Reconstructive Surgeons Research Articles

The law code of ChatGPT and artificial intelligence-how to shield plastic surgeons and reconstructive surgeons against Justitia's sword.

Large Language Models (LLMs) like ChatGPT 4 (OpenAI), Claude 2 (Anthropic), and Llama 2 (Meta AI) have emerged as novel technologies to integrate artificial intelligence (AI) into everyday work. LLMs in particular, and AI in general, carry infinite potential to streamline clinical workflows, outsource resource-intensive tasks, and disburden the healthcare system. While a plethora of trials is elucidating the untapped capabilities of this technology, the sheer pace of scientific progress also takes its toll. Legal guidelines hold a key role in regulating upcoming technologies, safeguarding patients, and determining individual and institutional liabilities. To date, there is a paucity of research work delineating the legal regulations of Language Models and AI for clinical scenarios in plastic and reconstructive surgery. This knowledge gap poses the risk of lawsuits and penalties against plastic surgeons. Thus, we aim to provide the first overview of legal guidelines and pitfalls of LLMs and AI for plastic surgeons. Our analysis encompasses models like ChatGPT, Claude 2, and Llama 2, among others, regardless of their closed or open-source nature. Ultimately, this line of research may help clarify the legal responsibilities of plastic surgeons and seamlessly integrate such cutting-edge technologies into the field of PRS.

Gender parity at the podium in UK plastic surgery conferences

Despite the increase in the proportion of female plastic surgeons in the United Kingdom (UK), all-male panels continue to prevail. This article sought to establish whether the genders of speakers at conferences hosted by leading UK plastic surgery associations, the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), and the British Association of Aesthetic Plastic Surgeons (BAAPS), are representative of the consultant workforce. Data on the gender distribution of plastic surgeons in the workforce over the last decade were obtained from NHS Digital Workforce Statistics. The demographics of invited speakers were sought from conference agendas for both BAPRAS (from 2012 to 2022) and BAAPS (from 2014 to 2021) posted on their association's websites. The proportion of female consultants increased from 16% in 2012 to 22% in 2022. The average proportion of female speakers at BAPRAS conferences was 16%±9% SD that was similar to the proportion of female consultants in practice (p=0.432). In contrast, the average proportion of female speakers at BAAPS conferences was lower than those in practice (7.88%±8.29% SD, p=0.0032). At BAAPS, 43% of speakers were UK plastic surgeons. Although the podium speakers at BAPRAS were reflective of the consultant population, BAAPS had little to no representation of UK based female plastic surgeons. Therefore, the conference organisers need to intentionally ensure that representation at podium is reflective of the workforce.

The Pedicled Anterolateral Thigh Flap as a Versatile Option for Resurfacing Extensive Lower Trunk Defects.

The resurfacing of large abdominal and perineal defects is a major concern, and it poses a great challenge to the reconstructive surgeon. The main target in the reconstruction of the abdomen is to ensure a stable soft-tissue cover, and a strong and reliable fascia to prevent hernia recurrence and fecal contamination. The pedicled anterolateral thigh flap (ALT) either in the myocutaneous or fasciocutaneous form is a work-horse for the closure of abdominal and perineal defects. There is a paucity of studies on the use of the anterolateral thigh flap among black Africans especially in Nigeria; hence, we present our experience with the use of this flap for extensive abdominal and perineal defects. The folders of all patients who had pedicled anterolateral thigh flap between January 2019 and July 2022 in our institution were reviewed. The patients' demographic data and the available details about the flap reconstruction were extracted from the folders. There were three males and two females, and the age range was between 22 and 48 years. Four cases resulted from tumor extirpation, while one was following extensive necrotizing fasciitis of the lower anterior abdominal wall. No gross anatomical variations were encountered intraoperatively. Four flaps had full survival, while one had marginal flap tip loss. The pedicled anterolateral thigh flap is an excellent reconstructive tool for the coverage of extensive abdominal and perineal defects.

Complex Heel Defect: A Comprehensive Study On Combined Regional Flaps For Sensate And Stable Coverage.

