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1.
Wound Repair Regen ; 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38747443

RESUMO

To evaluate the accuracy of AI chatbots in staging pressure injuries according to the National Pressure Injury Advisory Panel (NPIAP) Staging through clinical image interpretation, a cross-sectional design was conducted to assess five leading publicly available AI chatbots. As a result, three chatbots were unable to interpret the clinical images, whereas GPT-4 Turbo achieved a high accuracy rate (83.0%) in staging pressure injuries, notably outperforming BingAI Creative mode (24.0%) with statistical significance (p < 0.001). GPT-4 Turbo accurately identified Stages 1 (p < 0.001), 3 (p = 0.001), and 4 (p < 0.001) pressure injuries, and suspected deep tissue injuries (p < 0.001), while BingAI demonstrated significantly lower accuracy across all stages. The findings highlight the potential of AI chatbots, especially GPT-4 Turbo, in accurately diagnosing images and aiding the subsequent management of pressure injuries.

2.
Ann Plast Surg ; 93(2): 261-267, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38980915

RESUMO

BACKGROUND: Breast cancer survival rates have increased significantly, underscoring the importance of enhancing long-term health-related quality of life. Breast reconstruction following mastectomy has emerged as a common approach that contributes to improved health-related quality of life. Nonetheless, chronic pain following breast reconstruction is a prevalent issue that has a negative impact on overall well-being. METHODS: To examine recent findings on chronic pain after breast reconstruction and progress in pain management, we performed a review of the literature through independent searches using the MEDLINE database within NIH National Library of Medicine PubMed. RESULTS: The review suggested that autologous reconstruction causes chronic postsurgical pain, especially at specific donor sites, whereas implant-based reconstruction does not seem to increase the risk of chronic pain. Moreover, certain operational and patient factors are also associated with chronic pain. Appropriate pain management can reduce chronic pain and prevent the transition from acute to chronic pain. CONCLUSION: This scoping review evaluated the characteristics of long-term chronic pain after breast reconstruction. The findings provide patients with important treatment information and will assist with their decision on their preferred treatment.


Assuntos
Dor Crônica , Mamoplastia , Dor Pós-Operatória , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Dor Crônica/etiologia , Feminino , Dor Pós-Operatória/etiologia , Mastectomia/efeitos adversos , Neoplasias da Mama/cirurgia , Manejo da Dor/métodos , Qualidade de Vida
3.
Ann Plast Surg ; 92(6): 688-693, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38747560

RESUMO

BACKGROUND: At present, there is no golden standard for treatment of extracranial arteriovenous malformations (AVMs) and recurrence remains a major challenge with limited available evidence on the associated factors. This study aimed to evaluate the effectiveness of surgical treatment options, in terms of size reduction, symptoms, and early recurrence in patients treated surgically for AVMs. METHODS: A retrospective cohort study was conducted to evaluate patients with AVMs following surgical treatment in 2 centers from 2005 to 2020. Posttreatment lesion size and symptoms, as well as recurrence, were assessed. Multiple regression analysis was performed to identify factors associated with recurrence. RESULTS: Forty-four surgical treatment cases in 31 patients were assessed with a mean follow-up duration period of 67.9 ± 39.5 months. Treatment included total resection in 26 cases (59.1%) and partial resection 18 (40.9%), with free flap coverage used in 19 cases (43.2%). No acute exacerbation following treatment was observed in our cohort. Total resection significantly reduced posttreatment lesion size ( P < 0.001), symptoms ( P < 0.001), and recurrence (20.0%, P = 0.03). The recurrence rate was significantly higher after partial resection (73.7%, P = 0.03). Total resection was identified as an associated factor for significantly reduced AVM recurrence (odds ratio: 0.12; 95% confidence interval: 0.03, 0.52). However, the use of free flaps did not significantly reduce recurrence, post treatment size or improve AVM symptoms. CONCLUSIONS: Total resection is the optimal treatment for AVMs. Free flaps are useful in covering large defects but the regulative effect of free flap remains controversial.


