Plastic Surgery Techniques Research Articles

Extreme Oncoplastic Breast Surgery in Patients Presented to Ain Shams University Hospital, Initial Experience

Abstract Background Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. Objective s: Assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients. Assess the aesthetic results of the extreme oncoplasty of the enrolled patients. Patients and Methods This is a prospective cohort study to assess the feasibility of extreme oncoplasty and achievement of negative margins in the enrolled patients and the aesthetic results of the extreme oncoplasty. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Extreme oncoplasty techniques was proposed for patients in whom inclusion criteria was met. Diagnosis and staging examinations were carried out according to the standard protocol being conducted at Ain Shams University Hospitals. Results We report the oncoplastic outcomes after EO in a single institutional cohort of 20 patients with multifocal/Multicenteric or large tumors (≥50mm).While no major complications were observed after EO procedure, a low rate of minor complications (7.7%) was observed. Conclusion The combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. The preliminary results of our study indicate that selective patients (with multifocal/Multicenteric or large tumors) who were initially considered for mastectomy can be alternatively treated using Extreme oncoplasty (EO) followed by radiotherapy. EO can be considered as a safe and feasible surgical option for such patients without compromising aesthetic outcomes.

Клинические особенности стриктур спонгиозного сегмента уретры, подлежащих многоэтапной уретропластике или постоянной уретростомии

Introduction. Extended spongy urethral strictures require the use of plastic surgery techniques. In most cases, a one-stage urethral repair can be performed. However, staged urethroplasty and permanent urethrostomy are important in patients with extremely complex urethral strictures. Purpose of the study. To determine the clinical features of spongy urethral strictures, which cannot be cured by one-stage urethroplasty, but are subject to multistage plastic or permanent urethrostomy. Materials and methods. The study included 158 patients who underwent surgery for urethral strictures in 2010 − 2019. Inclusion criteria: spongy urethral strictures requiring staged urethroplasty or permanent urethrostomy. Exclusion criteria: age<18 years, proximal urethral strictures, urethra-vesical anastomosis and bladder neck stenosis, previously untreated congenital anomalies (hypospadias and epispadias), and history of any other urethral surgery not meeting the inclusion criteria. Results. The age of the patients ranged from 18 to 88 years. Iatrogenic (34.8%) and inflammatory (32.3%) urethral lesions predominate in the structure of etiological factors with the most common penile localization of narrowing (43.7%). The length of strictures in half of the patients exceeds 6 cm; a quarter of the sample has subtotal and total spongy urethral lesions. The proportion of recurrent urethral strictures is 56.3%. The average duration of the urethral stricture disease reaches 8 years. In 61.3% of cases, the disease is accompanied by complications from both local tissues and organs of the urinary and reproductive systems. Conclusion. Clinical evaluation of patients with spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy reveals a particular severity of urethral stricture disease. This category of patients has a high risk of unsuccessful outcomes with one-stage surgery. In these cases, patients require a multi-staged urethroplasty or a permanent urethrostomy.

Novel technique of development of human derived acellular dermal matrix.

Reconstructive surgery techniques have evolved exponentially in last decades. From regional flaps to free tissue transfer, tissue movilization has become the gold standart treatment in many reconstructive procedures. Main disadvantage from these techniques lies in the possibility of sequels in donor zone. Furthermore, raising comorbidities in general population and growing indications for reconstructive surgery in elder people, have triggered the development of new biomaterials which can offer support in the reconstruction while elicit donor zone morbidity. Advances in tissue decellularization techniques have brought numerous matrices which have shown effectivity in many reconstructive procedures. Use of acellular dermal matrices may become an eligible solution for many reconstructive procedures. From breast reconstruction assisted by matrices to complex wound coverage passing throught tendon repair techniques, acellular dermal matrices have shown effectiveness in last studies. Local production of this biomaterial leads to cost minimization derived from harvesting and manufacturing matrices in our centre and avoid out-of-stock and storage issues. Current original protocol proposed by our group include all steps from harvesting samples from cadaveric donors till matrix storage after decellularization proccess. The result is a high valued biomaterial in terms of biocompatibility and security profile available.

