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INTRODUCTION: Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema. METHODS: Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. RESULTS: A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). CONCLUSION: Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment.
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Background: Nurtec, a versatile migraine medication, has gained popularity. However, the awareness of migraine surgery remains uncertain. Methods: Following a descriptive approach, this cross-sectional study used Google Trends data as of December 1, 2023, to analyze internet search patterns. Approval from Vanderbilt University's institutional review board and adherence to Strengthening the Reporting of Observational Studies in Epidemiology guidelines were confirmed. Monthly relative search volume (RSV) data for "migraine surgery," "Nurtec," and "Rimegepant" were collected from January 1, 2004, to November 11, 2023, within the United States. Statistical analysis involved determining mean monthly RSV values and percentage changes for critical periods. Results: For "Nurtec," a significant surge in RSV occurred from March 2020 to April 2020 (344%). Additional peaks were observed from June 2020 to July 2020 (66%), October 2020 to December 2020 (169%), May 2021 to June 2021 (33%), and May 2023 to June 2023 (14%). "Migraine surgery" exhibited a notable 400% increase in RSV, from March 2005 to May 2005. However, post-2006, RSV for "migraine surgery" consistently remained low without noticeable peaks. Conclusions: The analysis of RSV trends for "Nurtec" and "migraine surgery" from 2004 to 2023 reveals the impact of pivotal events and marketing strategies on public interest. The distinct peaks in "Nurtec" RSV align with Food & Drug Administration approvals and marketing campaigns, highlighting the medication's accessibility. Conversely, the consistently low RSV for "migraine surgery" indicates limited awareness, emphasizing the need for enhanced promotion and education regarding surgical interventions.
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INTRODUCTION: A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery community describes 12 hours of warm ischemia and 24 hours of cold ischemia as the upper limits for digit replantation; however, these limits are largely anecdotal and based on older studies. We aimed to compare survival data from the large body of literature to aid surgeons and all those involved in the replantation process in hopes of optimizing success rates. METHODS: The PubMed database was queried on April 4th, 2023, for articles that included data on digit replantation survival in terms of temperature of preservation and ischemia time. All primary outcomes were analyzed with the Mantel-Haenszel method within a random effects model. Secondary outcomes were pooled and analyzed using the chi-square statistic. Statistical analysis and forest plot generation were completed with RevMan 5.4 software with odds ratios calculated within a 95% confidence interval. RESULTS: Our meta-analysis identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 0-12 hours of warm ischemia time ( P ≤ 0.05). The odds of survival in the early (0-6 hours) replantation group were around 40% greater than the later (6-12 hours) replantation group ( P ≤ 0.05). Secondary outcomes that were associated with higher survival rates included a clean-cut amputation, increased venous and arterial anastomosis, a repair that did not require a vein graft, and replants performed in nonsmokers ( P ≤ 0.05). DISCUSSION: Overall, these findings suggest that when predicting digit replantation success, time is of the essence when the digit has yet to be preserved in a cold environment. This benefit, however, is almost completely diminished when the amputated digit is appropriately maintained in a cold environment soon after injury. In conclusion, our results suggest that there is potential for broadening the ischemia time limits for digit replant survival outlined in the literature, particularly for digits that have been stored correctly in cold ischemia.
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Amputación Traumática , Traumatismos de los Dedos , Reimplantación , Humanos , Reimplantación/métodos , Amputación Traumática/cirugía , Traumatismos de los Dedos/cirugía , Factores de Tiempo , Dedos/irrigación sanguínea , Dedos/cirugía , Isquemia Tibia , Isquemia Fría , Isquemia/cirugía , TemperaturaRESUMEN
INTRODUCTION: Chronic infections and soft-tissue defects are serious complications after total hip arthroplasties (THAs) that may require hip disarticulation (HD). HD is a relatively high-risk procedure with poor long-term outcomes and survival. This is the first study to analyze the effect of an ipsilateral, pedicled vastus lateralis (VL) muscle flap in preventing HD in patients with recurrent complications after THA. METHODS: This retrospective case review analyzed the 6-month postoperative outcomes of 14 patients who underwent soft-tissue hip reconstruction with a VL muscle flap by a single surgeon. RESULTS: Most (86%) patients fully recovered after 6 months with preserved hip range of motion, no pain, and no weakness on ambulation. Two (14%) patients ultimately required HD despite introducing a VL flap. DISCUSSION: A VL muscle flap is an effective treatment of nonhealing THA and prophylactic intervention for patients at high risk for HD. The VL muscle is optimal because of its large size allowing reduction of soft-tissue dead space, its local anatomical location to the hip, and its exceptional vascularity. Additional prospective studies are necessary to determine the most appropriate population for this technique.
