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.

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。

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.

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.

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.

Current Status of ADSCs-Enriched Fat Grafts in Plastic Surgery

Autologous fat grafting is an increasingly popular technique in plastic surgery for volume augmentation and rejuvenation.However,the unpredictability of long-term volume retention limits its clinical application.Various animal studies have documented the positive effects of adipose tissue-derived stem cells(ADSCs)on the acceleration of lipofilling.However,the results have been inconsistent,and there is an insufficient number of high-quality clinical studies to formulate evidence-based recommendations for ADSC-enriched fat grafts.Moreover,related technical standards,such as the final count of harvested ADSCs and the enrichment ratio,have not yet been established.This systematic review included all clinical trials on ADSC-enriched fat grafts in plastic surgery from PubMed in the past 10 years,as well as all registered clinical trials on ClinicalTrials.Gov.To examine the current landscape of ADSCs harvest,we summarize the current applications of ADSCs in the field of plastic surgery and discuss the current barriers to universal clinical use.

Effect of Expanded Polytetrafluoroethylene Combined with Autologous Ear Cartilage in Nasal Plastic Surgery

Objective:To explore the effect of combined application of expanded polytetrafluoroethylene and autologous ear cartilage in nasal plastic surgery.Methods:76 cases of nasal plastic surgery patients in our hospital from September 2019 to September 2020 were selected as the research objects and divided into experimental group(38 cases,treated with expanded polytetrafluoroethylene+autologous ear cartilage surgery)and control group(38 cases,treated with autologous ear cartilage surgery).The treatment effect,appearance score and complications were compared.Results:The total effective rate of the experimental group(97.37%,37/38)was higher than that of the control group(78.95%,30/38),P<0.05;After treatment,the appearance score of the experimental group was(8.97±0.37),which was significantly higher than that of the control group(P<0.05);The total incidence of complications in the experimental group(5.26%,2/38)was significantly lower than that in the control group(21.05%,8/38),P<0.05.Conclusion:In the process of nasal plastic surgery,the combined application of autologous ear cartilage surgery and expanded polytetrafluoroethylene has obvious effect,improves the appearance of patients,and has less postoperative complications,which is worthy of promotion.

Plastic surgery

209445 Fabrication and application of three-dimensional autogenous cartilage framwork in auricular reconstruction/Pan Bo(潘博,Plast Surg Hosp,Chin Acad Med Sci,Beijing 100144)…∥Chin J Plast Surg.-2009,25(3).-161～164Objective To explore the fabrication and application of three-dimensional autogenous cartilage framwork in auricular reconstruction.Methods The process of fabrication of three-dimensional cartilage framework consisted of harvesting,carving and assembling the cartilage.The rib cartilage was harvested separately.The three-dimensional framework was composed of three main parts:the helix,the base and the pad,at different layer.The framework was fabricated according to the development of rib cartilage and contour and height of the reconstructed ear.Results From January 1992 to December 2006,5 248 patients of microtia were treated with 6 252 autogenous cartilage frameworks.Conclusion The three-dimensional framework is easily manipulated.The reconstructed ears look natural and had an erect contour.This method can effectively use the cartilage.10 refs,14 figs.

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.

Anesthesia for office-based facial plastic surgery procedures

Objective:The objective of this study is to provide a state-of-the-art review on the use of anesthetics for in-office facial plastic procedures.Methods:A search was performed on PubMed,Embase,Web of Science,and Cochrane Review using the keywords"anesthesia,""office-based procedures,""local anesthesia,""facial plastics,""oral sedation,""moderate sedation,"and"deep sedation."Results and Conclusions:Over the past few decades,the shift toward in-office invasive procedures has increased patient convenience and decreased hospital resource utilization.Many tools exist to reduce patient anxiety and discomfort in an office-based setting.With proper patient selection and technique,facial plastic surgeons can adequately anesthetize patients to perform Mohs reconstruction,cutaneous excisions,blepharoplasty,face-lifts,and other in-office procedures.

Plastic surgery after solid organ transplantations

Background More patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation. Methods A retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients. Results All patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results. Conclusions Immunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.

Stem cells and tissue engineering in plastic surgery:an update

Stem cells and tissue engineering have made great strides in plastic surgery.This review of the literature evaluates some current background information and recent advances in our laboratory to bring these areas more into the clinical setting.

Impact of a new teaching model on the fine cosmetic suturing operation and quantitative assessment of the training effect on plastic surgeons

Background Traditional lecture-based teaching(TLT)has long been the primary method of teaching plastic suturing techniques and even surgical education.It has been challenging to adapt this approach to fit the educational objectives of plastic surgery,which is a very practical science.Additionally,it is mainly teacher-led,and the course content is teacher-driven,which has disadvantages such as difficulty in motivating students and disconnection from clinical practice.Therefore,we developed a video point-to-point teaching(VPT)method and teamwork-based teaching(TBT)to study the effect of the new teaching model on fine cosmetic suturing operation(FCSO)and training outcomes for plastic surgeons.Methods We selected 30 junior doctors from the Department of Plastic and Reconstructive Surgery of the Chinese PLA General Hospital.All trainees were randomly assigned to three groups:TLT,VPT,and TBT.All trainees had their performances photographed,and a senior attending physician was appointed as a rater.We rated the process and results of FCSO according to a uniform rubric following the double-blind principle to compare the effects of different teaching modes on the trainees’FCSO and differences in training outcomes.Results There was no significant effect of video recording on trainees’FCSO(P>0.05).The total scores of the first suturing in the three groups were as follows:TLT group(13.18​±​1.66),VPT group(13.63​±​1.97),and TBT group(13.50​±​2.26),with no significant difference among the groups(P>0.05),indicating that the starting level of the trainees in the three groups was basically the same.There was no significant difference(P>0.05)between the VPT(20.30​±​2.17)and TBT(20.38​±​2.29)groups,but both of these groups were significantly better than the TLT group(16.43​±​1.86,P<0.01).Conclusion The TBT and VPT methods are significantly better than TLT.However,the TBT method is more economical and optimal for teachers and better utilizes students’initiative in learning and operation,which improves the teaching level and training efficiency.

