Advancements in Individualized Plastic and Reconstructive Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 3645

Special Issue Editors


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Guest Editor
Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany
Interests: plastic and reconstructive surgery; microvascular surgery; breast surgery; aesthetic surgery

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Guest Editor
Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
Interests: plastic and reconstructive surgery; microvascular surgery; breast surgery

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Guest Editor
Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital Paracelsus Medical University, Nuremberg, Germany
Interests: plastic and reconstructive surgery; microvascular surgery

Special Issue Information

Dear Colleagues,

This Special Issue will aim to present clinical research on the advancements in individualized plastic reconstructive surgery. It will also aim to provide a comprehensive platform for the latest developments and challenges in this field, with an unwavering focus on individual patient needs.

The current research in this field showcases the utilization of advanced imaging techniques, microsurgical precision, and tailored procedures to optimize outcomes. Yet, the field grapples with clinical complexities, such as achieving the perfect balance between personalization and maintaining safety and effectiveness.

The scope of this Special Issue spans a range of clinical topics, including personalized aesthetic surgery, autologous tissue transplantation, innovative biomaterials, and the integration of digital imaging for precise customization. This Special Issue will also explore the clinical application of tissue engineering and the innovations made in flap surgery to elevate patient satisfaction.

We invite clinicians, surgeons, and clinical researchers to contribute their original research and insights to advance our collective understanding of individualized plastic reconstructive surgery. Together, we strive to improve clinical outcomes and elevate the quality of care, ultimately enhancing the lives of our patients through tailored procedures.

Dr. Paul Immanuel Heidekrueger
Prof. Dr. Peter Niclas Broer
Dr. Denis C. Ehrl
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • patient-specific reconstructive procedures
  • microsurgical precision techniques
  • autologous tissue transplantation
  • digital imaging and customization
  • biomaterials in reconstructive surgery
  • tissue engineering for plastic reconstruction
  • flap surgery innovations
  • personalized cleft surgery
  • personalized aesthetic surgery

Published Papers (5 papers)