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Artroplastia de Reemplazo de Cadera , Músculo Cuádriceps , Colgajos Quirúrgicos , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Mamoplastia , Mastectomía , Dispositivos de Expansión Tisular , Humanos , Femenino , Mastectomía/efectos adversos , Mamoplastia/métodos , Mamoplastia/efectos adversos , Resultado del Tratamiento , Neoplasias de la Mama/cirugía , Implantes de Mama/efectos adversos , Expansión de Tejido/instrumentación , Expansión de Tejido/métodos , Implantación de Mama/instrumentación , Implantación de Mama/efectos adversos , Implantación de Mama/métodosRESUMEN
BACKGROUND: Acetyl hexapeptide-8, also known as Argireline, is a topical, short-acting, synthetic peptide that has recently gained popularity for its antiwrinkle effects. This agent has emerged as a more accessible alternative to botulinum neurotoxin. OBJECTIVE: This study evaluates the public interest in acetyl hexapeptide-8 in the United States from 2013 to 2023, as described by search volume on Google, the most-used search engine. METHODS: We analyzed the longitudinal relative monthly search volume from January 1, 2013, to January 1, 2023, for acetyl hexapeptide-related terms. We compared the internet search trends for "Botox" during this period to "Argireline." RESULTS: The terms "Argireline" and "Botox in a Bottle" both had substantial increases in search volume in 2022. Although its search volume is drastically increasing, "Argireline" was less searched than "Botox," which had a stable, up-trending search volume over the past decade. CONCLUSIONS: The increasing interest in acetyl hexapeptide-8 may be due to its cost-effectiveness and use as a botulinum neurotoxin alternative. Affordability, over-the-counter availability, and ease of self-application of the agent suggest its potential to enhance accessibility to cosmetic dermatologic care.
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The most common reconstruction technique following mastectomy is a 2-stage technique that involves tissue expansion followed by definitive implant-based reconstruction (IBR). Tissue expanders (TEs) have classically used saline for initial fill; however, TEs with an initial gas fill (GTE)-including the CO2-based AeroForm (AirXpanders, San Francisco, CA) TE and TEs initially filled with atmospheric air-have been increasingly used in the past decade. We aimed to compare the outcomes in breast reconstruction for tissue expanders initially filled with saline vs gas. PubMed was queried for studies comparing gas- and saline-filled tissue expanders (STEs) used in IBR. A meta-analysis was performed on major postoperative outcomes and the required expansion and definitive reconstruction time. Eleven studies were selected and included in the analysis. No significant differences existed between tissue expansion with GTEs vs STEs for 11 of the 13 postoperative outcomes investigated. Out of the complications investigated, only the risk of infection/cellulitis/abscess formation was significantly lower in the GTE cohort (odds ratio 0.62; 95% CI, 0.47 to 0.82; P = .0009). The time to definitive reconstruction was also significantly lower in the GTE cohort (mean difference [MD], 45.85 days; 95% CI, -57.80 to -33.90; P < .00001). The total time to full expansion approached significance in the GTE cohort (MD, -20.33 days; 95% CI, -41.71 to 1.04; P = .06). A cost analysis considering TE cost and infection risk determined that GTE use saved a predicted $2055.34 in overall healthcare costs. Surgical outcomes for both fill types were predominantly similar; however, GTEs were associated with a significantly decreased risk of postoperative infection compared to saline-filled TEs. GTEs could also reduce healthcare expenditures and require less time until definitive reconstruction after placement.
