Phillips BT, Alser O, Alviar Ortiz MP
… +12 more, Correa N, Escandón JM, Mansour SH, Moore M, Pachano Bravo A, Ramsey MD, Saad C, Shauly O, Shulzhenko NO, Spiller K, Szulia A, Zepeda Torres JM
Microsurgery is a specialized field within plastic surgery constrained by the high cost and limited availability of surgical microscopes, particularly in resource-limited settings. This lack of access hinders trainees fr...Microsurgery is a specialized field within plastic surgery constrained by the high cost and limited availability of surgical microscopes, particularly in resource-limited settings. This lack of access hinders trainees from developing essential microsurgical skills. Previous efforts have explored smartphone-based alternatives, but there remains a need for high-fidelity, accessible training microscopes. This study presents a novel, low-cost, travel-friendly surgical microscope designed for microsurgery training. Modified binocular objective lenses enable near-field stereoscopic viewing using a dual-mirror array. A 3D-printed chassis provides the correct top-down orientation, and an integrated light source operates on standard or battery power, ensuring usability in low-resource environments. Initial testing demonstrated a fixed 6.5× magnification, allowing trainees to perform end-to-end anastomoses on 2-mm vessels. Prototypes were deployed for microsurgery training in the United States, Rwanda, Ethiopia, and Vietnam through the SHARE (Surgeons in Humanitarian Alliance for Reconstruction, Research and Education) plastic surgery organization, Nuoy Reconstructive International, and the senior author's home institution. The authors' investigation continues to assess the effectiveness of the microscope compared with state-of-the-art surgical microscopes. By offering a low-cost, portable solution without compromising image quality, this innovation has begun to transform microsurgical education and operating room-based microscopy worldwide, increasing accessibility for trainees and patients in diverse settings.
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Define the indications, benefits, and drawbacks of thigh-based flap donor sites for breast reconstruction. 2. Recognize the differen...LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Define the indications, benefits, and drawbacks of thigh-based flap donor sites for breast reconstruction. 2. Recognize the differences between popular thigh-based flaps and the utility of each. 3. Understand the anatomy of thigh-based free flaps, including their landmarks, vascular pedicles, and techniques of flap harvest. 4. Manage donor-site healing and complications. SUMMARY: Thigh-based free flaps have become a popular flap option for autologous breast reconstruction. Critiques of thigh-based flaps include inadequate flap volume and donor-site concerns, such as poor appearance, sensory changes, and problematic healing; however, refinements in surgical technique have led to more predictable outcomes. The purpose of this article is to review the advantages and disadvantages of the various thigh-based free flaps for breast reconstruction, including gracilis myocutaneous, profunda artery perforator, and lateral thigh perforator flaps. Practical pearls for flap harvest and optimization of aesthetic results are provided.
BACKGROUND: The objective of this study was to evaluate the efficacy of botulinum toxin type A (BoNT-A) in preventing pathological scars and improving scar quality and to assess treatment safety and patient satisfaction....BACKGROUND: The objective of this study was to evaluate the efficacy of botulinum toxin type A (BoNT-A) in preventing pathological scars and improving scar quality and to assess treatment safety and patient satisfaction. METHODS: Randomized controlled trials and cohort studies identified in PubMed, Scopus, Embase, or Web of Science were included. Outcomes analyzed included scar quality, patient satisfaction, and adverse effects. Statistical analysis was performed using mean differences (MDs) and relative risks (RRs). Risk of bias was assessed with the Risk of Bias 2 and Risk of Bias in Nonrandomized Studies of Interventions tools. RESULTS: Nineteen studies with a total of 686 patients were included. BoNT-A showed significant improvements in several outcomes. The MD was -1.07 (95% CI, -1.59 to -0.56; P < 0.0001) on the Vancouver Scar Scale and 1.18 (95% CI, 0.94 to 1.42; P < 0.00001) on the visual analog scale. Scar width was reduced, with an MD of -0.21 (95% CI, -0.33 to -0.09; P = 0.0008). In the Stony Brook Scar Evaluation Scale and Patient and Observer Scar Assessment Scale, the differences favored BoNT-A, with MD of 1.64 (95% CI, 0.78 to 2.50; P = 0.0002) and -1.28 (95% CI, -2.02 to -0.53; P = 0.0008), respectively. Patient satisfaction was higher with BoNT-A (RR, 1.83 [95% CI, 1.10 to 3.07]; P = 0.02). Adverse effects were minimal and transient, with no significant differences between groups. CONCLUSIONS: BoNT-A is an effective and safe intervention. Its use reduces the formation of pathological scars and generates high levels of patient satisfaction, without serious adverse effects. However, studies with larger sample sizes and homogeneous designs are required to confirm these findings.
