共找到 20 条结果
暂无摘要（点击查看详情）
Artificial intelligence (AI) is fundamentally transforming the landscape of plastic surgery, yet the structural architecture of its most influential scholarship has not been systematically characterized. This study presents a bibliometric and visual analysis of the 100 most-cited English-language AI publications in plastic surgery. Scopus was searched from database inception through January 15, 2026. Eligible articles underwent dual independent screening in Covidence, and the 100 most-cited publications were analyzed using R (v4.4.1) and VOSviewer (v1.6.18) for citation metrics, authorship networks, geographic and institutional contributions, journal distribution, and thematic categorization. Of the 3827 retrieved records, 357 met the full inclusion criteria, and the top 100 were identified. These articles collectively received 2701 citations (average: 27.01 ± 22.19), with a marked post-2022 publication surge accounting for 79% of the studies, with 2024 contributing to 34% of that share. Patient education and large language model-based consultation constituted the dominant thematic cluster (35%), followed by ethical and governance considerations (17%) and outcomes prediction and risk modeling (13%). Aesthetic surgery represented the most prolific specialty (34%), with craniofacial and breast reconstruction each contributing to 21%. Aesthetic Plastic Surgery (n = 16) and the Aesthetic Surgery Journal (n = 10) led journal representation. The United States dominated global scholarly output, whereas Peninsula Health in Australia emerged as the most impactful institution, with Rozen and Seth jointly leading the analysis as top authors. This analysis demonstrates the intellectual topography of AI scholarship in plastic surgery, identifying prevailing thematic concentrations and underexplored domains, and offering a contemporary framework for future research priorities and international collaboration. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
Artificial intelligence (AI) and machine learning (ML) are increasingly being applied to preoperative risk prediction in plastic surgery; however, the methodological quality and clinical readiness of these models are yet to be systematically evaluated. This systematic review assessed the quality, risk of bias, and predictive performance of AI/ML preoperative risk prediction models in plastic surgery using the PROBAST+AI framework. Five databases were searched from inception through October 2025. Ten studies met the inclusion criteria, encompassing autologous breast reconstruction (n = 2), alloplastic breast reconstruction (n = 5), head and neck reconstruction (n = 1), burn surgery (n = 1), and aesthetic surgery (n = 1). Random forest was the most frequently used algorithm (n = 4), followed by neural networks (n = 2), deep forest with RUSBoost (n = 1), support vector machine (n = 1), and logistic regression (n = 1). AUC ranged from 0.66 to 0.82 among the 8 studies reporting discrimination. Critical methodological limitations were identified: only 2 studies (20%) performed external validation, 5 of 7 development studies (71.4%) had events per variable <10 indicating inadequate sample size, and 7 studies (70%) did not report model calibration. Pre-reconciliation inter-rater reliability across 102 paired domain-level ratings yielded a Cohen's kappa of 0.240 and Prevalence-Adjusted Bias-Adjusted Kappa of 0.039, consistent with published benchmarks for PROBAST-based systematic reviews. All discrepancies were resolved via structured consensus. Current AI/ML models for preoperative risk prediction in plastic surgery demonstrate variable performance and substantial methodological limitations that preclude clinical implementation. Multi-institutional prospective validation studies with rigorous methodology are needed before clinical adoption.
After reviewing this article, the reader should be able to: 1. Understand the indications for and principles of aesthetic breast revision surgery. 2. Describe surgical techniques to improve outcomes in reoperative breast augmentation. 3. Plan a surgical approach and execute the critical steps. 4. Recognize common implant and soft-tissue complications and have a basic understanding of their management. 5. Be aware of emerging adjunctive techniques, such as fat grafting, muscular support, and new implant technologies. Aesthetic breast revision surgery is a complex procedure that remains a central component of plastic surgery practice. Careful preoperative planning, associated with selection of the appropriate technique, can lead to predictable outcomes. An up-to-date understanding of contemporary surgical techniques may prevent complications, and preoperative discussion can prevent common misunderstandings and challenges inherent to the reoperative procedure. This evidence-based article reviews how the main techniques have evolved to best address patient goals and attain positive aesthetic outcomes and addresses controversies and knowledge gaps using clinical experience and a review of the current literature.
