Eplasty [JOURNAL]
Sun
200 papers
Outcomes of Complex Wound Reconstruction in High-Risk Patients Using Decellularized Extracellular Matrix from Porcine Urinary Bladder.
Baum GR, Cox CT, Valerio IL … +1 more , MacKay BJ
Eplasty · 2025 · PMID 40661093
BACKGROUND: The treatment of complex wounds remains a challenging aspect of reconstructive surgery, given their diverse nature and the frequent need for high-level surgical procedures. Standard treatment with flap covera...
BACKGROUND: The treatment of complex wounds remains a challenging aspect of reconstructive surgery, given their diverse nature and the frequent need for high-level surgical procedures. Standard treatment with flap coverage can achieve many goals; however, it is not without difficulties, including technical complexity, extended recovery times, donor site morbidity, and vascular complications, particularly in non-optimized patients. Acellular extracellular matrices, such as porcine urinary bladder matrices, have emerged as an alternative approach to support wound healing without the risks of high-level reconstruction. Urinary bladder matrix provides an extracellular matrix scaffold that supports intrinsic tissue regeneration mechanisms, allowing for stable, well-vascularized wound bed formation. METHODS: This retrospective case series examines the outcomes of urinary bladder matrix for the treatment of complex wounds in 21 patients deemed high-risk or unfavorable candidates for surgical management with local or free flap techniques. The patients were treated by 2 surgeons at 2 separate level 1 trauma centers from October 2019 through June 2022. Urinary bladder matrix was the primary wound management modality with serial wound debridement, matrix reapplication, and subsequent wound care tailored to each patient until definitive, stable coverage. RESULTS: In all cases, urinary bladder matrix facilitated soft tissue remodeling, permitting complete wound re-epithelization or preparation for skin grafting and/or flap coverage. Four patients' wounds re-epithelized on their own, while 17 patients received subsequent skin graft. In 2 of these cases, the initial split-thickness skin graft failed, requiring a second skin graft and or/flap coverage. CONCLUSIONS: Our results demonstrate that urinary bladder matrix facilitates definitive soft tissue reconstruction and can be a valuable adjunct to wound repair, providing a simpler, less morbid treatment option for patients with various comorbidities and injury mechanisms.
Surgical Management of Biopolymer Induced Granulomatous Hypercalcemia and Renal Insufficiency: A Case Report and Literature Review.
Brummund D, Chang A, Salagdo C
Eplasty · 2025 · PMID 40661092
Volumetric enhancement is a key component of body contouring, with injections of natural or synthetic biopolymers being one of the most common methods used. Biopolymers, however, are associated with both acute and chroni...
Volumetric enhancement is a key component of body contouring, with injections of natural or synthetic biopolymers being one of the most common methods used. Biopolymers, however, are associated with both acute and chronic complications including the risk of granulomatosis and hypercalcemia. Unrecognized and untreated, biopolymer-induced granulomatous hypercalcemia can lead to renal failure, metastatic calcifications, and death. Medical management is the primary treatment for biopolymer-induced granulomatous hypercalcemia, with corticosteroids and other drugs targeting calcium metabolism and immunomodulation. In cases refractory to medical management, surgical excision of biopolymer granulomatous tissue can normalize serum calcium and improve renal function. This case report of 2 patients and literature review of 4 patients investigates the rare surgical management of patients with biopolymer-induced granulomatous hypercalcemia, the morbidity of such a procedure, and adjunctive techniques that may be utilized to facilitate biopolymer removal and reduce complications.
Mitigating Hair Loss Among Scalp Laceration Repair Techniques: Review of the Literature.
Bailey V, Kherallah K, Warner J … +4 more , Moffit S, Moore M, Wainwright D, Harrington M
Eplasty · 2025 · PMID 40661091
Scalp lacerations represent a significant portion of traumatic wounds treated in emergency settings, presenting unique challenges due to the scalp's high vascularity and tension on closure. This study explores primary cl...
Scalp lacerations represent a significant portion of traumatic wounds treated in emergency settings, presenting unique challenges due to the scalp's high vascularity and tension on closure. This study explores primary closure techniques for scalp defects, focusing on sutures, staples, and the hair apposition technique (HAT). Given the cosmetic and psychological implications of hair loss associated with scalp laceration repairs, effective closure methods are paramount. This systematic review evaluates the efficacy of sutures, staples, and HAT in minimizing hair loss and enhancing cosmetic outcomes. Out of an initial 21530 literature sources, 7 studies were included in this analysis, selected through a comprehensive screening process. Findings suggest that while traditional methods like sutures and staples are widely used, HAT shows promise in reducing complications and preserving hair. The study underscores the importance of selecting appropriate closure techniques to optimize patient satisfaction and overall care quality.