Assuntos
Malformações Arteriovenosas , Recidiva , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Malformações Arteriovenosas/cirurgia , Estudos de Coortes , Estudos Retrospectivos , Resultado do Tratamento
4.
Ophthalmic Plast Reconstr Surg ; 40(3): 316-320, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38133626

RESUMO

PURPOSE: This study aimed to demonstrate the performance of the popular artificial intelligence (AI) language model, Chat Generative Pre-trained Transformer (ChatGPT) (OpenAI, San Francisco, CA, U.S.A.), in generating the informed consent (IC) document of blepharoplasty. METHODS: A total of 2 prompts were provided to ChatGPT to generate IC documents. Four board-certified plastic surgeons and 4 nonmedical staff members evaluated the AI-generated IC documents and the original IC document currently used in the clinical setting. They assessed these documents in terms of accuracy, informativeness, and accessibility. RESULTS: Among board-certified plastic surgeons, the initial AI-generated IC document scored significantly lower than the original IC document in accuracy ( p < 0.001), informativeness ( p = 0.005), and accessibility ( p = 0.021), while the revised AI-generated IC document scored lower compared with the original document in accuracy ( p = 0.03) and accessibility ( p = 0.021). Among nonmedical staff members, no statistical significance of 2 AI-generated IC documents was observed compared with the original document in terms of accuracy, informativeness, and accessibility. CONCLUSIONS: The results showed that current ChatGPT cannot be used as a distinct patient education resource. However, it has the potential to make better IC documents when improving the professional terminology. This AI technology will eventually transform ophthalmic plastic surgery healthcare systematics by enhancing patient education and decision-making via IC documents.


Assuntos
Inteligência Artificial , Blefaroplastia , Termos de Consentimento , Consentimento Livre e Esclarecido , Humanos , Blefaroplastia/métodos , Termos de Consentimento/normas , Consentimento Livre e Esclarecido/normas
5.
J Craniofac Surg ; 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39248688

RESUMO

The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap.

6.
J Craniofac Surg ; 35(1): e100-e102, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37972982

RESUMO

When managing cranial bone flap infections, infected bone flaps are typically removed and subsequently replaced with artificial bones 6 to 12 months after the inflammation subsides. However, defects in the occipital region pose challenges due to concerns regarding brain protection when patients lie in the supine position. Herein, the authors report the case of a 73-year-old woman with an occipital bone flap infection, which was successfully managed by reconstruction with a trapezius musculocutaneous flap immediately after removing the infected bone flap. One year and 2 months postoperatively, the wound had fully healed, and the patient remained symptom-free without any complications, such as sunken flap syndrome. Soft tissue reconstruction using pedicled trapezius musculocutaneous flap is a viable strategy for managing occipital bone flap infections. This flap ensures stable blood flow and requires minimal vascular manipulation, thereby reducing operation time as the patient does not need to change position.


Assuntos
Retalho Miocutâneo , Procedimentos de Cirurgia Plástica , Músculos Superficiais do Dorso , Feminino , Humanos , Idoso , Retalho Miocutâneo/cirurgia , Músculos Superficiais do Dorso/cirurgia , Osso Occipital/cirurgia , Lobo Occipital/cirurgia
7.
J Craniofac Surg ; 35(2): 577-581, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38231192

RESUMO

BACKGROUND: The widely used botox type A (BTX-A) is effective against synkinesis in facial palsy sequelae. Repeated injections are necessary and permanent improvements have been reported. We objectively evaluated the changes in synkinesis at >6 months after BTX-A injection, including changes over time with the number of administrations. METHODS: In 48 patients who received multiple BTX-A injections, evaluation by the Sunnybrook Facial Grading System (FGS) and integrated electromyography (iEMG) was performed before treatment and at least 6 months after the first, second, and third BTX-A injection. The iEMG ratio on the affected and healthy sides was calculated for each mimetic muscle and mimic motion. RESULTS: There was no significant difference in the FGS synkinesis score before treatment and after the third injection, although an improvement was observed. The iEMG ratio was significantly improved in the orbicularis oculi with open-mouth smile and lip pucker after the third dose compared to before treatment. The orbicularis oris showed a significant improvement when the eyelids were closed, while the platysma showed a significant improvement when the eyelids were closed and when the lip was pursed. Multiple regression analysis revealed that the orbicularis oculi and platysma had a greater effect on the iEMG ratio for the number of treatments than other factors. CONCLUSIONS: Repeated BTX-A injections showed improvements in synkinesis for the orbicularis oculi, orbicularis oris, and platysma, even after >6 months, compared to before treatment.