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Mastectomía , Dispositivos de Expansión Tisular , Expansión de Tejido , Humanos , Dispositivos de Expansión Tisular/efectos adversos , Femenino , Mastectomía/efectos adversos , Mastectomía/métodos , Expansión de Tejido/métodos , Expansión de Tejido/instrumentación , Expansión de Tejido/efectos adversos , Solución Salina/administración & dosificación , Mamoplastia/métodos , Mamoplastia/efectos adversos , Mamoplastia/economía , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Implantación de Mama/métodos , Implantación de Mama/efectos adversos , Implantación de Mama/instrumentación , Neoplasias de la Mama/cirugía , Implantes de Mama/efectos adversosRESUMEN
Total ankle arthroplasty (TAA) is a treatment for ankle arthritis that preserves the joint's mobility. Conditions causing poor peripheral blood flow are contraindications for TAA. A 63-year-old man with posttraumatic ankle osteoarthritis who was considered high-risk for TAA due to obesity, history of trauma, tobacco usage, chronic venous stasis, lymphedema, and hypertension subsequently underwent TAA followed by a prophylactic muscle free flap to improve peripheral blood flow and soft tissue integrity. He recovered with no pain and excellent ankle mobility. This case highlights the potential usage of prophylactic muscle free flaps to mitigate vascular risk factors in high-risk patients undergoing TAA.
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BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a type of non-Hodgkin lymphoma first linked with breast implants in 2011. The correlation between BIA-ALCL and textured devices has led to increased use of smooth devices. However, much of the data surrounding smooth and textured devices investigates breast implants specifically and not tissue expanders. OBJECTIVES: We performed a systematic review and a meta-analysis to compare surgical outcomes for smooth tissue expanders (STEs) and textured tissue expanders (TTEs). METHODS: A search was performed on PubMed, including articles from 2016 to 2023 (n = 419). Studies comparing TTEs and STEs and reported complications were included. A random-effects model was utilized for meta-analysis. RESULTS: A total of 5 articles met inclusion criteria, representing 1709 patients in the STE cohort and 1716 patients in the TTE cohort. The mean duration of tissue expansion with STEs was 221.25 days, while TTEs had a mean time of tissue expansion of 220.43 days.Our meta-analysis found no differences in all surgical outcomes except for explantation risk. STE use was associated with increased odds of explantation by over 50% compared to TTE use (odds ratio = 1.53; 95% CI = 1.15 to 2.02; P = .003). CONCLUSIONS: Overall, STEs and TTEs had similar complication profiles. However, STEs had 1.5 times higher odds of explantation. The incidence of BIA-ALCL is low, and only a single case of BIA-ALCL has been reported with TTEs. This indicates that TTEs are safe and may lower the risk of early complications requiring explantation. Further studies are warranted to further define the relationship between tissue expanders and BIA-ALCL.
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Implantación de Mama , Implantes de Mama , Neoplasias de la Mama , Linfoma Anaplásico de Células Grandes , Humanos , Femenino , Dispositivos de Expansión Tisular/efectos adversos , Implantes de Mama/efectos adversos , Implantación de Mama/efectos adversos , Mama/cirugía , Incidencia , Linfoma Anaplásico de Células Grandes/epidemiología , Linfoma Anaplásico de Células Grandes/etiología , Linfoma Anaplásico de Células Grandes/patología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Neoplasias de la Mama/cirugíaRESUMEN
Congenital clubfoot is addressed in infancy and rarely persists into adulthood. Ankle arthroplasty is an increasingly popular surgical intervention for patients with ankle arthritis since it allows a natural ankle range of motion and completely replaces a degenerative hindfoot. Here, we describe the first successful total ankle arthroplasty (TAA) for a patient with previously treated congenital clubfoot that reverted later in life. To address the patient's poor soft-tissue integument and reduce the likelihood of post-surgical complications, a perioperative latissimus muscle-free flap was performed. This two-staged, novel orthoplastic intervention addressed our patient's ankle issues and appears to be a viable option for clubfoot patients.
