Plastic surgery最新文献

The Impact of the COVID-19 Pandemic on Case Volume and Wait Times of Elective Hand Procedures: A Retrospective Chart Review Study COVID-19 大流行对手部择期手术的病例量和等待时间的影响：病历回顾研究

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-09-10 DOI: 10.1177/22925503241276544

Kathryn Uhlman, Isabella Churchill, Robert Dydynsky, Stepfanie Johnston, Cameron Leveille, Mark McRae, Matthew McRae

{"title":"The Impact of the COVID-19 Pandemic on Case Volume and Wait Times of Elective Hand Procedures: A Retrospective Chart Review Study","authors":"Kathryn Uhlman, Isabella Churchill, Robert Dydynsky, Stepfanie Johnston, Cameron Leveille, Mark McRae, Matthew McRae","doi":"10.1177/22925503241276544","DOIUrl":"https://doi.org/10.1177/22925503241276544","url":null,"abstract":"Introduction: The COVID-19 pandemic has decreased the number of surgeries performed in North America. The purpose of this study was to compare the number of elective hand surgeries performed during the pandemic to a corresponding pre-pandemic time period and to quantify the impact to the surgical backlog in hand surgery. Methods: Patient health records for individuals who underwent surgical management of carpal tunnel syndrome (CTS), Dupuytren's disease (DD) or stenosing tenosynovitis (time periods: March 11, 2018 to July 1, 2019 [pre-pandemic] and March 11, 2020 to July 1, 2021 [pandemic]) were retrieved from two academic institutions. The primary outcome was number of surgeries performed in each time period. Secondary outcomes included wait times for each time period; and variables as predictors of wait times, including a) age; b) gender; c) socioeconomic status; d) geographic location; and, e) comorbidities. Results: Seven-hundred-and-fifteen cases were included (447 CTR cases, 135 fasciotomy/subtotal palmar fasciectomy cases and 133 pulley release/tendon release cases). Two-hundred-and-sixty-four elective hand procedures were performed during the COVID-19 time period, compared to 451 in the pre-pandemic time period (n = 187 surgeries, 41.5%). Mean surgical wait times decreased for CTS and DD and increased for stenosing tenosynovitis during the pandemic compared to the corresponding pre-pandemic time period. No association or variation in wait times was found in regard to the aforementioned variables. Conclusions: During the pandemic, a decreased total number of elective hand surgeries were performed when compared to the corresponding pre-pandemic period. This contributes to a backlog of elective surgical procedures.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reconstructive Microsurgery and the Flow State 重建显微外科与流动状态

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-31 DOI: 10.1177/22925503241276548

Kevin W. Dowling, Christopher G. Landis, George H. Landis

{"title":"Reconstructive Microsurgery and the Flow State","authors":"Kevin W. Dowling, Christopher G. Landis, George H. Landis","doi":"10.1177/22925503241276548","DOIUrl":"https://doi.org/10.1177/22925503241276548","url":null,"abstract":"Introduction: “Flow states”, characterized by intense focus during complex tasks, are proposed as common to the practice of reconstructive microsurgery. Existing literature establishes close relationships between the experience of flow and key aspects of mental health. Taking a holistic approach, the paper defines flow and establishes its relevance to both microsurgical practice and to the life and well-being of microsurgeons. Means of cultivating and enhancing flow are offered with important acknowledgement of the benefits and potential pitfalls involved. Methods: The paper is based on an extensive literature review. Numerous sources are critically evaluated for research design, methodology, and consistency of results with existing literature before being synthesized for relevance to microsurgical practice. Results: Existing literature defines flow with precision by way of environmental preconditions and experiential characteristics. The relationship of flow to more general psychological health is also well-established. The effects of flow on performance and how to optimally utilize and balance flow are burgeoning topics of study. Conclusion: Microsurgeons may benefit from the explicit recognition of flow states and the application of strategies that foster and balance flow within microsurgery. Techniques such as mental visualization, mindfulness practices, and attention training are tools that may potentially enhance flow experiences, reduce stress, improve performance, and mitigate burnout. Overemphasizing flow within surgery at the expense of finding flow in life more broadly, however, can lead to negative consequences. The paper highlights the potential benefits of integrating flow states into reconstructive microsurgery, offers suggestions for finding flow effectively, and underscores the importance of harnessing flow not only within surgery but also across different life spheres to ensure a well-rounded, sustainable, and fulfilling professional and personal existence.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Postoperative Complications of Direct-to-Implant and Two-Staged Breast Reconstruction: A Stratified Analysis 直接植入和两阶段乳房重建术的术后并发症：分层分析

