Eplasty [JOURNAL]
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200 papers
Design of Buccinator Flaps for Oronasal Fistula Repair: A Technical Review and Case Series.
MacIsaac M, Mattia A, Halsey J … +1 more , Rottgers SA
Eplasty · 2026 · PMID 41837171
BACKGROUND: Oronasal fistula (ONF) repair remains a significant challenge in patients with cleft lip and palate, particularly when local palatal tissue is insufficient. Regional flaps, including the buccal myomucosal fla...
BACKGROUND: Oronasal fistula (ONF) repair remains a significant challenge in patients with cleft lip and palate, particularly when local palatal tissue is insufficient. Regional flaps, including the buccal myomucosal flap (BMMF) and the facial artery musculomucosal (FAMM) flap, offer reliable reconstructive options. This study reviews the surgical anatomy, design, and clinical outcomes of these buccinator-based flaps in ONF repair. METHODS: This retrospective case series included 13 patients who underwent ONF repair using a BMMF or a FAMM flap between 2017 and 2024. Patient demographics, fistula characteristics, surgical details, postoperative care, and outcomes were collected and analyzed. RESULTS: Six patients underwent BMMF reconstruction, while 7 received FAMM flaps. Successful fistula closure was achieved in 66.7% of patients in the BMMF group, with flap dehiscence occurring in 2 cases, both associated with digital manipulation. The FAMM flap cohort had a 100% fistula closure rate but exhibited a high incidence (86%) of postoperative scar contracture, with 4 patients requiring contracture release. CONCLUSIONS: Based on this experience, the authors propose an algorithm for flap selection in ONF repair. Posteriorly based BMMFs are well suited for fistulas at the junction of the hard and soft palate (Type III) and the posterior third of the hard palate (Type IV). Superiorly based FAMM flaps are preferred for anterior ONFs, particularly those extending into the alveolus. The central hard palate remains a reconstructive challenge, with FAMM flaps offering better reach, though they require staged inset and debulking. Both BMMF and FAMM flaps provide vascularized tissue for ONF closure with minimal donor site morbidity. Strategic flap selection based on fistula location optimizes outcomes while mitigating complications.
Single-Stage Breast Reconstruction With Immediate Free Nipple Grafting in Goldilocks Mastectomy Using Composite Nipple Graft and "Donut" Areolar Full-Thickness Skin Graft Shared From Noncancerous Breast.
Connor CH, Dodwani S, Carr QL … +5 more , Fell C, Shockley S, Cantrell R, Huett W, Wilhelmi BJ
Eplasty · 2025 · PMID 41836356
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Wolverine Hand: Intramedullary Threaded Nail Fixation of Four Metacarpal Fractures.
Brummund D, Chang A, Husain T
Eplasty · 2025 · PMID 41836355
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Batwing Mammoplasty Modification as a Treatment for Hurley Stage III Breast Hidradenitis Suppurativa.
Mortell T, Rosbrugh J, Aukerman W … +3 more , Kresofsky K, Babycos C, Chaffin A
Eplasty · 2025 · PMID 41836354
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A Suitable Indication for Crescent Mastopexy: Achieving Optimal Nipple Position in Nipple-Sparing Mastectomies.
Cantrell RA, Mostovych AL, Fell C … +5 more , Dodwani SD, Connor CH, Carr QL, Gorena C, Wilhelmi BJ
Eplasty · 2025 · PMID 41836353
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Comparison of Surgical Complications in Staged Versus Combined Hysterectomy Approach in Masculinizing Bottom Surgery: A National Surgical Quality Improvement Program Analysis.
Adebagbo OD, Tobin MJ, Park JB … +6 more , Rahmani B, Nickman S, Gettings M, Rajagopalan S, Kent MA, Cauley RP
Eplasty · 2025 · PMID 41822404
BACKGROUND: Masculinizing (female-to-male) gender-affirming bottom surgeries (GABS) commonly include hysterectomies and can be performed in a staged manner or at the time of masculinizing genital surgery. Prior studies w...