Facial Aesthetics in Artificial Intelligence: First Investigation Comparing Results in a Generative AI Study.
Yassa A, Akhavan A, Ayad S … +3 more , Ayad O, Colon A, Ignatiuk A
Eplasty · 2025 · PMID 40661090
BACKGROUND: Patients undergoing facial plastic surgery are increasingly using artificial intelligence (AI) to visualize expected postoperative results. However, AI training models' variations and lack of proper surgical...
BACKGROUND: Patients undergoing facial plastic surgery are increasingly using artificial intelligence (AI) to visualize expected postoperative results. However, AI training models' variations and lack of proper surgical photography in training sets may result in inaccurate simulations and unrealistic patient expectations. This study aimed to determine if AI-generated images can deliver realistic expectations and be useful in a surgical context. METHODS: The authors used AI platforms Midjourney (Midjourney, Inc), Leonardo (Canva), and Stable Diffusion (Stability AI) to generate otoplasty, genioplasty, rhinoplasty, and platysmaplasty images. Board-certified plastic surgeons and residents assessed these images based on 11 metrics that were grouped into 2 criteria: realism and clinical value. Analysis of variance and Tukey Honestly Significant Difference post-hoc analysis tests were used for data analysis. RESULTS: Performance for each metric was reported as mean ± SD. Midjourney outperformed Stable Diffusion significantly in realism (3.57 ± 0.58 vs 2.90 ± 0.65; < .01), while no significant differences in clinical value were observed between the AI models ( = .38). Leonardo outperformed Stable Diffusion significantly in size and volume accuracy (3.83 ± 0.24 vs 3.00 ± 0.36; = .02). Stable Diffusion underperformed significantly in anatomical correctness, age simulation, and texture mapping (most values were less than .01). All 3 AI models consistently underperformed in healing and scarring prediction. The uncanny valley effect was also observed by the evaluators. CONCLUSIONS: Certain AI models outperformed others in generating the images, with evaluator opinions varying on their realism and clinical value. Some images reasonably depicted the target area and the expected outcome; however, many images displayed inappropriate postsurgical outcomes or provoked the uncanny valley effect with their lack of realism. The authors stress the need for AI improvement to produce better pre- and postoperative images, and plan for further research comparing AI-generated visuals with actual surgical results.
Incidental Breast Carcinoma in Reduction Mammoplasty: A Systematic Review.
Gong JH, Akiki RK, Sullivan R
Eplasty · 2025 · PMID 40661089
BACKGROUND: Breast reduction is one of the most common plastic surgeries, with more than 40000 procedures performed in the United States annually. As breast reductions remove a portion of the breast and distort the anato...
BACKGROUND: Breast reduction is one of the most common plastic surgeries, with more than 40000 procedures performed in the United States annually. As breast reductions remove a portion of the breast and distort the anatomy, plastic surgeons need to be mindful of the possibility of breast cancer. In this study, we sought to review the available literature on breast cancer workup for patients undergoing reduction mammoplasties. METHODS: We queried the PubMed (National Institutes of Health) and Embase (Elsevier) databases to identify studies discussing breast cancer workup before breast reduction via preoperative imaging and/or at the time of surgery via histopathologic evaluation of breast specimens. Two individual reviewers screened the titles and abstracts for relevance. We extracted data on the outcomes of preoperative imaging and histopathologic evaluation of breast reduction specimens. RESULTS: Twenty-three articles published between 1996 and 2022 met the inclusion/exclusion criteria. Two studies evaluated only the role of preoperative imaging and reported a biopsy rate of 3.7% to 5.1% based on imaging findings. Three studies discussed only the role of histopathologic evaluation without mentioning the preoperative imaging requirements from the patients. For the remaining 18 studies, the rate of incidental breast cancer from breast reduction specimens was 0.0% to 2.0%. All studies recommended universal histopathologic evaluation of breast specimens. CONCLUSIONS: In this review, we found unanimous recommendations for performing histopathologic evaluation of breast reduction samples, consistent with the 2022 American Society of Plastic Surgeons clinical practice guideline. Further research is still required to determine the optimal preoperative imaging approach for breast reduction.
Pediatric Granular Cell Tumor of the Digital Nerve: A Case Report and Literature Review.