Individual studies have suggested a benefit in using Arnica and Bromelain for reducing ecchymosis following facial plastic surgery; however, the literature remains inconsistent and methodologically heterogeneous. An up-to-date review is therefore necessary to synthesize the available evidence and provide clearer guidance to clinicians and patients alike. The objective of this study was therefore to investigate the effectiveness of Arnica and Bromelain in reducing postoperative ecchymosis after facial plastic surgery. A PRISMA-guided search of Medline, Embase, Cochrane databases, Epistemonikos, and ClinicalTrials.gov was conducted up to August 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies evaluating Arnica and/or Bromelain use in facial plastic surgeries. The primary outcome was postoperative ecchymosis. Secondary outcomes included edema, adverse effects, and patient satisfaction. Ten articles were included, comprising 6 RCTs, 3 prospective, and one retrospective cohort study, with a total of 696 patients (mean age 35 years, range 15-78). Most studies examined rhinoplasty (60%), followed by blepharoplasty (30%). Most studies (80%) evaluated Arnica use, of which 63% demonstrated significant reductions in postoperative ecchymosis at various time points. Edema was assessed in 2 Arnica studies, both of which showed significant reductions. Two studies evaluated Bromelain, with one demonstrating reduced ecchymosis by postoperative day 7. Adverse events were rare and mild. Arnica may help reduce postoperative ecchymosis and edema after facial plastic surgery; however, the evidence for Bromelain is limited. Marked heterogeneity in dosing and assessment tools limits the generalizability of findings and the ability to perform meta-analysis. Certaines études ont suggéré un bénéfice de l’utilisation de l’arnica et de la bromélaïne pour réduire les ecchymoses après une chirurgie plastique faciale; cependant, la littérature reste incohérente et hétérogène sur le plan méthodologique. Une revue actualisée est donc nécessaire pour synthétiser les données disponibles et fournir des recommandations plus claires tant aux cliniciens qu’aux patients. L’objectif de cette étude était donc d’évaluer l’efficacité de l’arnica et de la bromélaïne dans la réduction des ecchymoses postopératoires après une chirurgie plastique faciale. Une recherche guidée par les critères PRISMA a été effectuée dans les bases de données Medline, Embase, Cochrane, Epistemonikos et ClinicalTrials.gov jusqu’en août 2025. Les études éligibles comprenaient des essais contrôlés randomisés (ECR) et des études observationnelles évaluant l’utilisation de l’arnica et/ou de la bromélaïne dans le cadre de chirurgies plastiques faciales. Le critère de jugement principal était l’ecchymose postopératoire. Les critères de jugement secondaires comprenaient l’œdème, les effets indésirables et la satisfaction des patients. Dix articles ont été retenus, comprenant six ECR, trois études de cohorte prospectives et une étude de cohorte rétrospective, portant sur un total de 696 patients (âge moyen de 35 ans, intervalle de 15 à 78 ans). La plupart des études portaient sur la rhinoplastie (60 %), suivie de la blépharoplastie (30 %). La plupart des études (80 %) ont évalué l’utilisation de l’arnica; parmi celles-ci, 63 % ont démontré une réduction significative de l’ecchymose postopératoire à différents moments. L’œdème a été évalué dans deux études sur l’arnica, qui ont toutes deux montré des réductions significatives. Deux études ont évalué la bromélaïne, dont une a démontré une réduction de l’ecchymose dès le 7e jour postopératoire. Les événements indésirables étaient rares et bénins. L’arnica pourrait contribuer à réduire les ecchymoses et l’œdème postopératoires après une chirurgie plastique faciale; toutefois, les données concernant la bromélaïne sont limitées. Une hétérogénéité marquée au niveau des posologies et des outils d’évaluation limite la généralisation des résultats et la possibilité de réaliser une méta-analyse.