BACKGROUND: Heel defect has remained a challenging situation for reconstructive surgeons. In large post traumatic defects, the goal is to provide a sensate and stable soft tissue coverage, especially for the weight-bearing part of the heel. The paucity of local tissue options makes the scenario difficult to deal with. OBJECTIVE: This study is aimed to reconstruct large defect, involving both the weight-bearing and non-weight-bearing part of the heel by combining two regional flaps. METHODS: A retrospective study, comprising of 11 patients from January 2016 to December 2019 with large traumatic heel defects, operated in our setup with combined medial plantar and reverse sural artery flap within 72 hours of injury. Follow up period was 6 months postoperatively. RESULT: All flaps survived well except one reverse sural flap, which was congested and later debrided and 2 had distal edge necrosis which were managed conservatively. All the reverse sural flaps were noted to have lymphedema, but only 3 patients opted for debulking surgery. The functional outcome was excellent, with all the patients being able to walk normally, both barefoot and with footwear. The weight-bearing area was sensate, a clear advantage of utilizing instep skin. CONCLUSION: In our experience, the combined strategy of utilizing local tissue for large heel defects, not only provides a sensate, stable, and reliable coverage but also avoids the lengthy procedure of free tissue transfer that in the end would not be able to give similar results.

The use of augmented reality for preoperative preparation of perforated flaps: a pilot study

Augmented reality (AR - augmented reality) is the addition of digital information to one or more senses, which allows the user to perform tasks more efficiently. This can be achieved by overlaying images, videos, or computer models. The aim the study is to study the use of AR for preoperative planning of perforant flaps and compare the results of visualization accuracy of various research methods. 3 patients with oncological diseases were examined, who were planned to lift and transplant a SCIP flap (in two cases) and a propeller flap on the perforant branch of the peroneal artery (in one case). All patients underwent a high-frequency ultrasound of 75 GHz examination of the donor zone and marking along it in the area of the planned flap lift. A CT scan of the donor area was also performed, followed by the superimposition of a segmentation image using HoloLens 2 virtual reality glasses. 7 measurements were obtained. AR for microsurgical planning was performed in two inguinal regions and was 100% correlated with the results of high-frequency ultrasound, in the case of perforant vessels of the peroneal artery, a discrepancy of 5 mm was noted for the X and Y axes in three perforant vessels. Augmented reality allows the reconstructive surgeon to see the anatomy of the area of interest in a particular patient before the incision. This area of medicine is certainly in demand, promising and requires further research with larger patient samples and randomization.

Versatility of Free Vascularised Fibular Flap in Extremity Reconstruction: A Retrospective Study

Introduction: Complex wounds of the extremities have always been a challenge for the reconstructive surgeon. Non-vascularized methods for the reconstruction of bony defects are associated with more complications. So the free vascularised fibular flap (FVFF) has become a workhorse flap for the reconstruction of these defects. In this study we aim to share our experience of reconstruction of such defects using free vascularised fibular flap. Material and methods: We performed a retrospective study of the 18 patients who underwent extremity reconstruction with free vascularised fibular flap at our hospital i.e. Yenepoya Medical College and Hospital, Mangaluru during a five-year period i.e. from January 2019 to December 2023. In all these patients, we studied and evaluated the cause and location of defects, type of free vascularised fibular flap, choice of the recipient vessels, type of the anastomosis, the survival rate, functional outcomes and complications. Results: Totally 18 patients with a mean age of 39.4 years had undergone extremity reconstruction with a free vascularised fibular flap with complete bone viability. The defects were present within the humerus, radius, femur, tibia and metatarsal. Union at the osteotomy sites was noted radiologically at an average time of five months. The average period to return function was 14 months. Conclusions: The use of a free vascularised fibula flap is the best modality for the reconstruction of the bony defects of the limb and is proved to have a high bony healing rate, early return to ambulation, good function of the extremity and less incidence of complication regardless of the cause of the bony defect. One or more skin paddle can be taken along with the bone for the coverage in case of exposure of deeper tissue.

