Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Dynamic Yet Stable Nasal Tip: Dual-pillar Medial Crural Reinforcement Technique Preserving Natural Alignment and Infratip Break in Asian Rhinoplasty.","authors":"Takamasa Nakai, Kazushi Sasaki, Junya Fukabori","doi":"10.1097/GOX.0000000000008118","DOIUrl":"10.1097/GOX.0000000000008118","url":null,"abstract":"<p><p>Asian rhinoplasty often requires additional tip support because the medial crura are frequently weak, short, or asymmetrical. Although septal extension grafts provide strong support, rigid fixation may reduce physiological tip mobility and efface the infratip break. We describe the dual-pillar medial crural reinforcement technique, which strengthens each medial crus while preserving its native contour. A retrospective review was performed of 42 Asian rhinoplasty patients treated between 2023 and 2025. The technique was used in patients with inadequate tip projection (Goode ratio <0.55), weak or asymmetrical medial crura, and a preference for preserving dynamic tip mobility. Thin cartilage grafts (0.8-2.0 mm) were individually shaped and secured along each medial crus as paired bilateral reinforcement with interrupted 5-0 polydioxanone sutures without rigid septal coupling. Outcomes included Goode ratio, infratip break angle, tip mobility (pragmatic 4-point clinical grading), and patient satisfaction. Mean Goode ratio improved from 0.51 ± 0.03 to 0.58 ± 0.02 (<i>P</i> < 0.001), and mean infratip break angle improved from 139 ± 7 to 118 ± 5 degrees (<i>P</i> < 0.001). Grade 3 physiological tip mobility was observed in 38 (90%) patients, whereas 4 (10%) patients showed grade 2 mobility. Mean patient satisfaction was 8.7 ± 0.9 on a 10-point visual analog scale. No complications requiring revision occurred. The dual-pillar technique provides structural reinforcement of the medial crura without changing their native shape. By preserving natural contour, infratip break, and dynamic tip mobility, it offers a useful alternative or adjunct to more rigid tip-support techniques in Asian rhinoplasty.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8118"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitation for Breast Reconstruction Surgery: A Practical and Evidence-based Guide.","authors":"Kristen Rezak, Ash Patel, Rebecca Knackstedt","doi":"10.1097/GOX.0000000000008072","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008072","url":null,"abstract":"<p><strong>Background: </strong>Prehabilitation, the systematic optimization of physical, nutritional, and psychosocial health before surgery, is well established in other surgical specialties but remains underused and inconsistently defined in breast reconstruction. Patients pursuing reconstruction frequently have modifiable vulnerabilities, including malnutrition, sarcopenia, impaired glycemic control, chronic pain, sleep disturbance, anxiety, and depression, which are associated with higher complication rates, delayed functional recovery, and worse quality of life.</p><p><strong>Methods: </strong>This review summarizes evidence-supported prehabilitation and perioperative optimization strategies from breast surgery and broader surgical populations and evaluates their relevance to breast reconstruction. We emphasize practical, multidisciplinary screening and targeted intervention across nutrition/metabolism, functional status, pain, sleep, and psychosocial health.</p><p><strong>Results: </strong>Multiple interventions have demonstrated benefit across surgical populations and are readily adaptable to breast reconstruction, including high-protein supplementation and micronutrient optimization, immunonutrition, carbohydrate loading with perioperative glycemic control, resistance training, multimodal pain management, stress-reduction techniques, and sleep hygiene. Implementation requires systematic assessment of nutritional, functional, psychological, and social risk factors and collaboration with dietitians, physical therapists, pain specialists, behavioral health clinicians, and social workers to deliver individualized optimization.</p><p><strong>Conclusions: </strong>Prehabilitation offers a feasible pathway to improve outcomes and patient experience in breast reconstruction. Prospective studies are needed to define the optimal content, timing, and intensity of multimodal programs and to tailor approaches for implant-based and autologous reconstruction.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8072"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitation for Limb Salvage Surgery: A Practical and Evidence-based Guide.","authors":"Daehee Jeong, David M Brogan, J Westley Ohman, Mitchell A Pet, Justin M Sacks, Saif Badran","doi":"10.1097/GOX.0000000000008071","DOIUrl":"10.1097/GOX.0000000000008071","url":null,"abstract":"<p><p>Surgical procedures carry inherent risks that can result in significant complications. Prehabilitation, a multidisciplinary preoperative strategy, aims to prepare patients for surgery and enhance postoperative recovery by optimizing various aspects of their health. This comprehensive review examines the role of prehabilitation in limb salvage surgery (LSS), focusing on vascular health, muscle mass, range of motion, psychological, and lifestyle optimization. The synthesis evaluated current literature on prehabilitation strategies in LSS, highlighting key areas for preoperative optimization, and offers a practical, evidence-based guide for prehabilitation in LSS. This guide includes discussions about