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BACKGROUND: Skin flap necrosis remains a significant challenge in reconstructive surgery, predominantly due to insufficient blood supply. Traditional methods like the surgical delay procedure, while effective, are invasive and associated with considerable patient discomfort and health care costs. This study explores the efficacy of Carbon Dioxide Fractional Laser (CDFL) treatment as a novel, less invasive alternative to enhance skin flap survival. METHODS: Twenty-nine adult male Sprague-Dawley rats were divided into 2 groups: a CDFL treatment group (n=14) and a control group (n=15). The CDFL group received laser pretreatment 1 week before flap surgery, whereas the control group underwent flap surgery without pretreatment. Flap survival was assessed 7 days postsurgery using indocyanine green fluorescence angiography. In addition, histological analysis was conducted to evaluate tissue integrity, capillary density, and VEGF expression. RESULTS: The CDFL-treated flaps showed significantly increased survival areas compared with controls (P<0.01). Histological evaluation revealed enhanced capillary dilation and increased VEGF expression in the CDFL group (P<0.05). Although capillary density was higher in the CDFL group, it did not reach statistical significance (P=0.052). CONCLUSION: CDFL pretreatment significantly improves skin flap survival in rats, suggesting potential as a minimally invasive alternative to traditional surgical delay techniques. This approach could offer substantial benefits in reconstructive surgery, reducing patient morbidity and associated costs. Further studies are warranted to confirm these findings in clinical settings.
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BACKGROUND: This study explores the dynamic changes in plastic surgery practices, focusing on the growth rates across different subcategories, particularly highlighting the trends in the United States. OBJECTIVES: To analyze evolving trends in plastic surgery using statistical methods, providing insights into the changes and growth patterns in various segments over time. MATERIALS AND METHODS: Utilizing data from 2005 to 2019 from the American Society of Plastic Surgeons, the authors, conducted a comprehensive statistical analysis using the SPSS program to investigate trends in plastic surgery procedures. RESULTS: Our analysis revealed no significant differences in year-on-year growth rates between cosmetic and reconstructive surgery. However, in reconstructive surgery subcategories, maxillofacial surgery showed the highest mean growth rate at 11.61%, though this was not statistically significant. In cosmetic minimally invasive procedures, soft tissue filler injections and botulinum toxin A injections experienced notably higher growth trends compared with microdermabrasion. CONCLUSION: The findings suggest that practitioners considering a career in plastic surgery should not focus solely on choosing between reconstructive and cosmetic surgery. Recognizing substantial growth in cosmetic minimally invasive procedures, especially botulinum toxin A injections and fillers, is vital for making informed career decisions.
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Técnicas Cosméticas , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos de Cirugía Plástica , Cirugía Plástica , Humanos , Estados Unidos , Procedimientos de Cirugía Plástica/tendencias , Técnicas Cosméticas/tendencias , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Cirugía Plástica/tendencias , Rellenos Dérmicos/administración & dosificación , Toxinas Botulínicas Tipo A/administración & dosificación , Pautas de la Práctica en Medicina/tendencias , Sociedades MédicasRESUMEN
The present study delves into the "beauty paradox," a multifaceted phenomenon influenced by wealth inequality, societal norms, and consumer behaviors, specifically regarding spending on cosmetic procedures. Relying on data from the United States Census Bureau and the American Society of Plastic Surgeons, the research primarily focuses on the Gini coefficient, Mean Logarithmic Deviation (MLD), and income data for the lowest and top 5% quintiles of mean household income over a 15-year span. The analysis uncovers a significant correlation between Total Expenditures on Cosmetic Surgery and minimally invasive procedures and the wealth of the top 5% income quintile. The "Cosmetic Enhancement Cycle (CEC)" is proposed, indicating a symbiotic growth between wealth accumulation among the affluent and the plastic surgery industry. As such, the "beauty paradox" lays bare the multifaceted consequences of wealth inequality, necessitating a comprehensive approach that addresses socioeconomic dynamics, accessibility of cosmetic procedures, societal norms, and perceptions. This investigation underscores the imperative for further exploration into the myriad ways that wealth inequality sculpts societies and influences behaviors, including within the context of the CEC.
