Surgical Management Of Platysma Hypertonicity In Facial Synkinesis: A Quantitative Analysis Of Lower Lip Dynamics

BACKGROUND: Glucocorticoids are ubiquitous medications used to manage many diseases by suppressing inflammation, autoimmunity, and edema. Although steroids have significant benefits, they are also associated with post-operative complications such as delayed wound healing and increased risk of infection. With advancement of microsurgery techniques, improved intraoperative monitoring, as well as expanding indications, the use of nerve transfers is greatly increasing. This study aims to characterize the effect of steroid use on post-operative outcomes of interventions for upper-extremity nerve damage through peripheral nerve grafting, nerve transfers, and digital nerve repair. METHODS: A retrospective cohort was used to analyze 13,734 total patients undergoing intervention for neurogenic bladder between the years 2000 to 2023. Patients were divided into Cohort A (steroid use, N=6,867 patients) and Cohort B (no steroid use, N=6,867 patients), with propensity score matching applied to balance baseline characteristics. Outcomes at 30 days, 60 days, 90 days, 1 year, and 2 years post-index events included adverse postoperative outcomes, and comparative analyses were performed. RESULTS: At 30, 60, 90 days, 1 year and 2 years post-op, patients taking steroids had significantly greater pain and sensory disturbance, wound infection, and wound dehiscence. At 60 and 90 days, the steroid cohort also had significantly greater graft rejection. Additionally at 90 days and 1 year, patients on steroids experienced significantly greater scar tissue formation. At 1 year, patients on glucocorticoid therapy experienced more systemic complications, such as sepsis and pulmonary emboli. At 2 years, the previously listed complications continued to increase accordingly with greater statistical significance. CONCLUSION: There are significant differences in postoperative outcomes between patients taking steroids and not taking steroids that undergo peripheral nerve surgery. Patients on steroid therapy were more likely to experience complications including sepsis, pulmonary emboli, scar tissue, graft rejection, pain and sensory disturbance, wound infection and dehiscence. Systemic complications typically occurred 1 or 2 years later, whereas localized complications occurred at all times but first had significance at the 30, 60, and 90 day intervals. The differences in outcomes demonstrate that steroid use can predispose patients to postoperative complications compared to patients not using steroids, which is an important consideration for peripheral nerve surgery.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/160.cgi*