Abstract

Topical antiaging therapies provide noninvasive delivery of active therapeutics. Exosomes, or extracellular nanovesicles, and peptides, small strings of amino acids, have shown promise as topical therapies in early trials, but neither is FDA approved. This review aims to elucidate the current and future landscape of topical exosomes and peptides as therapeutics for skin rejuvenation. A literature search was conducted using the keywords “peptides” OR “exosomes” AND “skin” OR “rejuvenation.” Primary endpoints included mechanisms of action in humans or live animals as well as clinical data supporting the use of exosomes or peptides topically for skin rejuvenation or wound healing. Secondary endpoints were safety, side effects, and efficacy. The articles were collected, organized, and sorted using the Covidence software (Melbourne, Australia) for systematic review. Nine articles evaluating topical application of exosomes and 9 of peptides met inclusion criteria. Topical exosomes were found to increase collagen deposition, accelerate wound healing, and improve overall cosmesis. Several clinical trials are currently underway. Topical peptides were found to improve appearance of fine lines and wrinkles, elasticity and viscoelasticity, skin texture, skin thickness, and the potential for accelerated wound healing. Peptides are quite common in “cosmeceutical” products, and several patents have been filed for topical peptide products aimed at increasing skin rejuvenation. This could indicate a movement toward pursuing FDA approval. The future of topical exosome and peptide products for the purpose of skin rejuvenation appears promising. Preliminary data from the studies reviewed here indicates that these products have the potential to be safe and effective.

Abstract

Social media has been demonstrated to serve as a critical tool for plastic surgeons, facilitating patient engagement, peer-to-peer education and learning, and outreach to the broader public community. This study aims to perform a meta-analysis of data to determine the most valuable and useful social media platforms for practicing plastic surgeons developing their practice by assessing the perceived value to the practice and quantifying return on investment. A systematic review was performed using PubMed (National Institutes of Health, Bethesda, MD). The initial search yielded 3592 articles. Sixteen articles met inclusion and exclusion criteria. It was found that patients are more likely to engage with aesthetic content rather than scientific content. Younger generations are more likely to utilize Instagram (Meta, Menlo Park, CA), Snapchat (Santa Monica, CA), and TikTok (Culver City, CA), while older generations may be more likely to utilize Facebook (Meta, Menlo Park, CA) and YouTube (San Bruno, CA). Age-specific recommendations include utilizing Instagram, Snapchat, and TikTok with emphasis on breast augmentation for patients aged 17 and 35 given this is the most common procedure performed for this age group. Patients between the ages of 36 and 70 are most likely to be engaged on Facebook, Instagram, and Facebook with liposuction being the most common procedure in this age group. For ages 70+, patients are most likely to utilize Facebook with the most common procedure performed as blepharoplasty. Effective social media marketing for the plastic surgeon considers delivering the right content and choosing the right platform. The right content and platform are critically dependent on the specific age of the audience.

Link to article here.

Abstract

Biosynthetic mesh has become more popular for immediate breast cancer implant-based reconstruction as an alternative to acellular dermal matrix (ADM) for soft tissue support. This meta-analysis investigates the various biosynthetic options available as well as complications and outcomes. PubMed, MEDLINE, and Embase were systematically reviewed for studies investigating the following types of mesh, TIGR, Vicryl, PDO, TiLOOP, Durasorb, and Galaflex, and their associated outcomes. The meta-analysis was completed in accordance with PRISMA guidelines and was performed to determine overall complication rates in patients who underwent breast reconstruction with the use of mesh. Data were combined by a pooling of proportional outcomes as inherent to meta-analysis. Heterogeneity of included studies was assessed with the Q and I2 statistical analysis. A total of 24 studies investigating six different types of mesh in 2167 individual breasts undergoing implant reconstruction were included. Summary effect sizes were calculated for the complications. The pooled rate of seroma formation was 5.26% (Q = 23.81%, I2 = 37.01%) reported in 13 studies, hematoma formation was 2.5% (Q = 0.25%, I2 = 58.27%) reported in 9 studies, skin necrosis was 5.5% (Q =2.86%, I2 = 423.78%) reported in 10 studies, infection rate was 4.8% (Q = 6.02%, I2 = 149.34%) in 21 studies, and implant loss was 3.85% (Q = 6.55%, I2 =129.07%) reported in 10 studies. Overall, while differences in mesh characteristics exist, the reported rate of complications is low. Biosynthetic mesh options should be taken into consideration in breast reconstruction given their demonstrated safety, significant cost advantage, and potential decrease in short-term complications in comparison to acellular dermal matrices.

Abstract

Current trends in breast reconstruction demonstrate that a majority of reconstructive procedures are now favoring alloplastic or implant-based approaches. Recent research on alloplastic reconstruction indicates that it may be safely performed in a one-stage, direct-to-implant procedure after mastectomy. This study ultimately aims to evaluate how the rates of complications requiring readmission or unplanned surgery differ among patients who were discharged on the same day as their mastectomy followed by reconstruction compared to those admitted overnight following their procedures. Retrospective analysis of patients that underwent immediate alloplastic breast reconstruction between 2011 and 2021 at Emory University Hospitals was conducted. Patient demographic features, surgical technique (laterality, one vs. two-step reconstruction), and surgical outcomes (complication type, complication frequency) were considered. Of 657 patients that underwent immediate alloplastic breast reconstruction, 559 (85%) patients were discharged following overnight admission, and 98 (15%) patients were discharged on the same day. Analysis of patient characteristics revealed no significant differences in age (p = 0.4937), BMI (p = 0.8607), hypertension (p = 0.7103), diabetes mellitus (p = 0.8271), or active tobacco use (p = 0.1818). Between same-day discharge and overnight admission cohorts, there was no significant difference in rates of overall complications (p = 0.2517), major complications (p = 0.8222), or minor complications (p = 0.3908). Complications included rates of hematoma (p > 0.9999), seroma (p > 0.9999), major (p = 0.7923) and minor (p > 0.9999) infection, major (p > 0.9999) and minor delayed wound healing (p = 0.7034, and implant/expander loss (p = 0.4768). This study presents evidence that same-day discharge following mastectomy and breast reconstruction is a safe option, associated with statistically comparable rates of complication as overnight discharges. However, patient education in the preoperative period is critical to its successful implementation and realization of healthcare savings.

Abstract

Plastic surgery has recently seen a significant rise in the adoption of artificial intelligence (AI) and machine learning (ML), aligning with broader trends across the medical field. These technologies aim to enhance surgical efficiency, optimize treatment planning, predict post-surgical aesthetic results, streamline patient management, and improve overall surgical decision-making. However, the integration of AI/ML into clinical practice presents ethical and practical challenges, including concerns about transparency, data bias, and security. The regulation and approval of AI/ML technologies, much like other medical devices, remain complex and continuously evolving. The US FDA has been proactive in addressing these challenges, developing specific frameworks for AI- and/or ML-based devices.

