The application of robotics in plastic and reconstructive surgery: A systematic review.

BACKGROUND: Robotic assisted surgery (RAS) has seen significant advancement in many surgical specialties, although the application of robotics in plastic and reconstructive surgery remains to be widely established. This systematic review aims to assess the role of RAS in plastic and reconstructive surgery. METHODS: The review protocol was published and registered a priori as CRD42024507420. A comprehensive electronic search for relevant studies was performed in MEDLINE, Embase and Google scholar databases. RESULTS: Overall, 132 studies were initially identified, of which, 44 studies satisfied the eligibility criteria with a cumulative total of 239 patients. RAS demonstrated a high degree of procedural success and anastomotic patency in microvascular procedures. There was no significant difference in periprocedural adverse events between robotic and manual procedures. CONCLUSION: RAS can be feasibly implemented in plastic and reconstructive surgery with a good efficacy and safety profile, particularly for microsurgical anastomosis and trans-oral surgery.

Management of Liposarcoma With Posterior Intercostal Artery Propeller Flap Reconstruction: A Case Report.

This case shows the administration of a 57-year-old male with liposarcoma within the right flank region. Surgical treatment of the case included wide local excision (WLE), taken after reconstruction utilizing a posterior intercostal artery propeller flap. Postoperative care included regular checking for signs of repeat. Comparison with similar cases highlights the changeability in clinical introduction and surgical approaches for liposarcomas. This case emphasizes the significance of convenient diagnosis, fastidious surgical procedures, and successful reconstruction in overseeing liposarcomas. This case report points to highlights the clinical administration, surgical intercession, and postoperative care included in treating a giant liposarcoma and compares this case with similar instances to emphasize the challenges and procedures in treating liposarcomas.

Automated thermographic detection of blood vessels for DIEP flap reconstructive surgery.

PURPOSE: Inadequate perfusion is the most common cause of partial flap loss in tissue transfer for post-mastectomy breast reconstruction. The current state-of-the-art uses computed tomography angiography (CTA) to locate the best perforators. Unfortunately, these techniques are expensive and time-consuming and not performed during surgery. Dynamic infrared thermography (DIRT) can offer a solution for these disadvantages. METHODS: The research presented couples thermographic examination during DIEP flap breast reconstruction with automatic segmentation approach using a convolutional neural network. Traditional segmentation techniques and annotations by surgeons are used to create automatic labels for the training. RESULTS: The network used for image annotation is able to label in real-time on minimal hardware and the labels created can be used to locate and quantify perforator candidates for selection with a dice score accuracy of 0.8 after 2 min and 0.9 after 4 min. CONCLUSIONS: These results allow for a computational system that can be used in place during surgery to improve surgical success. The ability to track and measure perforators and their perfused area allows for less subjective results and helps the surgeon to select the most suitable perforator for DIEP flap breast reconstruction.

Unilateral double facial artery: an anatomic variant and clinical implications.

Background: This paper reports a rare anatomical variant of the facial artery (FA) - namely, a double FA pattern - which has significant implications in a wide range of surgical and aesthetic medicine disciplines. Case: The study involves a case report and literature review of the FA and its variants. The case is that of a 61-year-old female cadaver with a unilateral FA variant branching pattern discovered during a cadaveric dissection for an anatomy course. Discussion: The dissection revealed an unusual supply of the typical FA distribution by two separate branches from either side of the maxillary artery. The first branch, termed FA1, followed a typical FA course arising from the external carotid to supply the lower portion of the face via lingual, inferior labial, and mental arterial branches. The second branch, termed FA2, arose superior to the maxillary artery near the origin of a typical transverse facial artery, to supply the upper portion of the face via superior labial, lateral nasal, and angular arterial branches. No direct communication between the two branches was observed grossly via dissection. The observed branching pattern has not previously been reported in literature and has critical implications for surgical planning and intervention. Conclusion: This study emphasizes the importance of understanding variant FA anatomy in procedures requiring precise anatomical knowledge of arterial supply to the face. Duplicate and/or secondary facial arteries necessitate careful consideration for their potential consequences on the success of surgery of the head and neck, dermal fillers, and embolization for epistaxis procedures.

