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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: closed (25 July 2024) | Viewed by 20062

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Special Issue Editors

Dr. Gabriel Del Corral

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Guest Editor

1. Department of Plastic and Reconstructive Surgery, District of Columbia, MedStar Georgetown University Hospital, Washington, DC, USA
2. Department of Plastic and Reconstructive Surgery, MedStar Franklin Square Medical Center, Baltimore, MD, USA
Interests: microsurgery; reconstructive surgery; maxillofacial surgery; cosmetic surgery; gender-affirming procedures; vaginoplasty; facial feminization; phalloplasty

Dr. Kenneth L. Fan

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Guest Editor

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
Interests: surgery

Dr. Oscar Javier Manrique

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Guest Editor

Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
Interests: breast reconstruction; lymphedema surgery; gender affirming surgery; oncologic and trauma reconstruction; vascularized composite allotransplantation; minimally invasive surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine promises to provide an in-depth exploration of recent innovations in the field of plastic surgery. Focusing on four key areas, this comprehensive review addresses breakthroughs in breast reconstruction, trunk reconstruction, lower-extremity reconstruction, as well as the latest advancements in lymphatic surgery and gender affirmation surgery.

Our aim is to provide readers with a comprehensive understanding of cutting-edge developments in plastic surgery, with particular emphasis on innovative techniques and emerging trends. The articles featured will delve into the current state of the field, exploring future directions and potential advancements.

Readers can anticipate a wealth of information on advancements in breast reconstruction, examining the most recent techniques and technologies that have revolutionized the field. Trunk and lower-extremity reconstruction will also be explored in detail, shedding light on novel approaches to addressing complex challenges in these areas.

This Special Issue will highlight the latest developments in lymphatic surgery, offering insights into the evolving landscape of this specialized branch of plastic surgery. The inclusion of gender affirmation surgery adds a progressive dimension to the collection, presenting the most up-to-date information on procedures designed to support individuals in affirming their gender identity.

In conclusion, this Special Issue aspires to captivate and inform its readership, providing an extensive overview of the most advanced and groundbreaking topics within the realm of plastic surgery.

The editorial team hopes that this collection will be not only informative but also inspire excitement and anticipation for the future of the field.

Dr. Gabriel Del Corral
Dr. Kenneth L. Fan
Dr. Oscar Javier Manrique
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

breast reconstruction
trunk reconstruction
lower-extremity reconstruction
lymphatic surgery
gender affirmation surgery

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Published Papers (8 papers)

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Research

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9 pages, 776 KiB

Open AccessArticle

Perioperative Patient-Initiated Communication in Gender-Affirming Mastectomy

by Christian X. Lava, Isabel A. Snee, Karen R. Li, George L. O’Hara, Niyati P. Bhatt, Oscar J. Manrique, Kenneth L. Fan and Gabriel A. Del Corral

J. Clin. Med. 2024, 13(12), 3368; https://doi.org/10.3390/jcm13123368 - 7 Jun 2024

Cited by 1 | Viewed by 1324

Abstract

Background: Gender-affirming mastectomy (GAM) improves the psychosocial functioning and quality of life of transgender and non-binary (TGNB) individuals. However, the perioperative period is often marked by emotional stress, concerns about surgical outcomes, and physical discomfort. While inpatient procedures provide multiple opportunities to engage with and educate patients, outpatient surgeries, such as GAM, pose a unique challenge as patients are followed for <24 h postoperatively. Given the heightened emotional and psychological distress related to gender dysphoria TGNB individuals often experience, addressing these gaps can significantly improve outcomes. This study aims to characterize patient and surgical characteristics associated with patient-initiated communication (PIC) frequency in this population. Methods: A single-center retrospective review of TGNB patients undergoing GAM from February 2018 to November 2022 was conducted. Demographics, surgical characteristics, and frequency of and reasons for perioperative PIC (30 days before and after surgery) were recorded. The primary outcome was the incidence of perioperative PIC. The secondary outcomes included (1) the rationale for PIC and (2) patient and surgical characteristics associated with PIC. Results: A total of 352 patients were included. Of these, 285 (74.6%) initiated communication in the perioperative period, totaling 659 PICs. The median age was 25.0 (interquartile range [IQR]: 9.0) years. The median body mass index (BMI) was 28.5 (IQR: 8.5) kg/m². The mean number of PICs was 0.7 ± 1.3 preoperatively and 1.3 ± 1.7 postoperatively (p < 0.001). The most frequent preoperative PIC subjects were administrative issues (AI; n = 66, 30.7%), preoperative requirements (n = 43, 20.0%), and cost and insurance (n = 33, 15.0%). The most frequent postoperative PIC subjects were wound care (n = 77, 17.3%), AI (n = 70, 15.0%), activity restrictions (n = 60, 13.5%), drainage (n = 56, 12.6%), and swelling (n = 37, 8.3%). Collectively, older patients (β = 0.234, p = 0.001), those with a history of major depressive disorder or generalized anxiety disorder (2.4 ± 3.0 vs. 1.7 ± 1.9; p = 0.019), and those without postoperative drains (n = 16/17, 94.1% vs. n = 236/334, 70.7%; p = 0.025) engaged in higher levels of PIC. There were no significant associations between other patient characteristics, perioperative details, or complications and PIC frequency. Conclusions: Perioperative PIC is prevalent among the majority of GAM patients at our institution, with age, psychiatric diagnosis, and postoperative drain use identified as significant predictors. To mitigate PIC frequency, it is crucial to ensure adequate support staffing and provide comprehensive postoperative instructions, particularly concerning activity restrictions and drainage management. These interventions may reduce PICs in high-volume centers. Further research should investigate targeted interventions to further support TGNB patients during the perioperative period. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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16 pages, 1951 KiB