Abstract

The procedure with the highest rate of opioid prescription in plastic surgery is abdominoplasty. Additionally, plastic surgery patients are at a particularly elevated risk of becoming opioid-dependent. The main objective of this study was to perform a systematic review and create an algorithm for a multimodal pain regimen specific to patients undergoing abdominoplasty. A systematic search of the research literature was performed to summarize the prevailing understanding of multimodal pain control in the management of abdominoplasty. The initial search yielded 448 articles. Sixty-eight manuscripts were identified for full-text review. The effectiveness of current strategies was evaluated by way of pain scores, opioid usage, and length of stay, as well as other measures of physical function such as time to early mobilization. In 32 studies involving 2451 patients, the efficacy of different pain regimens during abdominoplasty was evaluated. Among nontraditional, opioid-sparing analgesia, efficacy of treatment interventions for improved pain and decreased opioid usage was found inall studies. Among local infusion studies, efficacy of treatment interventions for improved pain and decreased opioid usage was found in 78% of studies. Last, among regional block studies, efficacy of treatment interventions for improved pain was found in 87%, with 73% efficacy for decreased opioid usage. Multimodal pain regimens in abdominoplasty have the potential to play an important role in opioid-sparing practices in medicine by incorporating nonopioid pain adjuvants such as nonsteroidal anti-inflammatory drugs and transversus abdominis plane blocks in the preoperative, perioperative, and postoperative periods.

Abstract

In patients who require complex abdominal wall reconstruction (CAWR), the need for a bowel anastomosis could impact procedure choice and outcome. In this retrospective cohort study, we examine the effect of bowel anastomosis on complications and hernia recurrence. All patients who underwent CAWR between 2011 and 2021 by the senior author were reviewed in a retrospective cohort analysis. Patients were included if they met the above criteria. Patients were excluded if they did not undergo the above procedure or if they underwent a different procedure simultaneously. Univariate analysis was performed for patients who underwent bowel anastomosis, and multiple variable logistic regression analysis was performed with respect to overall complications. A total of 264 patients underwent CAWR over a 10-year interval. A total of 41 patients underwent bowel anastomosis (16%), and 223 patients (84%) underwent CAWR without bowel anastomosis. Mean patient age was 55.50 ± 11.55 years. Mean patient body mass index was 32.36 ± 7.31 kg/m ² . Mean follow-up time was 10.20 months. There was a significant difference in hernia repair etiology, with higher rates of recurrent hernia repair among patients receiving bowel anastomosis (odds ratio, 2.98; 95% confidence interval, 1.49–5.95; P = 0.0018). Acellular dermal matrix was used more frequently in patients who required a bowel anastomosis (odds ratio, 3.74; 95% confidence interval, 1.75–8.00; P = 0.0018). Major and minor complications were also significantly higher in this cohort. Regression analysis for overall complications revealed the presence of bowel anastomosis, fascial repair technique, and follow-up time as independent predictors of overall complications. Bowel anastomosis performed at the time of CAWR significantly increased the rate of overall and major complications but did not predict hernia recurrence. Plastic surgeons should utilize this information in counseling patients and in deciding the most appropriate hernia repair technique.

Abstract

Hematoma formation after blepharoplasty is serious and potentially vision-threatening, with hypertension being the primary risk factor. The aim of this paper is to assess perioperative blood pressure trends and rates of complication in patients undergoing a strict blood pressure protocol designed to keep perioperative systolic blood pressure below 120 mmHg. A retrospective chart review was performed of 32 patients undergoing face lift with conomitant blepharoplasty from January 2015 to July 2018. For each patient blood pressure readings obtained before, during, and after surgery were reviewed. Two-sample one-tail T-tests were performed, and p values less than 0.05 were considered statistically significant. The mean systolic blood pressure (SBP) for all patients was highest intraoperatively. Patients with known hypertension had higher mean SBPs than patients without hypertension across all phases of care, with a statistically significant difference in immediate preoperative SBP (p=0.05). Males had a higher average blood pressure immediately postoperatively (p=0.05). A previous diagnosis of hypertension in females was associated with a higher immediate preoperative SBP (p=0.07) as well as age over 65 (p=0.07). The overall rate of complications was 37.5%. No patients experienced hematoma. This study demonstrated that keeping blood pressure below 120 mmHg after surgery was an effective method of preventing hematoma after blepharoplasty, even in patients concurrently on anti-coagulative medications. Special attention to blood pressure control should be shown to patients with known risk factors such as a previous diagnosis of hypertension, male sex, or age greater than 65.

Abstract

Reduction mammaplasty relieves macromastia symptoms while improving breast aesthetics, although the ideal breast aesthetically has been shown to differ culturally in previous crowdsourcing studies. Better understanding these differences can aid in setting postoperative expectations. The aim of this study was to characterize the ideal reduction mammaplasty according to demographics such as gender, ethnicity, socioeconomic status, and education. A crowdsourcing platform was utilized to collect 10,169 deidentified responses. Users completed 1 of 3 surveys, either a preoperative, postoperative, or preoperative and postoperative paired survey. The preoperative and postoperative surveys addressed 10 breast measurements, including upper breast slope, projection proportion, nipple position, breast width, and breast fullness. The paired preoperative and postoperative survey assessed the nipple-areola complex (NAC), chest fit, symmetry improvement, and scarring. Preoperative images were rated more aesthetic than postoperative images. This was consistent across all demographics evaluated. Females, African Americans, Asians, participants ages 55+, and participants with no high school degree or a graduate degree found the most improvement in breast symmetry (P = .001, P = .002, P = .027, P < .001, P = .01). Male and Hispanic participants were most likely to see no change in symmetry (P = .008, P = .04), and South Asian participants found breasts less symmetric postoperatively (P < .001). There were significant demographic differences in aesthetic ratings of the NAC, scarring, and breast fit. Perceived breast aesthetics after reduction mammaplasty vary significantly across demographics, including gender, ethnicity, age, socioeconomic status, and educational achievement. Surgeons should consider demographics when planning each patient's reduction mammaplasty.