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-30 DOI: 10.1177/22925503241276541

Jaimie L. Bryan, Kyle M. Ockerman, Lisa R. Spiguel, Elizabeth A. Cox, Sabrina H. Han, Nhan Trieu, Mario Blondin Fernandez, Frederick Heath, Sarah Sorice-Virk

{"title":"Postoperative Complications of Direct-to-Implant and Two-Staged Breast Reconstruction: A Stratified Analysis","authors":"Jaimie L. Bryan, Kyle M. Ockerman, Lisa R. Spiguel, Elizabeth A. Cox, Sabrina H. Han, Nhan Trieu, Mario Blondin Fernandez, Frederick Heath, Sarah Sorice-Virk","doi":"10.1177/22925503241276541","DOIUrl":"https://doi.org/10.1177/22925503241276541","url":null,"abstract":"Background: Post-mastectomy implant-based reconstruction can be performed as direct-to-implant (DTI) or two-staged reconstruction (TSR). Rigorous studies have explored postoperative complications between TSR or DTI, yet few have stratified outcomes by relevant populations, pre-operative findings, mastectomy characteristics, or plane of implant placement. We sought to compare the outcomes between these cohorts at our institution. Methods: All patients who underwent skin- or nipple-sparing mastectomy followed by DTI or TSR from 2011 to 2021 at a large academic medical center were included. Data included demographics, ADM use, mastectomy weight, plane of implant placement, and postoperative complications. Results: 295 patients were included. 271 (91.9%) received TSR, and 24 (8.1%) underwent DTI. Compared to TSR, DTI had a higher rate of NAC necrosis ( P = .007) and dehiscence ( P = .016). There was no difference in rate of other complications. Regardless of procedure, higher BMI ( P = .002), higher grade ptosis ( P = .01), and larger mastectomy weights ( P = .022) were associated with increased risk of complication. Pre-pectoral placement was not associated with risk of NAC or mastectomy skin necrosis. Prior tobacco use was associated with higher risk of infection ( P = .036) and dehiscence ( P = .025). Neoadjuvant and adjuvant chemotherapy was associated with increased risk of capsular contracture( P = .009). Conclusions: Our study suggests that TSR may be preferred to minimize risk of NAC necrosis and wound dehiscence, especially in high-risk patients. Pre-pectoral placement did not significantly affect risk of mastectomy or NAC necrosis and should be considered in all cases to minimize morbidity. Higher risk conditions for alloplastic reconstruction include higher degrees of ptosis, history of tobacco use, and higher BMIs.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Use of Recreational Cannabis Among Breast Reduction Patients: Characteristics, Complications, and Immediate Postoperative Analgesic Needs 乳房缩小术患者使用娱乐性大麻的情况：特征、并发症和术后即刻镇痛需求

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-30 DOI: 10.1177/22925503241276549

Peter E. Shamamian, Daniel Y. Kwon, Olachi Oleru, Nargiz Seyidova, Esther Kim, Simeret Genet, Abena Gyasi, Carol Y. Wang, Peter W. Henderson