Scrotal bridge flap reconstructive surgery for extensive penile paraffinoma: steps and outcomes from a single center: a case series

BackgroundTo describe our scrotal bridge flap technique in reconstructive surgery for extensive penile paraffinoma, a debilitating late complication of penile subcutaneous foreign material injection intended to achieve penile augmentation.Case presentationWe reviewed the medical records of 10 patients who underwent reconstructive surgery with the scrotal bridge flap technique for penile paraffinoma at our center between 2016 and 2019. Complete excision of fibrotic tissue and the overlying skin was performed, and penile resurfacing was achieved by mobilizing the scrotal skin superiorly to wrap around the penile shaft, leaving a skin bridge at the median raphe. All 10 patients successfully underwent scrotal bridge flap penile reconstruction with satisfying results. The mean operation duration was 286.1 min (range 213–363 min). No immediate major complications were observed in any of the patients, and no patients required revision surgery.ConclusionThe scrotal bridge flap technique is a reliable method for reconstructive surgery after the excision of penile paraffinoma.

3: Vitamin D Improves Autologous Fat Graft Retention

Purpose:Autologous fat grafting is a widely used technique in aesthetic and reconstructive surgery, however, unpredictable volume reabsorption may lead to unsatisfactory outcomes. Previously, we demonstrated that a fat-soluble Vitamin D3 analogue, calcitriol, significantly improved fat retention in a xenograft mouse model by 25% across multiple donors when injected systemically (p < 0.05). While calcitriol has minimal toxicity, is FDA approved, and has positive immunomodulatory and antioxidant properties, systemic administration bypasses key Vitamin D synthesis regulatory steps, thus increasing risk with high-dose use. We hypothesize that systemic supplementation with Vitamin D3 (cholecalciferol) will likewise improve fat-graft retention similar to calcitriol while avoiding potential regulatory and iatrogenic risk. In this study we compared in vivo human fat graft retention in mice treated with systemic cholecalciferol, calcitriol or vehicle control in a mouse xenograft model. In vitro adipose lipoaspirate culture was used to interrogate the therapeutic mechanism of action.Methods:Lipoaspirate was harvested from 6 unique donors using a 2mm cannula and used in parallel for both in vitro and in vivo studies. In vivo: 0.3mL of lipoaspirate was injected bilaterally on dorsal flanks of homozygous Foxn1nu immunocompromised mice. Calcitriol (50ng), cholecalciferol (50ng, 500ng, 5000ng) or vehicle control was administered thrice weekly by IP injection. Graft volume retention was measured at 12 weeks. In vitro: 1mL of lipoaspirate was submerged in phenol-red free DMEM (10% FBS) containing calcitriol or cholecalciferol (15.6nM, 62.5 nM or 250 nM) for 7 days with one media change. Terminal analyses include tissue weight, stromal cell viability, concentration of active vitamin D metabolite (1,25(OH)2D3), and gene upregulation by qRT-PCR.Results:Previously, we demonstrated that systemic administration of 50ng calcitriol thrice weekly significantly improved human fat graft retention across multiple donors in a mouse xenograft model. Our current in vivo data suggest 5000ng cholecalciferol is similarly effective. In-vitro assays show 62.5nM and 250nM cholecalciferol significantly increased adipose stromal cell viability compared to controls (85.3+/-2.9% and 87.7+/-3.7 versus 77.6+/-2.8%, respectively p<0.05;). Analysis of final adipose 1,25(OH)2D3 concentration by ELISA showed both calcitriol and cholecalciferol treatments equally increased Vitamin D metabolite concentrations in all donors. qRT-PCR analysis of gene expression show that pro-survival autophagy is significantly increased by both cholecalciferol and calcitriol, though increased concentration of calcitriol was required to induce significant increases from controls.Conclusion:Cholecalciferol (Vitamin D3) is a highly promising therapeutic for improving fat grafting outcomes. Our in vitro data suggests that in the context of hypoxia, nutrient depletion, or growth factor deprivation, such as occurs immediately following fat grafting, vitamin D3 promotes stromal cell autophagy. In this context, autophagy is crucial for maintaining cellular ATP production and macromolecular synthesis and, therefore, represents an essential pro-survival pathway which allows grafted cells to survive. The results herein provide evidence to incorporate vitamin D3 as a safe, cost-effective nutritional supplement into the perioperative workflow to improve fat viability after grafting.