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Introduction In 2019, the Centers for Medicare & Medicaid Services (CMS) combined all autologous breast flap procedures under one billing code, effective from December 31, 2024. This change will result in equal insurance reimbursement rates for popular flap options, such as transverse rectus abdominis muscle (TRAM) and deep inferior epigastric perforator (DIEP) flaps, which were previously billed separately using S-codes based on complexity. Methods This study aimed to analyze insurance code changes for autologous breast reconstruction flap procedures. Data were collected from the American Society of Plastic Surgeons' annual plastic surgery statistics reports, including specific insurance codes and case volumes from 2007 to 2020. A comprehensive analysis was conducted to assess recent trends in flap utilization rates, documenting any modifications or additions to the existing codes and their implementation years. Results The study analyzed billing codes and case volumes for autologous breast reconstruction procedures, with a focus on the DIEP flap and other alternatives. Non-autologous breast reconstruction procedures showed consistently higher case volumes compared to autologous procedures from 2007 to 2020. Notably, the popularity of the DIEP flap surpassed that of other flap options after 2011. Conclusion The removal of S-codes for autologous breast reconstruction by CMS and the subsequent potential decrease in insurance coverage for the DIEP flap may lead to a decrease in its utilization and a shift toward more invasive options, like the TRAM flap. This change could result in financial burdens for patients and widen socioeconomic disparities in breast reconstruction, limiting access to preferred reconstructive methods and impacting patient autonomy and overall well-being.
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The integrated plastic surgery residency match has risen to be the most competitive specialty in the 2022 match. This reality has prompted medical students to reach a high level of personal achievements, including pursuing research fellowships to boost research productivity. The competitive nature of this specialty has highlighted several barriers for applicants, such as those from groups underrepresented in surgery, of lower socioeconomic backgrounds, or without a home program. In recent years, there have been several changes to the match that stand to attenuate disparities among applicants, such as the transition to virtual interviews and the shift of the United States Medical Licensing Examination Step 1 score to pass-fail. The introduction of the Plastic Surgery Common Application and standardized letters of recommendation has altered the application process for the plastic surgery match. Given these recent trends, evaluating the current landscape and looking toward future directions for the integrated plastic surgery match becomes necessary. Understanding these changes will not only benefit medical students by giving them a transparent look into the match process but also provide a framework for other specialties to follow to increase accessibility to their specific specialty.
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Burn injury causes a coagulopathy that is poorly understood. After severe burns, significant fluid losses are managed by aggressive resuscitation that can lead to hemodilution. These injuries are managed by early excision and grafting, which can cause significant bleeding and further decrease blood cell concentration. Tranexamic acid (TXA) is an anti-fibrinolytic that has been shown to reduce surgical blood losses; however, its use in burn surgery is not well established. We performed a systematic review and meta-analysis to investigate the influence TXA may have on burn surgery outcomes. Eight papers were included, with outcomes considered in a random-effects model meta-analysis. Overall, when compared to the control group, TXA significantly reduced total volume blood loss (mean difference (MD) = -192.44; 95% confidence interval (CI) = -297.73 to - 87.14; P = 0.0003), the ratio of blood loss to burn injury total body surface area (TBSA) (MD = -7.31; 95% CI = -10.77 to -3.84; P 0.0001), blood loss per unit area treated (MD = -0.59; 95% CI = -0.97 to -0.20; P = 0.003), and the number of patients receiving a transfusion intraoperatively (risk difference (RD) = -0.16; 95% CI = -0.32 to - 0.01; P = 0.04). Additionally, there were no noticeable differences in venous thromboembolism (VTE) events (RD = 0.00; 95% CI = -0.03 to 0.03; P = 0.98) and mortality (RD = 0.00; 95% CI = -0.03 to 0.04; P = 0.86). In conclusion, TXA can potentially be a pharmacologic intervention that reduces blood losses and transfusions in burn surgery without increasing the risk of VTE events or mortality.