BACKGROUND: Masculinizing (female-to-male) gender-affirming bottom surgeries (GABS) commonly include hysterectomies and can be performed in a staged manner or at the time of masculinizing genital surgery. Prior studies with small patient cohorts have suggested that adopting a combined approach increases the likelihood of complications. This study aimed to characterize patients undergoing gender-affirming masculinizing genital surgery with and without concurrent hysterectomies and determine whether there were additive risks of concurrent procedures. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients with International Classification of Diseases-9/-10 gender dysphoria diagnoses who underwent masculinizing GABS (intersex for female to male, simple or complex scrotoplasty) from 2012 to 2022. Stratified by the presence of a concurrent hysterectomy, baseline characteristics, preoperative commodities, and 30-day postoperative outcomes were compared between single-stage GABS and those with concurrent hysterectomy. RESULTS: Of the 113 total patients included, 83 (73.5%) patients had a single-stage GABS and 30 (26.6%) patients had a GABS combined with hysterectomy. Baseline characteristics, including age, gender distribution, and preoperative comorbidities, were comparable between groups. The median operative time and hospital length of stay were similar between groups. However, single-stage GABS patients had higher rates of return to the operating room (14.5% vs 0.0%, = .03), wound complications (22.9% vs 0.0%, = .004), and all-cause complications (27.7% vs 6.7%, = .02). CONCLUSIONS: The results suggest that performing hysterectomies at the time of masculinizing GABS can be safe in appropriately selected patients. These findings highlight the potential safety benefits of combining GABS with hysterectomy and underscore the need for further research into optimizing outcomes for diverse patient populations, as a combined approach may improve efficiency, aid access to care, and improve patient satisfaction.
Alligator Assault: A Systematic Literature Review and Case Series at a Florida Level 1 Trauma Center.
Moffitt S, Koussayer B, Buller K … +6 more , Moore MG, McLaughlin M, Stoehr J, Schlub R, Doarn M, Troy J
Eplasty · 2025 · PMID 41822403
BACKGROUND: Alligator bites are a rare occurrence, though some literature on injurious human-alligator interactions exists. This report details 3 cases of alligator bite-related wounds with characteristic extensive tissu...
BACKGROUND: Alligator bites are a rare occurrence, though some literature on injurious human-alligator interactions exists. This report details 3 cases of alligator bite-related wounds with characteristic extensive tissue damage and subsequent reconstruction. We also review the literature on caring for this specific population. METHODS: The authors present a systematic literature review on alligator bite-related sequalae and care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed throughout the systematic literature review. The authors also present a case series of patients wounded by alligators who each presented to a large tertiary academic center on the west coast of Florida. RESULTS: Early debridement, prophylactic antibiotics, soft tissue reconstruction, and interdisciplinary care are the main tenets of care for patients who sustain alligator bites. Case 1 was a 53-year-old man with a left upper extremity bite with significant neurovascular damage and near transradial amputation who underwent emergent revascularization. After multiple attempts at limb salvage, the patient underwent formal transradial amputation. Case 2 was a 77-year-old woman with bites to her left upper and lower extremities, with concern for lower extremity Morel-Lavallée lesion. The lower extremity wound was reconstructed with lateral gastrocnemius muscular and fibularis longus musculocutaneous flaps and split-thickness grafting; ultimately, transradial amputation was necessary for the upper extremity after evidence of devascularization. Case 3 was a 34-year-old man with a facial injury and skull fracture. After initial operative repair of the facial nerve and soft tissue lacerations, the patient required later revision with cranioplasty and temporalis coverage because of a draining wound. All 3 patients survived their severe injuries. CONCLUSIONS: This case series represents a unique set of patients maimed by alligators and their subsequent surgical management. Recommendations from the literature review include an interdisciplinary approach, early operative investigation and initiation of broad-spectrum antibiotics, and to consider a staged reconstruction for these injuries.
Replacing Bacitracin With Vancomycin in Adams Triple Antibiotic Solution for Irrigation in Breast Implant Reconstruction: A Retrospective Review of 277 Reconstructions.
Carr QL, Connor CH, Cantrell R … +8 more , Dodwani S, Mostovych AL, Bennett M, Corey SL, Weeks DW, Azzolini A, Prewitt C, Wilhelmi BJ
Eplasty · 2025 · PMID 41822402
OBJECTIVES: Breast reconstruction following mastectomy commonly involves tissue expanders to create a suitable pocket for implantation. The use of triple antibiotic irrigation during tissue expander placement aims to red...