{"title":"The Use of Recreational Cannabis Among Breast Reduction Patients: Characteristics, Complications, and Immediate Postoperative Analgesic Needs","authors":"Peter E. Shamamian, Daniel Y. Kwon, Olachi Oleru, Nargiz Seyidova, Esther Kim, Simeret Genet, Abena Gyasi, Carol Y. Wang, Peter W. Henderson","doi":"10.1177/22925503241276549","DOIUrl":"https://doi.org/10.1177/22925503241276549","url":null,"abstract":"Introduction: The characteristics, complications, and postoperative analgesic needs of patients with a recent or active history of recreational cannabis use have not been explored explicitly in plastic surgery. In this study, the characteristics, complications, and postoperative analgesic needs within a population of breast reduction patients who use and do not use recreational cannabis were compared. Methods: A retrospective cohort study was carried out on patients who underwent breast reduction between 2019 and 2023. Demographics, comorbidities, recreational cannabis use, postoperative opioid use, and postoperative complications were collected. Patients with a recent history (<1 month since last cannabis use) or current cannabis use were then compared to patients with no history of cannabis use. Results: In total, 340 patients were included, 88 (26%) patients had a history of cannabis use and 252 (74%) did not. Patients in the cannabis-using group were significantly younger than in the non-cannabis-using group (28 years vs 40 years, P < .01), and significantly more patients in the non-cannabis group had hypertension (20% vs 6% P < .01). More patients in the cannabis-using group had hematomas (5% vs 1%, P = .041) and fewer had t-point breakdown (4% vs 0%, P = .046), but these figures lost statistical significance on multiple logistic regression analysis after controlling for possible confounding factors including demographics and comorbidities ( P > .05). There were no significant differences in proportions of opioid use or by doses of opioids, even when converted to oral morphine equivalents ( P > .05). Conclusion: The analgesic needs, postoperative pain levels, and complications between cannabis-using and non-cannabis-using cohorts were similar. Counseling on substance use preoperatively should still be encouraged, especially in younger patients seeking reduction mammaplasty.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

WALANT Proximal Row Carpectomy Under Field Sterility: A Case Report and Description of Technique 野外无菌条件下的 WALANT 近端行椎体切除术：病例报告和技术说明

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-19 DOI: 10.1177/22925503241268883

Brett Ponich, Alexander Platt, Madison Turk, Maleka Ramji, Aaron Knox

引用次数: 0

Treatment of the Hypertrophic Nipple in Breast Augmentation 隆胸手术中肥大乳头的治疗

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-16 DOI: 10.1177/22925503241268886

Lucila M. Olivera Whyte, Patricia E. Ahualli, Gustavo E. Prezzavento

{"title":"Treatment of the Hypertrophic Nipple in Breast Augmentation","authors":"Lucila M. Olivera Whyte, Patricia E. Ahualli, Gustavo E. Prezzavento","doi":"10.1177/22925503241268886","DOIUrl":"https://doi.org/10.1177/22925503241268886","url":null,"abstract":"Background: Disproportionately large nipples with respect to the areola and the breast can result in physical and psychological problems for the patient. When a breast augmentation is performed, the nipple is projected forward by the implant, creating an optical appearance of being more projected and bigger in size with respect to the areola. A successful nipple reduction should be able to reduce its diameter and projection to achieve a good esthetic result, preserving its sensitive and lactation functions simultaneously. Objectives: The purpose of this study is to describe our technique and results of nipple reduction in context of breast augmentation. Methods: We carried out a retrospective cohort of patients in which a simultaneous breast augmentation and nipple reduction was performed by the Plastic and Reconstructive surgery Department of the German Hospital (Deutsches Hospital), in Buenos Aires, Argentina, between January 2016 and June 2022. Our technique consisted of a circumferential resection of skin at the base of the nipple followed by a wedge resection of the inferior portion of the nipple. The results were evaluated by comparing preoperative and postoperative photographs. Results: We included 17 patients. No patient presented nipple necrosis, wound dehiscence, hypertrophic scarring or permanent loss of sensation. Lactation could not be evaluated in the postoperative follow-up. Esthetic results were satisfactory in all patients. Conclusions: We described our surgical technique, which allows the treatment of the hypertrophic nipple addressing the anteroposterior projection and diameter independently. In turn, it preserves the sensory. The implantation of the scars at the base of the nipple and its inferior surface achieved discreet scars and a good esthetic result with high satisfaction rates in our patients. Level of evidence: Level IV, retrospective cohort.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Commentary: A 10-Year Retrospective Review of Patient-to-Patient Transmitted Pathogens in Culture-Positive Burn Wounds at a Tertiary Burn Center 评论：一家三级烧伤中心对培养阳性烧伤创面中患者间传播病原体的 10 年回顾性研究

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-02 DOI: 10.1177/22925503241268878

Duncan Nickerson

引用次数: 0

ERASing Confounders: Measuring Differences in Post Operative Pathways ERASing Confounders：测量术后路径的差异

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-02 DOI: 10.1177/22925503241268888