Global surgery has emerged as a critical domain within global health, but despite growing academic interest, the structure, scope, and organization of global surgery initiatives within Canadian academic institutions remain incompletely characterized. We sought to conduct a national environmental scan of academic global surgery initiatives in Canada, examining participant characteristics, the structure and focus of initiatives, community motivations, and future priorities. We conducted a cross-sectional, survey-based study between July 2024 and April 2025, targeting Canadian physicians, trainees, researchers, and health professionals involved in global surgery. We invited participants via professional networks, academic institutions, and the trainee network of the Canadian Global Surgery Trainees' Alliance. The survey included both quantitative and qualitative items across 4 domains. We used descriptive statistics and thematic analysis to analyze responses. Forty respondents from 10 Canadian medical schools completed the survey, representing diverse surgical specialties and career stages. Most were affiliated with university-based global surgery offices (62%). Engagement was highest in research (65%), teaching (55%), and capacity building (55%), with trainees playing a central role. Key barriers included limited funding (95%), infrastructure gaps (70%), and lack of training opportunities (54%). Motivations for involvement included commitment to health equity, education, and sustainable partnerships. Respondents also identified future priorities, including training and education, improving access to surgical resources, and enhancing mentorship and evaluation frameworks. This study offers an overview of Canadian global surgery efforts, revealing enthusiastic but fragmented engagement. Findings highlight opportunities to strengthen coordination, formalize training structures, and improve sustainability within global surgery programs in Canada.
 The global aesthetic surgery industry is expanding rapidly, with success increasingly defined by patient-reported outcomes. Postoperative satisfaction, a key metric, is strongly influenced by preoperative psychological state.  To synthesize evidence on the relationship between preoperative psychological factors (e.g., body image, emotions, personality, expectations) and postoperative satisfaction.  A narrative review was conducted, including studies on body dysmorphic disorder (BDD), body image dissatisfaction, anxiety, depression, self-esteem, personality, and motivations across various procedures.  BDD is a consistent negative predictor of satisfaction, often a contraindication. Body image dissatisfaction, unrealistic expectations, and traits like neuroticism also correlate with lower satisfaction. Conversely, functionally motivated procedures (e.g., reduction mammaplasty) yield high, sustained satisfaction. Expectation-reality alignment is a core mediator. Surgical type, demographics, and time moderate the relationship. Standardized tools (e.g., BDDQ, FACE-Q) provide reliable assessment.  Preoperative psychological state critically determines satisfaction. Integrating standardized screening, expectation management, and perioperative psychological support within a collaborative biopsychosocial model is essential for optimizing outcomes and patient well-being. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
BACKGROUND: Traditional surgical approaches for gynecomastia are associated with significant trauma and insufficient protection of anatomical structures. Currently, endoscopic glandular excision has emerged as the primary treatment modality. A refined anatomical approach for endoscopic minimally invasive surgery is proposed, with evaluation of postoperative complications and aesthetic outcomes. This study is a single-center, single-arm prospective investigation that collected and analyzed clinical data from patients who underwent endoscopic mastectomy at The First Hospital of Hebei Medical University, aiming to evaluate postoperative complications and patient recovery outcomes with an emphasis on the refined anatomical approach. A total of 786 patients were included. The mean operative time was 117.8 ± 20.0 minutes, and the mean discharge time was 3.0 ± 0.7 days. Major complications included hematoma (n = 4, 0.5%) and nipple-areolar complex ischemia (n = 54, 6.9%). Among these, 52 cases of nipple-areolar complex ischemia resolved during follow-up, while 2 case progressed to necrosis (0.3%). Nipple-areolar complex sensation scores were 8.5 ± 2.0 (unilateral) and 8.0 ± 1.8 (bilateral). All procedures were completed without conversion to open surgery or significant intraoperative bleeding. Endoscopic glandular excision, through meticulous vascular and neural preservation, effectively restores the natural contour of the male chest while minimizing complications. This approach offers a safe and aesthetically favorable solution for gynecomastia patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Newsweek has published annual "America's Best Plastic Surgeons" rankings based on a peer-nomination survey for five years, now encompassing six aesthetic surgery categories that each identify the top 30 surgeons. To evaluate gender representation, geographic distribution, and recurrence patterns among surgeons included in these national rankings. All available ranked surgeons were reviewed (n=720). Surgeon gender and location were recorded. Duplicate entries were removed to identify unique surgeons. Recurrence across categories was evaluated. Of the 720 rankings published, 149 unique surgeons were identified. 134 (89.9%) were male and 15 (10.1%) were female. Compared with their estimated 20% representation in the national workforce, female plastic surgeons were significantly underrepresented in the rankings (10.1% vs 20%; p=0.002). Each year, female representation was significantly lower than expected (2021, p=0.004; 2022-2025, all p<0.001). Compared with their respective inaugural years, the proportion of female surgeons decreased in four categories. 35.6% of surgeons (n=53) appeared in more than one category, averaging 2.3 additional category listings. In 2025, surgeons previously ranked within the same category had appeared on average 2.8 times before. Geographically, surgeons were located in the South (n=54), Northeast (n=52), West (n=29), and Midwest (n=14). Significant gender disparities characterize the "America's Best Plastic Surgeons" lists, and redundancy patterns may indicate concentration among a limited subset of surgeons. Reevaluating survey methodology and the ranking process may improve representation and patient access to a more diverse selection of surgeons.
