Novel Approaches in Plastic and Reconstructive Surgery to Improve Quality of Life

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: 17 December 2024 | Viewed by 4085

Special Issue Editors


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Guest Editor
Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Interests: reconstructive surgery; hand surgery; peripheral nerve surgery; extremity reconstruction; pressure sore therapy

E-Mail Website
Guest Editor
Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Interests: reconstructive surgery; breast reconstruction; facial reanimation; surgical skin tumor therapy; aesthetic surgery
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Special Issue Information

Dear Colleagues,

Functional deficits resulting from trauma, congenital conditions, or cancer may cause long-lasting impairments that significantly impact the quality of life of affected patients. Plastic and reconstructive surgery offers many innovative solutions to address these issues and enhance patient outcomes.

We invite authors to submit original research papers, review articles, and novel technological approaches related to plastic and reconstructive surgery for this Special Issue "Novel Approaches in Plastic and Reconstructive Surgery to Improve Quality of Life" Potential topics may include:

  • Imaging for surgical planning and evaluation of outcomes
  • The role of artificial intelligence in improved decision making and patient outcomes.
  • Cell-based tissue repair for functional deficits, including the use of stem cells and other regenerative therapies.
  • Rehabilitation after reconstructive surgery to optimize functional recovery and quality of life.
  • Approaches to peripheral nerve reconstruction and monitoring of motor and sensory recovery.
  • Facial reconstruction techniques for a range of functional and aesthetic concerns, including facial paralysis, trauma, and congenital anomalies.
  • Breast reconstruction options and outcomes, including techniques for immediate and delayed reconstruction following mastectomy.
  • Surgical management of lymphedema, including microsurgical lymphatic reconstruction and other innovative approaches.

We welcome submissions from all fields of plastic and reconstructive research to expand the dialogue on how plastic and reconstructive surgery can transform and enhance patients’ lives.

Prof. Dr. Silvan Maximilian Klein
Dr. Alexandra M. Anker
Guest Editors

Manuscript Submission Information

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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. Life is an international peer-reviewed open access monthly 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

  • reconstructive surgery
  • peripheral nerve injury
  • tissue repair
  • tissue engineering
  • peripheral nerve gaps
  • management of bone defects
  • molecular aspects of tissue repair
  • cancer therapy
  • cancer diagnostics
  • tissue imaging
  • artificial intelligence
  • cell-based tissue repair
  • rehabilitation after reconstructive surgery
  • facial reconstruction
  • breast reconstruction
  • lymphedema surgery

Published Papers (5 papers)

