발표 논문
| 이달의 논문 2025년 5월 | ||
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| 등록일 : 2025.08.12 | ||
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Comparative 3-Dimensional Analysis of Philtral Ridge Projection in Unilateral Cleft Lip Repair Enhanced with Muscle-to-Subdermis SutureAffiliations
AbstractBackground: Recreating the philtral ridge and restoring orbicularis oris muscle (OOM) continuity in patients with cleft is a challenging task. The muscle-to-subdermis technique introduces an effective method for achieving the desired philtral ridge reconstruction. Methods: From August of 2015 to July of 2023, a retrospective study was conducted with a follow-up period of at least 6 months. This procedure involved a suture technique using muscle-to-subdermis sutures. Measurements of philtral projection were taken at 2 distinct points: one above Cupid's bow and the other at the midphiltral level. In the comparative analysis of philtral ridges between the cleft and noncleft sides, the root mean square projection value was assessed. In addition, an analysis of the restoration of the OOM included the use of color mapping from the midsagittal plane and covered 7 different points across 3 distinct horizontal planes: below subnasale, at the midphiltral level, and above Cupid's bow. Results: A total of 134 patients were included, with a 37.8-month follow-up (SD 9.4). Philtral side projection was well maintained, measuring -0.36 (0.43) mm, -0.24 (0.49) mm in the classic group versus 0.23 (0.29) mm, 0.20 (0.21) mm in the muscle-to-subdermis group ( P = 0.001). The root mean square projection value was 0.57 (0.46) versus 0.14 (0.046), indicating greater symmetry in the muscle-to-subdermis group, with no difference in sagittal vector analysis of the OOM between normal and cleft sides. Conclusions: A suturing technique using muscle-to-subdermis sutures has shown promising results in philtral projection and dimple formation. This improvement can be attributed to the combined effect of subdermis and fewer muscle sutures.
Lipedema: Clinical Features, Diagnosis, and ManagementAffiliations
AbstractLipedema is an adipose tissue disorder that principally affects women and is frequently misidentified as obesity or lymphedema. There have been relatively few studies that have precisely defined the pathogenesis, epidemiology, and treatment approaches for lipedema. However, successfully recognizing lipedema as a distinct condition is important for proper management. This review aimed to examine the existing literature on the epidemiology, pathogenesis, clinical presentation, differential diagnosis, and treatments for lipedema. The current research indicates that lipedema appears to be a clinical entity related to genetic factors and fat distribution, although distinct from lymphedema and obesity. Some available treatments include complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. The management of lipedema is complex and differs from that of lymphedema. Further high-quality randomized controlled trials are urgently needed to continue advancing our understanding of this often neglected disease and exploring optimal medical and surgical treatment regimens tailored specifically for lipedema patients. In summary, despite frequent misdiagnosis, enhanced recognition, and research into customized therapeutic strategies for this poorly characterized but likely underdiagnosed disorder represent promising steps forward. Level of evidence N/A. Keywords: lipedema; liposuction; lymphedema.
doi: 10.1097/GOX.0000000000006822. eCollection 2025 May.
Epithelial Turn-in Flap for Nasal Lining Reconstruction
Jessica S. Wang, MD*; Rocio Perez, MD†; Lee J. Yuan, MD†; Jong-Woo Choi, MD, PhD, MMM†
INTRODUCTION Full-thickness nasal defects pose a unique challenge for the reconstructive surgeon, as all layers of the nose must be addressed: the skin, the support, and the lining. Early attempts at nasal reconstruction focused on external resurfacing, which led to results marred by contracture.1,2 Thanks to the efforts of Menick and Millard, the importance of nasal lining reconstruction is now widely recognized.1,2 Addressing the internal lining helps to prevent tissue contracture, cartilage necrosis and aesthetic deformity.3 Current options for nasal lining reconstruction range from skin grafts to free tissue transfer.1,4,5 Skin grafts can be placed intranasally when the wound bed is small (less than 1.5 cm) and vascularized.1,3,5 Composite grafts may be used to provide simultaneous lining and support. However, grafts will inevitably contract, so if the wound is near the alar rim, this method will lead to visible deformity.3,5 A pedicled flap, typically a forehead flap, can be folded onto itself distally to line the nostril rim, but poor visualization during inset and tissue stiffness makes precise positioning difficult.5 Folding of the most distal aspect of the flap may also compromise vascularity.3,4 Furthermore, the resultant rim often appears bulky and requires further revision.3 Intranasal mucosal flaps provide highly vascular, thin, physiologic tissue for lining reconstruction. However, they are technically challenging to raise, cause significant intranasal morbidity (ie, septal perforation, airway narrowing), may be unavailable due to trauma, and are limited in size.3–5 Free tissue transfer, such as radial forearm free f lap, is another option, but the distant donor-site scar is not appealing to many patients. Additionally, poor color and texture match to facial skin requires the external surface to be replaced with a forehead flap.
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