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Research

12 pages, 2537 KiB  
Article
High-Volume Liposuction in Lipedema Patients: Effects on Serum Vitamin D
by Tonatiuh Flores, Celina Kerschbaumer, Florian J. Jaklin, Christina Glisic, Hugo Sabitzer, Jakob Nedomansky, Peter Wolf, Michael Weber, Konstantin D. Bergmeister and Klaus F. Schrögendorfer
J. Clin. Med. 2024, 13(10), 2846; https://doi.org/10.3390/jcm13102846 - 11 May 2024
Viewed by 358
Abstract
Background: Lipedema is a subcutaneous adipose tissue disorder characterized by increased pathological adipocytes mainly in the extremities. Vitamin D is stored in adipocytes, and serum levels inversely correlate with BMI. As adipocytes are removed during liposuction, lipedema patients might be prone to [...] Read more.
Background: Lipedema is a subcutaneous adipose tissue disorder characterized by increased pathological adipocytes mainly in the extremities. Vitamin D is stored in adipocytes, and serum levels inversely correlate with BMI. As adipocytes are removed during liposuction, lipedema patients might be prone to further substantial vitamin D loss while their levels are already decreased. Therefore, we examined the effect of liposuction on perioperative serum 25-hydroxyvitamin D levels. Methods: In patients undergoing lipedema liposuction, blood samples were obtained pre- and postoperatively. Statistical analyses were performed to correlate the volume of lipoaspirate, patients’ BMI and number of sessions to vitamin D levels. Results: Overall, 213 patients were analyzed. Mean liposuction volume was 6615.33 ± 3884.25 mL, mean BMI was 32.18 ± 7.26 kg/m2. mean preoperative vitamin D levels were 30.1 ± 14.45 ng/mL (borderline deficient according to the endocrine society) and mean postoperative vitamin D levels were 21.91 ± 9.18 ng/mL (deficient). A significant decrease in serum vitamin D was seen in our patients (p < 0.001) of mean 7.83 ng/mL. The amount of vitamin D loss was not associated with BMI or aspiration volume in our patients (p > 0.05). Interestingly, vitamin D dynamics showed a steady drop regardless of volume aspirated or preoperative levels. Conclusions: Many lipedema patients have low vitamin D levels preoperatively. Liposuction significantly reduced these levels additionally, regardless of aspirated volume or BMI. However, vitamin D loss was constant and predictable; thus, patients at risk are easily identified. Overall, lipedema patients undergoing liposuction are prone to vitamin D deficiency, and the long-term effects in this population are currently unknown. Full article
(This article belongs to the Special Issue Advancements in Individualized Plastic and Reconstructive Surgery)
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14 pages, 2046 KiB  
Article
PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study
by Angela Augustin, Ines Schoberleitner, Sophie-Marie Unterhumer, Johanna Krapf, Thomas Bauer and Dolores Wolfram
J. Clin. Med. 2024, 13(8), 2388; https://doi.org/10.3390/jcm13082388 - 19 Apr 2024
Viewed by 371
Abstract
(1) Background: DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) [...] Read more.
(1) Background: DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) versus monopolar electrocautery (MPE). (2) Methods: This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics and information on the postoperative course were collected and a comparative evaluation was conducted. (3) Results: The MPE group exhibited significantly (p* = 0.0324) higher abdominal drainage volume (351.11 ± 185.96 mL) compared to the PPB group (279.38 ± 183.38 mL). A subgroup analysis demonstrated that PPB significantly reduced postoperative wound fluid in patients with BMI > 30 kg/m2 (p* = 0.0284), without prior neoadjuvant chemotherapy (p** = 0.0041), and among non-smokers (p = 0.0046). Furthermore, postoperative pain was significantly (p**** < 0.0001) lower in the PPB cohort. (4) Conclusions: This study confirms the non-inferiority of the PEAK PlasmaBlade to conventional electrocautery for abdominal flap harvesting. The PPB demonstrated advantages, notably reduced drainage volume and lower postoperative pain levels. Recognizing patient subsets that benefit more from the PPB highlights the importance of personalized device selection based on patient characteristics. Full article
(This article belongs to the Special Issue Advancements in Individualized Plastic and Reconstructive Surgery)
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10 pages, 3993 KiB  
Article
How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach
by Julius M. Mayer, Sophie I. Spies, Carla K. Mayer, Cédric Zubler, Rafael Loucas and Thomas Holzbach
J. Clin. Med. 2024, 13(4), 1124; https://doi.org/10.3390/jcm13041124 - 16 Feb 2024
Viewed by 1119
Abstract
Background: Perineal nodular induration (PNI) is a benign proliferation of the soft tissue in the perineal region that is associated with saddle sports, especially road cycling. The etiology has not been conclusively clarified; however, repeated microtrauma to the collagen and subcutaneous fat tissue [...] Read more.
Background: Perineal nodular induration (PNI) is a benign proliferation of the soft tissue in the perineal region that is associated with saddle sports, especially road cycling. The etiology has not been conclusively clarified; however, repeated microtrauma to the collagen and subcutaneous fat tissue by pressure, vibration and shear forces is considered a mechanical pathomechanism. In this context, chronic lymphedema resulting in the development of fibrous tissue has been suggested as an etiological pathway of PNI. The primary aim of this study was to introduce and elucidate a novel operative technique regarding PNI that is assisted by indocyanine green (ICG). In order to provide some context for this approach, we conducted a comprehensive review of the existing literature. This dual objective aimed to contribute to the existing body of knowledge while introducing an innovative surgical approach for managing PNI. Methods: We reviewed publications relating to PNI published between 1990 and 2023. In addition to the thorough review of the literature, we presented our novel surgical approach. We described how this elaborate approach for extensive