Assuntos
Toxinas Botulínicas Tipo A , Eletromiografia , Paralisia Facial , Fármacos Neuromusculares , Sincinesia , Humanos , Toxinas Botulínicas Tipo A/uso terapêutico , Toxinas Botulínicas Tipo A/administração & dosagem , Masculino , Feminino , Sincinesia/tratamento farmacológico , Sincinesia/fisiopatologia , Sincinesia/etiologia , Paralisia Facial/tratamento farmacológico , Paralisia Facial/fisiopatologia , Pessoa de Meia-Idade , Adulto , Fármacos Neuromusculares/uso terapêutico , Resultado do Tratamento , Músculos Faciais/fisiopatologia , Músculos Faciais/efeitos dos fármacos , Idoso , Injeções Intramusculares , Adolescente
8.
J Craniofac Surg ; 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39374414

RESUMO

Subtotal temporal bone resection (STBR) frequently results in facial paralysis and depression, making reconstruction challenging due to significant tissue loss. This study aimed to evaluate the effectiveness of a procedure designed for simultaneous smile and soft tissue reconstruction after STBR. The authors included 3 patients who underwent latissimus dorsi (LD) neuromuscular flap combined with adipose flap transfer after STBR at the Tokyo Medical and Dental University Hospital between 2010 and 2016. Among these patients, 2 had facial vessels unsuitable for anastomosis due to prior neck dissection, and their masseteric nerves were unavailable for neurorrhaphy due to STBR. The thoracodorsal nerve was coaptated to the contralateral facial nerve in all patients and to the ipsilateral masseter nerve in one patient. Follow-up periods ranged from 7 to 13 years, with all patients achieving spontaneous smiles within 12 months post-surgery. Although depressive deformities improved, long-term follow-up revealed buccal muscle bulging due to unstable LD muscle fixation from a zygomatic arch defect caused by STBR. Revision surgeries, including muscle refixation with a tensor fasciae lata graft, muscle reduction, eyebrow lifting, blepharoplasty, and adipose tissue repositioning, were performed as needed. Ultimately, all patients achieved satisfactory facial contours and spontaneous smiles. This study demonstrates that free LD muscle with adipose flap transfer is effective for post-STBR reconstruction. However, detailed surgical planning and multistage reconstruction are often necessary due to the complexities involved.

9.
Aesthetic Plast Surg ; 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890161

RESUMO

In a recent Letter to the Editor authored by Daungsupawong et al. in Aesthetic Plastic Surgery, titled "ChatGPT and Clinical Questions on the Practical Guideline of Blepharoptosis: Correspondence," the authors emphasized important points regarding the input language differences between input and output references. However, advanced versions, such as GPT-4, have shown marginal differences between English and Chinese inputs, possibly because of the use of larger training data. To address this issue, non-English-language-oriented large language models (LLMs) have been developed. The ability of LLMs to refer to existing references varies, with newer models, such as GPT-4, showing higher reference rates than GPT-3.5. Future research should focus on addressing the current limitations and enhancing the effectiveness of emerging LLMs in providing accurate and informative answers to medical questions across multiple languages.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

10.
Aesthetic Plast Surg ; 2024 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-39322838

RESUMO

BACKGROUND: Lasting scars such as keloids and hypertrophic scars adversely affect a patient's quality of life. However, these scars are frequently underdiagnosed because of the complexity of the current diagnostic criteria and classification systems. This study aimed to explore the application of Large Language Models (LLMs) such as ChatGPT in diagnosing scar conditions and to propose a more accessible and straightforward diagnostic approach. METHODS: In this study, five artificial intelligence (AI) chatbots, including ChatGPT-4 (GPT-4), Bing Chat (Precise, Balanced, and Creative modes), and Bard, were evaluated for their ability to interpret clinical scar images using a standardized set of prompts. Thirty mock images of various scar types were analyzed, and each chatbot was queried five times to assess the diagnostic accuracy. RESULTS: GPT-4 had a significantly higher accuracy rate in diagnosing scars than Bing Chat. The overall accuracy rates of GPT-4 and Bing Chat were 36.0% and 22.0%, respectively (P = 0.027), with GPT-4 showing better performance in terms of specificity for keloids (0.6 vs. 0.006) and hypertrophic scars (0.72 vs. 0.0) than Bing Chat. CONCLUSIONS: Although currently available LLMs show potential for use in scar diagnostics, the current technology is still under development and is not yet sufficient for clinical application standards, highlighting the need for further advancements in AI for more accurate medical diagnostics. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online instructions to authors www.springer.com/00266 .