OBJECTIVES: Breast reconstruction following mastectomy commonly involves tissue expanders to create a suitable pocket for implantation. The use of triple antibiotic irrigation during tissue expander placement aims to reduce implant-related infections. Implant infections can lead to severe complications, often necessitating revision surgeries that may delay treatment of other conditions, such as cancer. For years, the most common solution used in breast pocket irrigation was the Adams solution, which comprises 80 mg gentamicin, 1 g cefazolin, and 50 000 U bacitracin in 500 mL of normal saline. However, the discontinuation of bacitracin has prompted the search for alternative formulations. Vancomycin, like bacitracin, has been shown to provide gram-positive coverage-only better. This study aims to evaluate the utility of a triple antibiotic solution (TAS) containing gentamicin, cefazolin, and vancomycin as a replacement for bacitracin in reducing infection rates following tissue expander placement. METHODS: A single-center retrospective chart review was conducted, including 152 patients who underwent a total of 277 breast reconstructions with a TAS comprising 80 mg gentamicin, 1 g cefazolin, and 1 g vancomycin from March 2020 to June 2024. Demographic and clinical data, perioperative characteristics, and postoperative outcomes-including infection rates and culture results-were analyzed. RESULTS: Infections occurred in 6 of 277 reconstructions (2.17% of implants). Methicillin-resistant was a significant pathogen in infections (50.00%). None of the systemic side effects of vancomycin, including nephrotoxicity, ototoxicity, or vancomycin flushing syndrome, were encountered. Furthermore, no evidence of drug-resistant bacteria was reported in any of the cases. CONCLUSIONS: This study highlights the potential utility of vancomycin as an acceptable alternative to bacitracin in triple antibiotic irrigation solution following tissue expander placement post-mastectomy. Additional research could help to further establish vancomycin's efficacy and safety. If validated, this approach could be a temporary alternative to the Adams solution until a better long-term strategy is identified.
Extreme Injury of Multiple Hand Extensor Tendons (Zones II to VII) Combined With an Extensive Degloving Injury of the Dorsal Hand: Staged Reconstruction Utilizing Silicon Rods and a Groin Flap.
Gakis C, Michalis I
Eplasty · 2025 · PMID 41822401
BACKGROUND: Extensive injuries of hand extensor tendons combined with soft tissue loss represent a reconstructive challenge. Single- or multiple-stage reconstruction cannot be principally adopted, and a single surgical p...
BACKGROUND: Extensive injuries of hand extensor tendons combined with soft tissue loss represent a reconstructive challenge. Single- or multiple-stage reconstruction cannot be principally adopted, and a single surgical plan cannot uniformly treat every patient. METHODS: The authors present a complex case of dorsal hand degloving injury accompanied by extensor tendons injury of the second, third, and fourth digits in zones II to VII, as well as radial wrist extensor tendons injury. The patient was treated in stages. Coverage was provided by a pedicled groin flap. Radial wrist extensors were reconstructed with a palmaris tendon graft, and the extensor digitorum communis was reconstructed with silicon rods and fascia lata grafts. CONCLUSIONS: A most satisfactory reconstruction was achieved.
Comparison of Multimodal Analgesia and Narcotic Regimen for Postoperative Pain Control of Plastic Surgery Breast Procedures.
Moffitt S, Koussayer B, Buller K … +11 more , Moore MG, McLaughlin M, Stoehr J, Schlub R, Doarn M, Troy J, Zeng W, Peterman N, Korte A, Parker M, Capito A
Eplasty · 2025 · PMID 41822400
BACKGROUND: Opioid analgesics are commonly used for postoperative pain management in plastic surgery, despite risks regarding dependence and complications. This study evaluates the noninferiority of multimodal analgesia...