Marco E, Liaqat A, Shamoun F
… +7 more, Hosseini B, Metcalfe KA, Lim DW, O'Neill AC, Hofer SOP, Croke J, Zhong T
Plast Reconstr Surg
· 2026 Jul · PMID 42340823
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BACKGROUND: Breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR) offer similar oncologic outcomes in early-stage breast cancer, leading patients to base decisi...BACKGROUND: Breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR) offer similar oncologic outcomes in early-stage breast cancer, leading patients to base decisions on nononcologic factors such as chest wall discomfort, tightness, and functional limitations. The authors' primary objective was to evaluate the effects of these operations on quality of life using the BREAST-Q Physical Well-Being: Chest subscale. The secondary objective was to assess the impact of different radiation regimens on chest physical well-being. METHODS: A retrospective review of stage 0 to III breast cancer patients who underwent BCS, MA, or IBR from 2015 to 2019 was conducted. The primary outcome was change in Physical Well-Being: Chest BREAST-Q scores from the preoperative period to 1-year postoperatively. A minimal important difference greater than or equal to 4 points indicated clinical significance. RESULTS: Of 517 patients, 202 underwent BCS, 125 underwent MA, and 190 underwent IBR. BCS patients demonstrated the highest decline of 15.3 points (89.1 to 73.8; P < 0.001) followed by MA with 12.7 points (76.6 to 63.9; P < 0.001). IBR had the smallest decline of 3.7 points (78.0 to 74.3; P = 0.022). A total of 262 radiation patients experienced a mean decline of 15.2 points (84.6 to 69.4; P < 0.001), with the regional node irradiation with boost group exhibiting the greatest decline of 21.5 points (88.5 to 67.0; P < 0.001). CONCLUSIONS: BCS patients, despite higher baseline scores, experienced the greatest decline, whereas IBR patients had the smallest. In addition, greater radiation intensity and extent correlated with larger declines. Integrating minimal important difference into clinical practice ensures that patient-reported outcomes capture changes that are meaningful to patients, guiding treatment decisions.
No single soft palate repair technique is universally optimal for cleft palate reconstruction; the ideal approach depends on cleft gap width and palatal configuration. Wide-gap clefts incur excessive tension with double...No single soft palate repair technique is universally optimal for cleft palate reconstruction; the ideal approach depends on cleft gap width and palatal configuration. Wide-gap clefts incur excessive tension with double opposing Z-plasty, whereas narrow-gap clefts may not require the complexity of intravelar veloplasty (IVV). We developed an institutional protocol selecting the repair technique based on intraoperative cleft gap measurement at the uvular neck: modified asymmetric small limb Z-plasty (MASLZ) for V-shaped gaps ≤ 6 mm, and straight-line repair (SLR) with overlapping IVV for gaps wider or U-shaped palates. Both techniques maximize levator veli palatini muscle overlap, the physiological basis of velopharyngeal competence. In 65 patients with unilateral cleft palate treated by a single surgeon (2015-2023; 34 MASLZ, 31 SLR), fistula formation (1 vs. 5; p = 0.0951) and secondary velopharyngeal insufficiency surgery (2 vs. 6; p = 0.1377) were comparable, and surgical group was not an independent predictor of secondary VPI surgery in multivariable analysis. Consistent palatoplasty outcomes can be achieved through individualized, algorithm-driven technique selection rather than uniform application of a single method.