11.
Aesthetic Plast Surg ; 48(11): 2057-2063, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38589561

RESUMO

BACKGROUND: Chat generative pre-trained transformer (ChatGPT) is a publicly available extensive artificial intelligence (AI) language model that leverages deep learning to generate text that mimics human conversations. In this study, the performance of ChatGPT was assessed by offering insightful and precise answers to a series of fictional questions and emulating a preliminary consultation on blepharoplasty. METHODS: ChatGPT was posed with questions derived from a blepharoplasty checklist provided by the American Society of Plastic Surgeons. Board-certified plastic surgeons and non-medical staff members evaluated the responses for accuracy, informativeness, and accessibility. RESULTS: Nine questions were used in this study. Regarding informativeness, the average score given by board-certified plastic surgeons was significantly lower than that given by non-medical staff members (2.89 ± 0.72 vs 4.41 ± 0.71; p = 0.042). No statistically significant differences were observed in accuracy (p = 0.56) or accessibility (p = 0.11). CONCLUSIONS: Our results emphasize the effectiveness of ChatGPT in simulating doctor-patient conversations during blepharoplasty. Non-medical individuals found its responses more informative compared with the surgeons. Although limited in terms of specialized guidance, ChatGPT offers foundational surgical information. Further exploration is warranted to elucidate the broader role of AI in esthetic surgical consultations. LEVEL OF EVIDENCE V: Observational study under respected authorities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Inteligência Artificial , Blefaroplastia , Blefaroptose , Humanos , Blefaroplastia/métodos , Blefaroptose/cirurgia , Feminino , Encaminhamento e Consulta , Aconselhamento/métodos , Masculino , Cirurgia Plástica , Relações Médico-Paciente , Adulto
12.
Aesthetic Plast Surg ; 48(13): 2389-2398, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38684536

RESUMO

BACKGROUND: ChatGPT is a free artificial intelligence (AI) language model developed and released by OpenAI in late 2022. This study aimed to evaluate the performance of ChatGPT to accurately answer clinical questions (CQs) on the Guideline for the Management of Blepharoptosis published by the American Society of Plastic Surgeons (ASPS) in 2022. METHODS: CQs in the guideline were used as question sources in both English and Japanese. For each question, ChatGPT provided answers for CQs, evidence quality, recommendation strength, reference match, and answered word counts. We compared the performance of ChatGPT in each component between English and Japanese queries. RESULTS: A total of 11 questions were included in the final analysis, and ChatGPT answered 61.3% of these correctly. ChatGPT demonstrated a higher accuracy rate in English answers for CQs compared to Japanese answers for CQs (76.4% versus 46.4%; p = 0.004) and word counts (123 words versus 35.9 words; p = 0.004). No statistical differences were noted for evidence quality, recommendation strength, and reference match. A total of 697 references were proposed, but only 216 of them (31.0%) existed. CONCLUSIONS: ChatGPT demonstrates potential as an adjunctive tool in the management of blepharoptosis. However, it is crucial to recognize that the existing AI model has distinct limitations, and its primary role should be to complement the expertise of medical professionals. LEVEL OF EVIDENCE V: Observational study under respected authorities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Inteligência Artificial , Blefaroptose , Guias de Prática Clínica como Assunto , Blefaroptose/cirurgia , Humanos , Blefaroplastia/métodos , Japão
13.
Aesthetic Plast Surg ; 2024 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-39322837

