Application experience and research progress of different emerging technologies in plastic surgery

In the diagnosis and treatment of plastic surgery,there are structural processing problems,such as positioning,moving,and reconstructing complex threedimensional structures.Doctors operate according to their own experience,and the inability to accurately locate these structures is an important problem in plastic surgery.Emerging digital technologies such as virtual reality,augmented reality,and three-dimensional printing are widely used in the medical field,particularly in plastic surgery.This article reviews the development of these three technical concepts,introduces the technical elements and specific applications required in plastic surgery,summarizes the application status of the three technologies in plastic surgery,and summarizes prospects for future development.

First Reconstructive Plastic Surgery of the Perineum in a Hominin Pan paniscus (Bonobo) and Plea by a Plastic Surgeon for Surgery for the Benefit of All Hominins (Members of the Human Lineage)

We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.

Chinese Journal of Plastic and Reconstructive Surgery

“Writing is thinking.To write well is to think clearly.That’s why it’s so hard.”—David McCullough As surgeons,our focus is to perform our procedures well,to master our skills,and to eventually improve on today’s standard of care.To achieve this,we spend an inordinate amount of time observing mentors at work and practicing and honing surgical skills in the operating room.

Optimal timing for plastic surgical procedures for common congenital anomalies:A review

Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

Indocyanine green:The guide to safer and more effective surgery

In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.

Application of Ultimate Oncoplastic Surgery in Breast-Conserving Surgery

Objective To investigate the application of oncoplastic surgery in breast-conserving surgery.Methods We retrospectively analyzed the clinical data of 103 breast cancer patients who underwent breast-conserving surgery in the First Affiliated Hospital of Henan University.All the patients were female whose tumor volume-to-breast volume ratio was greater than 20%.Fifty-two patients were treated with oncoplastic breast-conversing surgery(observation group),and 51 patients were treated with traditional breast-conserving surgery(control group).The volume of resected tissue,subjective satisfaction with breast shape,objective score of breast shape,and follow-up were compared between the two groups.Results In the observation group,the weight of resected breast tissue was 64.2–172.1 g,with a median of 98.7 g.In the control group,the weight of resected breast tissue was 67.5–175.7 g,with a median of 102.3 g.After 12 months of follow-up,the subjective satisfaction rate and objective score of breast shape in the observation group were significantly better than those in the traditional breast-conserving surgery group(P<0.05).There was no recurrence,metastasis,or death in the two groups.There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Oncoplastic breast-conserving surgery leads to better cosmetic results and a more satisfactory clinical results.

Comparison of Plastic Surgery Training Programs Between Hong Kong and Shanghai

The field of plastic surgery has developed rapidly in the last couple of decades in Hong Kong and Shanghai,China.Both cities have their own educational system for training plastic surgeons.Their training programs differ in many ways,including the surgical exposure of undergraduate studies,the structure,curriculum,and operative requirements of residency training.In general,Hong Kong has a single pathway of residency training with more early clinical exposure in an undergraduate study.On the contrary,Shanghai has multiple pathways of residency training that are heavily emphasized in academic research.Both Hong Kong and Shanghai should complement each other to modify their plastic surgery training programs that will eventually benefit the field of plastic surgery education。

Body Image and Personality in Aesthetic Plastic Surgery: A Case-Control Study

Introduction: The amount of research on the relationship between plastic surgery and psychological features, such as personality disorders and indexes of body image dissatisfaction, has increased significantly in the last years. Aim: The aim of the present study was to examine these psychological features among Italian patients who underwent aesthetic plastic surgery, testing the mediating role of the mass media influence on the relationship between them and the choice of aesthetic plastic surgery. The Personality Diagnostic Questionnaire 4+ (PDQ-4+) and the Body Uneasiness Test (BUT) were administered to patients who underwent aesthetic plastic surgery (N = 111) and participants who had no history of aesthetic plastic surgical procedures (N = 149). Results: Results showed that aesthetic patients reported higher indexes of body image disturbance than controls. No significant differences between aesthetic participants and controls were found in all three cluster B personality disorders. Moreover, the effect of body image dissatisfaction on the choice to undergo aesthetic plastic surgery was partially mediated by the influence of mass media. Conclusions: In conclusion, the present study confirmed the importance of body dissatisfaction as a predictor of the choice to undergo aesthetic surgery and highlighted the influence of media messages regarding physical appearance.