BACKGROUND: Opioid analgesics are commonly used for postoperative pain management in plastic surgery, despite risks regarding dependence and complications. This study evaluates the noninferiority of multimodal analgesia compared with traditional narcotic regimens for postoperative pain management in breast reduction mammoplasty and tissue expander placement following mastectomy. METHODS: A retrospective cohort study of 171 patients (107 breast reduction, 64 tissue expander placement) was conducted at a single tertiary academic medical center between 2018 and 2022. Patients received either multimodal analgesia (preoperative acetaminophen 1000 mg, postoperative tramadol 50 mg q6h PRN, and gabapentin 300 mg TID) or narcotic analgesia (hydrocodone-acetaminophen 5-325 mg q6h PRN). Pain intensity was measured using Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity scores at the 2-week postoperative visit. Supplemental pain medication requests were tracked for analgesic groups as a measure of inadequate pain control. RESULTS: In the breast reduction group, the mean difference in PROMIS scores between multimodal (57.29) and narcotic (56.24) groups was 1.05 (95% CI, -2.81-4.91), below the minimal clinically meaningful difference of 10 points. For tissue expander placement, the mean difference was -2.76 (95% CI, -8.73-3.21). No significant differences were found in supplemental medication requests between groups for either procedure ( > .05). CONCLUSIONS: Multimodal analgesia provides pain control comparable to traditional narcotic regimens in breast procedures. This approach may reduce opioid exposure with comparable patient-reported outcomes, supporting multimodal analgesic protocols as a strategy to mitigate opioid use in plastic surgery patients.
A Case of Extrasphincteric Enterocutaneous Fistula After Scrotal Reconstruction for Fournier Gangrene: Use of a Novel Salvage Technique.
Tobin MJ, Park JB, Raquepo TM … +6 more , Yamin M, Xun H, Jac A, Crowell KT, Kent MA, Cauley RP
Eplasty · 2025 · PMID 41822399
Anocutaneous and rectocutaneous fistulas are associated with high morbidity and mortality, and complex fistulas often pose challenges to surgical repair. Here, the authors report a case of a rare 7-cm extrasphincteric fi...
Anocutaneous and rectocutaneous fistulas are associated with high morbidity and mortality, and complex fistulas often pose challenges to surgical repair. Here, the authors report a case of a rare 7-cm extrasphincteric fistula that extended from the base of the phallus to the external anal canal in a patient with a history of scrotal reconstruction after Fournier gangrene. Despite the anterior location of the cutaneous sinus tract and initial concern for penile urethral involvement, intraoperative instillation of methylene blue revealed a long extrasphincteric anocutaneous fistula. With colorectal surgery co-involvement, the mature tract was dissected free from the urethra, base of the penis, and scrotum, and redirected inferiorly and diverted to a new position anterior to the anal sphincter complex. This technique created a significantly shorter tract that salvaged the scrotal reconstruction, preserved the sphincter complex, and minimized risk of infection to the scrotal reconstruction. This novel technique can be used as either a temporary or permanent solution to complex mature fistulas in high-risk patients.
Buccal Sulcus Approach to Septal Perforation Repair.
Quang KT, Murthy A
Eplasty · 2025 · PMID 41822398
The treatment of septal perforations is a challenging endeavor. The recurrence rate ranges from 30% to 70%. Operative correction often requires wide dissection, local flaps, and septal spacers. The pediatric population p...
The treatment of septal perforations is a challenging endeavor. The recurrence rate ranges from 30% to 70%. Operative correction often requires wide dissection, local flaps, and septal spacers. The pediatric population poses an even greater challenge given the limited size for visualization and less tissue available to transfer. The most common and successful methods involve endoscopic and open rhinoplasty techniques. The authors present a midfacial degloving approach via a transoral, gingivobuccal approach that does not require an endonasal component or external incisions.
Correspondence on "Performance of ChatGPT on the Plastic Surgery In-Training Examination".
Daungsupawong H, Wiwanitkit V
Eplasty · 2025 · PMID 41822397
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Thoracic Outlet Syndrome: An Overlooked Diagnosis in the Pediatric Population.
Mendes M, Nascimento R, Horta R … +2 more , Norton E, Silva Á
Eplasty · 2025 · PMID 41822396
Thoracic outlet syndrome (TOS) results from the compression of the brachial plexus and/or subclavian vessels. The diagnosis of this disorder in children is often overlooked because of the mistaken assumption that the dis...