Nicotine use is a well-established risk factor for surgical wound complications and overall postoperative morbidity;however, its impact on elective aesthetic procedures such as body contouring surgery remains poorly characterized. Using a large de-identifi ed electronic health record database (TriNetX), adult patients who underwent bodycontouring procedures between 2005 and 2025 were identifi ed and propensity score matched based on history ofnicotine dependence. Postoperative outcomes at 90-days were compared between patients with and withoutnicotine dependence, including wound complications, complications requiring operative intervention, seroma,venous thromboembolism, and opioid prescriptions. A total of 110,287 patients were identifi ed. After matching, each cohort had 17,065 patients. At 90-dayspostoperatively, patients with nicotine dependence demonstrated signifi cantly higher odds of wound complications,wound complications requiring operative intervention, seroma formation, and opioid prescriptions compared to non-nicotine users. No signifi cant diff erences were observed in venous thromboembolism rates between groups. These fi ndings suggest that nicotine dependence is associated with increased postoperative morbidity followingbody contouring procedures, particularly with respect to wound-related complications and opioid utilization. Routinepreoperative nicotine screening, patient education, and cessation interventions may play an important role inmitigating postoperative complications and improving outcomes in patients undergoing elective aesthetic bodycontouring surgery Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Preoperative digital imaging and simulation technologies have become increasingly important in aesthetic rhinoplasty for improving surgical planning, surgeon-patient communication, and patient expectation management. However, data evaluating the relationship between preoperative simulation and long-term postoperative outcomes remain limited. This retrospective study included 198 patients who underwent aesthetic rhinoplasty. The study population consisted of 138 female and 60 male patients with a mean age of 28 years. All patients underwent preoperative 2-dimensional (2D) photographic analysis and 3-dimensional (3D) digital simulation before surgery. Long-term postoperative outcomes, revision rates, postoperative discrepancies between preoperative planning and actual outcomes, and patient satisfaction were evaluated over a 3-year follow-up period. The study was conducted in accordance with ethical standards, and written informed consent was obtained from all participants. The overall revision rate was 12.6% (25/198 patients). Revision rhinoplasty was performed in 11 patients (44%) for inadequate dorsal contour depth, in 8 patients (32%) for tip ptosis, and in 6 patients (24%) for intermittent functional breathing problems associated with septal deviation. Most postoperative dorsal contour discrepancies remained within clinically acceptable limits. Eleven patients demonstrated a ∼1 mm discrepancy, 10 patients a ∼1.5 mm discrepancy, 5 patients a ∼2m m discrepancy, and 3 patients a ∼3 mm discrepancy between preoperative simulation and postoperative outcomes without requiring revision surgery. Preoperative 3D simulation improved visualization of surgical goals and facilitated patient understanding of postoperative expectations. Preoperative 2D and 3D digital imaging and simulation techniques represent valuable adjuncts in modern rhinoplasty practice. These technologies improve patient communication, facilitate expectation management, and may contribute to greater long-term postoperative satisfaction by improving consistency between preoperative planning and actual surgical outcomes.