Continuous oxygen monitoring to enhance ex-vivo organ machine perfusion and reconstructive surgery.

Continuous oxygenation monitoring of machine-perfused organs or transposed autologous tissue is not currently implemented in clinical practice. Oxygenation is a critical parameter that could be used to verify tissue viability and guide corrective interventions, such as perfusion machine parameters or surgical revision. This work presents an innovative technology based on oxygen-sensitive, phosphorescent metalloporphyrin allowing continuous and non-invasive oxygen monitoring of ex-vivo perfused vascularized fasciocutaneous flaps. The method comprises a small, low-energy optical transcutaneous oxygen sensor applied on the flap's skin paddle as well as oxygen sensing devices placed into the tubing. An intermittent perfusion setting was designed to study the response time and accuracy of this technology over a total of 54 perfusion cycles. We further evaluated correlation between the continuous oxygen measurements and gold-standard perfusion viability metrics such as vascular resistance, with good agreement suggesting potential to monitor graft viability at high frequency, opening the possibility to employ feedback control algorithms in the future. This proof-of-concept study opens a range of research and clinical applications in reconstructive surgery and transplantation at a time when perfusion machines undergo rapid clinical adoption with potential to improve outcomes across a variety of surgical procedures and dramatically increase access to transplant medicine.

Artificial Intelligence in Facial Plastics and Reconstructive Surgery.

Artificial intelligence (AI), particularly computer vision and large language models, will impact facial plastic and reconstructive surgery (FPRS) by enhancing diagnostic accuracy, refining surgical planning, and improving post-operative evaluations. These advancements can address subjective limitations of aesthetic surgery by providing objective tools for patient evaluation. Despite these advancements, AI in FPRS has yet to be fully integrated in the clinic setting and faces numerous challenges including algorithmic bias, ethical considerations, and need for validation. This article discusses current and emerging AI technologies in FPRS for the clinic setting, providing a glimpse of its future potential.

Examining the Most Impactful Strategies for In-service Preparation: A Systemic Review.

INTRODUCTION: Resident performance on the Plastic Surgery In-Service Examination (PSITE) is used as a predictor of success on the American Board of Plastic Surgery Written Examination, as well as resident progression and fellowship applications. However, information specifically addressing strategies on optimal PSITE preparation is lacking in the plastic surgery literature when compared to general surgery. For this reason, we aim to understand if the topic is well-studied and denote effective study strategies and curricular interventions in both fields that can help residents and programs optimize PSITE performance. METHODS: A literature search including studies from 2012 to 2022 was conducted following PRISMA guidelines in PubMed and EMBASE to identify articles on strategies to improve in-service exam scores for general surgery and plastic surgery. Only studies that reported measurable outcomes in raw score, percentile score, or percent correct were included. RESULTS: Qualitative analysis of 30 articles revealed 2 categories of interventions: individual study habits and institutional curricular interventions. In general surgery literature, 27 articles examined interventions positively impacting resident ABSITE scores, with 21 studies classified as institutional curricular interventions and 6 articles addressing individual study habits. Themes associated with improved ABSITE performance included mandatory remediation programs, dedicated study time, and problem-based learning interventions. In contrast, only 3 articles in plastic surgery literature discussed interventions associated with improved PSITE scores, all falling under curricular interventions. CONCLUSION: Unfortunately, the plastic surgery literature lacks concrete evidence on how residents can improve performance. Future research in plastic surgery should replicate successful strategies from general surgery and further investigate optimal preparation strategies for the PSITE. Such endeavors can contribute to improving resident performance and advancing plastic surgery education and patient care.

Chatting Up the Next Big Thing: Generating Novel Ideas for Systematic Reviews in Breast Reconstruction Research Using Chat-GPT.