Management of Nodular Nasal Basal Cell Carcinoma with Wide Excision, Transpositional Median Forehead Flap, Forehead Split Thickness Skin Graft: Case Report

Introduction: Basal cell carcinoma (BCC) is the most common skin type cancer with an incidence rate of around 75-80%. The most common location is in the head and neck area around 70-80% and followed by other body parts around 25% consist of the penis, vulva or perianal area and 5% on the skin. BCC occurs more frequently in light-skinned individuals compared to dark-skinned individuals. The incidence rate is relatively lower in Asians, blacks ethnic, and Hispanics.
 Case Presentation: A 66 years-old woman complained of scabs on the right side of her nose which had become increasingly widespread for the past 2 years. The wound was initially the size of a mole and was scratched until it spread until the patient was hospitalized. Physical examination showed a wound in the nasal area measuring 4 x 5 x 1 cm, irregular wound edges, cartilaginous wound base with necrotic tissue and pus. The first biopsy examination showed poorly differentiated basal cell carcinoma. The patient was treated with Nasal Reconstruction surgery consisting of wide excision was performed by surgical oncologist, transpositional median forehead Flap and forehead Split Thickness Skin Graft were performed by reconstructive plastic surgeon.
 Discussion: The diagnosis of BCC in this patient was based on regarding history taking, physical examination and histopathological examination. However, for defects with a diameter of more than 1.5 to 2 cm, generally recommended using axial pattern flaps such as forehead flaps, nasolabial flaps and dorsal nose flaps. In this case, the patient was treated with wide excision followed by nasal reconstruction with a transpositional forehead flap and forehead split thickness skin graft.
 Conclusion: Nevertheless, regional flaps remain the recommended procedure for nasal reconstruction after wide excision of the tumor. Accurate analysis of the damage combined with evaluation of the patient's clinical condition is necessary to select the best surgical technique. Thorough knowledge of regional vascular anatomy and a comprehensive multidisciplinary approach are important first steps for proper treatment of nasal skin cancer, so that the procedure for wide excision of nasal basal cell carcinoma followed by nasal reconstruction with transpositional forehead flap and split thickness skin graft, can provide satisfactory result.

Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons.

Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.

Poly-ε-Caprolactone 3D-Printed Porous Scaffold in a Femoral Condyle Defect Model Induces Early Osteo-Regeneration.

Large bone reconstruction following trauma poses significant challenges for reconstructive surgeons, leading to a healthcare burden for health systems, long-term pain for patients, and complex disorders such as infections that are difficult to resolve. The use of bone substitutes is suboptimal for substantial bone loss, as they induce localized atrophy and are generally weak, and unable to support load. A combination of strong polycaprolactone (PCL)-based scaffolds, with an average channel size of 330 µm, enriched with 20% w/w of hydroxyapatite (HA), β-tricalcium phosphate (TCP), or Bioglass 45S5 (Bioglass), has been developed and tested for bone regeneration in a critical-size ovine femoral condyle defect model. After 6 weeks, tissue ingrowth was analyzed using X-ray computed tomography (XCT), Backscattered Electron Microscopy (BSE), and histomorphometry. At this point, all materials promoted new bone formation. Histological analysis showed no statistical difference among the different biomaterials (p > 0.05), but PCL-Bioglass scaffolds enhanced bone formation in the center of the scaffold more than the other types of materials. These materials show potential to promote bone regeneration in critical-sized defects on load-bearing sites.

The Use of Acellular Tissue Matrices in Gender-Affirming Surgery: Review of the Literature and Institutional Experience.

Wound healing complications are not uncommon after genital gender-affirming surgery and can pose significant challenges for the reconstructive surgeon. Acellulartissue matrices are products that contain extracellular matrix compounds without living cells and are used to expedite and improve wound healing.Some of these products have been described for a variety of different indicationsin gender-affirming surgery. In this paper, the authors present a review of the current literature on the use of acellular tissue matrices in gender-affirming surgeryas well as the authors' institutionalexperience in using these products.

Breast reconstruction after mastectomy in patients with obesity: a narrative review.

Breast reconstruction in patients with obesity presents numerous challenges, both in terms of surgical technique and post-operative complication management. As breast reconstruction techniques continue to evolve, the armamentarium of reconstructive options for patients with obesity has vastly expanded. Options now include immediate or delayed, implant-based, autologous, or hybrid reconstruction. Determining the optimal breast reconstruction in this complex population requires nuanced and experienced decision-making. A literature search was conducted to identify studies assessing breast reconstruction considerations in patients with obesity. The search was performed on PubMed and was limited to English language studies published between 1990 and 2023. Primary studies, case reports, chart reviews, and qualitative studies were included. Additional articles were identified for inclusion based on a review of references, as well as a web-based search, to identify additional studies that were not captured with the primary search strategy. This narrative review article summarizes the current literature available to guide surgeons in breast reconstruction in patients with obesity. The advancements in oncologic surgery and breast reconstruction techniques have expanded available surgical options, including immediate or delayed implant-based, autologous, or hybrid breast reconstruction. Each approach has its unique advantages, disadvantages, and surgical considerations. Despite the challenges, patients with obesity can achieve favorable aesthetic outcomes through careful assessment of comorbidities and expectation management.