Masculinizing top surgery is the most prevalent gender-affirming procedure offered to transgender and gender diverse individuals, most commonly via gender-affirming mastectomy and free nipple grafting. Our institution presents a novel technique for gender-affirming top surgery, adapted from the modified Robertson technique for reduction mammoplasty. Our approach preserves a sensate and dynamic nipple using an inferiorly-based, bell curve pedicle. A retrospective chart review was conducted including all patients who underwent the Lahey modification technique for gender-affirming top surgery by a single surgeon at an academic hospital in Massachusetts from October 2018 to November 2024. Patient characteristics, intra-operative data, and clinical outcomes were analyzed utilizing descriptive statistics and univariate logistic regression. Outcomes were stratified by resection weight greater or less than the mean (x̄ = 571.5 g) to inform patient selection. Thirty-eight patients (72 nipples) were included in this study. The median length of follow-up was 5 months (range 1 week-60 months). In total, there was partial necrosis of seven nipples (9.7%), decreased sensation in seven nipples (9.7%), and complete loss of sensation in one nipple (1.4%). None of the patients experienced complete nipple loss. There was an overall high rate of subjective patient satisfaction. This study demonstrates that the Lahey modification is a safe technique for gender-affirming top surgery for patients with a wide range of breast sizes and ptosis. Our results exhibit high rates of retained nipple sensation and piloerection, with satisfactory aesthetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
With the progressive shift of minimally invasive aesthetic medicine toward regeneration-oriented therapeutic paradigms, injectable materials have evolved from providing simple volumetric augmentation to enabling tissue remodeling and long-term structural improvement. Regenerative functional microspheres, as representative biostimulatory injectable materials have demonstrated expanding clinical value in facial rejuvenation, skin texture enhancement, and scar repair. However, studies on different material systems remain fragmented with respect to their mechanisms of action, manufacturing strategies, and clinical outcomes, and the lack of systematic integration and cross-comparison has hindered manufacturing standardization and standardized clinical application. Focusing on aesthetic medical applications, this review systematically summarizes the regenerative mechanisms, major material systems, fabrication strategies, and clinical evidence of regenerative functional microspheres. Centered on the critical clinical effects of biostimulation and collagen remodeling, this review highlights recent advances in regenerative mechanisms and material design, outlines the influence of key fabrication technologies on product uniformity and safety, and systematically analyzes major clinical indications and therapeutic characteristics, while also discussing key challenges and future development trends in this field. This review aims to provide a structured overview to guide material design, process optimization, and clinical translation of regenerative microspheres, offering a reference framework for innovation and application of regenerative aesthetic materials.
Xu et al. recently published a prospective clinical trial examining ultrasound-based optic nerve sheath diameter (ONSD) monitoring during liposuction surgery in prone and supine positions, demonstrating that prone position significantly elevates ONSD a validated noninvasive surrogate for intracranial pressure (ICP). While this represents a valuable proofs-of-concept for perioperative ONSD monitoring in cosmetic surgery, several methodological concerns warrant discussion. We critically appraise four key methodological limitations: (1) exclusive enrollment of female patients without justification, despite established sex differences in ONSD diagnostic accuracy; (2) absence of a predefined clinical action threshold despite reported values remaining below established intervention cutoff; (3) uncontrolled confounding by the dexmedetomidine anesthetic regimen, which has known ICP-lowering properties; and (4) non-randomized group allocation by anatomical region, introducing procedural confounding. Future studies should incorporate sex-inclusive enrollment, predefined ONSD action thresholds, comparator anesthetic arms, and randomized positioning protocols to validate this promising monitoring approach for broader clinical application. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
The rising incidence of massive weight loss (MWL) in women has led to an increased demand for breast surgery. Autoaugmentation and implant-based augmentation mastopexy represent well-established procedures in this patient population. However, there is a notable lack of direct comparison of these 2 surgical approaches in the current literature. This retrospective study included 100 consecutive patients with MWL over the past 7.6 years (64 autoaugmentation and 36 implant-based). Complication and surgical revision rates were collected retrospectively. During a follow-up examination, postoperative BREAST-Q scores, 36-item Short Form Health Survey scores, and aesthetic outcomes were evaluated. The included patients had a mean age of 39 ± 10.6 years and a median follow-up time of 2.8 years (range, 0.3 to 7.6 years). In the autoaugmentation group, most aesthetic evaluation criteria and postoperative BREAST-Q scores for Satisfaction with Breasts (P < 0.001) and Satisfaction with Outcome (P < 0.001) were significantly higher. According to Clavien-Dindo classification, complications in the autoaugmentation group were mainly managed conservatively, whereas most complications in the implant group required surgical revision (P = 0.009). Recurrent ptosis occurred more frequently in the implant group. The 36-item Short Form Health Survey results indicated no significant group differences. A tendency toward increased use of autoaugmentation techniques among 100 patients with MWL was observed, achieving significantly higher outcome scores and lower complication rates. If sufficient breast tissue is available, implant use should be avoided in this patient population. If an implant is required, patients should be thoroughly informed about the higher complication rates and potential need for revision surgery.