Thoracic outlet syndrome (TOS) results from the compression of the brachial plexus and/or subclavian vessels. The diagnosis of this disorder in children is often overlooked because of the mistaken assumption that the disorder does not affect children. There is a lack of knowledge concerning the etiology, treatment, and long-term results of this pathology among younger patients. We present a case of a 14-year-old girl with paresthesia and weakness of the upper right limb due to an ipsilateral cervical rib. The severity of her complaints motivated the use of surgical decompression by the supraclavicular approach. After a 6-month follow-up period and after an active rehabilitation and strength training program, the patient was free of symptoms. Thoracic outlet syndrome etiology, treatment choices, and outcomes in the pediatric population remain debatable. Conservative treatment is steered mainly to improving the patient's posture during the activities of daily living by mitigating the compression on the brachial plexus. Surgical decompression is the treatment of choice for patients with persistent significant symptoms.
A Rare Case of Cutaneous Metastasis of Hepatocellular Carcinoma to the Chin: Case Report and Review of Surgical Management.
Ruiz J, Ross J, Rice K … +4 more , Whalen K, Le NK, Kettlestrings L, Payne WG
Eplasty · 2025 · PMID 41822395
Hepatocellular carcinoma (HCC) is a debilitating complication of primary hepatic disease with a significant annual incidence worldwide. Untreated HCC may result in a severe reduction to life expectancy, dependent on stag...
Hepatocellular carcinoma (HCC) is a debilitating complication of primary hepatic disease with a significant annual incidence worldwide. Untreated HCC may result in a severe reduction to life expectancy, dependent on staging at diagnosis. Typically, HCC has a propensity to metastasize to the lung, peritoneum, and bone. Cutaneous HCC metastases are rarely encountered, with few described in the literature. The authors present a case of a 66-year-old man with biopsy-proven cutaneous HCC metastasis to the chin. The patient was managed with excision, followed by staged reconstruction. Surgical management and a review of the literature are discussed.
Soft Tissue Reconstruction With Synthetic Electrospun Fiber Matrix Following Musculoskeletal Injury: A Retrospective Case Series.
Cosgrove C
Eplasty · 2025 · PMID 41822394
BACKGROUND: Restoration of a stable and functional soft tissue envelope following traumatic injury to the musculoskeletal system is critical. Where primary closure is not feasible, other reconstructive options must be co...
BACKGROUND: Restoration of a stable and functional soft tissue envelope following traumatic injury to the musculoskeletal system is critical. Where primary closure is not feasible, other reconstructive options must be considered to achieve soft tissue coverage of critical structures. Skin substitutes have been utilized to stimulate granulation tissue and support incorporation of autografts. This present study aims to investigate the use of a fully synthetic electrospun fiber matrix (SEFM) (Restrata; Acera Surgical, Inc) in the management of post-traumatic soft tissue defects. The objective of the present retrospective case series was to assess healing outcomes, including time to healing and incidence of complications, following a single application of the SEFM to soft tissue trauma surrounding musculoskeletal injury. METHODS: Medical charts of patients with soft tissue injury secondary to musculoskeletal trauma and who were treated with the SEFM in the operating room following bony instrumentation or fasciotomy procedures were retrospectively reviewed following institutional review board approval. Included patients were treated with the SEFM in conjunction with negative pressure wound therapy as a means of preparing open wounds for definitive management via split-thickness skin grafting or secondary intention healing. RESULTS: Eleven patients met the inclusion criteria. Injury etiologies included 8 open fractures in both upper and lower extremities, 2 open foot-crush injuries, and 1 incidence of forearm compartment syndrome. Ten patients achieved complete healing with minimal complications. CONCLUSIONS: Preliminary results indicate that the SEFM may be a viable adjunctive treatment for open post-traumatic wound beds to promote granulation tissue for definitive closure.
Congenital Upper Extremity Anomalies Misdiagnosed as Ulnar Longitudinal Deficiency.
Sferopoulos NK
Eplasty · 2025 · PMID 41822393
BACKGROUND: Patients with a congenital hand plate or upper limb anomaly, a dysplastic ulna, or a syndrome may present with morphologic forms commonly misdiagnosed as ulnar longitudinal deficiency (ULD). METHODS: Patients...