RESUMO

BACKGROUND: The Generative Pre-trained Transformer (GPT) series, which includes ChatGPT, is an artificial large language model that provides human-like text dialogue. This study aimed to evaluate the performance of artificial intelligence chatbots in answering clinical questions based on practical rhinoplasty guidelines. METHODS: Clinical questions (CQs) developed from the guidelines were used as question sources. For each question, we asked GPT-4 and GPT-3.5 (ChatGPT), developed by OpenAI, to provide answers for the CQs, Policy Level, Aggregate Evidence Quality, Level of Confidence in Evidence, and References. We compared the performance of the two types of artificial intelligence (AI) chatbots. RESULTS: A total of 10 questions were included in the final analysis, and the AI chatbots correctly answered 90.0% of these. GPT-4 demonstrated a lower accuracy rate than GPT-3.5 in answering CQs, although without statistically significant difference (86.0% vs. 94.0%; p = 0.05), whereas GPT-4 showed significantly higher accuracy for the level of confidence in Evidence than GPT-3.5 (52.0% vs. 28.0%; p < 0.01). No statistical differences were observed in Policy Level, Aggregate Evidence Quality, and Reference Match. In addition, GPT-4 rated significantly higher in presenting existing references than GPT-3.5 (36.9% vs. 24.1%; p = 0.01). CONCLUSIONS: The overall performance of GPT-4 was similar to that of GPT-3.5. However, GPT-4 provided existing references at a higher rate than GPT-3.5. GPT-4 has the potential to provide a more accurate reference in professional fields, including rhinoplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

14.
J Reconstr Microsurg ; 40(2): 102-108, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37142252

RESUMO

BACKGROUND: The transverse cervical artery is less commonly used than other external carotid arteries as a recipient vessel. Therefore, we aimed to compare the utility of the transverse cervical artery as a recipient vessel with that of the external carotid artery system for microvascular head and neck reconstruction by quantitative analysis of dynamic-enhanced computed tomography. METHODS: Fifty-one consecutive patients who underwent free jejunum transfer following total pharyngolaryngectomy between January 2017 and December 2020 were retrospectively reviewed. Ninety-four pairs of the diameters of the transverse cervical artery, superior thyroid artery, and lingual artery, measured via computed tomography angiography, were analyzed. Operative outcomes were compared between the following groups based on the recipient artery: transverse cervical artery (n = 27), superior thyroid artery (n = 17), and other artery (n = 7) groups. RESULTS: In the analysis of the computed tomography angiography, nine transverse cervical arteries (9.6%) could not be identified. However, the percentage was significantly lower than the percentage of superior thyroid arteries (20.2%) and lingual arteries (18.1%) (p < 0.01). Among the identified vessels, the transverse cervical arteries (2.09 ± 0.41 mm) and the lingual arteries (1.97 ± 0.40 mm) were significantly larger than the superior thyroid arteries (1.70 ± 0.36 mm) in diameter at the commonly used level (p < 0.01). Multivariate analysis revealed that prior radiation therapy was not an independent factor significantly affecting transverse cervical artery diameter (p = 0.17). Intraoperative anastomotic revision was required in only two cases of the superior thyroid artery. CONCLUSION: The transverse cervical artery can offer a larger caliber and more reliable candidate than the superior thyroid artery for a recipient artery. More liberal use of the transverse cervical artery may improve the safety of microsurgical head and neck reconstruction.


Assuntos
Neoplasias de Cabeça e Pescoço , Procedimentos de Cirurgia Plástica , Humanos , Estudos Retrospectivos , Neoplasias de Cabeça e Pescoço/cirurgia , Angiografia por Tomografia Computadorizada , Jejuno , Pescoço/cirurgia , Artérias/cirurgia
15.
Br J Nurs ; 33(3): 104-108, 2024 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-38335106

RESUMO

This case study describes the successful management of a patient with primary lymphoedema, who was experiencing lymphorrhoea and epidermolysis, using a multidisciplinary approach. The patient had Klippel-Trenaunay syndrome. The multidisciplinary team, in an outpatient clinic in Japan, included a certified lymphoedema therapist, plastic surgeons, and a wound, ostomy and continence nurse. The team performed complex physical therapy and lymphaticovenular anastomosis, which promoted the resolution of the lymphorrhoea. This resulted in improvements in skin condition, the prevention of recurrent cellulitis, and no increase in limb circumferences during the 1-year follow-up period. This report highlights the importance of a multidisciplinary approach to lymphoedema management, including lymphorrhoea control that fitted in with the patient's daily life. It is hoped that this article will contribute to the improvement of the quality of life of patients with lymphoedema.