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10 pages, 913 KiB  
Article
Integrating AI in Lipedema Management: Assessing the Efficacy of GPT-4 as a Consultation Assistant
by Tim Leypold, Lara F. Lingens, Justus P. Beier and Anja M. Boos
Life 2024, 14(5), 646; https://doi.org/10.3390/life14050646 - 20 May 2024
Viewed by 322
Abstract
The role of artificial intelligence (AI) in healthcare is evolving, offering promising avenues for enhancing clinical decision making and patient management. Limited knowledge about lipedema often leads to patients being frequently misdiagnosed with conditions like lymphedema or obesity rather than correctly identifying lipedema. [...] Read more.
The role of artificial intelligence (AI) in healthcare is evolving, offering promising avenues for enhancing clinical decision making and patient management. Limited knowledge about lipedema often leads to patients being frequently misdiagnosed with conditions like lymphedema or obesity rather than correctly identifying lipedema. Furthermore, patients with lipedema often present with intricate and extensive medical histories, resulting in significant time consumption during consultations. AI could, therefore, improve the management of these patients. This research investigates the utilization of OpenAI’s Generative Pre-Trained Transformer 4 (GPT-4), a sophisticated large language model (LLM), as an assistant in consultations for lipedema patients. Six simulated scenarios were designed to mirror typical patient consultations commonly encountered in a lipedema clinic. GPT-4 was tasked with conducting patient interviews to gather medical histories, presenting its findings, making preliminary diagnoses, and recommending further diagnostic and therapeutic actions. Advanced prompt engineering techniques were employed to refine the efficacy, relevance, and accuracy of GPT-4’s responses. A panel of experts in lipedema treatment, using a Likert Scale, evaluated GPT-4’s responses across six key criteria. Scoring ranged from 1 (lowest) to 5 (highest), with GPT-4 achieving an average score of 4.24, indicating good reliability and applicability in a clinical setting. This study is one of the initial forays into applying large language models like GPT-4 in specific clinical scenarios, such as lipedema consultations. It demonstrates the potential of AI in supporting clinical practices and emphasizes the continuing importance of human expertise in the medical field, despite ongoing technological advancements. Full article
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7 pages, 828 KiB  
Article
Risk Stratification with Sarculator and MSKCC in Patients with Primary and Secondary Angiosarcoma
by Yonca Steubing, Nilofar Ahmadi, Flemming Puscz, Alexander Wolff, Jannik Hinzmann, Felix Reinkemeier, Sonja Verena Schmidt, Alexander Sogorski, Maxi Von Glinski, Mustafa Becerikli, Maria Füth, Jessica Zuchowski, Hannah Brüggenhorst, Tom Huyghebaert, Ingo Stricker, Marcus Lehnhardt and Christoph Wallner
Life 2024, 14(5), 569; https://doi.org/10.3390/life14050569 - 28 Apr 2024
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Abstract
Background: Sarculator and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms are freely available risk prediction scores for surgically treated patients with primary sarcomas. Due to the rarity of angiosarcomas, these scores have only been tested on small cohorts of angiosarcoma patients. In neither [...] Read more.
Background: Sarculator and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms are freely available risk prediction scores for surgically treated patients with primary sarcomas. Due to the rarity of angiosarcomas, these scores have only been tested on small cohorts of angiosarcoma patients. In neither the original patient cohort upon which the Sarculator is based nor in subsequent studies was a distinction made between primary and secondary angiosarcomas, as the app is intended to be applied to primary sarcomas. Therefore, the objective of our investigation was to assess whether the Sarculator reveals a difference in prognosis and whether such differentiation aligns with actual clinical data. Patients and Methods: Thirty-one patients with primary or secondary soft tissue angiosarcoma, treated at our Sarcoma Center from 2001 to 2023, were included in the study. Actual survival rates were compared with nomogram-derived data for predicted 5-year survival (Sarculator), as well as 4-, 8- and 12-year sarcoma-specific death probabilities (MSKCC). Harrell’s c-index was utilized to assess predictive validity. Results: In total, 31 patients were analyzed. The actual overall 5-year survival was 22.57% with a predicted 5-year survival rate of 25.97%, and the concordance index was 0.726 for the entire cohort. The concordance index results from MSKCC for angiosarcoma patients were below 0.7 indicating limited predictive accuracy in this cohort, particularly when compared to Sarculator. Summary: Nomogram-based predictive models are valuable tools in clinical practice for rapidly assessing prognosis. They can streamline the decision-making process for adjuvant treatments and improve patient counselling especially in the treatment of rare and complicated tumor entities such as angiosarcomas. Full article
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12 pages, 8767 KiB  
Article
Lateral Tarsoplasty Combined with a Full-Thickness Skin Graft for Managing Severe Lower Eyelid Ectropion Following the Subciliary Approach for Infra-Orbital Rim Fracture: A Retrospective Observational Study
by Wonseok Cho, Chang Gyun Kim, Eun A Jang and Kyu Nam Kim
Life 2024, 14(3), 314; https://doi.org/10.3390/life14030314 - 28 Feb 2024
Viewed by 759
Abstract
Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging for beginning surgeons to manage. This study reports the usage of lateral tarsoplasty combined with a full-thickness skin [...] Read more.
Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging for beginning surgeons to manage. This study reports the usage of lateral tarsoplasty combined with a full-thickness skin graft (FTSG) to correct severe ectropion following the subciliary approach for infra-orbital rim fractures. We retrospectively reviewed all facial fracture cases involving infra-orbital rim fractures through a subciliary approach treated in our department between March 2021 and May 2023. Electronic medical records and clinical digital photographs of patients who met the inclusion criteria were reviewed. After reviewing 196 cases that used the subciliary approach, we found 6 patients (3.06%; 4 males and 2 females; mean age, 68.5 ± 4.89 years) with postoperative severe ectropion managed using lateral tarsoplasty and FTSG. The mean ectropion development and correction times after facial fracture surgery were 0.78 ± 0.24 and 0.91 ± 0.37 months, respectively. At the 12-month follow-up, all patients showed favorable outcomes, and the position of their lower eyelids was well maintained without ectropion recurrence. Based on these successful outcomes, lateral tarsoplasty combined with FTSG is proposed to be an effective and straightforward method for managing lower eyelid ectropion caused by facial fracture surgery. Full article
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13 pages, 1993 KiB  
Article
Health Implications of Lipedema: Analysis of Patient Questionnaires and Population-Based Matched Controls
by Sally Kempa, Mascha Gross, Dmytro Oliinyk, Andreas Siegmund, Martina Müller, Lukas Prantl and Hauke C. Tews
Life 2024, 14(3), 295; https://doi.org/10.3390/life14030295 - 22 Feb 2024
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Abstract
We conducted a comparative study involving 39 female patients with lipedema and group-matched controls at a ratio of 1:5. The primary survey tool was the German Health Update (GEDA 2019/2020-EHIS) questionnaire, which was developed by the Robert Koch Institute (RKI), Germany. The secondary [...] Read more.
We conducted a comparative study involving 39 female patients with lipedema and group-matched controls at a ratio of 1:5. The primary survey tool was the German Health Update (GEDA 2019/2020-EHIS) questionnaire, which was developed by the Robert Koch Institute (RKI), Germany. The secondary survey tool was the German Pain Questionnaire. The prevalence of hypertension (p = 0.041) and high blood lipids (p = 0.024) was lower in the lipedema group compared to the control group. General health and well-being indicators demonstrated lower overall health ratings (p < 0.001) and higher physiotherapy use in patients with lipedema (p = 0.016). Mental health assessment revealed higher depression prevalence and severity (p = 0.001), together with a lower number of close contacts (p = 0.032). Furthermore, patients with lipedema experienced higher levels of pain (p < 0.001) and more significant pain-related disability in daily activities (p < 0.001) than controls. Correlation analysis among patients with lipedema showed a positive correlation between pain severity and depressive symptoms (ρ = 0.612, p < 0.001) and a moderate positive correlation with impaired health-related quality of life (ρ = 0.418, p = 0.010). In summary, our findings highlight significant differences in health and well-being between patients with lipedema and matched controls, especially in overall, metabolic, and mental health, as well as pain perception. The findings emphasize the need for a validated lipedema-specific questionnaire and a multidisciplinary treatment approach with a combination of physical therapies, lifestyle adjustments, and psychological strategies. Full article
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Systematic Review
Evidence-Based Approaches to Anticoagulation in Reconstructive Microsurgery—A Systematic Literature Review
by Niklas Biermann, Juy Chi Chak, Anna Wiesmeier, Silvan M. Klein, Marc Ruewe, Steffen Spoerl, Philipp Kruppa, Lukas Prantl and Alexandra M. Anker
Life 2024, 14(1), 82; https://doi.org/10.3390/life14010082 - 3 Jan 2024
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Abstract
This systematic review addresses the crucial role of anticoagulation in microsurgical procedures, focusing on free flap reconstruction and replantation surgeries. The objective was to balance the prevention of thrombotic complications commonly leading to flap failure, with the risk of increased bleeding complications associated [...] Read more.
This systematic review addresses the crucial role of anticoagulation in microsurgical procedures, focusing on free flap reconstruction and replantation surgeries. The objective was to balance the prevention of thrombotic complications commonly leading to flap failure, with the risk of increased bleeding complications associated with anticoagulant use. A meticulous PubMed literature search following Evidence-Based-Practice principles yielded 79 relevant articles, including both clinical and animal studies. The full-texts were carefully reviewed and evaluated by the modified Coleman methodology score. Clinical studies revealed diverse perioperative regimens, primarily based on aspirin, heparin, and dextran. Meta-analyses demonstrated similar flap loss rates with heparin or aspirin. High doses of dalteparin or heparin, however, correlated with higher flap loss rates than low dose administration. Use of dextran is not recommended due to severe systemic complications. In animal studies, systemic heparin administration showed predominantly favorable results, while topical application and intraluminal irrigation consistently exhibited significant benefits in flap survival. The insights from this conducted systematic review serve as a foundational pillar towards the establishment of evidence-based guidelines for anticoagulation in microsurgery. An average Coleman score of 55 (maximum 103), indicating low overall study quality, however, emphasizes the need for large multi-institutional, randomized-clinical trials as the next vital step. Full article
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