The Relevant Roles of Plastic and Orthopedic Surgery in Hand Salvage

Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.

Historical Case Report: 45 Years of the First Plastic Surgery in Morbid Obese in Brazil and Their Weight Loss

Before the 70s, in Brazil, each city had its morbidly obese, considered as the “excessive fats”, in very small numbers if we compare it with the current percentage. There was no classification of the degree of obesity by the body mass index (BMI) as we have today. By chance, on a Saturday in June 1975, at the Outpatient Clinic of the 23rd Infirmary of Santa Casa da Misericórdia Hospital in Rio de Janeiro, arrived the patient I. S., 41 years old, 1.70 m tall, supported by her two children, weighing 210 kg in weight body. Knowing that bariatric surgery only appeared in the 1980s, before that, patients with morbid obesity were left to their own devices, with hypertension and diabetes. The patient I. S. was hospitalized for 3 years in our Plastic Surgery Service, having received nutritional monitoring, had sporadic discharges and undergone 9 reparative plastic surgeries. She was discharged weighing 71 kg, with self-esteem recovered and happy to start a new life, without hypertension and diabetes.

A Short Term Review of Operated Cases in the Plastic Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: Surgical problems are of much disturbance to the world and should therefore be given serious attention. The prevalence of these surgical problems, has made plastic surgery become a broadly relevant and acceptable way for addressing problems like injuries, congenital anomalies, surgical infections and malignancies among others. Aim: This study is to quantify and characterize surgical procedures done in the plastic surgery theatre located in the new Accident and Emergency (A & E) Building of KATH. Materials and Methods: Data were obtained from the Operation Register/Theatre Books in the plastic surgery theatre at the A & E Centre on cases operated on from October 1, 2009 to September 30, 2012. Data entry, presentation and analysis were done using Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: Adults formed the majority of patients who sought for plastic surgery with a percentage of 70.3%. The male patients also outnumbered the females recording (61.5%) out of the total number of patients. Most of the cases recorded were acquired cases (93.2%). Reconstructive surgery was the commonest operation performed (30%);in 53.8% cases general anaesthesia was used. Conclusion: Among all the procedures used reconstructive surgery was the commonest surgery performed in the unit and general anaesthesia was the most type of anaesthesia used for the operations.

Saudi Arabia, Breast Plastic Surgery, Breast Construction

In this review article, various preferences in breast plastic surgery particularly after breast cancer will be discussed in view of the diverse indications for the different construction procedures. The various conditions that necessitate the need for reconstruction are appraised, the important reconstructive procedures are discussed. The most important indications procedures discussed in this review include;Prophylactic subcutaneous mastectomy, Lumpectomy and Radiation, Modified Mastectomy with Axillary Sampling, Nipple reconstruction, and the contralateral breast. These procedures are discussed in view of plastic surgeon practice and patients acceptability in Saudi Arabia. Data from Saudi Arabia in particular was identified through searches of the EMBASE, and MEDLINE database, using the keywords: Saudi Arabia, breast plastic Surgery, breast reconstruction, autologous breast reconstruction, breast augmentation. Advances in prosthetic technologies and modifications in autologous flap techniques, and the development of novel tissue alternatives have allowed for sustained developments in breast reconstruction results. A variety of attitudes has been accessible for addressing the difficulties that endure after resection of breast cancer in Saudi Arabia. Patients should be educated to accept different process in this context.

Improving Confidence and Practical Skills in Plastic Surgery for Medical Students and Junior Doctors: A One-Day Session

Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps;b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.