Open AccessArticle

A Multidisciplinary Approach to End-Stage Limb Salvage in the Highly Comorbid Atraumatic Population: An Observational Study

by Karen R. Li, Christian X. Lava, Monique B. Neughebauer, Rachel N. Rohrich, Jayson Atves, John Steinberg, Cameron M. Akbari, Richard C. Youn, Christopher E. Attinger and Karen K. Evans

J. Clin. Med. 2024, 13(8), 2406; https://doi.org/10.3390/jcm13082406 - 20 Apr 2024

Cited by 3 | Viewed by 1518

Abstract

Background: The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The four pillars of managing patient comorbidities, infection control, blood flow status, and biomechanical function are critical in achieving successful limb salvage. The authors present their multidisciplinary institutional experience with a review of 300 FTTs performed for the complex LE limb salvage of chronic LE wounds. Methods: A single-institution, retrospective review of atraumatic LE FTTs performed by a single surgeon from July 2011 to January 2023 was reviewed. Data on patient demographics, comorbidities, preoperative management, intraoperative details, flap outcomes, postoperative complications, and long-term outcomes were collected. Results: A total of 300 patients who underwent LE FTT were included in our retrospective review. Patients were on average 55.9 ± 13.6 years old with a median Charlson Comorbidity Index of 4 (IQR: 3). The majority of patients were male (70.7%). The overall hospital length of stay (LOS) was 27 days (IQR: 16), with a postoperative LOS of 14 days (IQR: 9.5). The most prevalent comorbidities were diabetes (54.7%), followed by peripheral vascular disease (PVD: 35%) and chronic kidney disease (CKD: 15.7%). The average operative LE FTT time was 416 ± 115 min. The majority of flaps were anterolateral thigh (ALT) flaps (52.7%), followed by vastus lateralis (VL) flaps (25.3%). The immediate flap success rate was 96.3%. The postoperative ipsilateral amputation rate was 12.7%. Conclusions: Successful limb salvage is possible in a highly comorbid patient population with a high prevalence of diabetes mellitus, peripheral vascular disease, and end-stage renal disease. In order to optimize patients prior to their LE FTT, extensive laboratory, arterial, and venous preoperative testing and diabetes management are needed preoperatively. Postoperative monitoring and long-term follow-up with a multidisciplinary team are also crucial for long-term limb salvage success. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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14 pages, 6077 KiB

Open AccessReview

Gender-Affirming Phalloplasty: A Comprehensive Review

by Brandon Alba, Ian T. Nolan, Brielle Weinstein, Elizabeth O’Neill, Annie Fritsch, Kristin M. Jacobs and Loren Schechter

J. Clin. Med. 2024, 13(19), 5972; https://doi.org/10.3390/jcm13195972 - 8 Oct 2024

Viewed by 4243

Abstract

The goals of gender-affirming phalloplasty typically include an aesthetic phallus and scrotum, standing micturition, and/or penetrative intercourse. Phalloplasty can be performed using both free and pedicled flaps. Complications include flap-related healing compromise and urethral issues, including stricture and fistula. Phalloplasty has high patient [...] Read more.