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The authors present a case of a 34-year-old female patient with von Willebrand disease who developed a recurrent right auricular keloid after childbirth. The patient had previously undergone surgical excision of the keloid in 2017, which led to the diagnosis of von Willebrand disease due to uncontrolled bleeding. After a successful pregnancy in 2023, the patient experienced keloid recurrence. Surgical excision and radiotherapy were performed in April 2023, followed by DDAVP administration to control postoperative bleeding. At 1-year follow-up, no recurrence was observed. This case highlights the potential impact of pregnancy on keloid recurrence and the challenges of managing keloids in patients with bleeding disorders.
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Blowout fractures are a common type of facial injury that requires accurate measurement of the fracture area for proper treatment planning. This systematic review aimed to summarize and evaluate the current methods for measuring blowout fracture areas and explore the potential role of artificial intelligence (AI) in enhancing accuracy and reliability. A comprehensive search of the PubMed database was conducted, focusing on studies published since 2000 that investigated methods for measuring blowout fracture area using computed tomography scans. The review included 20 studies, and the results showed that automatic methods, such as computer-aided measurements and computed tomography-based volumetric analysis, provide higher accuracy and reliability compared with manual and semiautomatic techniques. Standardizing the method for measuring blowout fracture areas can improve clinical decision-making and facilitate outcome comparison across studies. Future research should focus on developing AI models that can account for multiple factors, including fracture area and herniated tissue volume, to enhance their accuracy and reliability. Integration of AI models has the potential to improve clinical decision-making and patient outcomes in the assessment and management of blowout fractures.
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Inteligencia Artificial , Fracturas Orbitales , Humanos , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X , Toma de Decisiones ClínicasRESUMEN
Facial fractures, particularly mid-facial fractures, can result in various complications, such as functional and esthetic problems. Prompt reconstruction of the fractured bones is crucial for restoring normal anatomy and function and preventing complications. However, such procedures can be complex and carry the risk of potential complications. The authors report the case of a 27-year-old man who underwent open reduction and internal fixation of the left zygomatic complex fracture and reconstruction of the left inferior orbital wall. During the surgery, heavy bleeding from the posterior superior alveolar artery due to a broken bone near the pterygomaxillary region caused a prolonged surgery time and the development of a pseudoaneurysm. The pseudoaneurysm was eventually treated with superselective transcatheter embolization using 25% N-Butyl cyanoacrylate glue. This case highlights the challenges in the management of mid-facial fractures and the potential complications that can arise during surgery, particularly when dealing with the pterygomaxillary region.
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Aneurisma Falso , Fracturas Craneales , Fracturas Cigomáticas , Masculino , Humanos , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Estética Dental , Fracturas Craneales/complicaciones , Fracturas Craneales/cirugía , Fracturas Cigomáticas/complicaciones , Fracturas Cigomáticas/cirugía , ArteriasRESUMEN
Background Fingertip injuries with volar pulp tissue defects present a significant challenge in management. This study aimed to evaluate the efficacy of a conservative treatment protocol using artificial dermis and semi-occlusive dressings for these injuries. Methods A single-center, prospective study was conducted on 31 patients with fingertip injuries involving volar pulp defects. The treatment protocol included wound debridement, application of artificial dermis (Pelnac®), and a semi-occlusive dressing (IV3000®). The outcomes were assessed using subjective questionnaires and objective measures, including fingerprint regeneration, sensory function, pain, and cosmetic appearance. Results The mean treatment duration was 45.29 days (SD = 17.53). Complications were minimal, with only one case (3.22%) directly attributable to the treatment. Fingerprint regeneration was considerable (mean score = 2.58, SD = 0.67). The sensory disturbances were minimal, with no significant differences across injury types. Post-treatment pain was low (mean = 0.45, SD = 0.67), and cosmetic satisfaction was high (mean = 4.09, SD = 0.94). The overall patient satisfaction was high (mean = 4.41, SD = 0.67), regardless of injury severity. Conclusions The conservative treatment protocol using artificial dermis and semi-occlusive dressings is a promising strategy for managing fingertip injuries with volar pulp defects. This approach minimizes surgical morbidity and achieves excellent functional and aesthetic outcomes.