Bercu CH, Neupane R, Ramirez A … +2 more , Brathwaite C, Berger AJ
Eplasty · 2025 · PMID 40661088
INTRODUCTION: Granular cell tumors (GCTs) are rare soft tissue neoplasms thought to originate from Schwann cells of the peripheral nervous system. These tumors predominantly occur in the head and neck regions. Instances...
INTRODUCTION: Granular cell tumors (GCTs) are rare soft tissue neoplasms thought to originate from Schwann cells of the peripheral nervous system. These tumors predominantly occur in the head and neck regions. Instances of GCTs affecting peripheral nerves of the upper extremity, particularly in the hand, are exceptionally rare. METHODS: A 9-year-old girl presented with a rapidly growing mass on the left index finger. Ultrasound and magnetic resonance imaging revealed a mass encasing the neurovascular bundle extending to the dermal surface. Biopsy confirmed the presence of a GCT. Intraoperatively, the tumor, which was embedded within the radial nerve and adherent to the tendon sheath, was excised. Nerve reconstruction was performed with a posterior antebrachial cutaneous nerve graft. RESULTS: Histopathology showed pleomorphic polygonal cells with granular cytoplasm and mild nuclear atypia. Immunohistochemical staining was positive for S100, CD68, SOX10, NKI/C3, inhibin, and TFE3, confirming the diagnosis of a benign GCT. The tumor was successfully excised with clear margins. CONCLUSIONS: Here we present the 5th documented case of GCT originating from the digital nerve and first-ever case treated with excision and posterior antebrachial cutaneous nerve graft reconstruction. The successful use of a nerve graft in this case underscores the value in preserving sensory function after tumor excision. Long-term follow-up is essential to monitor for recurrence and ensure favorable outcomes.
Effectiveness of Using Autologous Saphenous Vein as Arteriovenous Graft for Patients With Chronic Wounds Undergoing Hemodialysis.
Kuwabara M, Hosoyamada H, Tokuno K … +3 more , Hirayama T, Ichijo E, Yamamoto N
Eplasty · 2025 · PMID 40661087
Although the first choice of vascular access for hemodialysis is still the creation of an arteriovenous fistula, the increasing number of vascular access creations in Japan, as well as the inability of percutaneous trans...
Although the first choice of vascular access for hemodialysis is still the creation of an arteriovenous fistula, the increasing number of vascular access creations in Japan, as well as the inability of percutaneous transluminal angioplasty to effectively restore patency in stenotic and obstructed native vascular accesses, has resulted in an increase in the rate of arteriovenous grafting for hemodialysis. However, for patients with infected wounds, using a prosthetic graft is generally contraindicated because of the risk of the spread of infection. In such cases, options tend to be limited to less frequently used or novel methods of vascular hemodialysis access, such as basilic vein transposition and autologous vein transplantation. Herein, we report 3 successful cases of arteriovenous grafting using an autologous saphenous vein. Careful preoperative evaluation of the vascular anatomy is necessary to effectively determine the best option for vascular access in such patients.
Intensive Care Unit Admission Following Cleft Palate Repair in Patients With Pierre Robin Sequence Corrected With Mandibular Distraction.
Goza SD, Baker KE, Brown MI … +9 more , Hopper SJ, Phillips J, Sink MC, Benedict KC, Brown KW, Fernstrum CJ, Friel MT, Humphries LS, Hoppe IC
Eplasty · 2025 · PMID 40661086
BACKGROUND: Patients with Pierre Robin Sequence (PRS) treated with mandibular distraction (MD) frequently suffer from a cleft palate (CP). There are no standard practices surrounding the need for admission to a pediatric...
BACKGROUND: Patients with Pierre Robin Sequence (PRS) treated with mandibular distraction (MD) frequently suffer from a cleft palate (CP). There are no standard practices surrounding the need for admission to a pediatric intensive care unit (PICU) following CP repair in these patients. This study will investigate the frequency of airway events following CP repair in this subset of patients. METHODS: A retrospective chart review of all patients with PRS treated with MD that also required CP repair surgery at the authors' institution from 2012 to 2022 was performed. Intraoperative and postoperative analgesic usage, preoperative and postoperative respiratory status, presence of a concomitant operation, comorbid anomalies, as well as age and weight at CP repair were recorded. Our primary outcomes included length of stay following CP repair, presence of airway events perioperatively/postoperatively, and admission status following CP repair. RESULTS: Twenty-nine patients underwent MD during this period, of which 13 patients also underwent repair of a CP. The average length of stay following CP repair was 2.3 days. Only 2 airway events were noted, and only 3 patients were admitted to the PICU following repair. Presence of comorbid musculoskeletal and neurologic abnormalities was associated with postoperative PICU admission.Remaining intubated following CP repair was associated with increased analgesic usage intraoperatively. A longer duration of intubation following MD was associated with PICU admission and remaining intubated following CP repair. CONCLUSIONS: Overall, it appears that admission to the floor following CP repair in PRS patients with a history of MD is generally safe.