Prophylactic Use of Negative Pressure Wound Therapy in High-risk Patients Undergoing Oncoplastic and Reconstructive Breast Surgery.

Negative pressure wound therapy (NPWT) has emerged as an adjunct to reduce wound complication rates in many surgical domains. This study investigated the prophylactic use of PICO NPWT in high-risk patients undergoing oncoplastic and reconstructive breast surgery. This was a prospective multicenter national audit. The findings were compared against Association of Breast Surgery/British Association of Plastic, Reconstructive and Aesthetic Surgeons (ABS/BAPRAS) Oncoplastic Guidelines for best practice. Data from 267 patients were included from seven centers. All patients had at least one high-risk factor for postoperative wound complications, whereas 78 patients (29.2%) had more than one. Thirty-six patients (13.5%) developed postoperative wound complications. An estimated 16 (6%) developed skin flap necrosis, wound dehiscence occurred in 13 patients (4.9%), and 15 patients (5.6%) developed postoperative wound infection. Eleven patients (4.1%) required further surgery due to wound complications. In total, 158 patients underwent mastectomy with immediate implant reconstruction. Postoperative wound complication rate was comparable in this subgroup (n = 22; 13.9%). Implant loss rate was 3.8%, which was within the 5% target mentioned in the ABS/BAPRAS guidelines. The estimated total cost saving was US $105,600 (£84,613) and US $395.50 (£316.90) per patient. Wound infection rate (5.6%) was much lower than the 25% reported by both iBRA study and National Mastectomy and Breast Reconstruction Audit. Our study suggests that prophylactic use of NPWT in oncoplastic and reconstructive breast surgery results in low rates of wound-related complications with associated healthcare cost benefits in patients with high-risk factors for wound-related complications. However, a prospective randomized control trial is required.

Current status of pre- or subpectoral breast reconstruction in Japan.

Breast reconstruction using silicone breast implants (SBIs) has been performed for many patients in Japan under the initiative of the Japan Oncoplastic Breast Surgery Society (JOBSS) since SBIs were first covered by insurance in 2013. A change in the lineup of available SBIs owing to the Allergan crisis caused a decrease in the availability of SBIs appropriate to Japanese breast contours. Recently, the number of immediate implant-based breast reconstructions (IBRs) was approximately 4,000 in one year and was slightly decreasing. The SBI is generally placed under the pectoralis major muscle. Because the number of patients with one-stage, implant-based operative indications is small, an acellular dermal matrix is not available in Japan, and the complication rate in one-stage, IBR is high, most immediate, IBRs are performed in two stages. The prevalence of immediate, one-stage, IBRs is approximately 10%. Fat grafting by injection using Coleman's technique is performed in many hospitals under the JOBSS initiative as a surgery combined with SBI insertion. Complications after SBI placement may be less common in Japan than those in other countries. Japanese breast reconstructive surgeons undertake preventive measures to lessen these complications according to guidelines and experts' opinions, which may contribute to the low complication rate after SBI placement. The total reported number of patients with breast implant-associated anaplastic large cell lymphoma is four, and no patients have died because of this disease. In Japan, procuring informed consent and diagnosing and treating this disease are performed according to the JOBSS guidelines.

A-T Flap for Reconstruction of Nasal Dorsum Skin Defects.

Reconstruction of nasal defects can be challenging, especially when encountering larger defects. We describe the use of a single-stage conversion of an 'A' shaped defect to a 'T' shaped scar of large nasal skin defects in the cosmetically sensitive supra-tip and supra-alar regions. This study aimed to determine whether an A-T flap is a suitable option for nasal reconstruction and if so where and what size defects it can be used for. Retrospective case series review over an 8-year period (2011-2019) in a tertiary referral center in the United Kingdom. Case analysis was undertaken in 2020 including all patients who underwent A-T reconstruction of nasal defects. A review of histology, case notes, and clinical photography was undertaken. A total of 27 patients were identified-13 (48%) female and 14 (52%) male. The median age was 73 years (range 31-90 years). Defect locations were supra-tip (48%) and supra-alar (52%). The largest defect closed was 895 mm2 (30 × 38 mm). Range 35 to 895 mm2 (median 264 mm2). No patient required revision or corrective procedures. No functional impairment was identified. Patient and clinician reported aesthetic outcomes as good in all cases. No reports of this technique could be identified in the literature. The A-T flap is a viable option for supra-tip and supra-alar skin defects (up to 895 mm2 in our series). It aligns well with the basic principles of nasal reconstruction. The flap can be performed under local anesthesia in one stage, resulting in good functional and aesthetic outcomes and so can be considered a valuable tool for the nasal reconstructive surgeon.