Abstract

Reduction mammoplasty is a common reconstructive and esthetic procedure with variable long-term outcomes regarding breast shape, projection, and nipple–areolar complex. One common complaint is recurrent breast ptosis, which may be mitigated by sufficient support of the inferior pole. This review will look at the effects of mesh in mitigating postoperative ptosis following reduction mammoplasty. A comprehensive review of the literature was performed using the PubMed database. Manuscripts that provided data with respect to the effects of mesh on cosmetic outcomes, patient-reported outcomes, complications, and surveillance were utilized. Six studies with a total of 634 patients were included in this review. There is limited evidence to support a cosmetic benefit with the use of mesh in reduction mammoplasty patients. While subjective satisfaction was demonstrated in one paper, few others had objective measurements of the impact of mesh. Complications included infection, skin necrosis, and loss of nipple sensation. Mammography was found to not be affected by mesh placement. The use of mesh during reduction mammoplasty is a relatively modern innovation that does not appear to have a significantly different risk profile than that of traditional reduction procedures. There is limited cosmetic value based on currently available data. More objective future analysis is necessary in order to justify the use of mesh in reduction mammoplasty for its claimed cosmetic benefits. This journal requires that authors assign a level of evidence to each article.

Abstract

Cellulite is a common esthetic concern affecting most women. Despite its prevalence, there is no consensus on the optimal treatment approach for cellulite, partly due to the complex and multifactorial nature of its pathophysiology. Understanding the underlying biological processes along with available treatment options is important to be able to effectively counsel patients on effective management of this condition. This review aims to focus on high-quality evidence behind pathophysiology of cellulite, severity and grading, and its available treatment options. A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to pathophysiology, grading scales, and applications of treatment options were utilized. Using the existing CSS classification, an evidence-based algorithm is proposed for treatment of cellulite. Mild cellulite is best served with lifestyle modifications such as healthy diet, hydration, and exercise. Use of topicals in mild cellulite patients as adjuncts to lifestyle modifications have the highest efficacy, although there are inconsistent data on topical treatments. Moderate cellulite is best targeted with noninvasive treatment options including laser therapy, radiofrequency, and ultrasound. Radiofrequency demonstrates the strongest efficacy in the current peer-reviewed literature. Severe cellulite is recommended to be treated with minimally invasive approaches such as subcision and injectables. Cellulite is a challenging cosmetic problem to treat, and thus multimodal treatment options should be considered in an attempt to achieve optimal outcomes and patient satisfaction. As the pathophysiology of cellulite is further elucidated, more targeted treatments may be developed in the future. This journal requires that authors assign a level of evidence to each article.

Abstract

Since the initial invention of microneedling, advancements have been made to improve the desired effects. The addition of radiofrequency to microneedling devices was developed within the past decade as a way to induce thermal injury and increase dermal heating to enhance the dermal wound healing cascade. With an overabundance of literature and mainstream media focused on microneedling and radiofrequency microneedling, this review aims to focus on the available high-quality evidence. A comprehensive review of the literature was performed across PubMed and Embase databases. Attention was focused on manuscripts that provided objective data with respect to clinical application, innovation, anatomy, and physiology. Optimal outcomes are achieved when needle depth is targeted to the reticular dermis. Needle depth should reflect the relative differences in epidermal and dermal thickness throughout the face. A depth of at least 1.5 mm should be used for the forehead and temporal skin, 1.0 mm for the malar region, 2.0 mm (maximum depth for radiofrequency microneedling) for the nasal side walls, 0.5 mm for the perioral skin, and 1.5 mm for the neck. Deeper settings can be used with care to provide some fat reduction in the submentum. The authors find herein that radiofrequency microneedling is a safe adjunctive tool to surgical aesthetic procedures. The addition of radiofrequency poses an advance over traditional microneedling devices for skin tightening with improvements in both safety and efficacy over time.

Abstract

There are many functional and aesthetic benefits to lipoabdominoplasty (combination of liposuction with abdominoplasty), including increase in core strength, reduction in urinary incontinence, and improvement in lower back pain. However, patients are still hesitant to undergo surgery due to the perceived fears of postsurgical drains, and postoperative pain. To propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve postoperative pain control. A total of 80 patients operated on between July 2020 and December 2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized preoperative, intraoperative, and postoperative pain regimen. Pain scores were measured across all patients in the immediate postoperative period, and postoperative days (PODs) 1, 7, 28, and 90. Mean pain scores in the postanesthesia recovery unit were 0.46/10 (+/− 0.18). Subsequent reassessment in the postop recovery suite yielded mean pain scores of 0.34 (+/− 0.15). Mean pain scores on POD1 were 1.23 (+/− 0.15) and consistent through to POD7 at 1.24 (+/− 0.11) with patients taking an average of 6.65 total Percocet 5 mg (Endo Pharmaceuticals Inc., Malvern, PA) during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory drugs. A total of 75/80 patients (93.75%) reported zero pain at 4 to 6 weeks after surgery (mean pain score 0.10 +/− 0.08). The multimodal analgesia protocol consisting of preoperative or immediate induction intravenous Tylenol (Johnson & Johnson, New Brunswick, NJ), precut local analgesia with Marcaine (Pfizer Inc., New York, NY) and lidocaine, and intraoperative use of liposomal bupivacaine can improve perioperative pain control in patients undergoing

Abstract

As we enter a new year, this article serves as an opportunity to ponder on the impact of a worldwide pandemic on physicians and the field of plastic surgery, which began 4 years ago in January 2020. When looking at the data in the general-surgery and reconstructive literature, the surgical treatment of patients with COVID-19 appears safest 8 weeks after infection. It was also found that the so-called Zoom-boom crush of cosmetic surgery cases following pandemic lockdown appeared to be largely due to a backlog of cases. Cosmetic surgery, particularly facial cosmetic surgery, continues to increase in popularity year over year. However, the effects on plastic surgery training remain unclear. Even so, those affected by the pandemic seem more driven than ever to find job stability and security.

Abstract

Advances in face and neck lifting involve release of tethering points along the superficial musculoaponeurotic system–platysma complex to freely manipulate the deep natural glide plane in the face and neck. The aim of this article was to determine a combination of deep plane techniques for addressing the face and neck and to elucidate, for the first time, a measurable endpoint for the gonial angle. Analysis of deep plane tethering and decussation zones was also undertaken. Methods Extended deep plane surgery performed in 79 patients (158 hemifaces; age, 30-75 years; 95% female), over a 3-month period, was reviewed. Patients were followed for 1 year. Measurements were performed systematically during deep plane face and neck lifting. Before intervention, the mean [standard deviation] gonial depth was 9.4 [3.6] mm on the left and 8.3 [2.7] mm on the right. The mean depth created below the gonial angle when measuring the traditional suspension to the anterior mastoid was 15.8 [3.3] mm on the left and 13.7 [2.5] mm on the right. The distance postoperatively when measuring the gonial depth after performing the crevasse technique was 23.2 [2.2] mm on the left and 22.5 [2.5] mm on the right. This represents a mean increase in the advancement of 7.4 mm on the left and 8.8 mm on the right (average, 8.1 mm) which was demonstrated to be statistically significant bilaterally (P < .0001). The deep plane techniques described here aid manipulation of the deep plane and deep neck space, while also providing measurable endpoints and more effective modes of fixation by utilizing the mastoid crevasse. The use of techniques that release tension and allow redrape produce the most natural and well-balanced results.