Trends and Techniques in Aesthetic Plastic Surgery

Trends and Techniques in Aesthetic Plastic Surgery

Evaluation of Modified Millard’s Technique with Premaxilla Shortening in Bilateral Labioplasty at Malahayati Hospital Banda Aceh 2016- 2019

Introduction: Cleft Lip and Palate (CLP) is a congenital abnormality in the form of gaps in the lips, gums and palate. This disorder occurs due to a disruption in the first trimester of pregnancy that causes disruption of the process of fetal growth and development. Surgical techniques for reconstructive surgery vary greatly, but labioplasty using a modified millard technique with premaxillary shortening is a technique that we used in this study with the aim of premaxilla shortening to reduce the tension of the suture wound and will reduce the scar formed in Bilateral labioplasty after surgery. Method: This research is a cohort with a retrospective approach conducted on labioplasty patients at Malahayati Hospital in Banda Aceh, which was handled in the period of 2016 - 2019. The sample amounted to 23 respondents who will be analyzed using the frequency distribution table. Results: From the results of the study found male sex as much as 60.9%, the age of patients in the age group 2 years and over as much as 69.6%, 6-9 months evaluation time as much as 87.0%, the diagnosis of complete bilateral labioplasty as much as 65.2% and good outcome in bil ateral labioplasty using modified millard technique with premaxilla shortening as much as 73.9% Conclusion: From the overall it can be concluded that the majority of male sex is the most, the highest in the age group 2 years and above, the most evaluation time is 6-9 months, the most common diagnosis is complete bilateral labiolasty and the most results on bilateral labioplasty using modified millard techniques with premaxillary shortening is good outcome.

Jawline reshape technique with suspension threads to improve the effect of blepharoplasty on face rejuvenation.

Blepharochalasis, induced by the aging process, is an important esthetic blemish which can be solved by blepharoplasty, the most performed cosmetic surgical procedure in the world today to repair droopy eyelids. Nowadays, there is a greater interest to combine blepharoplasty with minimally invasive treatments to harmonize the oval shape of the face. Therefore, blepharoplasty technique could be associated with face thread lifting, a safe and effective technique that optimizes the rejuvenation of the central and lower part of the face. The aim of this study was to assess the overall safety and efficacy of blepharoplasty combined with suspension thread lifting. The author also aimed to demonstrate patients' satisfaction after treatment. The study involved 12 patients undergoing blepharoplasty plus threads lifting to improve the mandibular line. Patient's satisfaction was valuated with global esthetic improvement score, visual analog scale score, before and after treatment clinical images. All patients showed optimized face rejuvenation and high satisfaction. Patients experienced an immediate improvement in face harmony in addition to the eye refinement and expressed their satisfaction. The combination of plastic surgery and minimal invasive technique did not cause adverse events to the patients and they would recommend it. Interest in thread lifting is currently high, and this study highlights the excellent outcome and the visible results of blepharoplasty and threads combination.