Sternal bone anatomy on preoperative imaging as an independent predictor of deep sternal dehiscence following median sternotomy

Complications following median sternotomy are associated with morbidity, mortality, and major healthcare costs. With plastic surgeons being increasingly consulted to close complex sternotomy wounds, a more accurate risk stratification tool for this comorbid patient population is warranted. This study examines the association of preoperative radiologic sternal measurements and deep sternal dehiscence, comparing this with other known clinical risk factors. A decreased manubrium sternal thickness relative to body weight (<0.13mm/kg) and an absolute inferior sternal width ≤13.8mm had a significant association with the development of deep sternal dehiscence, even with adjustment for known clinical risk factors. With such measurements assisting in further risk stratification, the opportunity to improve risk assessment holds value for plastic and reconstructive surgeons who are consulted to close extensive sternotomy wounds.

A preliminary analysis of patient reported outcomes following posterolateral mandible reconstruction: The role of flap type.

The choice of tissue type for free flap reconstruction of posterolateral mandible resections is dependent on patient and defect characteristics. We compared clinical and patient-reported outcomes following reconstruction of these defects with a soft tissue or bony free flap. A retrospective review was performed on patients who underwent posterolateral segmental mandibulectomy with immediate free flap reconstruction at MSKCC from 2006 to 2021. Outcomes of interest were patient-reported outcome measures (PROMs) assessed by FACE-Q surveys and complications at the flap recipient site. Ninety patients received a bony flap and 24 patients received a soft tissue flap. Patients reconstructed with soft tissue flaps had greater rates of composite soft tissue defects (p < 0.0001), condyle resection (p = 0.001), and peripheral vascular disease (p = 0.035). Complication rates were similar between the cohorts (p > 0.05). Bony flaps scored higher on multiple FACE-Q scales: Facial Appearance (p = 0.023) Eating/Drinking (p = 0.029), Smiling (p = 0.012), Speaking (p < 0.001), Swallowing (p = 0.012), Smiling Distress (p = 0.037), and Speaking Distress (p = 0.001). Reconstruction of posterolateral mandibular defects has a similar complication profile when utilizing a bony or soft tissue free flap. Bony flaps may perform better with respect to PROMs. Reconstructive surgeons should consider using bony flap reconstruction to achieve higher patient satisfaction and quality of life.

An Analysis of Male Plastic Surgery Content on TikTok.

TikTok is a powerful and popular source of patient education. However, the lack of content regulation raises concerns about the spread of medical misinformation. We aimed to analyze the source, content, quality, and reliability of TikTok posts focusing on surgical and nonsurgical cosmetic treatments for men. A search was conducted on TikTok with 16 popular hashtags related to male cosmetic procedures. The top 25 male-focused videos from each hashtag were chosen for analysis. Videos were categorized by content creator, video type, and descriptive metrics. Educational videos were evaluated for quality with the validated modified DISCERN (mDISCERN) score and the Patient Education Materials Assessment Tool (PEMAT) scale. Statistical analysis was performed with univariate and linear regression models. The included 399 videos totaled 389 million views, 16.4 million likes, 174,594 comments, and 586,743 shares. Most videos were uploaded by plastic and reconstructive surgeons (38.3%). A significant number (38%) of videos by physicians were posted by international physicians, with videos by United States physicians receiving fewer views, comments, and shares than videos posted by international physicians. Patient experience was the most common video category (48.9%). Educational videos had low overall quality, with physician-created videos demonstrating higher DISCERN and PEMAT scores but lower engagement compared to nonphysician videos. The quality of TikTok videos on male cosmetic surgery was generally low, emphasizing the importance of accurate information dissemination by physicians on social media. The strong presence of international physicians highlights the potential implications of social media on medical tourism.