Abstract

Lower blepharoplasty is one of the most commonly performed facial plastic surgeries and can be approached through many different techniques to improve perceived aging and fatigue due to prominent eyelid fat pads, deep tear troughs, loose eyelid skin, and global periorbital deflation. The technique discussed herein is a personal approach to lower eyelid rejuvenation surgery by the senior author, focusing on volume preservation with conservative resection and transposition of lower eyelid fat pads, muscle preservation, and microfat grafting. The authors discuss a series of 80 patients with case examples and a technique video.

Abstract

The effect of immediate implant and autologous breast reconstruction on complication rates has been studied extensively; however, the patient-reported outcomes for these procedures during immediate, one-stage reconstruction has yet to be comprehensively investigated. This study compared the patient-reported outcomes for immediate implant reconstruction with those associated with immediate autologous reconstruction to determine the advantages and disadvantages for each modality from the patient's perspective. A literature search of PubMed between 2010 and 2021 was performed, and 21 studies containing patient-reported outcomes were selected for the analysis. A meta-analysis of patient-reported outcome scores was performed separately for immediate breast reconstruction using autologous tissue transfer and synthetic implants. Results: Nineteen manuscripts were included, representing data on a total of 1342 patients across all studies. The pooled mean of patients' satisfaction with their breasts was 70.7 (95% CI, 69.4-72.0) after immediate autologous reconstruction and 68.5 (95% CI, 67.1-69.9) after immediate implant reconstruction, showing a statistically significant difference in outcomes (p < 0.05). The pooled mean of patients' sexual well-being was 59.3 (95% CI, 57.8-60.8) after immediate autologous reconstruction and 62.8 (95% CI, 60.7-64.8) after immediate implant reconstruction (p < 0.01). The pooled mean of patients' satisfaction with their outcome was 78.8 (95% CI, 76.2-81.3) after immediate autologous reconstruction and 82.3 (95% CI, 80.4-84.1) after immediate implant reconstruction (p < 0.05). The results of each meta-analysis were summarized on forest plots depicting the distribution of patient-reported outcome scores from each study. Immediate reconstruction with implants may have a similar or greater capacity to achieve patient satisfaction and improve patients' QoL compared to those associated with immediate reconstruction with autologous tissue transfer when both procedures are available.

Abstract

Breast augmentation procedures are one of the most commonly performed aesthetic procedures in the United States. Little work has focused on the general public's overall perception of the ideal breast or has validated them with patient photographs. To validate crowdsourced perceptions of breasts with their alignment to the aesthetics of breast augmentation patients. A prospective cross-sectional study was performed using participants enrolled through the AmazonMechanical Turk crowdsourcing platform (Amazon Web Services, Amazon, Seattle, WA) to obtain participant opinions ofhow closely patient breasts aligned with previously obtained results of 4 ideal breast characteristics. Outcomes were reported based on the correlation between breast attractiveness and alignment to ideal breast characteristics, both before and after breast implant procedures. 2306 responses from 737 participants reported patient photograph alignment with ideal breast projection proportion (1.0) as having the highest correlation to opinions of heightened aesthetic beauty (R = 0.98, P < 0.001), and ideal nipple direction (front) as having the lowest correlation to aesthetic beauty (R = 0.90, P < 0.001). Younger age groups (18-24) and participants with a high school diploma or less rated patients as less attractive, while married and wealthy individuals reported higher attraction levels. Crowdsourcing can be a useful tool for aesthetic surgery preferences and has helped reveal key takeaways. The importance of the 4 breast characteristics has been validated, with alignment to all 4 characteristics tested having a high correlation to preferences. Differences in preference across demographic groups are a topic to further investigate.

Abstract

Lymphedema is a severe debilitating disease characterized by the accumulation of excessive protein-rich fluid in the interstitial space. Given the severe morbidity associated with this disease process, various surgical and nonsurgical treatment modalities have been developed to attempt to reduce the incidence and symptoms associated with lymphedema. Manual lymphatic drainage (MLD) is a component of complete decongestive therapy on-surgical treatment which has demonstrated benefit in reducing the development of lymphedema following surgery. Here we provide a review of literature on MLD and its potential mechanism of action. This paper aims to educate patients, physicians, and surgeons about MLD regarding its efficacy and utility in the treatment paradigm for lymphedema and to translate concepts from the treatment of lymphedema to cosmetic procedures.

Abstract

A paucity of evidence currently exists regarding factors affecting the success of lower extremity reconstruction at restoring a functional limb. We aim to determine the effect of foot fracture on outcome measures of ambulatory success after lower extremity salvage in a trauma population. A retrospective chart review was performed on 63 patients presenting to an urban level 1 trauma center between 01/2007 and 01/2015 who received soft tissue coverage of a lower extremity traumatic wound. Demographics, injury, and perioperative data were recorded. Patients were administered the Lower Extremity Functional Scale (LEFS) questionnaire via phone. The LEFS is out of 80 possible points. Ambulatory success is measured on a scale of 0 to 4 across 20 activities, with 0 indicating “extreme difficulty or inability to perform activity”, and 4 indicating “no difficulty”. Functional outcomes were compared using a two-tailed two-sample unequal variances t-test. This study represents data on the 63 unique patients treated with vascularized flaps whom we attempted to contact. A total of 21 patients completed the LEFS questionnaire, representing an overall response rate of 33%. Responders to the surveys included 4 (19%) patients with foot fractures and 17 (81%) without foot fractures. Average total LEFS scores were significantly lower in patients with foot fractures (23.8 ± 5.9) than in patients without (36.2 ± 19.2) foot fractures (p = 0.04). With respect to the SF36 functional scale, patients with foot fractures paradoxically reported significantly higher measures of physical functioning (81 ± 11) in comparison to those without a foot fracture (59 ± 25) at a p-value of 0.02, and role limitation due to physical health (98 ± 3) versus those with no foot fracture (74 ± 37) at a p-value of 0.02. Sustaining a foot fracture during severe traumatic injury that necessitates lower extremity reconstruction may result in significantly decreased ambulatory success scores. Fractures of the foot may predict poor patient reported functional outcomes following lower extremity reconstruction and should be considered as a factor in the pre-operative risk and benefit assessment when deciding whether to attempt reconstruction of the mangled limb.