shared decision-making, nutritional and metabolic considerations, and the management of comorbid conditions, including limb-, psychological-, and lifestyle-based optimizations. These strategies reduce frailty and improve surgical outcomes, which is particularly relevant for LSS patients, given their frequent predisposition to increased frailty. Despite this, standardized prehabilitative approaches in LSS remain underexplored. Comprehensive prehabilitation, tailored to individual patient needs, is crucial for optimizing outcomes in LSS. Further research is necessary to establish standardized protocols and broaden the application of prehabilitation in this specialized area of surgery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8071"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Regenerative Outcomes: Histopathological Comparison of Calcium Hydroxylapatite Alone and Combined With Platelet-rich Fibrin: A 6-week Study.","authors":"Julián Hernández, Natalia Ruiz, Brian Ramírez, Rafael Parra-Medina, María C Hernández, Agustina Varela","doi":"10.1097/GOX.0000000000008046","DOIUrl":"10.1097/GOX.0000000000008046","url":null,"abstract":"<p><strong>Background: </strong>Calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) is a widely used biostimulatory filler that promotes collagen production through fibroblast activation. Platelet-rich fibrin (PRF) has been proposed as a bioactive adjunct capable of enhancing tissue regeneration. Because collagen remodeling becomes more evident weeks after injection, this study aims to evaluate whether the addition of PRF modifies the subdermal tissue response at 6 weeks.</p><p><strong>Methods: </strong>A prospective observational study was conducted in 5 patients undergoing abdominoplasty. Four conditions were evaluated: saline (control), PRF alone, CaHA-CMC + saline solution, and CaHA-CMC + PRF. Injections were administered subdermally 6 weeks before surgery. Tissue samples were collected intraoperatively and analyzed using hematoxylin and eosin staining and immunohistochemistry. A semiquantitative histomorphometric surrogate analysis was performed using the collagen-associated eosinophilic area. Statistical comparisons were conducted using Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>The CaHA-CMC + PRF group demonstrated the highest collagen-associated eosinophilic area values (~4.4 times versus control; <i>P</i> = 0.01), followed by CaHA-CMC + saline solution (~2.3 times; <i>P</i> = 0.03). The PRF-only group showed a mild, nonsignificant increase (~1.6 times; <i>P</i> = 0.08). Immunohistochemical analysis suggested increased type IV collagen expression, CD45-positive, lymphocyte infiltration, and neovascularization in the CaHA-CMC + PRF group compared with other groups. These findings indicate a more pronounced and coordinated tissue response in the presence of PRF.</p><p><strong>Conclusions: </strong>The addition of PRF to CaHA-CMC may enhance subdermal tissue remodeling at 6 weeks. However, given the small sample size and semiquantitative methodology, these results should be interpreted as exploratory and require further validation.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8046"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nanofat in Plastic Surgery: A Systematic Review of Clinical Outcomes, Safety, and Emerging Applications.","authors":"Claire G Olivas, Orr Shauly, Daniel J Gould","doi":"10.1097/GOX.0000000000008107","DOIUrl":"10.1097/GOX.0000000000008107","url":null,"abstract":"<p><strong>Background: </strong>The beauty industry has seen a shift in standards, with patients increasingly favoring natural and subtle enhancements over dramatic cosmetic changes. In this evolving landscape, nanofat has emerged as a promising tool to plastic surgeons due to its regenerative potential and biocompatibility. Despite its growing popularity, hesitancy regarding its efficacy and side effects persists.</p><p><strong>Methods: </strong>A systematic literature review was conducted in December 2024 following PRISMA guidelines. Databases searched included PubMed, Embase, MEDLINE, Scopus, Web of Science, and Cochrane Library databases.</p><p><strong>Results: </strong>A total of 18 studies met the inclusion criteria, encompassing 768 patients. Nine studies (n = 512 patients) assessed patient satisfaction, with most patients reporting above-average satisfaction. Eight studies (n = 188) reported outcomes using the Vancouver Scar Scale and Patient and Observer Scar Assessment Scale, all showing significant improvements in scar characteristics. Additional outcomes included collagen synthesis and transforming growth factor beta 1 expression (n = 68), hair density and thickness (n = 9), and histological analysis of skin samples (<i>n</i> = 24). Regarding safety, 12 studies reported no significant complications such as granulomas or cysts, whereas 8 studies noted mild side effects, including erythema, hyperpigmentation, and edema.</p><p><strong>Conclusions: </strong>Nanofat demonstrates significant potential as a cost-effective, well-tolerated regenerative therapy in both aesthetic and reconstructive contexts. Although preliminary findings are promising, further high-quality studies are necessary to establish standardized methodologies and optimize preparation techniques.