Five-Segment Mandibular Osteotomy: A Novel Approach to the Correction of Complex Post-Traumatic Mandibular Deformities.

Post-traumatic mandibular malocclusion is a complex condition that poses a significant challenge to reconstructive surgeons. The malocclusion that ensues from bilateral condylar and parasymphseal fractures presents a particular challenge as it leads to bilateral posterior shortening and lingual tilting of dental arch leading to a combination of open anterior bite, crossbite, overbite, underbite, and/or facial asymmetry. The complexity of such malocclusion requires intricate freedom of movement of the mandibular arch that can be achieved by performing a 5-segment mandibular osteotomy. This is a case series of 9 adult patients with significant post-traumatic mandibular malocclusion who were treated with 5-segment mandibular osteotomy technique. This article details the demographics, surgical technique and outcomes in this cohort of patients. All 9 patients in this series had condylar fracture as part of the index mandibular trauma. They have a common post-traumatic deformity of the mandibular arch due to shortening of the vertical mandibular height in the fracture site and variable degrees of lingual tilting leading to crossbite. The 5-segment mandibular osteotomy provided an adequate correction of dental and facial deformities in all 9 patients. One patient had a relapse of the dental malocclusion that required postoperative rescue orthodontics. Furthermore, one patient had a significant postoperative hemorrhage that required a facial artery ligation. Post-traumatic mandibular malocclusion is a complex deformity that poses a great challenge to practicing surgeons. Five-segment mandibular osteotomy is a technique that provides ample degrees of movement of mandibular segments that is necessary to correct such deformity.

Risk of complications in panfacial bone fracture according to surgeons: A meta-analysis

BackgroundPanfacial bone fractures pose intricate challenges due to severe fragmentation and loss of landmarks. Surgeons use a variety of reduction techniques, including bottom-up and top-down approaches. This single proportional meta-analysis explores sequencing differences and complications between oal and maxillofacial Surgery surgeons (OMSs) and plastic and reconstructive surgeons (PRSs) in treating panfacial bone fractures. MethodsThe PubMed and Scopus databases were searched systematically, and we compiled fourteen studies published between 2007 and 2023 involving 1238 patients. A systematic review of the included studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and data on the reduction techniques; total complication rates; and rates of malocclusion, enophthalmos, infection, asymmetry, and aesthetic complications were collected. ResultsThe bottom-up technique was the most prevalent for both types of surgeons (57.1%, 8 out of 14). Malocclusion rates (I2=0% for OMSs and 41% for PRSs) were similar between the groups (p=0.72), but PRSs tended to have a lower enophthalmos rate (I2=0% for OMSs and 32% for PRSs) than OMSs (p < 0.01). Infection rates remained consistent across all studies. However, high heterogeneity was observed for the total complication rate (I2=94% for OMSs and 85% for PRSs) and asymmetry and aesthetic complications (I2=88% for OMSs and 92% for PRSs), making direct comparison between the two groups inconclusive. ConclusionsIn this study, the differences in surgical techniques and levels of interest have a greater impact on the outcomes of panfacial bone fracture than the surgeon’s specialty. However, more in-depth studies are needed to accurately pinpoint panfacial bone fracture reduction trends and differences in postoperative complications in the two expert groups.

The Subcalcaneal Fat Pad: An Innovative Space for Passage of the Pedicle in Free Flap Reconstruction of Lateral Heel Defects.

Soft-tissue defects of the lateral heel remain a challenge for reconstructive surgeons. Although a reliable vascular supply for free flap anastomosis is available anteriorly from the anterior tibial vessels and medially from the posterior tibial vessels, the vascular anatomy of the lateral side lacks suitable donor vessels for free flap anastomoses. Although the pedicle can be passed either ventrally beneath the skin or dorsally between the Achilles tendon and calcaneus, these passages are hardly applicable for lateral heel defects. We identified the space between the plantar surface of the calcaneus and the plantar aponeurosis as an innovative approach for reconstruction. Therefore, we propose the subcalcaneal fat pad as an alternative and reliable route for the passage of the flap pedicle to the posterior tibial vessels in free flap reconstruction of soft-tissue defects in the lateral calcaneal region. Consequently, the vascular pedicle can be safely anastomosed to the posterior tibial vessels. This approach provides a new option for recipient vessels in free flap reconstruction.