Background: Perioperative fluid therapy plays a critical role in the outcome of microvascular free-flap surgery. While both inadequate and excessive fluid administration may impair flap perfusion and systemic recovery, the impact of fluid balance and crystalloid volume-normalized to body weight and operative time-on postoperative complications remains underexplored. This study investigates the dose-dependent effects of intraoperative fluid and crystalloid administration on flap-related and systemic outcomes. Methods: This retrospective, single-centre cohort study included 495 adult patients who underwent microvascular free-flap transplantation between 2009 and 2020. Intraoperative fluid balance and crystalloid volumes were normalized to patient weight and operative duration (mL/kg/h) and stratified into pre-defined thresholds. The primary endpoint was the incidence of flap-related complications (partial/total flap loss, thrombosis, revision surgery). Secondary endpoints included flap loss, suture insufficiency, pneumonia, ICU length of stay (LOS-ICU), and in-hospital mortality. Results: Higher intraoperative fluid rates were significantly associated with higher complication rates. Flap-related complications occurred in 54.8% of patients receiving >10 mL/kg/h versus 37.1% in the ≤5 mL/kg/h group (p < 0.01) and reached 100% in patients receiving >20 mL/kg/h, although this category comprised only seven patients (p < 0.01). Suture insufficiency increased from 3.1% (≤5 mL/kg/h) to 57.1% (>20 mL/kg/h; p < 0.01). Pneumonia incidence rose from 8.8% (≤5 mL/kg/h) to 31.9% (>10 mL/kg/h; p < 0.01). A U-shaped trend was observed for flap loss, with the highest rate (24.6%) at >10 mL/kg/h. Crystalloid volume > 3000 mL was significantly associated with higher flap loss (20.2% vs. 0.2%; p < 0.01) and suture insufficiency (7.0% vs. 0.2%; p = 0.02). Red blood-cell (RBC) transfusions were associated with higher overall complication rates (45.6% vs. 34.2%; p < 0.01) and suture insufficiency (9.9% vs. 3.4%; p < 0.01). Gelatin-based colloids showed no negative impact. Operative time was the only strong independent predictor of total flap loss; each additional operative hour increased the odds of flap loss by 34% (p < 0.001). Intraoperative noradrenaline use and a history of neoadjuvant radiotherapy were not independently associated with flap-related complications or flap loss. Median LOS-ICU increased from 2 days to 10 days in patients receiving >20 mL/kg/h (p < 0.01). In-hospital mortality increased significantly with higher fluid volumes (0.3% for ≤10 mL/kg/h vs. 28.6% for > 20 mL/kg/h; p < 0.01). Conclusions: In 495 microvascular free-flap reconstructions, diagnosis, flap type, defect localization and operative time emerged as key determinants of postoperative outcomes, while defect type itself showed no predictive value. Intraoperative fluid overload-particularly crystalloid rates exceeding 10 mL/kg/h-is associated with a significantly higher risk of flap-related complications, pneumonia, prolonged ICU stay and mortality. These findings support the implementation of individualized or goal-directed fluid strategies in microvascular reconstructive surgery to optimize outcomes.
