Plastic and reconstructive surgery最新文献

{"title":"Comment on \"Moving Toward the Outpatient DIEP Flap: Factors Influencing Early Discharge\".","authors":"Haïzam Oubari, Guillaume Henry, Fabien Boucher, Ali Mojallal","doi":"10.1097/PRS.0000000000012498","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012498","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Hybrid Breast Reconstruction: Dual-Plane Approach Using Prepectoral Implants and Retropectoral Fat Grafting.","authors":"Alexandre Mendonça Munhoz","doi":"10.1097/PRS.0000000000012497","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012497","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prepectoral vs Subpectoral Implant-Based Breast Reconstruction: Evaluating the Shift.","authors":"Holly Cordray, Salman Khan, Malia Voytik, Justus Zemberi, Gustavo Capone, Ashley E Chang, Robyn B Broach, Saïd C Azoury","doi":"10.1097/PRS.0000000000012480","DOIUrl":"10.1097/PRS.0000000000012480","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated trends in implant-based breast reconstruction, anticipating a shift toward prepectoral implants instead of subpectoral implants, and correlated these shifts with clinical outcomes.</p><p><strong>Methods: </strong>The cohort included adult patients who received implant-based breast reconstruction at the University of Pennsylvania Health System from 2018-2024. Analyses used linear regression to trend implant plane selection over time, and Chi-square/Fisher's tests with relative risk (RR) to compare postoperative complications by reconstructive approach.</p><p><strong>Results: </strong>Among 686 patients, reconstructions were subpectoral (301 cases) or prepectoral (385 cases). Prepectoral reconstructions rose significantly across the study period ( P = .001), from 4.0% of cases in 2018 to 90.2% in 2024. Prepectoral reconstructions showed significantly lower incidence of postoperative fat necrosis (RR 0.3, 95% CI: 0.1-0.9), nipple-areolar complex necrosis (RR 0.2, CI: 0.1-0.5), and chronic pain (RR 0.3, CI: 0.1-0.8). Prepectoral reconstructions showed significantly higher incidence of infection (RR 3.3, CI: 2.0-5.5), delayed healing/dehiscence (RR 2.0, CI: 1.3-2.9), readmission (RR 2.1, CI: 1.2-3.6), and reoperation for complications (RR 2.0, CI: 1.5-2.8). Prepectoral reconstructions showed higher reoperation rates for threatened prosthetic loss (RR 2.9, CI: 1.7-4.9) and prosthetic failure rates (RR 2.8, 1.5-5.2).</p><p><strong>Conclusions: </strong>Implant plane preference reversed across 2018-2024, from subpectoral to prepectoral. Despite certain advantages, prepectoral (vs subpectoral) reconstructions showed twice the risk of readmission and reoperation, including nearly threefold risk of reoperation for threatened prosthetic loss and ultimate failure. These results warrant further study to determine ways to improve outcomes following prepectoral reconstruction or whether surgeons should revisit subpectoral placement in predetermined high-risk cases.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Initial Nonoperative Treatment Choices for Thumb Carpometacarpal Osteoarthritis\".","authors":"Drew W Nute, Kavya K Sanghavi, Aviram M Giladi, Kenneth R Means","doi":"10.1097/PRS.0000000000012436","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012436","url":null,"abstract":"<p><strong>Background: </strong>We evaluated whether baseline patient-reported outcome measures (PROMs) are associated with initial treatment choice of hand therapy (HT) or corticosteroid injection (CI). We hypothesized patients with worse baseline PROMs would choose CI.</p><p><strong>Methods: </strong>We have an ongoing prospective study of patients aged 35-85 with thumb carpometacarpal (CMC) osteoarthritis (OA). We track initial treatments and PROMs including visual analog/numerical rating sub-scales (VA/NRS), brief Michigan Hand Questionnaire (bMHQ), and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Global Health (GH) modules. Global Mental Health (GMH), Global Physical Health (GPH), and EuroQol are calculated. We retrospectively identified patients from 2019-2022 who initially chose HT or CI. We performed pairwise comparisons of independent variables between HT and CI groups, then exploratory bivariate logistic regression (LR) analyses for independent variables. We then performed more stringent multivariable LR analyses.</p><p><strong>Results: </strong>We included 156 patients with 191 thumbs (average age 61 years (SD 9); 77% female). 158 thumbs received initial HT and 33 CI. For exploratory bivariate LR analyses, baseline and activity-related VA/NRS pain and bMHQ scores were worse for patients pursuing CI. Each multivariable LR model demonstrated higher VA/NRS activity-related pain levels and was still independently associated with increased odds of choosing CI.</p><p><strong>Conclusions: </strong>Adjusting for covariates, baseline activity-related pain was associated with increased odds for choosing CI. Other baseline PROMs/demographics were not associated with initial treatments. Our findings can inform providers, patients, and investigators considering HT and CI, as well as their potential comparative outcomes, for initiating nonoperative thumb CMC OA care.