Abstract

Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients. A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates. Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies. Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.

Abstract

There are many functional and aesthetic benefits to lipoabdominoplasty (combination liposuction with abdominoplasty), including increase in core strength, reduction in urinary incontinence, and improvement in lower back pain. However, patients are still hesitant to undergo surgery due to the perceived fears of post-surgical drains, and post-operative pain. Objectives Propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve post-operative pain control. A total of 80 patients operated on between July 2020 and December 2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized pre-, intra-, and post-operative pain regimen. Pain scores were measured across all patients in the immediate post-operative period, and post-operative days 1, 7, 28, and 90. Mean pain scores in the post-anesthesia recovery unit were 0.46/10 (+/- 0.18). Subsequent reassessment in the post-op recovery suite yielded mean pain scores of 0.34 (+/- 0.15). Mean pain scores on POD1 were 1.23 (+/- 0.15), and consistent through to postoperative day 7 (POD7) at 1.24 (+/- 0.11) with patients taking an average of 6.65 total Percocet 5mg during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory medications medications. A total of 75/80 patients (93.75%) reported zero pain at 4-6 weeks after surgery (mean pain score 0.10 +/- 0.08). The multimodal analgesia protocol consisting of preoperative or immediate induction IV Tylenol, precut local analgesia with marcaine and lidocaine, and intraoperative use of liposomal bupivacaine, can improve perioperative pain control in patients undergoing lipoabdominoplasty.

Abstract

Oncoplastic breast reconstruction has improved esthetic results after breast‐conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection‐to‐breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.

Abstract

In this review, a summary of the rich history of autologous fat grafting is provided, and a comprehensive summary of the science and theory behind autologous adipocyte transplantation, as well as the techniques commonly used is described. These include recipient site preparation, harvesting, processing, and engraftment. In addition, important considerations for preoperative and postoperative management are discussed to maximize graft retention. Special considerations in grafting to the breast, face, and buttocks are also summarized.

Abstract

Approximately one-third of men develop erectile dysfunction after radical prostatectomy. Microsurgical grafts of various nerves have been shown to successfully correct neurogenic erectile dysfunction (nED). However, little is known about the anatomic variations of these nerves in the exploration of nerve transfer to avoid using a graft. This study seeks to identify structural, topographic, and distributional variations in humans of the ilioinguinal and genitofemoral nerves, as well as to identify the best candidates for end-to-end neurorrhaphy in patients with sensory or parasympathetic penile dysfunction, with a single coaptation reducing axonal dropout. Three adult male cadavers were obtained from the USC Keck School of Medicine fresh tissue cadaver lab. The diameter, length, and number of sensory branches of the left ilioinguinal, genitofemoral, and dorsal nerve of the penis were assessed in each cadaver. Distance from sensory branch points of the ilioinguinal and genitofemoral nerves to the base of the dorsal nerve of the penis and to the cavernous plexus of the prostate were also measured. The genitofemoral nerve (1.8 mm) was found to be larger in diameter than the ilioinguinal (0.9 mm) in all cadavers (p > 0.05). Mean distance to the dorsal nerve of the penis measured 8.0 cm, and 6.6 cm to the cavernous plexus. The dorsal nerve of the penis demonstrated an average of 3.3 sensory branches, with mean diameter of 1.6 mm. The average diameter of the dorsal nerve of the penis proper measured 3.7 mm across cadavers. The genitofemoral and ilioinguinal nerves have been identified as potential candidates for end-to-end neurorrhaphy to the dorsal nerve of the penis in the setting of neurogenic erectile dysfunction, with the aim at avoiding nerve grafting.

Abstract

Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, superficial musculoaponeurotic system (SMAS) manipulation, by way of plication, overlap, or SMASectomy, is common and has been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique. Objectives To assess the benefits and risks of the SMASectomy technique. The records of all patients who underwent a facelift procedure between December 2004 and March 2019 were reviewed for this study. All procedures were performed at an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited outpatient facility in Marina Del Rey, California. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications. Average operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes were observed among those patients who underwent SMASectomy. This was significantly lower (P < 0.000001) than those who did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients who underwent SMASectomy. No deep vein thrombosis (DVT) events were observed in this patient population. In the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results.

Abstract

Primary surgical management of carpal tunnel syndrome (CTS) is performed using an open or endoscopic technique. This study aimed to gather data on public perception of the cost, recovery, and associated potential complications of these two techniques. Participants were recruited using Amazon Mechanical Turk (MTurk©) and presented with a series of scenarios regarding open or endoscopic carpal tunnel release. Scenarios involved cost differential, duration of recovery, surgical technique, and potential complications following surgery. Participants were asked to provide a utility score between 0 and 100, with 0 representing the equivalent of death and 100 representing the participant feeling they were in perfect health. A total of 410 participants completed the survey. Participant demographic data included average age of 37.78 (range 18–78), 62.4% female participants, 83.4% right-handed, 78.7% worked full- or part-time jobs, and 56.5% would be unable to complete their work with one hand immobilized. Participants favored endoscopic versus open surgery in both dominant and non-dominant hands (p < 0.0001). However, they viewed temporary paresthesia from endoscopic surgery less favorably to significant surgical site tenderness in open carpal tunnel release in both dominant and non-dominant hands (p < 0.0001). When considering cost, recovery duration, and technical ability required by the surgeon, patients prefer endoscopic carpal tunnel release over open surgery in both dominant and non-dominant hands. Subgroup analysis suggests that attitudes towards endoscopic versus open carpal tunnel release are not influenced by ability to perform work with the hand immobilized or income level.

Abstract

This case series introduces a novel therapy combining platelet-rich plasma (PRP) with fat grafting to improve hair quality and density in patients with non-scarring alopecia. The treatment builds on the synergistic effects of PRP’s growth signaling and fat grafting’s angiogenic properties, enhancing scalp quality and hair restoration outcomes. Three cases are presented: a female patient with alopecia post-COVID-19 hospitalization and two males with androgenic alopecia. All patients showed improved hair density and quality, with visible growth starting at 4 weeks, peaking at 12 weeks, and sustained through 6 months to 1 year. This approach demonstrates promise over PRP alone but requires further clinical studies for validation.