Cameron F. Leveille, Brian Chin, Christopher J. Coroneos

引用次数: 0

Reduction Mammoplasty in the Pediatric Population: An Analysis of Pediatric NSQIP Data From 2012 to 2019. 减少乳房成形术在儿科人群中的应用:2012 - 2019年儿科NSQIP数据分析

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-01 Epub Date: 2022-10-17 DOI: 10.1177/22925503221128986

Erica M Bien, Matthew D Rich, Pedram Zargari, Thomas J Sorenson, Ruth J Barta

{"title":"Reduction Mammoplasty in the Pediatric Population: An Analysis of Pediatric NSQIP Data From 2012 to 2019.","authors":"Erica M Bien, Matthew D Rich, Pedram Zargari, Thomas J Sorenson, Ruth J Barta","doi":"10.1177/22925503221128986","DOIUrl":"10.1177/22925503221128986","url":null,"abstract":"Introduction: Reduction mammoplasty is becoming more commonly performed in the pediatric population yet the risk factors for complications have not been well-studied. The purpose of this study was to assess the relationship between preoperative patient characteristics and postoperative complications in a large population of pediatric patients undergoing reduction mammoplasty. Methods: Pediatric patients undergoing reduction mammoplasty were identified within the 2012 to 2019 National Surgical Quality Improvement Program database for cross-sectional study. The predictor variables were age, body mass index (BMI), diabetes, chronic steroid use, time under anesthesia, and operative time, and the primary outcome was a 30-day postoperative surgical site-related complication. Multivariate logistic regression was performed to identify a relationship between predictor variable and primary outcome. Results: A total of 1216 pediatric patients were identified with a mean age of 16.6 years and mean BMI of 30.8 kg/m2. The incidence of overall postoperative complications was 4.6%. Superficial surgical site infection (SSI) was the most common complication (29/1216; 2.4%). BMI was significantly associated with superficial SSI (odds ratio: 1.03, 95% confidence interval: 1.00-1.05, P = .02). Sixteen patients (1.32%) underwent a second operation, most commonly to address hematoma/seroma (7/16; 43.8%). Conclusion: In a large series of patients, pediatric reduction mammoplasty is a safe procedure with a low complication rate. BMI was significantly associated with the incidence of superficial SSIs with the most common cause for reoperation being a hematoma/seroma. This study can help guide the discussion between physicians and patients regarding potential risks associated with pediatric reduction mammoplasty.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48718492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding the Appropriate and Beneficial Use of Before and After Photos in Breast Surgery: A North American Survey. 了解乳腺手术前后照片的适当和有益使用：一项北美调查

IF 0.7 4区医学

Plastic surgery Pub Date : 2024-08-01 Epub Date: 2023-01-03 DOI: 10.1177/22925503221146783

Shaishav Datta, Chantal R Valiquette, Ron Somogyi

{"title":"Understanding the Appropriate and Beneficial Use of Before and After Photos in Breast Surgery: A North American Survey.","authors":"Shaishav Datta, Chantal R Valiquette, Ron Somogyi","doi":"10.1177/22925503221146783","DOIUrl":"10.1177/22925503221146783","url":null,"abstract":"Introduction: Before and after photographs (BAPs) in breast surgery have been identified as important components of the informed consent process. Currently, there is limited consensus on the contents and presentation of BAPs. This study collected the opinions of prior and prospective patients on this topic. Methods: A survey, based on criteria identified by our previous nominal group technique (NGT) study, was designed to obtain patient perspectives on BAPs in breast surgery. Amazon Mechanical Turk, a validated crowd-sourcing tool, was used to identify and survey a group of 72 participants who indicated that they had undergone or were planning to undergo breast surgery. Likert items were analyzed using either chi-squared or Fisher's exact test. Results: Most respondents were cis-gendered-women (89%), Caucasian (83%), and between 31 and 41 years old (38%). Respondents agreed that BAPs are important to the consent process, for enabling patient-centered care, and should be presented in standardized sets. BAPs should be more accessible through different platforms, display multiple time points to show the healing process, and have multiple views including close-ups of scars. Photos should be unaltered except for de-identification, and have more diversity with regard to patient gender, age, skin color, and body mass index. These results align with results from our NGT study. Conclusion: Through this study we have identified many criteria that BAPs should meet according to prior and prospective breast surgery patients. Surgeons should think critically about how they present BAPs during the consent process to ensure effective patient-centered care.","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45783000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0