Drainless Implant Removal: A Technique to Minimize Breast Disfigurement After Explantation.
Fell C, Mostovych AL, Cantrell R … +4 more , Major E, Dodwani SD, MacDavid J, Wilhelmi BJ
Eplasty · 2024 · PMID 40529381
Abstract loading — click title to view on PubMed.
Pedicled Bilateral Deep Inferior Epigastric Perforator Flap With Intraflap Anastomosis for Hip/Thigh Reconstruction.
Nisco A, Taskindoust M, Yu J … +1 more , Wang D
Eplasty · 2024 · PMID 40529380
Abstract loading — click title to view on PubMed.
Outcomes of Brachial Plexus Neurolysis in 40 Patients With Obstetric Brachial Plexus Injury.
Nath RK, Somasundaram C
Eplasty · 2025 · PMID 40469489
BACKGROUND: Severe traction injury to the brachial plexus (BP) during childbirth can induce the formation of intraneural scar tissue or neuroma in continuity. This can lead to nerve entrapment and demyelination, which in...
BACKGROUND: Severe traction injury to the brachial plexus (BP) during childbirth can induce the formation of intraneural scar tissue or neuroma in continuity. This can lead to nerve entrapment and demyelination, which inhibit axonal transport to the target muscles. Secondary complications include muscle weakness, contractures, joint deformity, and altered limb growth with prolonged and persistent disability. These patients find difficulty performing activities of daily living. BP neurolysis is one of the multistage reconstructive procedures in patients with obstetric brachial plexus injury (OBPI). The successful outcome of BP neurolysis is reported in patients with OBPI. We report improvements in all Mallet functional movements, including forearm supination angle (the Nath-modified Mallet), in 40 OBPI patients after BP neurolysis. METHODS: Forty OBPI patients (25 female and 15 male with a mean age of 14 years, range 2-25 years; 29 on the right and 11 on the left) underwent BP neurolysis and follow-up evaluations with the lead author and surgeon (RKN). All these patients had undergone multiple previous surgeries, such as primary exploration, Botox, nerve transfer, humeral or forearm osteotomy, wrist tendon transfer, mod Quad, triangle tilt, and biceps tendon lengthening. Patients' pre- and postoperative shoulder functions were evaluated by the surgeon in the clinic and from photos/videos. These functional movements include shoulder abduction, external rotation, hand-to-mouth movement, hand-to-neck movement, and hand-to-spine movement, which score from 1 (no movement) to 5 (normal movement). In addition to the Mallet functional movements, the supination angle (the angle between the midline of the body and the tangential line to the palm with arms straight; neutral = 0, full supination = 90°, full pronation = -90°) was also evaluated and scored using the Nath-modified Mallet before and after BP neurolysis. RESULTS: Of the 40 patients in this report, 37 (93%) achieved a Mallet grade of 5/5 (n = 23, 58%) or 4/5 (n = 14, 35%) in shoulder abduction after BP neurolysis. The other 3 patients had a Mallet grade of 3/5 (90 degrees) postoperatively in shoulder abduction. There was statistically highly significant improvement after BP neurolysis in shoulder abduction (3.9 ± 0.7 to 4.5 ± 0.6, < .0001), external rotation (2.9 ± 1.0 to 3.8 ± 1.1, < .0001), hand-to-mouth (4.2 ± 0.7 to 4.5 ± 0.7, < .03), hand-to-neck (3.6 ± 0.8 to 4.2 ± 0.8, < .0001), hand-to-spine (2.9 ± 1.1 to 3.4 ± 1.2, < .004), forearm supination (3.8 ±1.1 to 4.2 ±1.0, < .0001), the Nath-modified total Mallet score (21 ± 3.1 to 25 ± 3.3, < .0001), including supination angle (40.5 ± 48.8 to 56.3 ± 41.6, < .001). Improvement in the Nath-modified total Mallet functions was weakly associated with follow-up time after BP neurolysis (R = 0.17, = .0003). CONCLUSIONS: Among the 40 patients, 37 (93%) achieved a Mallet grade of 5/5 or 4/5 in shoulder abduction after surgery with a mean follow-up of 2 years. All upper-limb functional movements improved significantly as BP neurolysis improves axonal transport to the target muscles after surgically removing the external and internal scarring of the upper trunk and its terminal branches. Additionally, neurolysis decompresses the BP from external compression by the surrounding connective tissues and densely scarred scalene muscles. Thus, it can provide these patients with an effective and rapid functional recovery. These children and their parents are pleased with the progress and increased ability to perform their activities of daily living after surgery.