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8107"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Deep Plane and Superficial Musculoaponeurotic System Facelifts Using Artificial Intelligence-Based Age Estimation.","authors":"Shu Juet Tan, Kian Steppe, Mark M Mims","doi":"10.1097/GOX.0000000000008113","DOIUrl":"10.1097/GOX.0000000000008113","url":null,"abstract":"<p><strong>Background: </strong>Although artificial intelligence (AI) is implemented in diagnostic medicine, few modalities exist to evaluate aesthetic outcomes. The literature demonstrates AI's ability to predict patient age mainly from frontal views, despite the importance of profile views in age perception. It is also uncertain how the predominant facelift techniques (deep plane versus SMAS) and adjunct procedures affect AI estimation. We aimed to investigate AI's ability to estimate age pre- and postoperatively using frontal and profile views, comparing outcomes across techniques and adjuncts.</p><p><strong>Methods: </strong>For each facelift technique in this retrospective study, Face++ AI age estimation software evaluated pre- and postoperative photographs of 100 female patients, identified from plastic surgery websites. Patients (N = 200) were grouped by facelift technique and adjunct procedures, and Microsoft Excel was implemented for data analysis.</p><p><strong>Results: </strong>Two hundred patients (100 deep plane, 100 SMAS; mean age 59.97 y) were analyzed using Face++ AI. Frontal images showed modest apparent age reduction (~2.5-2.8 y) with moderate accuracy, whereas profile images demonstrated substantial underestimation and high variability with a mean absolute error of 16-23 years. No significant differences in AI-estimated age reduction were detected between surgical approaches, and adjunct procedures did not significantly affect age estimates.</p><p><strong>Conclusions: </strong>This study uniquely evaluates Face ++ AI age estimation for SMAS and deep plane facelifts using both frontal and profile views within a single dataset. AI detected modest age reduction in frontal views but was inaccurate in profiles, and adjuncts had no significant effect, highlighting current AI limitations.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8113"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Plastic and Reconstructive Surgery: A Bibliometric Study of the 50 Most-cited Articles.","authors":"Pharel Njessi, Olivier Camuzard, Elise Lupon","doi":"10.1097/GOX.0000000000008120","DOIUrl":"10.1097/GOX.0000000000008120","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has gained increasing attention in the surgical literature, including plastic and reconstructive surgery (PRS). However, the characteristics and trends of the most influential publications on AI in PRS remain poorly defined.</p><p><strong>Methods: </strong>The online Web of Science Core Collection was searched on November 18, 2025, to identify articles on AI applications in PRS. Title, authorship information, publication year, journal, funding, and citation count were recorded. Studies were further classified based on application domain and PRS subspecialty.</p><p><strong>Results: </strong>The 50 most-cited articles on AI in PRS were published between 2001 and 2024, with citation counts ranging from 45 to 124. Most articles originated from the United States (n = 18; 1166 citations) and were published by plastic surgeons (n = 17; 1332 citations). Imaging assessment (n = 21; 1564 citations) represented the most common application of AI, whereas the predominant PRS subspecialty was craniofacial surgery (n = 32; 2364 citations).</p><p><strong>Conclusions: </strong>This bibliometric analysis highlights the most influential publications and emerging applications of AI in plastic surgery, revealing that image-based approaches predominate, particularly in craniofacial surgery, whereas adoption remains uneven across PRS subspecialties. These findings underscore current research priorities and identify areas where AI development remains limited, offering a foundation to guide future work in this rapidly evolving field.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8120"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Labial Flap Reconstruction: A Novel Modification of the McIndoe Vaginoplasty for Vaginal Agenesis.","authors":"Zakaria Yahya Arajy, Sarmad Khunda, Rasha Fadhil Abas","doi":"10.1097/GOX.0000000000008123","DOIUrl":"10.1097/GOX.0000000000008123","url":null,"abstract":"<p><strong>Background: </strong>Primary amenorrhea and sexual dysfunction may be caused by congenital vaginal agenesis, which is frequently associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. The aim of surgical reconstruction is to restore the anatomy, function, sensation, and aesthetics, thereby improving quality of life by reconstructing the vagina, particularly with a novel bilateral labia majora flap vaginoplasty technique.</p><p><strong>Methods: </strong>This was a retrospective interventional case series (2014-2024) conducted in Baghdad that involved women aged 18-30 years with MRKH syndrome and complete vaginal agenesis. Following the preoperative evaluation, patients received neovagina reconstruction using bilateral labial flaps and split-thickness grafts. Postoperative treatment included antibiotics, progressive vaginal dilation, estrogen therapy, and follow-up. Outcomes were assessed in terms of anatomy and function, complications, operative outcomes, cosmetic outcomes, and partner satisfaction. The data were described using descriptive statistics.