Hybrid mastopexy: improving outcomes on implant-based augmentation mastopexy with fat

BackgroundAutologous fat transplantation for breast augmentation represents an increasingly interesting technique in plastic surgery. Only a few standardized procedures are available. Hybrid augmentation mastopexy combines the benefits of autologous fat transplantation and implant-based breast augmentation mastopexy, reducing implant-related complications and prothesis size. Herein, we describe our surgical approach as a “hybrid aesthetic surgery.”MethodsA retrospective analysis of all patients who underwent hybrid breast augmentation and lifting with simultaneous fat grafting was carried out. Clinical outcomes, ultrasound evaluation of upper pole fullness, aesthetic postoperative results, and complications were examined. ResultsEighteen patients with a mean age of 33 years (range: 24–52 years) and mean BMI of 25.8 kg/m2 (range: 21.4–32.1 kg/m2) were included in this study. Mean injected fat volume per breast was 115 cc (range: 78–144 cc). Patients were followed up for a mean of 9.4 months (range: 6–24 months). No fat necrosis or major complications were encountered during the follow-up. Patient satisfaction was high in terms of breast shape, size, and coverage of the breast implant. No recurrence of ptosis was observed yet and no secondary revision surgery was performed.ConclusionsHybrid mastopexy augmentation is an effective and safe procedure that combines the benefits of autologous fat grafting and implant-based breast augmentation. The transfer of autologous soft tissue allows obtaining a natural breast shape, reducing the onset of rippling and prothesis size. The reduction of prothesis size prevents ptosis recurrence but provides the desired projection. This reliable option improves long-term breast shape with elevated patient’s satisfaction.Level of evidence: Level IV, therapeutic study.

Robotic Mitral Valve Repair After Failed Transcatheter Edge-to-Edge Repair

Mitral valve repair is infrequently performed in patients undergoing corrective surgery for failed mitral transcatheter edge-to-edge repair in current United States practice. This article describes surgical techniques for reconstructive surgery after failed transcatheter edge-to-edge repair. Nine patients underwent robotic-assisted mitral surgery after failed transcatheter edge-to-edge repair between 2008 and 2020 at a single center. Repair was completed in 88.9% (n= 8) patients, and freedom from >2+ mitral regurgitation was 87.5% (n= 7) at a median follow-up of 1.9 years.

A twostep supraclavicular flap method in head and neck reconstruction for refractory osteoradionecrosis

Techniques of reconstructive surgery of the head and neck region have existed since Antiquity, with the pedicled forehead flap of Susruta as a reference. These methods are constantly evolving, with the introduction of free flaps in the 1980s, and more recently new technologies such as CAD-CAM. However, the surgical management of patients treated by radiotherapy for upper airway cancers remains a challenge in terms of functional and aesthetic results. Indeed, cervical irradiation, which alters the quality of skin and vascular tissue, jeopardizes good healing after head and neck reconstructive surgery.In this article, the authors proposed to revisit the standard technique of the pedicled supraclavicular flap. Flap design inspired from the known and described technique of the two-stage forehead flap, for the management of a fragile patient with refractory mandibular osteoradionecrosis.

Techniques of reconstructive surgery. Experience in reconstructing postoperative defects in children with forearm bone sarcomas. Case series

Introduction. Osteosarcoma is an extremely malignant mesenchymal, highly differentiated tumor from bone tissue, proceeding aggressively, characterized by the rapid development of distant metastases. Ewing's sarcoma is not less complex disease, which can be explained by its biological characteristics, including aggressive course, a tendency to develop early hematogenous metastases and frequent relapses. The aim of the study – checking the possibility of complications, the level of restoration of functions according to the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (МSTS) scales after endoprosthesis, and the installation of a spacer. Materials and methods. We analyzed clinical cases of 7 children aged 8 to 15 years, who received treatment at the N.N. Blokhin National Medical Research Center of Oncology, оf the Ministry of Health of Russia in the period 2013–2019. Osteosarcoma was diagnosed in 4 patients, and Ewing’s sarcoma in 3 patients. They underwent organ-preserving surgical treatment of the upper limb in one of three ways – endoprosthesis, placement of a spacer, and replacement with autologous bone on microvascular anastomoses. In the course of the study, a method was used to assess limb function according to the TESS and МSTS scales. Results. It was found that in the postoperative period in all patients, regardless of the applied method of organ-preserving surgery, the results varied within 1,4–1,5 on the TESS scale, and 91–95 % on the MSTS scale. Postoperative complications in the form of post-traumatic neuropathy and dislocation were identified in 4 patients. 1 patient had local recurrence, 1 patient was diagnosed for metastatic leisure of lung tissue. It should be noted that the condition of all patients is currently satisfactory, no lethal cases have been identified. Conclusion. We believe that the results of this study are promising. However, it is necessary to conduct a longer period of observation of patients and evaluate their 5-year survival.