Rare Case of Pediatric Lower Limb Verrucous Venous Malformation: Treatment Approach and Considerations.
Chen-Carrington A, Goodreau A, Strife BJ … +2 more , Shinn L, Rhodes J
Eplasty · 2025 · PMID 40469488
BACKGROUND: Verrucous venous malformation (VVM) is a rare, congenital, low-flow vascular anomaly composed of capillaries and veins in the dermis and subcutaneous tissues. Diagnosis is difficult because knowledge of cases...
BACKGROUND: Verrucous venous malformation (VVM) is a rare, congenital, low-flow vascular anomaly composed of capillaries and veins in the dermis and subcutaneous tissues. Diagnosis is difficult because knowledge of cases is rare and typically identified with sonographic imaging and elevated GLUT-1. Treatment is mired by high rates of recurrence and residual pain, with further enlargement upon resection or injury. Current management strategies include a combination of laser therapy, surgery, cryotherapy, and topical steroids, each with varying rates of success. METHODS: The authors examine a case of confirmed VVM, which was initially treated with a candela pulsed dye laser and propranolol to no avail. A combination of surgical approaches were chosen. CONCLUSIONS: We now look to topical sirolimus 1% as an adjunct for this patient with residual lesions. Questions remain as to the effectiveness, optimal dose, and duration of topical sirolimus and whether this combination of surgical and topical intervention will be effective in the treatment for VVM.
Augmenting the Breast Reconstruction: Core Projection With Hybrid Microsurgical Breast Reconstruction With Flap and Stacked Prepectoral Acellular Dermal Matrix.
Daytz AE, Silverman JB, Minasian RA … +6 more , Sanchez SB, Yom J, Aiello C, Robinson E, Smith ML, Tanna N
Eplasty · 2025 · PMID 40469487
BACKGROUND: Many patients who require breast reconstruction prefer a flap-based approach for various reasons, including the permanence and aesthetic benefit of a breast that looks and feels natural. For patients who desi...
BACKGROUND: Many patients who require breast reconstruction prefer a flap-based approach for various reasons, including the permanence and aesthetic benefit of a breast that looks and feels natural. For patients who desire autologous breast reconstruction following mastectomy but lack adequate donor site volume, the authors utilize the novel hybrid flap, prepectoral acellular dermal matrix (HyPAD) approach. In this technique, the deep inferior epigastric perforator (DIEP) flap is augmented with a stacked acellular dermal matrix (ADM). The purpose of this study is to quantify the soft tissue augmentation and core projection achieved with this technique during autologous flap-based breast reconstruction. METHODS: Consecutive patients who underwent the HyPAD technique during the study period (August 2021 to December 2022) were identified. All patients lacked adequate donor site volume and wished to avoid the placement of implants during their reconstruction. Demographic information and outcomes were assessed. Intraoperatively, the weights (g) of the mastectomy specimen, the flap donor site, and the stacked ADM were recorded. RESULTS: During the study period, 21 patients (n = 21) were identified. The mean age of patients at the time of surgery was 48.9 ± 7.85 years. The mean body mass index was 24.1 kg/m ± 3.3 kg/m. The mean mastectomy specimen weight was 436.35 g, and the mean flap weight was 370.73 g, posing an average discrepancy of 15.04% or 65.62 g. The average weight of the ADM used to augment the flap was 81.76 g. This weight accounted for an average of 18.07% of the total reconstructed breast weight. CONCLUSIONS: The use of ADM during autologous breast reconstruction provides patients with an alternative to implants that allows them to obtain their desired breast volume. Given the aesthetic impact that ADM has on the total amount of flap weight and projection, it is recommended that the HyPAD technique be considered for patients who desire a breast that cannot be restored with their own flap weight and wish to avoid implants.
Prediction of Intra-abdominal Adhesions and Uterine Scar Grade Based on Abdominal Scar Characteristics in Women With a Previous Cesarean Section: A Diagnostic Accuracy Study.