</p><p><strong>Results: </strong>Twelve patients (mean age 21.2 y) were subjected to modified McIndoe vaginoplasty. The average operative time was 2.5 hours, and there was minimal blood loss and no transfusion. One patient developed a hematoma that required secondary grafting. The mean neovaginal length at 6 months postoperative was 7.4 cm; 83.3% of patients were sexually active, the majority reported satisfaction with the procedure, dyspareunia was minimal, and partners reported satisfaction. Cosmetic outcomes were very good in 91.7% of patients.</p><p><strong>Conclusions: </strong>Modification of the McIndoe vaginoplasty technique using bilateral labia majora flaps seems to be safe, effective, and aesthetically superior in patients with MRKH syndrome, as it enhances functionality and cosmesis; larger studies are required to validate the long-term results and assess cost-effectiveness.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8123"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the Role of Robot-assisted Microsurgery: Implementation, Challenges, and Outlook From a High-volume Tertiary Care Center.","authors":"Khaled Dastagir, Alexandra Renko, Martynas Tamulevicius, Nadjib Dastagir, Florian Bucher, Peter M Vogt","doi":"10.1097/GOX.0000000000008098","DOIUrl":"10.1097/GOX.0000000000008098","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted microsurgery (RAMS) extends conventional microsurgical techniques by enhancing precision, eliminating tremor, and providing motion scaling. Despite its promising role in plastic and reconstructive surgery, its clinical implementation remains limited. Recent advancements, notably the Symani Surgical System, address prior challenges in scale and dexterity, enabling interventions in challenging anatomical regions. This study shares our single-center experience using RAMS across diverse reconstructions and assesses its implementation, feasibility, and short-term outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 40 consecutive RAMS procedures between March 2023 and April 2024 performed by a single surgeon at a high-volume tertiary care center using the Symani Surgical System. Patient demographics, surgical details, and outcomes were systematically collected.</p><p><strong>Results: </strong>Forty patients underwent robot-assisted reconstructions; 26 cases involved free tissue transfer and 14 acute hand trauma, including digital replantations. Two cases involved lymphovenous anastomoses, either combined with or preformed separately from lymph node transfer. A total of 130 robot-assisted anastomoses were performed: 43 arterial anastomoses, 57 venous anastomoses, 7 vein-to-artery anastomoses, 4 lymphovenous anastomoses, and 19 nerve coaptations. No flap loss or revisions occurred. Mean anastomosis time was approximately 16.4 minutes (±9.6 min).</p><p><strong>Conclusions: </strong>RAMS demonstrated safety, feasibility, and favorable clinical outcomes in a variety of reconstructive cases. Although initial challenges such as prolonged operative times and elevated costs persist, these decline with experience and familiarity. RAMS holds potential for broader clinical integration and future applications, including remote microsurgery. Further studies should evaluate its long-term outcomes, cost-effectiveness, and routine application.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8098"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WALANT Versus Sedation for Hand Trauma: A Comparative Cost Analysis in a Portuguese Public Hospital.","authors":"Cláudia Santos Lopes, Donald H Lalonde, Samuel Ribak, Anabela Almeida, Dário Ferreira, João Marques-Gomes","doi":"10.1097/GOX.0000000000008124","DOIUrl":"10.1097/GOX.0000000000008124","url":null,"abstract":"<p><strong>Background: </strong>Wide-awake local anesthesia no tourniquet (WALANT) has been increasingly adopted in elective hand surgery; however, its economic impact in acute hand trauma remains insufficiently documented within the Portuguese public healthcare system. This study compares hospital costs associated with WALANT-based and conventional anesthesia-based care pathways in the surgical treatment of acute hand and wrist trauma.</p><p><strong>Methods: </strong>A retrospective observational study was conducted, including all adults undergoing surgery for acute hand or wrist trauma during a 2-year period at a Portuguese public hospital. Patients were classified into the WALANT or non-WALANT groups according to routine practice. Cost comparisons were adjusted for age and diagnostic group. A restricted sensitivity analysis was performed among patients not treated with WALANT who were retrospectively considered eligible for WALANT.</p><p><strong>Results: </strong>Ninety-nine patients were included, with 49 treated with WALANT and 50 with conventional anesthesia. Adjusted analyses demonstrated lower costs in the WALANT group. Cost reductions were primarily driven by the avoidance of hospital admission, with additional contributions from reduced surgical team size and the absence of routine preoperative investigations. In the sensitivity analysis, lower total cost, lower direct cost excluding hospitalization, and shorter length of stay remained significant. The hypothetical model suggested additional potential savings.</p><p><strong>Conclusions: </strong>A WALANT-based care pathway was associated with lower hospital costs in the surgical management of acute hand and wrist trauma, suggesting that it may represent an efficient strategy for care pathway reorganization in the Portuguese public healthcare system.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8124"},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}