Virtual Reality in Surgery: Double Blind, Randomized Clinical Trial of Pain Control and Augmented Satisfaction

Introduction: Virtual reality (VR) utilizing a head-mounted display allows viewers to immerse themselves in a virtual environment. This technology may be useful in attenuating pain and anxiety and reducing patient subjective stress as well as objective physiological increase in heart rate and blood pressure. Aside from the improved experience, physiological stress is reduced which results in improved patient outcomes. Patients and methods: Eligible participants were all adults aged 18 or over who had non craniofacial lesions requiring minor surgery. A total of 99 adult patients who were capable of independent consent were randomized to receive a virtual reality experience (VR) or standard music distraction (no VR). Patients were recruited for the study during their office visit when scheduling minor procedure surgery. This was a single center, double-blind, controlled study conducted at Guthrie Clinic Robert Packer Hospital in Sayre, Pennsylvania between March 2019 to January 2020 (pre-pandemic). Ethics approval for this study was obtained from the Institutional Review Board of the Guthrie Clinic. Results: The change in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) significantly decreased from pre-procedure to mid-procedure in the VR group compared with standard. Herein our results are presented. Conclusions: Reductions in intraprocedural SBP, DBP and HR can be achieved when using VR. Although subjective reporting of pain and anxiety were not different between groups, VR significantly improves patient satisfaction compared with non VR standards.

Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique:Two case reports

BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.

Fat management in upper blepharoplasty:Addition or subtraction blepharoplasties,how and when

BACKGROUND As one of the most common aesthetic surgical procedures carried out today,blepharoplasty should be in the repertoire of every plastic surgeon.The term blepharoplasty encompasses a wide range of techniques and options that must be tailored to the specific defect and patient one has to treat.A sound knowledge of the upper and lower eyelids’anatomy is essential for proper surgical execution.Trends have shifted towards more conservative methods(especially of the fat compartment)and sometimes in combination with augmentation techniques,helping to reach a rejuvenated appearance.AIM To present an overview of the surgical techniques considered for upper lid blepharoplasty and fat pad management,in addition to information on how a surgeon may approach the best treatment for his patient based on current publications in literature.METHODS We searched the literature published between 2013,to 2023 using Medline and Reference Citation Analysis.The database was searched using the keywords“upper blepharoplasty”AND“fat”.Papers without full text/abstracts and reviews were excluded.The search strategy followed the PRISMA.The American Society of Plastic Surgeons guidelines for Therapeutic Studies checklist was used to assess all articles.Two authors individually reviewed each article and rated them for importance and relevance to the topic.A consensus was sought and the most relevant studies.RESULTS After the application of the selection criteria used in our review,13 publications were found to address upper lid blepharoplasty specifically.Three of these studies were reviews and three were retrospective studies.Five publications were comparative studies and a further two were clinical trials.CONCLUSION The tendency of modern surgery is to be conservative,by removing adipose tissue only if strictly necessary and restoring the volume of the upper eyelid in a concept of beauty that espouses a"full"sight.There is no gold standard technique to achieve younger and enhanced eyelids.Long-term prospective comparative studies are fundamental in understanding which path is the best to follow.

High-Performance Macrotia Surgery

Many articles report that macrotia is a rare ear deformity, but this is not the reality that we encounter in our service. In accordance with anthropometric studies of the ears, we consider that an aesthetically normal ear measures 6.0 cm in length on the vertical axis and 3.7 cm on the horizontal axis in boys, with ear growth maturing at 13 years of age, and 5.91 cm in length on the vertical axis and 3.37 cm on the horizontal axis, with ear growth maturing at age 12 in girls. When the measurements exceed these averages, we consider that the patient has macrotia. The authors describe a new technique of surgical correction of macrotia that results in an average reduction of 1.7 cm on the vertical axis and 0.8 cm on the diagonal axis with an average surgical time of forty-five minutes, fast learning curve, and little scarring. This technique also allows it to be combined with otoplasty and correction of the lobe length. Because of these items we call the technique High-Performance Macrotia Surgery. Level IV: Evidence is obtained from multiple time series with or without the intervention, such as case studies.

Psychosomatic Medicine and Evidence-Based Surgery:Reflections and Perspectives

This article reflects on the need for psychosomatic medicine research in the field of surgery by complementing psychological/psychiatrist approaches with a physician’s(particularly surgeon’s)point of view.Focusing on esthetic/cosmetic surgery,a broader notion of“psychosomatic surgery”is also used regarding plastic surgery as well as examples of vascular and general surgery.Relevant literature reviews are utilized to gain a more comprehensive bio-psycho-social perspective.By providing a deeper understanding in the specialty areas,it makes a case for evidence-based practice by shedding light on psychosomatic medicine research on surgery in the United States with cross-cultural implications.