Abstract

Nipple inversion is a common condition seen in 10% of females. Patients often present with physical insecurities and difficulty breastfeeding and would be best counseled initially by a primary care provider. We examined the body of literature and public perception of nipple inversion to provide a patient-centered perspective of the condition and its repair. We conducted a prospective cross-sectional study surveying random volunteers using internet crowdsourcing. Studies examining the correction of nipple inversion reporting posttreatment recurrence rates were considered for systematic review. Five-hundred three people were surveyed, and 398 (mean age 35.6 years, 57.9% female) were included in final analysis. Seventy-one (17.8%) have or once had nipple inversion, and 18 (31.6% of females with nipple inversion) reported resultant difficulty breastfeeding. One-hundred thirty-five (33.9%) would advise repair, and 283 (71.1%) would advise repair if unable to breastfeed. Two-hundred eighteen (54.8%) would search online for more information about nipple inversion. Forty-four studies, including 1,940 patients and 3,361 nipples, were examined for systematic review. Seven techniques severed lactiferous ducts, and 31.8% reported breastfeeding outcomes, but as a number of patients. Studies were inconsistent in the reporting of baseline patient data and outcomes. Nipple inversion may be more common than previously reported. The majority of people would consider surgical correction, advice someone with nipple inversion to undergo repair for breastfeeding, and consult online resources for more information. Methodological and reporting limitations of existing evidence limit conclusions regarding the superiority of operative techniques with regard to patient satisfaction and breastfeeding outcomes.

Abstract

Immediate post-mastectomy autologous breast reconstruction in breast cancer patients requiring post-mastectomy radiation therapy (PMRT) minimizes the number of operations patients must undergo and alleviates the psychological impact of living without a breast. However, the safety and impact of radiation on the reconstructed breast remains to be established. This study aimed to compare immediate versus delayed autologous reconstruction in the setting of PMRT to determine optimal sequencing of reconstruction and adjuvant radiation. A systematic review of the literature identified 292 studies meeting criteria for full-text review, 44 of which underwent meta-analysis. This represented data on 1,927 immediate reconstruction patients and 1,546 delayed reconstruction patients (3,473 total patients). Early complications included flap loss, fat necrosis, thrombosis, seroma, hematoma, infection, and skin dehiscence. Late complications included fibrosis or contracture, severe asymmetry, hyperpigmentation, and decreased flap volume. Immediate breast reconstruction did not demonstrate significantly increased complication rates. Reported mean complication rates in immediate versus delayed reconstruction groups respectively were fat necrosis 14.91% and 8.12% (p=0.076), flap loss 0.99% and 1.80% (p=0.295), hematoma 1.91% and 1.14% (p=0.247), infection 11.66% and 4.68% (p=0.155), and thrombosis 1.51% and 3.36% (p=0.150). Seroma rates were significantly lower in the immediate cohort at 2.69% versus 10.57% in the delayed cohort (p=0.042). Complication rates are comparable between immediate and delayed breast reconstruction in the setting of PMRT. Given the patient benefits incurred by an immediate reconstruction algorithm, immediate autologous breast reconstruction should be considered as a viable treatment option in patients requiring PMRT.

Abstract

Pediatric thumb hypoplasia is a group of congenital hand disorders encompassing gross underdevelopment or complete lack of a thumb. Index pollicization and toe transfer are both reasonable reconstructive options, and there is no clear consensus if either method provides a more functional or aesthetically pleasing result. Considering the psychological distress associated with poor cosmetic outcomes, aesthetics must be considered when choosing reconstructive method. A survey was generated using images of reconstructed thumbs from published papers and educational websites and posted on Amazon Mechanical Turk asking participants to rate the images on their overall aesthetic appearance, identify aesthetic features, rank thumbs according to what appears most natural, and answer a series of hypothetical functional questions. Responses were stratified by reconstruction type and analyzed with chi-square, two-sample t test, and linear regression analyses. Participants in the study were diverse across age, sex, ethnicity, and education. The average rating of the thumbs was 5.8 for index pollicization and 5.6 for toe transfer, ranging from 3.85–8.34 across both reconstructive types. Index pollicization was significantly associated with being ranked as “most natural” but neither reconstructive type was associated with being ranked as “least natural.” Aesthetic factors, including length, width, nail, and position of thumb significantly affected overall aesthetic score but only accounted for around 30% of the variation in overall score. There was no significant difference in response to hypothetical functional scenarios based on reconstructive type or dominant vs. non-dominant hand. Limitations of this study include the lack of granularity in crowdsourcing data and the lack of photographic standardization of the thumbs included in the survey. Reconstructive method should continue to be selected on an individual basis based on individual anatomy.

Abstract

This study validates the assessment of aesthetic outcomes in web-space reconstruction for finger syndactyly using the Yuan Grading Scale and crowdsourced public perceptions. A survey was conducted with internet volunteers to evaluate the aesthetic appearance of dorsal flaps using a visual analog scale (VAS) and categorical grading. Results showed a strong correlation between higher VAS scores and higher categorical grades, with excellent dorsal flaps receiving significantly higher scores. This validation supports the Yuan Grading Scale as a reliable tool for evaluating aesthetic outcomes, helping guide future practices to align with patient preferences.

Abstract

This study compares the cost-utility of surgical versus nonsurgical treatments for erectile dysfunction (ED). Using a cost-utility analysis, the study evaluates the costs, outcomes, and quality of life associated with both treatment types. Data were derived from Medicare reimbursement rates, hospital charges, and utility scores from Amazon Mechanical Turk. Results showed that surgical interventions for ED were more cost-effective, with a lower lifetime cost and a higher quality-adjusted life-year (QALY) gain (10.77 years) compared to nonsurgical treatments. The study concludes that surgery offers better value and outcomes for ED patients, while nonsurgical treatments like PDE5 inhibitors are costlier with less clinical benefit.

Abstract

This study evaluates the public’s perception of nonsurgical versus surgical treatments for erectile dysfunction (ED), including novel microsurgical options. A cross-sectional survey was conducted with participants from Amazon Mechanical Turk. Results showed that patients rated microsurgical intervention significantly higher on the visual analog scale (VAS = 74.55) compared to nonsurgical treatments like PDE5 inhibitors (VAS = 52.51), vacuum erection devices (VED) (VAS = 39.77), and penile prosthesis surgery (VAS = 54.82). Many participants were dissatisfied with nonsurgical treatments but were open to considering surgical options. The study suggests that microsurgical interventions should be made more accessible and presented as viable alternatives for ED treatment.

Abstract

This study assessed the U.S. population’s perception and knowledge of COVID-19 and their response behaviors. A cross-sectional survey conducted on March 24, 2020, with 969 participants showed significant differences in perceived severity of the pandemic between age groups and genders. The majority of participants followed CDC guidelines, yet many did not correctly assess their personal risk level, highlighting the need for further public education on the risks associated with the pandemic.