Applying Bruce Lee’s Jeet Kune Do Combat Philosophy in Plastic &Reconstructive Surgery—7 Principles for Success

At first glance, it may appear that martial arts and surgery do not relate to each other at all. However, martial arts and surgery are all one on the path of knowledge and self discovery. Innovations are constantly being developed;some techniques stand the test of time while others are relegated to history. Martial arts and surgery have also branched out for example boxing, taekwondo, jujitsu and wrestling for martial arts whereas surgery has branched out to orthopaedics, paediatrics, cardiothoracic and neurosurgery to name a few. Some choose to specialize while others choose to be a generalist. Learning methodologies in martial arts and plastic surgery are similar. Martial arts students are the equivalent of surgical residents, and both have to enroll in a school that prepares them to be practitioners of their respective arts. In the last century, formal martial arts academies and surgical residency training programs have sprung up. The standards and entrance requirements vary from school to school as do training methodology and philosophical concepts. In this article, we seek to analyze Bruce Lee’s martial arts’ philosophy of Jeet Kune Do (JKD) and that how we can apply it to our personal path in Plastic & Reconstructive Surgery.

Oncoplastic Breast Surgery Using Spindle Shaped-Partial Mastectomy for Early Breast Cancer in the Upper Quadrant Area

Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.

Versatility of therapeutic reduction mammoplasty in oncoplastic breast conserving surgery

Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, "therapeutic mammoplasty" or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients(14%). Nine patients(15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.

Prospective application of poloxamer 188 in plastic surgery:A comprehensive review

An increasing number of researchers have demonstrated that poloxamer 188(P188)can be used as a pharmaceutical excipient for clinical applications.Its membrane-sealing effects and inherent biological activities make it an extremely promising agent for plastic surgery.In this review,we summarize the positive roles of P188 in autologous fat grafting,wound healing,and cartilage transplantation.These roles include improving the survival rate of fat grafts and chondrocytes,stimulating the metabolic activity of adipocytes,promoting wound healing,and contributing to cartilage formation.Although further research is still needed,it is clear that P188 has great potential and application value in the field of plastic surgery.

Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

Background: Integration of neoadjuvant chemotherapy (NCT) in early 70s resulted that many LABC tumors become resectable but with total mastectomy especially those with partial response, oncoplastic techniques give better oncological outcome with better cosmetic results. Objective: We evaluate the oncological safety of oncoplastic breast surgery (OS) in LABC showing partial response to NCT. Methods: We prospectively analyzed the data of 32 out of 58 patients with LABC who showed partial response to NCT and could have conservative surgery with advanced oncoplastic techniques rather than total mastectomy. Results: Out of 58 patients with LABC, received neoadjuvant chemotherapy, complete response was observed in 8 patients (13%), partial response reported in 32 (55.1%) cases, 12 patients (20%) had stable disease and 6 patients (10%) showed progressive disease. Data of 32 cases were studied (mean age 44.84 ± 9.10 years;range 26 - 59 years). Inferior pedicle was performed in 9 cases, mini LD flap in 3 patients, 5 had Grissotti technique, 6 with superomedial pedicle, 4 had V mammoplasty and 3 with J mammoplasty and 2 had vertical mammoplasty. Margins were positive in 5 cases (15.6%) with mean margin width 9.63 ± 5.72 (range 0 - 22 mm), and the local recurrence was reported in 2 cases (6.2%). Complications were reported in 3 cases (9.3%). The follow up was 1.67 ± 1.03 (range 0 - 3.3 years). Conclusions: Integration of neoadjuvant chemotherapy together with advanced oncoplastic techniques opens a new way for management of LABC especially those showing partial response with avoidance of total mastectomy, and comparable oncological safety in addition to better aesthetic and psychological outcome.

The Concept of Oncoplastic Breast Surgery Applied in Surgery for a Giant Fibroadenoma

The treatment of a 40-year-old woman with a giant fibroadenoma in her left breast is presented. The fibroadenoma measured 14 × 5 × 3 cm and weighed 170 g. We demonstrate that the surgical strategy and the reconstructive techniques in oncoplastic breast cancer surgery successfully can be applied to the treatment of these rare benign tumours improving the cosmetic and functional outcome.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.