BACKGROUND: In reconstructive plastic surgery, the need for comprehensive research and systematic reviews is apparent due to the field's intricacies, influencing the evidence supporting specific procedures. Although Chat-GPT's knowledge is limited to September 2021, its integration into research proves valuable for efficiently identifying knowledge gaps. Therefore, this tool becomes a potent asset, directing researchers to focus on conducting systematic reviews where they are most necessary. METHODS: Chat-GPT 3.5 was prompted to generate 10 unpublished, innovative research topics on breast reconstruction surgery, followed by 10 additional subtopics. Results were filtered for systematic reviews in PubMed, and novel ideas were identified. To evaluate Chat-GPT's power in generating improved responses, two additional searches were conducted using search terms generated by Chat-GPT. RESULTS: Chat-GPT produced 83 novel ideas, leading to an accuracy rate of 83%. There was a wide range of novel ideas produced among topics such as transgender women, generating 10 ideas, whereas acellular dermal matrix (ADM) generated five ideas. Chat-GPT increased the total number of manuscripts generated by a factor of 2.3, 3.9, and 4.0 in the first, second, and third trials, respectively. While the search results were accurate to our manual searches (95.2% accuracy), the greater number of manuscripts potentially diluted the quality of articles, resulting in fewer novel systematic review ideas. CONCLUSION: Chat-GPT proves valuable in identifying gaps in the literature and offering insights into areas lacking research in breast reconstruction surgery. While it displays high sensitivity, refining its specificity is imperative. Prudent practice involves evaluating accomplished work and conducting a comprehensive review of all components involved.

A Comprehensive Literature Review on Advancements and Challenges in 3D Bioprinting of Human Organs: Ear, Skin, and Bone.

The field of 3D bioprinting is rapidly emerging within the realm of regenerative medicine, offering significant potential in dealing with the issue of organ shortages. Despite being in its early stages, it has the potential to replicate tissue structures accurately, providing new potential solutions for reconstructive surgery. This review explores the diverse applications of 3D bioprinting in regenerative medicine, pharmaceuticals, and the food industry, specifically focusing on ear, skin, and bone tissues due to their unique challenges and implications in the field. Significant progress has been made in cartilage and bone scaffold fabrication in ear reconstruction, yet challenges in functional maturation persist. Recent advancements highlight the potential for patient-specific ear substitutes, emphasizing the need for extensive clinical trials. In skin regeneration, 3D bioprinting addresses limitations in existing models, offering opportunities for improved wound healing and realistic skin models. While challenges exist, progress in biomaterials and in-situ bioprinting holds promise. In bone regeneration, 3D bioprinting presents personalized solutions for defects, but scaffold design refinement and addressing regulatory and ethical considerations are crucial. The transformative potential of 3D bioprinting in the field of medicine holds the promise of redefining therapeutic approaches and delivering personalized treatments and functional tissues. Interdisciplinary collaboration is essential for fully realizing the capabilities of 3D bioprinting. This review provides a detailed analysis of current methodologies, challenges, and prospects in 3D bioprinting for ear, skin, and bone tissue regeneration.

Superficial musculoaponeurotic system interpositional graft after temporomandibular joint discectomy.

Arthroplasty with discectomy is a proven treatment for internal derangement of the temporomandibular joint (TMJ), however there is no consensus on the type of interpositional graft that should be used after the disc is removed. While an ideal graft should be easy to obtain and provide an adequate buffer between the articular surfaces, the authors suggest that it should also minimize donor site morbidity. This Technical Note highlights the technique for harvesting and utilizing the superficial musculoaponeurotic system (SMAS) as an interpositional graft. Three patients were treated with a SMAS graft after TMJ arthroplasty with discectomy. The average pain score decreased from 9/10 preoperatively to 2/10 at 6 weeks postoperatively, while the average maximum incisal opening increased from 31 mm to 36.7 mm. Since these patients were concurrently treated with a facelift, they were asked about their esthetic outcome on a scale of 1-10, with 1 representing extremely dissatisfied and 10 representing extremely satisfied. The average esthetic rating at 6 weeks postoperatively was 9.3/10. The SMAS interpositional graft technique eliminates a second surgical site, improves function, reduces pain, and provides the opportunity for concurrent esthetic facial rejuvenation if desired.