Abstract

This study assessed the incidence of psychological disorders in patients seeking aesthetic rhinoplasty. A cross-sectional survey of 298 participants found that 38.95% of women and 27.78% of men were willing to undergo rhinoplasty, with younger adults (18-24) being more inclined to consider surgery. Additionally, 57.84% of those interested in rhinoplasty reported a psychological disorder, such as major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder. The study highlights the importance of assessing mental health prior to surgery, as underlying psychological issues may lead to unsatisfactory outcomes.

Abstract

This study surveyed 718 participants to assess perceptions of ideal abdominal contours and interest in nonsurgical methods. The results showed that 100% of participants considered a six-pack as the ideal abdominal muscle count. The top two aesthetic features were symmetry (61.06 ± 1.87) and natural feel (60.72 ± 1.75). Participants who exercised more than twice a week were significantly more interested in nonsurgical procedures (P = 0.007). The study concluded that ideal abs are symmetric, natural, and consist of six muscles, with fitness enthusiasts and millennials more likely to prefer nonsurgical methods.

Abstract

Subfascial breast augmentation is a technique originally developed to reduce the risks of capsular contracture while decreasing the postoperative pain associated with subpectoral augmentation. It was pioneered in Brazil by Dr. Graf and others, and recently this technique has gained interest in the aesthetic world. A systematic analysis of subfascial breast augmentation was conducted to assess the combined reported rates of capsular contracture, animation deformity, and complications. The PubMed, Embase, and Web of Science databases were searched for studies on the subfascial plane for breast augmentation. A total of 3743 patients across 22 studies were analyzed, with 38 cases of capsular contracture, representing a rate of 1.01%. Several infections were reported, representing a rate of 0.1%. Animation deformity was not reported, though rippling, malrotation, axillary banding, sensory deficit, and asymmetry were occasionally observed. Subfascial breast augmentation appears to have a low complication rate and an extremely low rate of capsular contracture at approximately 1%. This technique may provide the benefits of low rates of capsular contracture while avoiding the discomfort and future animation deformity associated with subpectoral augmentation.

Abstract

The recent discovery of lymphatic vessels in the meningeal layers calls into question the known mechanisms of fluid and macromolecule homeostasis and immunoregulation within the central nervous system. These meningeal lymphatic vessels and their potential role in the pathophysiology of neurological disease have become a rapidly expanding area of research, with the hopes that they may provide a novel therapeutic target in the treatment of many devastating conditions. This article reviews the current state of knowledge surrounding the anatomical structure of the vessels, their functions in fluid and solute transport and immune surveillance, as well as their studied developmental biology, relationship with the novel hypothesized “glymphatic” system, and implications in neurodegenerative disease in animal models. Furthermore, this review summarizes findings from the human studies conducted thus far regarding the presence, anatomy, and drainage patterns of meningeal lymphatic vessels and discusses, from a clinical perspective, advancements in both imaging technologies and interventional methodologies used to access ultrafine peripheral lymphatic vessels.

Abstract

The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated. The authors systematically reviewed the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluated graft survival and satisfaction within specific populations in a meta-analysis. PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed. The pooled rates of graft survival were 84.98% (95% CI 78.90–91.06) using micrografts and 93.11% (95% CI 91.93–94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12–97.20) using micrografts and 86.25% (95% CI 74.00–98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64–96.76) using micrografts and 97.00% (95% CI 92.48–100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59–100.0) using micrografts and 88.70% (95% CI 66.49–100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts. Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates.

Abstract

A systematic review and meta-analysis were conducted to assess the efficacy of greater occipital nerve block in treating chronic migraine headaches. A total of 417 patients across nine studies were analyzed. The intervention significantly reduced the frequency of migraines, with a pooled mean difference of -3.6 headache days per month (95% CI, -1.39 to -5.81 days, p < 0.00001) compared to controls. In addition, the intervention resulted in a significant decrease in headache severity, with a pooled mean difference of -2.2 in pain scores (95% CI, -1.56 to -2.84, p < 0.0121). The findings suggest that greater occipital nerve block should be recommended for migraine patients, especially those who may require surgical intervention.

Abstract

The physical appearance of the face plays a critical role in social interactions, with a direct correlation between a patient’s self-image and the perceptions of others. This can negatively impact self-esteem, leading to anxiety, depression, and social avoidance, which may further exacerbate these conditions. Psychosocial concerns have been identified as potential motivators for seeking esthetic rhinoplasty. Although successful operations can improve quality of life and self-esteem in patients with sound mental health, they may result in unsatisfactory outcomes for those with significant mental health disorders. A cross-sectional study of 298 random volunteers was conducted, with participants completing a 10-item SHNOS scale and a 26-question PRIME-MD questionnaire to assess the functional need for rhinoplasty and the incidence of psychological disorders. Participants were also asked to evaluate their satisfaction with the overall appearance of their nose before and after the survey. Among the participants, 38.95% of women and 27.78% of men were willing to undergo esthetic rhinoplasty. Young adults aged 18-24 were more likely (52.92%) to seek rhinoplasty compared to other age groups. Income also played a significant role, with 47.37% of those earning $50,000–$75,000 annually interested in rhinoplasty, compared to 32.41% of those with incomes under $50,000. Of those interested in rhinoplasty, 57.84% reported a psychological or mental health disorder, such as major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder. These findings indicate that many individuals seeking esthetic rhinoplasty may be experiencing mental health challenges, underscoring the importance of assessing patient mental health before treatment to avoid unsatisfactory outcomes.

Abstract

A retrospective study of 2,032 solid organ transplant recipients (SOTR) between 1993 and 2016 examined rates of skin cancer and dermatoses in a Hispanic-majority population. Of the patients, 52.1% were Hispanic, with 15.5% diagnosed with skin cancer or dermatoses. Skin cancer was found in 16.8% of Hispanics compared to 39.8% in non-Hispanic white (NHW) patients. Squamous cell carcinoma (SCC) was the most common skin cancer in both groups, but Hispanics had fewer cases and were less likely to have multiple skin cancers. Hispanics had a significantly higher rate of fungal infections (28.0%) compared to other groups. The study highlights that Hispanic SOTR face an elevated risk for skin cancer and other dermatoses. However, the results may not be generalizable to all Hispanic populations, and larger prospective studies are needed to better understand racial/ethnic differences in post-transplant skin conditions.

Abstract

Otoplasty, a century-old procedure with over 200 variations, has evolved through continued modifications. This article reviews the anatomy, principles, and key contributions to aesthetic otoplasty, highlighting commonly used techniques and patient outcomes. The treatment of prominent ears has advanced through experimentation, with outcomes influenced by the patient’s anatomy, the surgical technique, and patient-centered goals. Aesthetic otoplasty remains a significant and common procedure in plastic surgery, with an integrated approach to ensure optimal results.