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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14 pages, 1532 KiB

Open AccessReview

Three-Dimensional Printing in Breast Reconstruction: Current and Promising Applications

by Horacio F. Mayer, Alejandro Coloccini and José F. Viñas

J. Clin. Med. 2024, 13(11), 3278; https://doi.org/10.3390/jcm13113278 - 2 Jun 2024

Cited by 3 | Viewed by 1849

Abstract

Three-dimensional (3D) printing is dramatically improving breast reconstruction by offering customized and precise interventions at various stages of the surgical process. In preoperative planning, 3D imaging techniques, such as computer-aided design, allow the creation of detailed breast models for surgical simulation, optimizing surgical outcomes and reducing complications. During surgery, 3D printing makes it possible to customize implants and precisely shape autologous tissue flaps with customized molds and scaffolds. This not only improves the aesthetic appearance, but also conforms to the patient’s natural anatomy. In addition, 3D printed scaffolds facilitate tissue engineering, potentially favoring the development and integration of autologous adipose tissue, thus avoiding implant-related complications. Postoperatively, 3D imaging allows an accurate assessment of breast volume and symmetry, which is crucial in assessing the success of reconstruction. The technology is also a key educational tool, enhancing surgeon training through realistic anatomical models and surgical simulations. As the field evolves, the integration of 3D printing with emerging technologies such as biodegradable materials and advanced imaging promises to further refine breast reconstruction techniques and outcomes. This study aims to explore the various applications of 3D printing in breast reconstruction, addressing current challenges and future opportunities. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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15 pages, 287 KiB

Open AccessReview

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

by Kaylyn Pogson-Morowitz, Denisse Porras Fimbres, Brooke E. Barrow, Nicholas C. Oleck and Ash Patel

J. Clin. Med. 2024, 13(10), 2876; https://doi.org/10.3390/jcm13102876 - 13 May 2024

Cited by 2 | Viewed by 1946

Abstract

Abdominal wall reconstruction is a common and necessary surgery, two factors that drive innovation. This review article examines recent developments in ventral hernia repair including primary fascial closure, mesh selection between biologic, permanent synthetic, and biosynthetic meshes, component separation, and functional abdominal wall reconstruction from a plastic surgery perspective, exploring the full range of hernia repair’s own reconstructive ladder. New materials and techniques are examined to explore the ever-increasing options available to surgeons who work within the sphere of ventral hernia repair and provide updates for evolving trends in the field. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

12 pages, 7867 KiB

Open AccessReview

Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

by Nicholas C. Bene, Peter C. Ferrin, Jing Xu, Geolani W. Dy, Daniel Dugi III and Blair R. Peters

J. Clin. Med. 2024, 13(10), 2760; https://doi.org/10.3390/jcm13102760 - 8 May 2024

Viewed by 5136

Abstract

Gender-affirming vaginoplasty (GAV) comprises the construction of a vulva and a neovaginal canal. Although technical nuances of vulvar construction vary between surgeons, vulvar construction is always performed using the homologous penile and scrotal tissues to construct the corresponding vulvar structures. Therefore, the main differentiating factor across gender-affirming vaginoplasty techniques is the tissue that is utilized to construct the neovaginal canal. These tissue types vary markedly in their availability, histology, and ease of harvest and have different advantages and disadvantages to their use as neovaginal lining. In this narrative review, the authors provide a comprehensive overview of the tissue types and associated operative approaches used for construction of the neovagina in GAV. Tissue choice is guided by several factors, such as histological similarity to natal vaginal mucosa, tissue availability, lubrication potential, additional donor site morbidity, and the specific goals of each patient. Skin is used to construct the neovagina in most cases with a combination of pedicled penile skin flaps and scrotal and extra-genital skin grafts. However, skin alternatives such as peritoneum and intestine are increasing in use. Peritoneum and intestine are emerging as options for primary vaginoplasty in cases of limited genital skin or revision vaginoplasty procedures. The increasing number of gender-affirming vaginoplasty procedures performed and the changing patient demographics from factors such as pubertal suppression have resulted in rapidly evolving indications for the use of these differing vaginoplasty techniques. This review sheds light on the use of less frequently utilized tissue types described for construction of the neovaginal canal, including mucosal tissues such as urethral and buccal mucosa, the tunica vaginalis, and dermal matrix allografts and xenografts. Although the body of evidence for each vaginoplasty technique is growing, there is a need for large prospective comparison studies of outcomes between these techniques and the tissue types used to line the neovaginal canal to better define indications and limitations. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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15 pages, 879 KiB