Durai V, Dorairajan G
Eplasty · 2025 · PMID 40469486
BACKGROUND: This study aims to investigate the relationship between cutaneous scar morphology and severe intra-abdominal adhesions and to predict uterine scar grade in repeat cesarean sections. It could be a valuable too...
BACKGROUND: This study aims to investigate the relationship between cutaneous scar morphology and severe intra-abdominal adhesions and to predict uterine scar grade in repeat cesarean sections. It could be a valuable tool to plan elective repeat cesarean sections in patients with predicted weak uterine scars and also to have an experienced surgeon for repeat cesareans in patients predicted to have dense intra-abdominal adhesions. METHODS: Preoperatively, the external scar was assessed using the Manchester score in 260 women. Intraoperatively, the Knightly score was used for adhesions at 5 different sites. The total adhesion score was categorized into scores ≤5 and >5 (severe adhesions). The uterine scar was graded using the Qureshi method and grouped into intact scar and weak scar (grades 3 and 4). Fischer exact and chi-square tests were used to compare the groups. The receiver operating characteristic curve calculated a cutoff score for predicting severe adhesions and weak scars. RESULTS: Of the 260 patients, 63.5% had adhesions and 36.5% had no adhesions. The distortion of the skin scar had 71.3% specificity, and the texture had 84.8% sensitivity in predicting severe adhesions. Similarly, the texture had 72.2% sensitivity, and the distortion had 68.3% specificity in predicting weak uterine scar. A Manchester Scar Scale score of 9 includes the area under the curve of 0.72 for predicting severe adhesions and 0.62 for predicting weak uterine scar. A score of 9 was 66.6% sensitive and 66.5% specific, with a negative predictive value (NPV) of 93.2% for predicting severe adhesions. The same score was 55.5% sensitive and 65.1% specific, with an NPV of 90.1% for predicting weak uterine scar. CONCLUSIONS: A Manchester Scar Scale cutoff score of 9 has a high NPV for predicting severe adhesions and weak uterine scar. The texture had high sensitivity, and distortion had high specificity for predicting severe adhesions.
AI in Cosmetic Surgery: A New Look at Virtual Abdominoplasty and Buttock Augmentation.
Yassa A, Akhavan AA, Ayad S … +1 more , Ayad O
Eplasty · 2025 · PMID 40469485
BACKGROUND: Online before-and-after photos commonly guide patient expectations in body contouring surgeries. However, recent artificial intelligence (AI) advancements allow for lifelike "photos" of hypothetical individua...
BACKGROUND: Online before-and-after photos commonly guide patient expectations in body contouring surgeries. However, recent artificial intelligence (AI) advancements allow for lifelike "photos" of hypothetical individuals, which patients can use in their decision-making. The accuracy of AI models, trained on divergent image sets, in showing realistic figures, cosmetic defects, and surgical outcomes is questionable. This study sought to evaluate the quality of these images. METHODS: We utilized AI platforms GetIMG, Leonardo, and Perchance to create pre- and post-surgery visuals for abdominoplasty and buttock augmentation. Expert board-certified plastic surgeons and plastic surgery residents assessed the images across 11 criteria, focusing on realism and clinical value. ANOVA and Tukey honestly significant difference post-hoc tests were executed for data analysis. RESULTS: Realism and clinical value scores among AI models (mean ± standard deviation) were not significantly different, indicating comparable performance (GetIMG 3.83 ± 0.81, Leonardo 3.30 ± 0.69, Perchance 2.68 ± 0.77; > .05). Perchance significantly underperformed in size and volume accuracy ( = .02) and pathological feature recognition ( = .01 and .03). No consistent underperforming metric was identified when evaluated. The phenomenon of the "uncanny valley" was also identified. CONCLUSIONS: Despite some realistic and accurate surgical predictions, most AI-generated images were anatomically unrealistic, demonstrated inaccurate postoperative results, and invoked the "uncanny valley" effect. Given the uniformly poor performance, patients should avoid using these images for surgical decisions due to the potential of unrealistic expectations. Surgeons are advised to use real patient photos for consultations. Future research aims to compare AI images with actual before-and-after photos and include a bigger pool of experts for evaluation.
Use of Continuous Topical Oxygen Therapy in Combination to Optimize the Chronic Wound Environment Prior to Cellular, Acellular, and Matrix-Like Product Application: A Retrospective Case Series.
