction. • In treatment, orthoplastic principles should be followed in a stepwise manner. • The integrity of the soft tissue envelope dictates the timing of reconstruction of nerve, tendon and bone injuries.