Open AccessSystematic Review

Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review

by Viraj Shah, Bashar Hassan, Rena Hassan, Malory Alexis, Myan Bhoopalam, Lorreen Agandi and Fan Liang

J. Clin. Med. 2024, 13(12), 3580; https://doi.org/10.3390/jcm13123580 - 19 Jun 2024

Viewed by 1676

Abstract

Objectives: Fewer than one-fifth of all studies on gender-affirming care originate from low- and middle-income countries (LMICs). This is the first systematic review to examine surgical demographics and outcomes following gender-affirming surgery (GAS) in LMICs. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five databases were systematically searched for original studies and case series on GAS within LMIC settings. Excluded reports included animal studies, non-English language studies, secondary studies including reviews, individual case reports and conference abstracts. Results: This review includes 34 studies involving n = 5064 TGNB individuals. Most studies (22, 64.7%) were from upper-middle-income countries, followed by lower-middle-income countries (12, 35.3%). A total of 31 studies (91.2%) reported on post-operative outcomes. Of n = 5013 patients who underwent GAS, 71.5% (n = 3584) underwent masculinizing and 29.5% (n = 1480) underwent feminizing procedures. The predominant procedures were metoidioplasty (n = 2270/3584, 63.3%) and vaginoplasty (n = 1103/1480, 74.5%). Mean follow-up was 47.7 months. In patients who underwent metoidioplasty, 6.8% (n = 155) of patients experienced a complication and 6.3% (n = 144) underwent revision surgery. In patients who underwent vaginoplasty, 11.5% (n = 127) of patients experienced a complication and 8.5% (n = 94) underwent revision surgery. Of the studies (25/34, 73.5%) that reported on quality of life and post-operative satisfaction, the majority showed marked improvements in psychosocial and functional outcomes. Notably, no post-surgical regret was reported among the surveyed patients. Conclusions: Existing literature on GAS in LMICs remains scarce and is concentrated in select institutions that drive specific procedures. Our review highlights the low reported volumes of GAS, variability in surgical outcomes and quality of life. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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12 pages, 542 KiB

Open AccessSystematic Review

Body Contouring as Gender-Affirming Surgery in Transgender Patients: A Systematic Review of the Current Literature

by Alejandra Aristizábal, María Ríos-Sánchez, Joseph M. Escandón, Dean DeRoberts, Enrique Armenta, Gabriel Del Corral, Andrés Mascaro and Oscar J. Manrique

J. Clin. Med. 2024, 13(12), 3523; https://doi.org/10.3390/jcm13123523 - 16 Jun 2024

Viewed by 1487

Abstract

Background: There is an increasing demand for body contouring and gender-affirming surgeries, and so is the need to compare outcomes between techniques. Gender dysphoria is a discrepancy between gender identity and the sex assigned at birth. One way to address this is to perform procedures to enable patients to look according to their desired gender identity. Gaps in knowledge regarding the best approaches and which surgical techniques yield the most patient satisfaction remain. This article summarizes up-to-date studies, including upper and lower body contouring procedures. Methods: A systematic review was performed using terms related to body contouring in gender-affirming surgery for transgender patients. All articles included surgical and patient-reported outcomes following either chest or lower body contouring procedures. Results: 15 studies, including trans male chest wall contouring, trans female breast augmentation, and lower body contouring, with 1811 patients, fulfilled the inclusion criteria. The double incision (DI) techniques consistently resected more tissue and had better BODY Q scores than non-overweight patients. Bleeding was increased in periareolar, semicircular, and obese patients with DI techniques. Nipple depigmentation and sensation loss were more common with double-incision-free nipple graft techniques (DIFNG). Lower body contouring patients had average implant sizes bigger than 200 mL and reported 2 gluteal implant displacements, 1 exposure, and one rupture. Eight percent of patients who underwent large-volume fat grafting reported dissatisfaction due to fat reabsorption. Conclusions: The debate between the double incision and periareolar techniques continues. Variations of the DIFNG technique continue to be the most common approach; however, nipple depigmentation and loss of sensation are also more common with it. Regarding increased bleeding with periareolar techniques, there is still no evidence that hormonal therapy may be playing a role in it. For lower-body trans female contouring, implants could help with the longevity of contouring results in patients needing large-volume fat grafting. There is an increasing evaluation of gender-affirming body contouring patient-reported outcomes; however, there is still a need for a validated way to report satisfaction scores in lower body contouring. Validated surveys could help identify surgical candidates based on satisfaction patterns, specifically for transgender and non-binary patients. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

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