Assuntos
Linfedema , Qualidade de Vida , Humanos , Linfedema/prevenção & controle , Celulite (Flegmão)/terapia , Anastomose Cirúrgica/métodos , Convulsões
16.
Angiogenesis ; 26(1): 37-52, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35902510

RESUMO

Orbital cavernous venous malformation (OCVM) is a sporadic vascular anomaly of uncertain etiology characterized by abnormally dilated vascular channels. Here, we identify a somatic missense mutation, c.121G > T (p.Gly41Cys) in GJA4, which encodes a transmembrane protein that is a component of gap junctions and hemichannels in the vascular system, in OCVM tissues from 25/26 (96.2%) individuals with OCVM. GJA4 expression was detected in OCVM tissue including endothelial cells and the stroma, through immunohistochemistry. Within OCVM tissue, the mutation allele frequency was higher in endothelial cell-enriched fractions obtained using magnetic-activated cell sorting. Whole-cell voltage clamp analysis in Xenopus oocytes revealed that GJA4 c.121G > T (p.Gly41Cys) is a gain-of-function mutation that leads to the formation of a hyperactive hemichannel. Overexpression of the mutant protein in human umbilical vein endothelial cells led to a loss of cellular integrity, which was rescued by carbenoxolone, a non-specific gap junction/hemichannel inhibitor. Our data suggest that GJA4 c.121G > T (p.Gly41Cys) is a potential driver gene mutation for OCVM. We propose that hyperactive hemichannel plays a role in the development of this vascular phenotype.


Assuntos
Mutação com Ganho de Função , Malformações Vasculares , Humanos , Células Endoteliais , Junções Comunicantes/genética , Mutação , Veias , Malformações Vasculares/metabolismo
17.
Microsurgery ; 43(4): 392-396, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36710458

RESUMO

Nasal alar reconstruction with the free auricular helix flap is challenging because the flap is prone to congestion. We report two cases of successful nasal alar reconstruction using free auricular helix flaps utilizing the flow-through concept. Case 1 was a 37-year-old man presented with a basal cell carcinoma in the nasal cavity. After radical excision, we transferred a 20 × 20 mm2 free flow-through auricular helix flap by interposing the T-portion of the superficial temporal artery of the flap to the transected facial artery. Case 2 was a 39-year-old man presented with neurofibromatosis type I and a nasal alar deformity after multiple excision of the neurofibroma. We corrected the deformity with a 26 × 22 mm2 free auricular helix flap. We used a flow-through arterial graft of the descending branch of the lateral circumflex femoral artery to bridge the gap between the flap artery and the recipient facial artery of the submandibular region because an appropriate recipient artery was not available around the defect. Both of the flaps survived without vascular compromise and no donor-site complication occurred. The esthetic results of the nasal ala were satisfactory. The flow-through arterial anastomosis diverted the arterial flow to the peripheral side of the recipient artery and relieved flap congestion. These physiological properties of flow-through anastomosis may stabilize the flap circulation and improve the success rate of free auricular helix flap transfer.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Rinoplastia , Masculino , Humanos , Adulto , Nariz/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Rinoplastia/métodos , Artéria Femoral/cirurgia
18.
J Craniofac Surg ; 34(7): e649-e651, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37276336

RESUMO

Skeletal grafts are usually required to reconstruct defects after maxillectomy for acceptable aesthetic and functional results. Postoperative infection is a serious complication; however, few studies have evaluated the vulnerability to infection of various skeletal reconstructive materials used for maxillary reconstruction. A retrospective study was conducted on 53 cases in which maxillary skeletal reconstruction was performed between 2010 and 2021. The postoperative infection rate was compared between various skeletal reconstructive materials, including costal cartilage, scapula, fibula, ilium, cranium, and titanium mesh. In addition, the risk factors for postoperative infection were evaluated using 2-group comparison tests. Of 53 patients, 14 (25.4%) contracted an infection postoperatively. No significant differences were observed in the infection rates among the materials used for skeletal reconstruction. Cases undergoing secondary reconstruction tended to have a higher infection rate (34.4%) than primary reconstruction (14.3%). For nonvascularized skeletal grafts (41 cases), the concomitant use of soft-tissue flaps decreased the infection rate from 30.8% to 17.9%. Costal cartilage was the most frequently used material (31 cases), primarily for orbital floor reconstruction. Regarding the costal cartilage, nasal wall reconstruction had a higher infection rate (100%) than reconstruction of other parts of the maxilla (0.0%-17.9%). Nonvascularized skeletal grafts, mainly costal cartilage grafts, were safely used for maxillary reconstruction. However, caution should be exercised for postoperative infection in secondary cases and in cases where costal cartilage is used for nasal wall reconstruction. Covering nonvascularized skeletal grafts with soft-tissue flaps may be an effective countermeasure.