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gluteal Augmentation with Fat Grafting: A Systematic Review and Meta-Analysis of Complications and Procedural Factors.","authors":"Ahmed Elsaftawy, Michał Bonczar, Marta Jagosz, Tomasz Bonczar, Paweł Stajniak, Tomasz Główka, Patryk Ostrowski","doi":"10.1097/PRS.0000000000012437","DOIUrl":"10.1097/PRS.0000000000012437","url":null,"abstract":"<p><strong>Background: </strong>Fat grafting has become one of the most widely used methods for gluteal augmentation, yet concerns remain regarding its safety and complication profile. This study aims to update and synthesize complication rates associated with gluteal fat grafting, with a particular focus on procedural factors.</p><p><strong>Methods: </strong>A systematic search through PubMed, Embase, Scopus, and Cochrane Library was conducted following PRISMA guidelines. Original clinical studies reporting complications following autologous fat grafting for gluteal augmentation were included.</p><p><strong>Results: </strong>A total of 38 studies comprising 22,151 patients were included. The pooled incidence of minor complications was 3.58% (95% CI: 1.75-5.99%), with seromas occurring in 2.03% and contour irregularities in 2.29% of cases. Pulmonary embolism had a pooled incidence of 0.04%. Ultrasound-guided fat grafting was associated with lower rates of both major (0.02% vs. 0.08%) and minor (2.82% vs. 3.70%) complications. Subcutaneous-only injection planes demonstrated the lowest complication rates compared to intramuscular or combined approaches. The use of lipoaspirate additives and drains did not consistently lower complication rates and was sometimes associated with increased adverse outcomes.</p><p><strong>Conclusions: </strong>Fat grafting is generally safe when performed using evidence-based techniques. Subcutaneous-only injection and ultrasound guidance are associated with improved outcomes and may enhance procedural safety. Continued research with prospective, standardized studies is necessary to refine procedural strategies and minimize complication risks.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residing in a Food Desert is Associated with an Increased Risk of Complications Following Breast Reconstruction.","authors":"Christian X Lava, Varsha Harish, Karen R Li, Alexandra Junn, Nicolas Greige, Ilana G Margulies, Mimi Yue Wu Young, Samer Jabbour, Rajiv P Parikh, Kenneth L Fan","doi":"10.1097/PRS.0000000000012479","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012479","url":null,"abstract":"<p><strong>Background: </strong>Food deserts (FD) are areas with high rates of food insecurity due to limited access to healthy food and a high concentration of unhealthy food options. This study aimed to describe the comorbidity burden in patients residing in FDs and assess the impact of residing in a FD on postoperative outcomes following mastectomy.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing mastectomy from January 2014 to November 2018 was conducted. Low food access (LFA) was defined as an area where residents lived >1 (urban) or >10 (rural) miles from the nearest supermarket. Primary outcomes included minor and major complications (i.e., return to the operating room).</p><p><strong>Results: </strong>A total of 1,553 patients were included. Of whom, 675 (43.5%) resided in LFA areas and 878 (56.5%) in non-low food access (NLFA) areas. Mean BMI was 28.4±8.0 and 28.6±7.3 kg/m2, respectively (p=0.897). Mean Charlson Comorbidity Index was 2.6±1.3 and 2.3±1.2, respectively (p<0.001). The LFA group experienced more minor complications than the NLFA group (n=190, 28.1% vs. n=187, 21.3%; p=0.002). The LFA group had a higher incidence of reoperation than the NLFA group (n=83, 12.3% vs. n=64, 7.3%; p=0.001). A LFA sub-analysis revealed that low income patients had a higher incidence of reoperation (n=28/158, 17.7% vs. n=55/517, 10.6%; p=0.018).</p><p><strong>Conclusion: </strong>The findings suggest a potential relationship between food access, increased comorbidities, and postoperative complications. Further studies are warranted to better assess the relationship between FDs and post-operative outcomes to better address social determinants of health for breast reconstruction patients.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fat Repositioning with Deep Fat Excision in Transcutaneous Lower Blepharoplasty.","authors":"Jianwu Chen, Changhong Li, Fuguang Zhang, Yanhong Wu, Yuzhi Wang, Qi Li, Ningjing Li, Xiangdong Qi, Cheng Biao","doi":"10.1097/PRS.0000000000012416","DOIUrl":"10.1097/PRS.0000000000012416","url":null,"abstract":"<p><strong>Background: </strong>Lower blepharoplasty has shifted from fat resection to preservation via repositioning, yet severe fat herniation still requires selective excision. Traditional resection may compromise transposition. This study introduces deep fat excision to optimize the balance between removal and repositioning, enhancing aesthetic outcomes.</p><p><strong>Methods: </strong>From 2018 to 2024, 107 patients underwent transcutaneous lower blepharoplasty with deep fat excision. The technique involved incising the orbital septum at the arcus marginalis to selectively resect deep-layer fat, followed by septum-fat flap transposition to correct tear trough deformities. Surgical outcomes were assessed using Hirmand's grading system through evaluations by clinicians, two publicly available AI (Artificial Intelligence) platforms, and the FACE-Q survey.