Management of a complicated colonexposed sacrococcygeal wound after pelvic exenteration: a case report.

DECLARATION OF INTEREST: This work was supported by the Naval Medical University and the University of Shanghai for Science and Technology Joint Projects (2020-RZ04), the Innovative Clinical Research Program of Shanghai Changzheng Hospital (2020YLCYJ-Y16), and the academic project of Naval Medical University (2022QN073). The authors have no conflicts of interest to declare.

Prevalence of body dysmorphic disorder, its clinical characteristics and psychiatric comorbidities in patients admitted to a plastic surgery outpatient clinic.

PURPOSE: The present study aimed to determine the prevalence of body dysmorphic disorder (BDD), its clinical features, and comorbidities in patients applying for plastic and reconstructive surgery. METHOD: Five-hundred and seventy nine participants who applied to the plastic and reconstructive surgery outpatient clinic completed a sociodemographic data form, and were subjected to the Body Perception Scale (seventy-nineBPS), Social Appearance Anxiety Scale (SAAS), TEMPS-A Temperament Scale, and Beck Depression Inventory (BDI). Participants who scored 135 or more on the BPS were included in a psychiatric interview. Next, the participants diagnosed with BDD were compared with participants with a high BPS scores but without a BDD diagnosis, along with a control group. RESULTS: The prevalence of BDD among all patients attending the plastic surgery outpatient clinic was found to be 4.7%, whereas the prevalence was 8.6% among those specifically seeking cosmetic procedures. The mean SAAS, BDI, TEMPS-A depressive, and anxious scores were higher in the BDD group compared to the controls (p < 0.001). The difference in the mean SAAS, BDI, TEMPS-A depressive, and anxious scores of the patients with a high BPS scores and the control group was comparable to the difference observed between the BDD and control groups. A regression analysis revealed that the SAAS and depressive temperament scores have an effect on the BPS score. CONCLUSION: The significantly high comorbidity of BDD in patients seeking plastic and reconstructive surgery underscores the importance of identifying these patients to prevent unnecessary surgical procedures.

Cyber social proof and hazard: Investigating the impact of social media on pediatric burn incidents - Analysis and comprehensive literature review.

Investigating the growing concern of pediatric burn injuries caused by social media challenges. Adolescents, seeking fame or succumbing to peer pressure, engage in risky behaviors, recording and sharing them online. The study presents two case reports detailing severe burn injuries resulting from such challenges, highlighting the physical and psychological toll on affected children and their families. In Case report 1, a 14-year-old suffered severe burns attempting a TikTok challenge involving igniting a soaked t-shirt. The patient's critical condition necessitated intensive care, surgical procedures, and skin grafts, accompanied by complications like anemia and sepsis. Case report 2 features a 9-year-old who sustained extensive burns while attempting another social media challenge. Treatment included escharolysis, skin grafts, and surgeries, with complications managed during the recovery process. A literature review explores social media-generated burn injuries, revealing their physical and psychological impact. The influence of social proof and peer pressure on adolescents' behavior in the digital age is discussed. The pandemic's effect on mental health is considered, emphasizing the vulnerability of adolescents to such challenges. In conclusion, the paper highlights the rising incidence of teen burn injuries linked to social media challenges. Urgent measures are needed to restrict the promotion of risky behaviors on social platforms. Alongside state-of-the-art burn treatments, comprehensive psychological care is essential for young patients and their families to cope with trauma. Increased content monitoring and the dissemination of prevention materials are recommended to mitigate the occurrence of such incidents.

Mode division multiplexing reconstructive spectrometer with an all-fiber photonics lantern.