Breast implant-associated Mycobacterium fortuitum infections with presumed rib osteomyelitis are exceedingly rare, with fewer than 7 cases reported globally. We report the first documented case from Latin America, identified through systematic review of PubMed and SciELO databases. A 25-year-old woman with no predisposing comorbidities underwent mastopexy and breast augmentation with a retropectoral silicone implant. She developed a persistent left breast wound unresponsive to conventional treatment at an outside institution and was referred to our center ∼14 months postoperatively with a chronic fistula and rib exposure. A multidisciplinary approach (plastic surgery, orthopedic surgery, and infectious disease) was employed. Serial surgical debridement with vacuum-assisted closure therapy was performed. Cultures confirmed M. fortuitum sensitive to clarithromycin and doxycycline; combination therapy with clarithromycin and moxifloxacin was administered for 6 months. Wound closure was achieved with epigastric and thoracoabdominal pedicle flaps, followed by bilateral autologous fat grafting for breast reconstruction. At 8-year follow-up, the patient reported satisfaction with the aesthetic result. This case emphasizes the importance of maintaining clinical suspicion for nontuberculous mycobacterial infection in chronic nonhealing wounds following breast implant surgery, even in immunocompetent patients without identifiable risk factors. Level of Evidence: 5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
暂无摘要（点击查看详情）
Background The present study focuses on uncommon surgically managed disorders of the small intestine. Although several of these entities, such as gastrointestinal stromal tumors, Crohn's disease requiring surgery, and symptomatic Meckel's diverticulum, are not classified as rare diseases by epidemiological definitions, they represent infrequently encountered indications for operative management at individual centers. Evaluating these surgically managed conditions together provides insight into diagnostic challenges, operative decision-making, and postoperative outcomes encountered in routine surgical practice. Methodology A retrospective observational study was conducted including all patients with uncommon surgically managed small intestinal disorders between January 2020 and December 2025. Clinical, operative, histopathological, and postoperative outcome data were extracted from institutional medical records. Patients were followed through outpatient records and hospital databases until the last available follow-up (median = 24 months; range = 3-36 months). Continuous variables were analyzed using Student's t-test or Mann-Whitney U test, and categorical variables using the chi-square test or Fisher's exact test, as appropriate. Descriptive statistics with 95% confidence intervals (CIs) were used to summarize clinical outcomes. Results In total, 34 patients were included. The mean age was 46.7 ± 16.4 years, and 70.6% were male (24/34; 95% CI: 52.5%-84.9%). Gastrointestinal stromal tumors were the most common pathology (26.5%; 95% CI: 12.9%-44.4%). Contrast-enhanced computed tomography was performed in all patients (34/34, 100%) and demonstrated the highest radiological-pathological concordance, with the preoperative radiological impression corresponding to the final operative and histopathological diagnosis in 31 of 34 patients (91.2%). Emergency surgery was required in 41.2% of patients (14/34; 95% CI: 24.6%-59.3%). Postoperative morbidity occurred in 11.8% (4/34; 95% CI: 3.3%-27.5%), with no postoperative mortality. During a mean follow-up of 21.4 ± 8.6 months, symptom resolution occurred in 94.1% (32/34; 95% CI: 80.3%-99.3%), disease recurrence in 5.9% (2/34; 95% CI: 0.7%-19.7%), diagnosis-specific follow-up outcomes in 94.1% (95% CI: 80.3%-99.3%), and overall survival in 100% (95% CI: 89.7%-100%). Conclusions Uncommon surgically managed small intestinal disorders encompass a heterogeneous group of congenital, inflammatory, vascular, and neoplastic conditions that present substantial diagnostic and therapeutic challenges. Timely diagnosis and definitive surgical management are associated with favorable postoperative outcomes; however, disease-specific interpretation remains important because of the heterogeneity of the cohort.
Maintaining optimal mammoplasty outcomes remains a significant challenge for surgeons. Complaints such as early ptosis, waterfall, and double-bubble deformities can compromise the longevity of aesthetic outcomes. This surgical report describes the split mammary gland retromuscular technique (SMART) mammoplasty, a novel approach aimed at preventing early glandular descent and waterfall deformity and ensuring long-term aesthetic results. This technique involves splitting the mammary gland pillars into deep and superficial layers along the coronal plane in a superior pedicle mammoplasty, transposing the deep layer of the gland into a submuscular pectoralis major strip, and using the superficial layers for breast closure.