Assuntos
Neoplasias Maxilares , Procedimentos de Cirurgia Plástica , Humanos , Maxila/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Neoplasias Maxilares/cirurgia , Estudos Retrospectivos , Estética Dentária , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco
19.
J Craniofac Surg ; 34(8): 2464-2467, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37316982

RESUMO

Composite grafts are excellent options for treating external nasal deformities because they provide support and include the skin, which improves the delicate anatomy of the nose. However, they are constrained by size limits since the grafts rely on blood flow to the nasal bed. This is a critical issue when the recipient sites have scarring or degenerative diseases. A novel stair-step incision was made to produce a graft bed with a blood supply and to maximize the use of nonvascularized composite grafts. Instead of making a full-thickness defect through the skin envelope and lining, we placed individual incisions and connected them via a subcutaneous dissection. By dividing the defect into 2 layers, the graft bed was produced and the risk of fistula was reduced. From 2009 to 2020, we satisfactorily conducted 3 cases of nasal reconstruction with a stair-step incision followed by a composite tissue graft. One patient was a girl, and 2 were men. Their ages ranged from 11 to 44 years. The largest graft was 24 × 24 mm in size. No complications were observed. The stair-step incision method for nasal reconstruction can eliminate the limitations of composite grafts and maximize improvements through a simple procedure. This makes composite grafts safer in cases with poor vascularity, enables larger composite grafts to survive, and lowers the risk of fistula formation by avoiding full-thickness defects.


Assuntos
Fístula , Neoplasias Nasais , Rinoplastia , Masculino , Feminino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Retalhos Cirúrgicos/cirurgia , Neoplasias Nasais/cirurgia , Estética Dentária , Nariz/cirurgia , Rinoplastia/métodos , Transplante de Pele/métodos , Fístula/cirurgia
20.
Ann Plast Surg ; 89(6): e39-e44, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416701

RESUMO

BACKGROUND: Although the deep inferior epigastric artery perforator flap is the criterion standard for autologous breast reconstruction, lumbar artery perforator (LAP) and superior gluteal artery perforator (SGAP) flaps are recent trends as alternatives. The purpose of our study was to clarify differences of these flaps based on multislice CT findings of the same patient. METHODS: Retrospective study was conducted on 58 patients who underwent preoperative contrast-enhanced multislice CT for breast reconstruction using deep inferior epigastric artery perforator. Of these, 32 patients' data were evaluated excluding 26 patients' data either for the lumbar or gluteal fat being outside the imaging range or for nondepiction of the vascular pedicle origin of LAP or SGAP flap. Vascular pedicle diameter, pedicle length, and subcutaneous fat thickness were measured for LAP and SGAP flaps. RESULTS: The vascular pedicle diameter, pedicle length, and fat thickness were 2.1 (SD, 0.3) mm, 3.4 (SD, 0.4) cm, and 4.9 (SD, 1.0) cm, respectively, for LAP flaps; and 1.7 (SD, 0.2) mm, 5.6 (SD, 1.1) cm, and 2.7 (SD, 0.7) cm, respectively, for SGAP flaps. CONCLUSIONS: The LAP flaps had thicker subcutaneous fat and a larger vascular pedicle diameter, whereas the SGAP flaps had a longer vascular pedicle. As donor material for breast reconstruction, the LAP flap is indicated for cases where absolute volume is needed; otherwise, the SGAP flap is more advantageous as it facilitates vascular anastomosis with its longer vascular pedicle.


Assuntos
Mamoplastia , Retalho Perfurante , Humanos , Retalho Perfurante/irrigação sanguínea , Estudos Retrospectivos , Nádegas/diagnóstico por imagem , Nádegas/cirurgia , Nádegas/irrigação sanguínea , Mamoplastia/métodos , Artérias/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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