Abstract

Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.

Abstract

Modern approaches to erectile dysfunction (ED) often involve multimodal medical therapy and surgery. Recent advances in microsurgery have introduced new options for patients suffering from ED. This review reevaluates anatomical and physiological principles that mediate erection, aiming to enhance the understanding for reconstructive surgeons exploring new interventions. Various approaches are available to restore nerve function and treat neurogenic and vasculogenic ED. Somatic sensory loss can be addressed through direct neurorrhaphy or neuroplasty, while microvascular techniques can repair damaged small vessels in the pelvis. Classical approaches include vein stripping to reduce venous outflow or direct vascularization to improve inflow. Microsurgical interventions have shown improvements in ED following radical prostatectomy. Continued innovation and collaboration between plastic surgeons and urologists will provide solutions to this common and challenging issue.

Abstract

A cost-utility analysis was performed to assess the most cost-effective treatment for chronic migraines between injection therapy and surgical decompression. Injection therapy offered a minor improvement in quality-adjusted life-years (QALYs) over surgical decompression (QALY Δ = 0.6), but long-term injection therapy was significantly more expensive. The cost of injection treatment was estimated at $106,887.96 more than surgery. The incremental cost-utility ratio in favor of surgical decompression was $178,163.27. Despite a slight QALY deficit, surgical decompression proved to be highly cost-effective. Surgery is a durable solution, and patients requiring injections for less than 8.25 years may not benefit as much from surgical intervention.

Abstract

Anaplastic large-cell lymphoma (ALCL) is a very rare but life-threatening complication that has largely been demonstrated to be associated with breast implants (BIA-ALCL). Patients are at risk of BIA-ALCL with the placement of breast implants for either cosmetic or reconstructive purposes, with the highest risks associated with textured breast implants. In the past decade, an increasing number of publications have focused on BIA-ALCL, but there has yet to be a reported case outside of the breast. Here, we describe a unique instance of gluteal implant-associated ALCL (GIA-ALCL) in a middle-aged woman. The patient received bilateral textured silicone gluteal implants only a year prior to her diagnosis of GIA-ALCL. The patient later presented to the Plastic and Reconstructive Surgery Department at our institution with ulceration at the site of her gluteal implants. Unfortunately, her condition deteriorated before explanation could be performed. Biopsy of a left lung mass demonstrated "hallmark" cells of ALCL ("horseshoe"-shaped nuclei). The diagnosis was verified by immunohistochemical testing that revealed expression of CD30, CD4, CD43, BCL6, Perforin, and Ki67 in a population of abnormal cells. The goals of this case report are thus to demonstrate that all patients undergoing implantation of textured silicone implants are at risk of developing ALCL and to provide evidence for the possible new diagnosis of GIA-ALCL.

Abstract

Migraine headaches affect 15.6% of the U.S. population (approximately 50 million Americans). Individuals aged 35–44 reported the fewest migraines, averaging 2.73 per month, with the lowest severity. In contrast, those aged 45+ experienced the most severe headaches, with a Visual Analog Scale (VAS) score of 44.23 mm. The highest migraine frequency and severity were observed in households with an annual income of $75,000–$100,000. Among treatment options, the lowest utility scores for adverse outcomes from injection therapy were related to hematoma (47.60 mm) and vertigo (54.40 mm). Physicians offering surgical or minimally invasive treatments should address patient concerns regarding clinical outcomes and treatment costs.

Abstract

Common treatment for chronic migraine headaches includes the injection of corticosteroid and anesthetic agents at local trigger sites. However, the effects of therapy are short-term, and lifelong treatment is often necessary. In contrast, surgical decompression of migraine trigger sites accomplishes the same goal and demonstrates successful long-term elimination of chronic migraines. Injection therapy offered a minor incremental benefit in quality-adjusted life-years greater than surgical decompression (QALY Δ = 0.6). However, long-term injection therapy was significantly costlier to society than surgical decompression, with treatment estimated at $106,887.96 greater than the cost of surgery. The results of the cost-utility analysis conferred a positive incremental cost-utility ratio of $178,163.27 in favor of surgical decompression. Surgery provides a durable intervention and has been shown to be extremely cost-effective despite a very minor QALY deficit in comparison to injection therapy. If patients are identified who require treatment in the form of injections for less than 8.25 years, they may fall into a group that should not be offered surgery.

Abstract

Erectile dysfunction (ED) affects 50-60% of men aged 40-70, with physical trauma being a major cause, categorized as vasculogenic, neurogenic, or idiopathic. While many patients do not respond to nonsurgical treatments, few opt for surgery due to procedural complexity and low historical success rates. A review of 19 studies identified promising microsurgical treatments for ED, including microvascular arterial bypass penile revascularization surgery (MABS) and cavernous nerve graft reconstruction using end-to-side ilioinguinal, genitofemoral, and sural grafts, all showing high success rates. Additionally, minimally invasive treatments like botulinum toxin (BoNT-A) and adipose-derived stem cell (ADSC) therapy have shown potential, with BoNT-A advancing to phase II human trials. These novel microsurgical and minimally invasive approaches offer high success rates for patients with neurogenic or vasculogenic ED.

Abstract

Periodontal disease (PD) is associated with obstructive sleep apnea (OSA) by a postulated bidirectional causal-effect relationship of PD and OSA through systemic infl ammation. PD may contribute to OSA through aspiration of periodontal bacterial pathogens into the lungs, causing a decrease in lung function that consequently contributes to OSA. Xerostomia also plays a role in increasing the surface tension of the upper airway lining liquid and resultantly contributes to OSA.

Abstract

A systematic review and meta-analysis assessed the efficacy of greater occipital nerve block for chronic migraine treatment. Nine studies involving 417 patients were included. Results showed a significant reduction in headache frequency, with a pooled mean difference of -3.6 days per month (95% CI: -1.39 to -5.81 days, p < 0.00001). Additionally, pain severity decreased by a pooled mean difference of -2.2 (95% CI: -1.56 to -2.84, p < 0.0121). The findings support greater occipital nerve block as an effective treatment for chronic migraine, especially for patients who may eventually require surgical intervention.

Abstract

Standard of care treatment for H. pylori infection is a multidisciplinary clinical management protocol, merging triple medication therapy with periodontal mechanical removal of biofilm deposits and chemical antiseptic disinfection. A joint coordination between the dentist and the physician is a prerequisite for the success of this treatment regimen.