Wahab N, Cole W, Woodmansey E
Eplasty · 2024 · PMID 40463926
BACKGROUND: This retrospective case series details the use of a continuous topical oxygen therapy (cTOT) device for wound bed preparation prior to the application of cellular, acellular, and matrix-like products (CAMPs)...
BACKGROUND: This retrospective case series details the use of a continuous topical oxygen therapy (cTOT) device for wound bed preparation prior to the application of cellular, acellular, and matrix-like products (CAMPs) on lower extremity wounds. METHODS: A retrospective records review was conducted in a single outpatient wound care center. Treatment consisted of 2 weeks of cTOT followed by CAMP application. Weekly wound photos and measurements were obtained through chart review. Patients included in this study did not achieve complete wound closure within the 2-week cTOT treatment period and were transitioned to application of a CAMP as per standard practice at the lead author's clinic. RESULTS: This study included 4 patients (5 wounds). The mean patient age was 71.8 years, and wound types included 3 diabetic foot ulcers (DFUs) and 2 venous leg ulcers (VLUs). The mean wound area reduction seen in this patient cohort was 74.7% and 76.1% at 4 and 6 weeks, respectively. Overall, a mean healing time of 8 weeks was noted across all wounds with a mean number of 6 CAMP applications. CONCLUSIONS: Wound healing should be approached in an algorithmic manner, starting with wound bed optimization. In this patient cohort cTOT proved to be an effective way to improve the quality of the wound bed, in addition to the standard cleansing and debridement, prior to CAMP application. The authors believe that this combination of topical methods might have synergistic effects and improve wound healing, and the results of this study support this assumption.
Rapid Response to Sirolimus in Patients with PIK3CA-Related Overgrowth Spectrum.
Nye JR, Green JC, Talanker M … +6 more , Barrera J, Richardson K, Menon NM, Hebert AA, Greives MR, Atkinson AA
Eplasty · 2024 · PMID 40463925
-related overgrowth spectrum (PROS) is an umbrella term used to unify a heterogenous group of vascular overgrowth disorders by a shared genetic cause. Given that patients with PROS have a known, or likely, gene mutation...
-related overgrowth spectrum (PROS) is an umbrella term used to unify a heterogenous group of vascular overgrowth disorders by a shared genetic cause. Given that patients with PROS have a known, or likely, gene mutation in the PI3K/AKT/mTOR cascade, we hypothesize they experience a rapid response to inhibitors of this pathway, including sirolimus. In the following case series, we describe 3 patients with PROS and their response to sirolimus therapy. Despite their unique clinical presentations, insight into the genetic origin of their vascular overgrowth allowed for their successful treatment with the same medication.
Collagen Matrix and Staged Skin Grafting for Plantar Reconstruction: Lessons Learned in Treatment of Palmoplantar Keratoderma.
Choi J, Applebaum MA, Feldmann ME
Eplasty · 2024 · PMID 40463924
BACKGROUND: Tissue defects of the weight-bearing surface of the foot are challenging wounds to reconstruct. Traditionally, skin grafting has had limited success in achieving both a durable and functional construct for am...
BACKGROUND: Tissue defects of the weight-bearing surface of the foot are challenging wounds to reconstruct. Traditionally, skin grafting has had limited success in achieving both a durable and functional construct for ambulation. This case series describes a 2-staged approach to using a collagen bilayer matrix with subsequent skin grafting for plantar reconstruction in 3 sisters with palmoplantar keratoderma (PPK). METHODS: Outcomes of 3 patients (ages 7, 13, and 15 years) who underwent plantar excisions of both feet for treatment of PPK were reviewed retrospectively. Data collection included tissue defect size, duration of non-weight-bearing activity, skin grafting technique, surgical complications, incidence of graft loss, total inpatient stay, and long-term functional status. Sensory outcomes were measured using Semmes Weinstein monofilament testing, along with patient-reported outcomes utilizing the Manchester-Oxford Foot Questionnaire (MOXFQ). RESULTS: All 3 patients, totaling 6 feet, underwent plantar excisions of PPK. A collagen bilayer matrix was applied, followed by staged skin grafting (mean = 25.5 days between stages). Average total inpatient stay across treatment course was 2.6 days. There were 2 surgical site infections and 2 unanticipated returns to the operating room for excision of PPK recurrence. There were no incidences of graft loss. At an average of 6.9 years follow-up, all 3 patients had an intact reconstruction, preserved protective sensation, and normal gait and shoe-wear. Patient-reported ratings for foot pain varied from poor to excellent. CONCLUSIONS: A method of plantar reconstruction utilizing a collagen bilayer matrix and staged skin grafting is presented, demonstrating excellent long-term durability and functional outcomes.