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Antifibrinolíticos , Quemaduras , Ácido Tranexámico , Tromboembolia Venosa , Humanos , Ácido Tranexámico/uso terapéutico , Antifibrinolíticos/uso terapéutico , Tromboembolia Venosa/prevención & control , Quemaduras/cirugía , Quemaduras/tratamiento farmacológico , Pérdida de Sangre Quirúrgica/prevención & controlRESUMEN
BACKGROUND: Parkinson's disease (PD) is a neurodegenerative movement disorder that results in a variety of motor deficits such as unsteady gait, bradykinesia, resting tremor, and rigidity. OBJECTIVE: The objective of this study was to quantify and assess the challenges and preferences Parkinson's disease patients have regarding footwear. METHODS: A 13-question survey was designed to assess footwear challenges and preferences among PD patients. A total of 89 PD patients, both male and female, were surveyed in the outpatient setting at UC Irvine during their appointments with the senior author. RESULTS: A majority of the PD patients in our cohort (64%) reported experiencing difficulties wearing shoes on their own. Patients who experienced difficulties wearing shoes were significantly more likely to report having been forced to make changes to their desired outfits (pâ=â0.0011), choosing not to wear dress shoes due to their discomfort (pâ=â0.0175), and preferring shoes without laces (pâ=â0.0 048). CONCLUSIONS: The present study is the first attempt to use a survey to quantify the challenges and preferences reported by PD patients in regard to their usage of footwear. Inspired by our findings, the study team designed a novel dress shoe prototype that may address some of the difficulties and concerns gathered through our survey.
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Evaluación de Necesidades , Enfermedad de Parkinson/rehabilitación , Zapatos/normas , Anciano , Femenino , Trastornos Neurológicos de la Marcha , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Mixed reality, a blending of the physical and digital worlds, can enhance the surgical experience, leading to greater precision, efficiency, and improved outcomes. Various studies across different disciplines have reported encouraging results using mixed reality technologies, such as augmented and virtual reality. To provide a better understanding of the applications and limitations of this technology in plastic surgery, we performed a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The initial query of the National Center for Biotechnology Information database yielded 2544 results, and only 46 articles met our inclusion criteria. The majority of studies were in the field of craniofacial surgery, and uses of mixed reality included preoperative planning, intraoperative guides, and education of surgical trainees. A deeper understanding of mixed reality technologies may promote its integration and also help inspire new and creative applications in healthcare.
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Realidad Aumentada , Procedimientos de Cirugía Plástica/métodos , Cirugía Plástica/métodos , Realidad Virtual , Instrucción por Computador/métodos , Instrucción por Computador/tendencias , Humanos , Planificación de Atención al Paciente/tendencias , Procedimientos de Cirugía Plástica/educación , Procedimientos de Cirugía Plástica/tendencias , Cirugía Asistida por Computador/educación , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/tendencias , Cirugía Plástica/educación , Cirugía Plástica/tendenciasRESUMEN
Diabetes mellitus (DM) is a chronic disease that results in a variety of systemic complications. Recently, stem cell-based therapies have been proposed as potential modalities to manage DM related complications. Mesenchymal stem cell (MSC) based therapies are often considered as an ideal stem cell-based treatment for DM management due to their immunosuppressive characteristics, anti-inflammatory properties and differentiation potential. While MSCs show tremendous promise, the underlying functional deficits of MSCs in DM patients is not well understood. Using the MEDLINE database to define these functional deficits, our search yielded 1826 articles of which 33 met our inclusion criteria. This allowed us to review the topic and illuminate four major molecular categories by which MSCs are compromised in both Type 1 DM and Type II DM models which include: (1) changes in angiogenesis/vasculogenesis, (2) altered pro-inflammatory cytokine secretion, (3) increased oxidative stress markers and (4) impaired cellular differentiation and decreased proliferation. Knowledge of the deficits in MSC function will allow us to more clearly assess the efficacy of potential biologic therapies for reversing these dysfunctions when treating the complications of diabetic disease.