Submental Myodermal Flap in Buccal Reconstruction after Extended Combined Resection

Background. Oral mucosal cancer is the most prevalent squamous cell cancer of head and neck, with 6,723 cases registered in Russia, including 94 per Volgograd Region, in 2018. A high tumour advancement and complex topography of the surgical area result in extensive soft-tissue defects and impaired swallowing, chewing and speech.Aim. Efficacy assessment of submental myodermal flap application in buccal reconstruction after extended combined oncological resections.Materials and methods. Submental myodermal flap was used as a buccal reconstruction technique in 112 patients aged 42 to 75 years during 2015–2020. Surgery for primary tumour was performed in 88 cases, and in 24 — for recurrence after radiotherapy or surgical excision.Results and discussion. A six-year experience of the submental myodermal flap usage in reconstructive surgery allowed evidently wider indications for extensive oral resection combined with extended, also bilateral, lymphadenectomy. Clinical records on the technique application in primary and recurrent cancer are presented.Conclusion. The submental myodermal flap technique in combination with extended or extended combined surgery for oral mucosal cancer notably increases the tumour resectability at this location and improves function restore in patients. The method widens indications for higher-volume operative aid, considerably reduces postoperative complications and holds a promise to enable more radical surgery. This plastic surgery technique is aesthetic and effectively repairs speech and digestive functions, bringing improvement to the patients’ quality of life and social adaptation.

REDUCTION MAMMOPLASTY FOR BENIGN PHYLLODES TUMOUR IN AN ADOLESCENT FEMALE

Phyllodes tumours are rare neoplasm of female breast especially among adolescent women. We present a case of 17 year old female patient present with large benign phyllodes tumour. The patient was treated with one stage excision with reduction mammoplasty. Symmetry of the breast contour and nipple areola complex position could be restored. Standard plastic surgery techniques like reduction mammoplasty might be applied in treating large benign tumours not compromising the aesthetic aspect of the breast.

Lipofilling in Breast Oncological Surgery: A Safe Opportunity or Risk for Cancer Recurrence?

Lipofilling (LF) is a largely employed technique in reconstructive and esthetic breast surgery. Over the years, it has demonstrated to be extremely useful for treatment of soft tissue defects after demolitive or conservative breast cancer surgery and different procedures have been developed to improve the survival of transplanted fat graft. The regenerative potential of LF is attributed to the multipotent stem cells found in large quantity in adipose tissue. However, a growing body of pre-clinical evidence shows that adipocytes and adipose-derived stromal cells may have pro-tumorigenic potential. Despite no clear indication from clinical studies has demonstrated an increased risk of cancer recurrence upon LF, these observations challenge the oncologic safety of the procedure. This review aims to provide an updated overview of both the clinical and the pre-clinical indications to the suitability and safety of LF in breast oncological surgery. Cellular and molecular players in the crosstalk between adipose tissue and cancer are described, and heterogeneous contradictory results are discussed, highlighting that important issues still remain to be solved to get a clear understanding of LF safety in breast cancer patients.

The Expanding Role of Geometric Morphometrics in Craniofacial Surgery.