BACKGROUND: Patients with a congenital hand plate or upper limb anomaly, a dysplastic ulna, or a syndrome may present with morphologic forms commonly misdiagnosed as ulnar longitudinal deficiency (ULD). METHODS: Patients who had been misdiagnosed with ULD over the past 35 years were identified from the hospital database. Twenty-six patients with photographs and/or conventional radiographs that could be adequately reproduced were enrolled in the study. RESULTS: In 16 unilateral cases, the final diagnosis changed to symbrachydactyly (6 cases), Poland syndrome (3 cases), transverse deficiency (1 case), radial longitudinal deficiency (2 cases), and congenital pseudarthrosis of the ulna with osteolysis in patients with neurofibromatosis type 1 (4 cases). In 10 bilateral cases, the final diagnosis changed to constriction ring sequence (3 cases), brachydactyly (6 cases), and congenital bilateral negative ulnar variance in a patient with central metacarpal medullary stenosis. This research presents the findings of the 7 most illustrative cases and focuses on their differential diagnosis. Additionally, the literature review summarizes the most common congenital anomalies included in the differential diagnosis of ULD, presenting their clinical and/or radiographic features as detected in patients referred to our service. CONCLUSIONS: A detailed evaluation of patients with even simple unilateral congenital hand or upper limb anomalies is invaluable to the diagnostic investigation. The treating pediatrician, clinician, or surgeon should also be sufficiently familiar with the clinical and radiographic features of congenital anomalies and the long list of syndrome-related deficiencies that the differential diagnostic process of ULD includes. Missed or misinterpreted findings in patients with congenital hand or upper limb anomalies, usually recorded after single diagnosis documentation, may result in a misdiagnosis of ULD and delayed detection of associated congenital, medical, or syndromal disorders.
An Analysis of Risk Factors for Complication Following Upper Extremity Amputation.
Mendiratta D, Fletcher C, Herzog I … +4 more , Para A, Joshi T, Vosbikian MM, Ahmed IH
Eplasty · 2025 · PMID 41822392
BACKGROUND: Upper extremity amputations (UEAs) comprise anywhere from 14% to 50% of amputations. Risk factors for lower extremity amputations (LEA), such as diabetes, have been established in the literature. The authors...
BACKGROUND: Upper extremity amputations (UEAs) comprise anywhere from 14% to 50% of amputations. Risk factors for lower extremity amputations (LEA), such as diabetes, have been established in the literature. The authors attempt to illuminate similar associations with UEA, which have been studied to a lesser degree. In this study, the authors explore preoperative risk factors that may predispose patients to complications after UEA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2006 to 2018 for patients undergoing various levels of UEA using current procedural terminology codes. Demographic and comorbidity data were collected, including level of amputation; levels included shoulder disarticulation (SD), transhumeral/elbow disarticulation, transradial/wrist disarticulation, and transcarpal. Outcomes included major systemic complications, prolonged length of stay (LOS), unplanned reoperation, surgical site infection (SSI), and death. Chi-squared and multivariate binary regression analysis were used to determine odds ratios. RESULTS: Overall, 3907 patients undergoing UEA were identified. Upon multivariate binary regression analysis, hyponatremia, hypoalbuminemia, history of cardiac disease, and SD were independent risk factors for major systemic complications. SD amputation was an independent risk factor for major systemic complications, shock/septic shock, and prolonged LOS. History of cardiac disease was an independent risk factor for major systemic complications, prolonged LOS, and death. Diabetes was an independent risk factor for prolonged LOS, unplanned reoperation, and SSI. CONCLUSIONS: The study found that in patients undergoing UEA, there was an increased risk of 30-day complications in those with hyponatremia, hypoalbuminemia, cardiovascular disease, diabetes, and proximal amputations.
Reconstruction of an Upper Lip Midline Defect With Bilateral Lip Advancement Flaps.
Himejima T, Fukui M, Kunieda S … +4 more , Masuoka H, Hihara M, Mitsui T, Kakudo N
Eplasty · 2025 · PMID 40800224
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Controversy of Breast Reduction in Adolescent Patients: An Overview of a Sometimes-Challenging Proposition.
Carr QL, Shockley S, Connor C … +5 more , Dodwani S, Fell C, Cantrell R, Huett W, Wilhelmi BJ
Eplasty · 2025 · PMID 40800223
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