cases of PNI involves surgical excision combined with tissue doubling and intraoperative ICG visualization for exact lymphatic vessel obliteration to minimize the risk of recurrence based on the presumed context of lymphatic congestion. Results: The literature research yielded 16 PubMed articles encompassing 23 cases of perineal nodular induration (PNI) or cyclist’s nodule. Of these, 9 cases involved females, and 14 involved males. Conservative treatment was documented in 7 cases (30%), while surgical approaches were reported in 16 cases (70%). Notably, a limited number of articles focused on histopathological or radiological characteristics, with a shortage of structured reviews on surgical treatment options. Only two articles provided detailed insights into surgical techniques. Similarly to the two cases of surgical intervention identified in the literature research, the post-operative recovery in our ICG assisted surgical approach was prompt, meaning a return to cycling was possible six weeks after surgery. At the end of the observation period (twelve months after surgery), regular scar formation and no signs of recurrence were seen. Conclusion: We hope that this article draws attention to the condition of PNI in times of increasing popularity of cycling as a sport. We aimed to contribute to the existing body of knowledge through our thorough review of the existing literature while introducing an innovative surgical approach for managing PNI. Due to the successful outcome, the combination of tissue doubling, intraoperative ICG visualization and postoperative negative wound therapy should be considered as a therapeutic strategy in cases of large PNI. Full article
(This article belongs to the Special Issue Advancements in Individualized Plastic and Reconstructive Surgery)
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11 pages, 4804 KiB  
Article
Optimizing Orthognathic Surgery: Leveraging the Average Skull as a Dynamic Template for Surgical Simulation and Planning in 30 Patient Cases
by Hsiu-Hsia Lin, Jyun-Cheng Kuo, Lun-Jou Lo and Cheng-Ting Ho
J. Clin. Med. 2023, 12(24), 7758; https://doi.org/10.3390/jcm12247758 - 18 Dec 2023
Viewed by 856
Abstract
Virtual planning has revolutionized orthognathic surgery (OGS), marking a significant advancement in the field. This study aims to showcase the practical application of our established 3D average skull template as a guiding framework for surgical planning, and to share valuable insights from our [...] Read more.
Virtual planning has revolutionized orthognathic surgery (OGS), marking a significant advancement in the field. This study aims to showcase the practical application of our established 3D average skull template as a guiding framework for surgical planning, and to share valuable insights from our clinical experience. We enrolled 30 consecutive Taiwanese patients (18 females and 12 males) who underwent two-jaw orthognathic surgery with surgical simulation, utilizing the average skull template for planning. Results indicate the method’s applicability and precision. By adhering to the surgical plan, post-operative outcomes closely aligned with the average skull template, showing negligible deviations of less than 2 mm. Moreover, patients expressed high satisfaction with post-surgery facial changes, with the chin appearance receiving the highest satisfaction scores, while the lowest scores were attributed to nose appearance. Notably, the substantial change in lower jaw position post-mandibular setback surgery contributed to increased satisfaction with the chin position. In conclusion, this study does not seek to replace established surgical planning methods, but underscores that utilizing an average skull as a surgical design template provides a viable, accurate, and efficient option for OGS patients. Full article
(This article belongs to the Special Issue Advancements in Individualized Plastic and Reconstructive Surgery)
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11 pages, 6549 KiB  
Article
Giant Penoscrotal Lymphedema—What to Do? Presentation of a Curative Treatment Algorithm
by Denis Ehrl, Paul I. Heidekrueger, Riccardo E. Giunta and Nikolaus Wachtel
J. Clin. Med. 2023, 12(24), 7586; https://doi.org/10.3390/jcm12247586 - 8 Dec 2023
Cited by 2 | Viewed by 625
Abstract
Background: While rare, penoscrotal lymphedema (PL) is accompanied with devastating effects on the quality of life of patients. Moreover, especially for patients with excessive (giant) PL, no standardized curative treatment has been defined. This article therefore retrospectively evaluates the authors’ surgical treatment approach [...] Read more.
Background: While rare, penoscrotal lymphedema (PL) is accompanied with devastating effects on the quality of life of patients. Moreover, especially for patients with excessive (giant) PL, no standardized curative treatment has been defined. This article therefore retrospectively evaluates the authors’ surgical treatment approach for giant PL, which includes resection alone or in combination with a free vascularized lymph node transfer (VLNT). Methods: A total of ten patients met the inclusion criteria. One patient dropped out of the study before therapy commenced. Eight of the nine remaining patients presented with end-stage (giant) PL. One patient presented with manifest pitting edema. All patients were treated with penoscrotal resection and reconstruction. Additionally, five patients received VLNT into the groin or scrotum. Results: The extent of the lymphedema was specified with a treatment-oriented classification system. The median follow-up was 49.0 months. No patient showed a recurrence. Patients who received VLNT into the scrotum displayed a significantly improved lymphatic transport of the scrotum. Conclusions: Advanced PL should be treated in a standardized surgical fashion as suggested by our proposed algorithm. VLNT from the lateral thoracic region into the scrotum must be considered. If treated correctly, surgical intervention of end-stage PL leads to good results with a low recurrence rate. Full article
(This article belongs to the Special Issue Advancements in Individualized Plastic and Reconstructive Surgery)
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