Geometric morphometrics (GM) is an advanced landmark-based quantitative method used to study biological shape and form. Historically, GM has been limited to non-biomedical fields such as comparative biology; however, this technique confers advantages over traditional cephalometric methods, warranting a review of current applications of GM to human craniofacial disorders. The RISmed package was used to extract metadata associated with PubMed publications referencing GM analysis techniques in craniofacial and reconstructive surgery. PubMed search terms included "geometric AND morphometric AND craniofacial;" and "geometric AND morphometric AND reconstructive surgery." Duplicate search results were eliminated. Search yielded 139 studies between 2005 and 2020, of which 27 met inclusion criteria. Human craniofacial studies constituted 2% of all queried GM studies. Among these, cleft lip and palate were the most commonly studied craniofacial conditions (7 studies, 26%), followed by sagittal craniosynostosis (4 studies, 15%). Seventeen studies (63%) used GM to assess skeletal structures, seven studies (26%) examined both skeletal and soft tissues, and three studies (11%) analyzed soft tissues only. Eleven studies (40.1%) employed a GM approach to evaluate postoperative changes in craniofacial morphology. Two studies (7%) systematically compared GM analysis with conventional shape measurements. The ability to study shape while controlling for variability in structure size and imaging technique make GM a promising tool for understanding growth patterns in complex craniofacial diseases. Furthermore, GM overcomes many limitations of traditional cephalometric techniques, and hence may claim an expanded role in the study of human craniofacial disorders in clinical and research settings.

A Five-Year Study of Cicatricial Entropion at Kirana Eye Hospital: Clinical Characteristics and Surgical Outcomes

Purpose: Cicatricial entropion is an inward turning of eyelid margin caused by scarring tissue of the posterior lamella. The chronic damage of cicatricial entropion can irritate the ocular surface and harm the cornea. Proper reconstructive surgery techniques are needed to prevent further damage and visual impairment. This retrospective study was done to evaluate the clinical characteristics of cicatricial entropion and surgical outcomes to repair entropion at Kirana Eye Hospital, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Methods: Records of all patients with cicatricial entropion who underwent surgical repair between January 2012 and December 2017 were reviewed retrospectively. Variables include basic and clinical characteristics, and surgical outcomes were recorded and analysed. Results: A hundred and twenty-two eyelids from 79 patients were included. Of those patients, 57% were female with mean age 51.4 years old. The laterality tendency is bilateral in 43 patients (54.4%). The most common initial complaints were foreign body sensation (35.4%). Cicatricial entropion is most commonly found on the upper eyelid (97.5%) with moderate severity. The majority of etiology is unknown but referred to chronic ocular surface inflammation in 51 eyelids (64.6%). Combined procedures were performed in most of the eyelids (79.5%). Conclusion: It is imperative that combined procedures be carried out in a moderate-severe degree cicatricial entropion. In our current study, recurrence mostly happen in patients suffering from Stevens-Johnson syndrome.