This study presents a high-accuracy, all-fiber mode division multiplexing (MDM) reconstructive spectrometer (RS). The MDM was achieved by utilizing a custom-designed 3 × 1 mode-selective photonics lantern to launch distinct spatial modes into the multimode fiber (MMF). This facilitated the information transmission by increasing light scattering processes, thereby encoding the optical spectra more comprehensively into speckle patterns. Spectral resolution of 2 pm and the recovery of 2000 spectral channels were accomplished. Compared to methods employing single-mode excitation and two-mode excitation, the three-mode excitation method reduced the recovered error by 88% and 50% respectively. A resolution enhancement approach based on alternating mode modulation was proposed, reaching the MMF limit for the 3 dB bandwidth of the spectral correlation function. The proof-of-concept study can be further extended to encompass diverse programmable mode excitations. It is not only succinct and highly efficient but also well-suited for a variety of high-accuracy, high-resolution spectral measurement scenarios.

Gothenburg Breast reconstruction (GoBreast) II protocol: a Swedish partially randomised patient preference, superiority trial comparing autologous and implant-based breast reconstruction.

INTRODUCTION: Although breast reconstruction is an integral part of breast cancer treatment, there is little high-quality evidence to indicate which method is the most effective. Randomised controlled trials (RCTs) are generally thought to provide the most solid scientific evidence, but there are significant barriers to conducting RCTs in breast reconstruction, making both recruitment and achieving unbiased and generalisable results a challenge. The objective of this study is to compare implant-based and autologous breast reconstruction in non-irradiated patients. Moreover, the study aims to improve the evidence for trial decision-making in breast reconstruction. METHODS AND ANALYSIS: The study design partially randomised patient preference trial might be a way to overcome the aforementioned challenges. In the present study, patients who consent to randomisation will be randomised to implant-based and autologous breast reconstruction, whereas patients with strong preferences will be able to choose the method. The study is designed as a superiority trial based on the patient-reported questionnaire BREAST-Q and 124 participants will be randomised. In the preference cohort, patients will be included until 62 participants have selected the least popular alternative. Follow-up will be 60 months. Embedded qualitative studies and within-trial economic evaluation will be performed. The primary outcome is patient-reported breast-specific quality of life/satisfaction, and the secondary outcomes are complications, factors affecting satisfaction and cost-effectiveness. ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethical Review Authority (2023-04754-01). Results will be published in peer-reviewed scientific journals and presented at peer-reviewed scientific meetings. TRIAL REGISTRATION NUMBER: NCT06195865.

The osteocutaneous radial forearm free flap: A multidisciplinary review of the evidence.

The osteocutaneous radial forearm (OCRFF) is a versatile free flap option for bony defects of the head and neck, given the thinness and pliability of the forearm cutaneous paddle, pedicle length, reliability, lack of atherosclerosis, and functional concerns common to other osseous donor sites. The OCRFF was once associated with a high risk of radial fracture, in addition to concerns about the quality and durability of bone stock for osseous reconstruction, particularly for the mandible. Following the introduction of prophylactic plating of the radius, the incidence of symptomatic radial fracture has drastically decreased. Furthermore, modifications of the bony osteotomies and other evolutions of this flap harvest have increased the use of the OCRFF throughout the head and neck. Despite these advantages, the OCRFF is not widely utilized by microvascular reconstructive surgeons due to perceived limitations and risks. Herein, we present a multidisciplinary, contemporary review of the harvest technique, outcomes, and perioperative management for the OCRFF.

Finite element analysis of the treatment of a minimally invasive approach combined with a novel anatomical locking plate for scapular body fractures.

BACKGROUND: The minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited. METHODS: Finite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively. RESULTS: Through static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement. CONCLUSION: The minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures.

Unseparated Temporal Muscle and Duramater Cranioplasty Methods Following Decompressive Craniectomy: Technical Note.