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Background: This study aimed to investigate the impact of the COVID-19 pandemic on breast reconstruction trends in the United States, focusing on implant-based and autologous techniques, as well as the timing of reconstruction (immediate vs. delayed). Methods: A retrospective analysis of data from 2015 to 2022 from the American Society of Plastic Surgeons' National Plastic Surgery Statistics was conducted. Annual trends in breast reconstruction procedures were analyzed, comparing the pre-pandemic (2015-2019) and pandemic (2020-2022) periods. A sensitivity analysis was performed to assess the impact of missing data from 2019 and 2021. Results: The total number of breast reconstructions increased from 106,338 in 2015 to 151,641 in 2022. The proportion of implant-based reconstructions decreased from 81.41% pre-pandemic to 76.51% during the pandemic (p < 0.001), with a notable rise in direct-to-implant procedures from 10.37% to 19.12% (p < 0.001). Autologous reconstructions increased from 18.59% to 23.49% (p < 0.001). Among autologous techniques, DIEP flaps remained the most popular. Immediate reconstruction rates increased from 72.61% pre-pandemic to 75.57% during the pandemic, while delayed reconstruction rates decreased from 27.39% to 24.43% (p < 0.001). The sensitivity analysis confirmed the robustness of these trends. Conclusions: During the COVID-19 pandemic, there was a significant shift towards autologous breast reconstruction techniques, particularly DIEP flaps, and an increase in immediate reconstructions in the United States. Within implant-based reconstructions, the proportion of DTI procedures increased while the proportion of tissue expander procedures decreased. These changes likely reflect adaptations in surgical practice and decision-making processes in response to the unique challenges posed by the pandemic, rather than alterations in surgical techniques themselves. The insights gained from this study can help guide plastic surgeons and healthcare providers in preparing for future pandemics or similar disruptions.
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Cosmetic filler injections have gained popularity in recent years, but the rise in complications has led to an increase in legal disputes. This study analyzes civil court rulings related to cosmetic filler injection lawsuits in South Korea from 2007 to 2023. A retrospective case analysis was performed using a systematic database search, and a mixed-methods approach was employed for data analysis. The study examined 27 cases, revealing a high rate of liability findings against medical practitioners. Skin necrosis and blindness were the most common complications, and intravascular filler injection was recognized as negligence. Violation of informed consent was found in most cases, with mean compensation awards of ₩193,019,107 KRW ($142,831 USD) for first instance cases and ₩81,845,052 KRW ($60,564 USD) for second instance cases. The findings emphasize the importance of practitioner awareness, adherence to precautionary measures, and proactive prevention and management of complications. Collaboration among stakeholders is crucial for developing strategies that prioritize patient safety and minimize legal disputes in the aesthetic medicine industry. This study provides valuable insights for enhancing medical practices and safeguarding patient well-being in the field of cosmetic filler injections.
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Técnicas Cosméticas , Rellenos Dérmicos , Humanos , República de Corea , Rellenos Dérmicos/efectos adversos , Técnicas Cosméticas/efectos adversos , Estudios Retrospectivos , Femenino , Mala Praxis/legislación & jurisprudencia , Cosméticos/efectos adversos , Responsabilidad Legal , Masculino , Consentimiento Informado/legislación & jurisprudenciaRESUMEN
The volume of cosmetic procedures and expenditures has increased over the past 15 years. Recent studies have shown that the market for cosmetic procedures follows the standard laws of economics. However, no studies published in the literature have found a direct correlation between US stock market indices and expenditures on cosmetic surgery and minimally invasive procedures. Methods: The authors analyzed annual cosmetic procedure statistics from the American Society of Plastic Surgeons for 2005-2020 against economic indices, including major US stock market indices [NASDAQ 100, S&P 500, Dow Jones Industrial Average (DJIA), Russell 2000 indices from the New York Stock Exchange, gross domestic product (GDP)], median income of US citizens, and the US population from the Federal Reserve Bank of St. Louis. Pearson correlation coefficient and multiple regression analysis were used for the statistical analysis. Results: Total expenditure on cosmetic surgery and minimally invasive procedures (TECP) has more than doubled since 2005 to 2020. TECP revealed statistically significant correlations with all other indicators. TECP had the greatest correlation with DJIA (r = 0.952, P < 0.001). In the multiple regression analysis, the increase in TECP led to the rise of the NASDAQ 100 index (adjusted R2 was 0.790, P < 0.001). Conclusions: There was a statistically significant correlation between the TECP in USA and the major indices of the US stock market. In particular, the increase in TECP led to the rise of the NASDAQ 100 index.
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BACKGROUND: The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation. METHODS: A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, Kwire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent'). RESULTS: The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire. CONCLUSION: The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time.