Treatments for Periductal Mastitis: Systematic Review and Meta-Analysis

Introduction: Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high risk of recurrence after treatment. There are many available treatments for PDM, but none is widely accepted. This study aims to evaluate the various treatment failure rates (TFR) of different invasive treatment measures by looking at recurrence and persistence after treatment. In this way, it sets out to inform better clinical decisions in the treatment of PDM. Methods: We searched PubMed, Embase, and Cochrane Library databases for eligible studies about different treatment regimens provided to PDM patients that had been published before October 1, 2019. We included original studies written in English that reported the recurrence and/or persistence rates of each therapy. Outcomes were presented as pooled TFR and 95% CI for the TFR. Results: We included 27 eligible studies involving 1,066 patients in this study. We summarized 4 groups and 10 subgroups of PDM treatments, according to the published studies. Patients treated minimally invasively (group 1) were subdivided into 3 subgroups and pooled TFR were calculated as follows: incision and drainage (n = 73; TFR = 75.6%; 95% CI 27.3–100%), incision alone (n = 74; TFR = 20.1%; 95% CI 0–59.9%), and breast duct irrigation (n = 123; TFR = 19.4%; 95% CI 0–65.0%). Patients treated with a minor excision (excision of the infected tissue and related duct; group 2) were divided into 4 subgroups and pooled TFR were calculated as follows: wound packing alone (n = 127; TFR = 2.1%; 95% CI 0–5.2%), primary closure alone (n = 66; TFR = 37.1%; 95% CI 9.5–64.8%), primary closure under antibiotic treatment cover (n = 55; TFR = 4.8%; 95% CI 0–11.4%) , and additional nipple part removal (n = 232; TFR = 9.6%; 95% CI 5.8–13.4%). Patients treated with a major excision (excision of the infected tissue and the major duct; group 3) included the following 2 subgroups: patients treated with a circumareolar incision (n = 142; TFR = 7.5%; 95% CI 0.4–14.7%) and patients treated with a radial incision of the breast (n = 78; TFR = 0.6%; 95% CI 0–3.6%). Group 4 contained patients receiving different major plastic surgeries. The pooled TFR of this group (n = 86) was 3.4% (95% CI 0–7.5%). Conclusion: Breast duct irrigation, which is the most minimally invasive of all of the treatment options, seemed to yield good outcomes and may be the first-line treatment for PDM patients. Minor excision methods, except for primary closure alone, might be enough for most PDM patients. Major excision, especially with radial incision, was a highly effective salvage therapy. The major plastic surgery technique was also acceptable as an alternative treatment for patients with large lesions and concerns about breast appearance. Incision and drainage and minor excision with primary closure alone should be avoided for PDM patients. Further research is still needed to better understand the etiology and pathogenesis of PDM and explore more effective treatments for this disease.

Expanding the Horizon: Single-port Robotic Vascularized Omentum Lymphatic Transplant.

Summary:Vascularized omentum lymphatic transplant is frequently used for the treatment of lymphedema due to demonstrated efficacy, a reduced complication profile, and, in particular, negligible risk of donor site lymphedema. Historically harvested by open laparotomy, more recent techniques involve laparoscopic omental harvest. Although effective and reproducible, laparoscopy may be limited by reduced visualization, minimal tactile feedback, multiple port sites, and imprecise instrumentation. Therefore, we employed the da Vinci Single-Port (SP) surgical robot system for vascularized omentum lymphatic transplant. A 52-year-old man with a 3-year history of progressive left lower extremity swelling and lymphoscintigraphy and magnetic resonance lymphangiogram consistent with lymphedema of unknown etiology underwent vascularized omentum lymphatic transplant to the left groin. A 2.5-cm infraumbilical incision was used for placement of the primary trocar, through which the camera and operating instruments were passed. Following robotic harvest, the omental lymph node flap was transferred to the left groin for microsurgical anastomosis. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6 weeks, there were no complications. Here, we show for the first time the safety and feasibility of robotic omental lymph node flap harvest for extremity lymphedema using the da Vinci Single-Port robotic system. The benefits of this technology include a minimally-invasive approach that allows for flap dissection and removal through a single 2.5-cm incision. Further investigation is necessary to characterize the indications and limitations of this technique in plastic surgery.

Summary of the Experience in the Diagnosis and Treatment of Complex Preauricular Fistulas in 78 Children.

Objective: This study aimed to investigate the application of mini-incisions in complex preauricular fistula resection in children.Methods: A total of 78 children who were diagnosed with preauricular fistula infection between January 2017 and December 2019 were included in the study. Their clinical data were analyzed retrospectively, and surgical treatment with mini-incisions based on plastic surgery principles and techniques was provided.Results: All the patients achieved healing following the first application of the treatment. The patients were followed up for 6–42 months, and no recurrence or local auricular deformation occurred.Conclusion: The application of mini-incisions and plastic surgery techniques in complex preauricular fistula resection in children can achieve a good effect and improve the satisfaction of the children and their parents.