</p><p><strong>Results: </strong>Clinically, 91.6% of patients achieved complete elimination of fat bulges and tear trough deformity, while 8.4% exhibited undercorrection in these areas. AI assessments showed 70.9% consistency with clinical evaluations (κ = 0.58). Lower eyelid FACE-Q scores improved significantly from 66.7 ± 12.5 preoperatively to 21.9 ± 15.4 postoperatively (P < 0.001), with high decision satisfaction (71.1 ± 19.9) and a perceived age reduction of 3.3 years (patient-perceived) and 5.8 years (AI-predicted). Minor complications included undercorrection, orbital hematoma, and residual tear trough deformity.</p><p><strong>Conclusion: </strong>Deep fat excision achieves the balance between fat excision and repositioning, improving aesthetic outcomes in severe fat herniation cases. Additionally, integrating AI-assisted analysis enhances preoperative planning and postoperative evaluation, supporting its potential role in aesthetic surgery.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Vitamin D Insufficiency Impacts Postoperative Outcomes in Abdominally Based Breast Reconstruction.","authors":"Zain Aryanpour, Jamie E Cronin, Ananya Shah, Jerry H Yang, Evan J Haas, Julian Winocour, Christodoulos Kaoutzanis, David W Mathes, Katie G Egan","doi":"10.1097/PRS.0000000000012491","DOIUrl":"10.1097/PRS.0000000000012491","url":null,"abstract":"<p><strong>Background: </strong>Hypovitaminosis D has been associated with wound healing complications in animal models as well as increased morbidity, infection, and hospital length of stay in clinical studies of surgical patients. This study aims to evaluate the association between perioperative Vitamin D (25-OHD) levels and postoperative outcomes in patients undergoing autologous breast reconstruction.</p><p><strong>Methods: </strong>We performed a retrospective review of patients undergoing autologous breast reconstruction at an academic institution. Patients with 25-OHD levels measured within three months of reconstruction were included. Variables of interest included patient demographics, comorbidities, perioperative 25-OHD levels, and postoperative surgical and medical complications. Standard statistical analysis was performed with significance set to p<0.05.</p><p><strong>Results: </strong>147 patients who underwent abdominally based breast reconstruction had undergone 25-OHD testing within three months of reconstruction and were included in analysis. 25-OHD insufficiency (<30 ng/mL) was found to be significantly associated with surgical site infections (OR 2.8, p=0.04), donor site seromas (OR 13.2, p=0.01), and medical complications (OR 4.0, p=0.02) on univariate and multivariable analysis.</p><p><strong>Conclusion: </strong>Our data suggests that 25-OHD insufficiency impacts surgical and medical complications in patients undergoing autologous breast reconstruction. Enhanced understanding of perioperative 25-OHD status may help inform clinical decisions and present opportunities for optimizing patients to improve surgical outcomes in breast reconstruction.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Migraine Surgery in Reducing Pharmacological Treatment Requirements.","authors":"Emily C Yanoshak, Lee H Kilmer, Samantha L Mason, Brent R DeGeorge, Jonathan S Black","doi":"10.1097/PRS.0000000000012490","DOIUrl":"10.1097/PRS.0000000000012490","url":null,"abstract":"<p><strong>Introduction: </strong>Migraines impact 35 million Americans, leading to decreased quality of life and are the third leading cause of disability worldwide. Recent studies have demonstrated a nearly 90% success rate for migraine surgery, defined as the elimination or at least a 50% reduction in symptoms. This study aimed to determine the effect of migraine surgery on medication usage.</p><p><strong>Methods: </strong>A national insurance database containing ICD and CPT codes, along with patient demographics, was utilized. Patients diagnosed with chronic migraines via ICD codes were included. Propensity score matching using medical comorbidities created a treatment group that underwent peripheral nerve decompression or transection surgery (CPT-64716 or CPT-64771) and a control group that did not undergo surgery. Medication usage before and after surgery was compared among surgical patients. A logistic regression was performed to identify predictors of undergoing migraine surgery.</p><p><strong>Results: </strong>In a database of 165 million patients, 10,641,115 (6.4%) were identified with migraines. Of these, 1,852 (0.02%) underwent migraine surgery, with a mean and median time to surgery of 3.1 and 2.3 years, respectively (SD 2.8 years). Propensity score matching resulted in 1,948 patients in both control and treatment groups. Post-surgery, the use of abortive medications, including triptans, ergots, and NSAIDs, significantly decreased (p<0.05). Preventative medication use, including beta-blockers, antiepileptics, calcium channel blockers, and antidepressants, also significantly decreased (p<0.01).</p><p><strong>Conclusions: </strong>Peripheral nerve decompression or transection surgery may be effective in reducing medication usage among migraine patients. Further research is needed to assess the impact of migraine surgery on overall healthcare costs.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spotlight in Plastic Surgery: October 2025.","authors":"","doi":"10.1097/PRS.0000000000012289","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012289","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4","pages":"670-673"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}