Objective: Cranioplasty (CP) is used to repair cranial defects after decompressive craniectomy. During this procedure, the temporal muscle can contract or retract toward the base and adhere to the scalp flaps above and/or below the dura. Several complications including functional and cosmetic problems can occur following CP. This study presents the technical notes and outcomes of CP. Methods: This retrospective observational study collect data of CP-procedures using unseparated muscle-dura technique performed at our hospital in 2019-2022. Technical note is presented regarding the lack of separation of the temporal muscles from the dura mater. A bone flap or titanium mesh was placed above the temporal muscle layer, which was still attached to the dura mater. Functional outcomes were evaluated using OHIP-14 Questionnaire to assess mastication quality. Results: Twenty-three patients were included in this study. Initial surgeries were mostly caused by trauma (65.2%). Most patients underwent autologous bone flap CP (52.2%), during which the bone flap was stored in either the abdominal subcutaneous pocket or cryoprecipitated. Only one patient experienced mastication problems after CP (p<0.001). Temporal hollowing remained a problem in this technique. However, dissection of the temporalis muscle to reduce temporal hollowing can cause facial nerve injuries and masticatory problems. Due to the lack of temporal muscle manipulation, our patients had minimal mastication problems. Conclusion: CP should be performed to improve functional and aesthetic outcomes. A CP technique with the temporal muscle unseparated from the dura mater can be selected to avoid damage to the muscle and mastication problems after surgery.

Emergency Foot Fillet Free Flap Based on Posterior Tibial Vessels for Reconstruction of Contralateral Heel and Sole: A Unique Spare Part Surgery.

Introduction: Reconstruction of the sole is an extremely challenging problem for a reconstructive microsurgeon. The specialized nature of its skin and subcutaneous tissue makes reconstruction arduous. When posed with complex bilateral lower extremity trauma where one limb was nonsalvageable, we harvested the uninjured foot fillet flap for free flap cover to reconstruct the contralateral sole. We report two such cases with follow-up assessment. Patients and Methods: Two cases of sole reconstruction with emergency foot fillet free flap scavenged from the amputated contralateral limb were retrospectively analyzed. In both the patients, foot fillet free flap based on the posterior tibial neurovascular bundle was used. The follow-up assessment data collected included flap status, presence of any complications and prosthesis use, and functional status of the limbs at final follow-up. Results: Both the free flaps survived. Postoperative period was uneventful. No complications such as wound infection, delayed healing, flap necrosis, or scar breakdown were noted. The plantar flaps had recovery of protective sensation. Both the patients are ambulant; the first man with a fitted prosthesis and the second woman with the aid of a walker. Conclusion: The opportunity to utilize spare tissue from the amputated limb should be seized. Loss of the plantar aspect of foot poses a real challenge. The plantar foot fillet free flap is a durable flap with preservation of plantar sensations. It is probably the best choice as it replaces "like with like." Prerequisites for utilizing the "spare part surgery" concept are meticulous initial debridement as well as emergency free tissue transfer, which require senior input and excellent infrastructure.

Educational and Clinical Outcome Measures in an Integrated Hand Service.

Background: We recently sought to integrate our orthopaedic and plastic hand surgeons with the goal of improving education, patient care, and providing seamless, continuous coverage for our trauma center. Our hypothesis was that integration could serve both the orthopaedic and plastic surgery training programs well and provide more consistent care for the trauma patients. Materials and Methods: Program director approval was granted for blinded analysis of case logs from plastic and orthopaedic surgery programs from 2012 through 2019. Data on mean and total number of hand cases were analyzed and compared for both specialties. Institutional Review Board approval was granted for a retrospective review of patient outcomes. Results: For both orthopaedic and plastics resident trainees, the mean number of hand cases increased during this study period suggesting that the integration had a favorable impact on both programs. The mean number of hand cases for orthopaedic residents rose from 163 to 246. The mean number of hand cases for plastic surgery residents rose from 218 to 295. Patient outcomes as reflected in length of stay and time to consultation also improved. Conclusion: To improve hand surgical training and patient care, an integrated orthoplastics approach to hand surgery was implemented at our institution. Plastic surgery trainees are completing more hand surgery cases in an integrated model (p < 0.001), including fracture care (p < 0.047). Orthopaedic surgery trainees have doubled the percentage of integumentary and microsurgery cases in the integrated model (p < 0.001). The educational and clinical changes affected in an integrated model have changed the paradigm for educating future hand surgeons at our institution.