Results of a Single-Institution Quality Improvement Initiative to Reduce Perioperative Blood Transfusion During Open Complex Cranial Vault Reconstruction.
Wright JM, MacIsaac MF, Rottgers SA … +4 more , Miller A, Fierstein J, Zamora L, Fernandez A
Eplasty · 2024 · PMID 40463923
BACKGROUND: Craniosynostosis repair via open complex cranial vault remodeling (OCCVR) is a complicated surgical procedure associated with morbidity and blood loss, often requiring blood transfusion. The Pediatric Craniof...
BACKGROUND: Craniosynostosis repair via open complex cranial vault remodeling (OCCVR) is a complicated surgical procedure associated with morbidity and blood loss, often requiring blood transfusion. The Pediatric Craniofacial Collaborative group created the Pediatric Craniofacial Surgery Perioperative Registry (PCSPR) to capture data relating to the perioperative management of children undergoing craniofacial surgery. A tertiary pediatric hospital implemented its own quality improvement (QI) initiative with the aim of reducing blood transfusion volumes and exposures in patients undergoing OCCVR. The initiative included preoperative iron supplementation, intraoperative use of cell saver and tranexamic acid, maintenance of normothermia, and restrictive transfusion protocols. METHODS: Patients were included in the study if they had a diagnosis of craniosynostosis, were younger than 18 years, and underwent OCCVR. Patient demographics, comorbidities, and perioperative data were recorded using the PCSPR. Outcomes included blood transfusion volume, number of blood donor exposures, and intra and postoperative complications. Outcomes before and after the initiative were compared. RESULTS: The median perioperative allogenic blood transfusion volume decreased from 35 mL/kg pre-QI to 24 mL/kg post-QI ( < .001). There was a significant decrease in the number of blood donor exposures, and the number of patients who experienced a transfusion-free perioperative period increased from 10.9% to 19.6% ( = .037). There were no observed differences in perioperative complications, hospital and intensive care unit length of stay, or mortality. CONCLUSIONS: This QI initiative has resulted in reduced blood transfusion volumes and reduced blood donor exposures without an increase in perioperative complications related to blood loss. Further multi-institutional research is necessary to create national standards for the anesthetic care of all patients undergoing OCVR.
Performance of ChatGPT on the Plastic Surgery In-Training Examination.
Raine BE, Kozlowski KA, Fowler CC … +1 more , Frey JD
Eplasty · 2024 · PMID 40463922
BACKGROUND: Recently, the artificial intelligence chatbot Chat Generative Pre-Trained Transformer (ChatGPT) performed well on all United States Medical Licensing Examinations (USMLE), demonstrating a high level of insigh...
BACKGROUND: Recently, the artificial intelligence chatbot Chat Generative Pre-Trained Transformer (ChatGPT) performed well on all United States Medical Licensing Examinations (USMLE), demonstrating a high level of insight into a physician's knowledge base and clinical reasoning ability. This study aims to evaluate the performance of ChatGPT on the American Society of Plastic Surgeons (ASPS) Plastic Surgery In-Training Examination (PSITE) to assess its clinical reasoning and decision-making ability and investigate its legitimacy related to plastic surgery competencies. METHODS: PSITE questions from 2015 to 2023 were included in this study. Questions with images, charts, and graphs were excluded. ChatGPT 3.5 was prompted to provide the best single letter answer choice. Performance was analyzed across test years, question area of content, taxonomy, and core competency via chi-square analysis. Multivariable logistic regression was performed to identify predictors of ChatGPT performance. RESULTS: In this study, 1850 of 2097 multiple choice questions were included. ChatGPT answered 845 (45.7%) questions correctly, performing the highest on breast/cosmetic topics (49.6%) ( = .070). ChatGPT performed significantly better on questions requiring the lowest level of reasoning (knowledge, 55.1%) compared with more complex questions such as analysis (41.4%) ( = .001). Multivariable analysis identified negative predictors of performance including the hand/lower extremity topic (OR = 0.73, = .038) and taxonomy levels beyond knowledge ( < .05). Performance on the 2023 exam (53.4%) corresponded to a 4th percentile score when compared with all plastic surgery residents. CONCLUSIONS: While ChatGPT's performance has shown promise in other medical domains, our results indicate it may not be a reliable source of information for plastic surgery-related questions or decision-making.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe