Plastic surgery最新文献

{"title":"The Incidence of Malignant and High-Risk Pathology Findings in Postreduction Mammaplasty Patients.","authors":"Bryn L Hoffman, Katrina M Jaszkul, Sarah Sloss, Laryssa Kemp, Rachel Phelan, Douglas R McKay, Glykeria Martou","doi":"10.1177/22925503241309928","DOIUrl":"10.1177/22925503241309928","url":null,"abstract":"<p><p><b>Introduction:</b> Reduction mammaplasty is often performed to alleviate symptoms of macromastia or for symmetry after a lumpectomy in the contra-lateral breast. Abnormal pathology including breast cancer can be incidentally found in reduction mammaplasty specimens, but there is no consensus on risk factors or detection rates. This study aimed to elucidate the incidence of malignant and high-risk pathology findings in patients undergoing breast reduction in a Canadian context. <b>Methods:</b> We conducted a retrospective review of all reduction mammaplasty cases performed by 5 surgeons between January 2001 and May 2023. Patients were categorized into Group A, those undergoing bilateral reduction for macromastia symptoms, and Group B, those with a history of breast-conserving surgery seeking unilateral reduction postlumpectomy. <b>Results:</b> In total, 1383 breasts from 872 patients were examined: 1022 in Group A and 361 in Group B. Group B was significantly older (56.9 ± 9.3 vs 44.0 ± 13.9 years) whereas Group A had a significantly higher BMI (33.1 ± 8.4 vs 30.1 ± 5.8). High-risk and malignant pathology incidence was 1.4% overall. The sole malignancy detected was in a patient in Group A without prior breast cancer history. Multivariate analysis revealed BMI as a significant predictor for high-risk pathologies (OR 1.134, 95% CI [1.012-1.271]). <b>Conclusions:</b> Our findings align with previously reported incidence rates of pathological findings in mammaplasty specimens and highlight the correlation between BMI and pathology risk. These results underscore the importance of a comprehensive history and preoperative counselling about the possibility of further treatment following pathological discoveries during reduction mammaplasty.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241309928"},"PeriodicalIF":0.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047013","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}

{"title":"A Comparison of Complication Rates in Flexor Tendon Repair Performed in Operating Rooms Versus Clinic-Based Procedure Rooms.","authors":"Laurent Tessier, Ariane Gélinas, Alexandra Speak, Donald Lalonde, Jacques Haddad","doi":"10.1177/22925503241309926","DOIUrl":"10.1177/22925503241309926","url":null,"abstract":"<p><p><b>Background:</b> Wide-awake local anesthesia no tourniquet (WALANT) surgery has demonstrated its value in hand surgery allowing surgeons to safely operate patients in different settings outside of a formal operating room (OR). Flexor tendon lacerations have historically been repaired in the controlled setting of an OR. Plastic surgeons at our university-affiliated center have increasingly been performing flexor repairs in clinic-based procedure rooms (PRs). This study set out to evaluate the safety and complication rates of primary flexor tendon repair performed in PRs compared to those performed in the OR. <b>Method:</b> A unicentric retrospective study was conducted with patients who underwent primary flexor tendon repair between 2019 and 2023 in both clinic-based PRs and the OR. Primary outcomes included presence of tendon rupture and secondary outcomes included infection, adhesion, reintervention, and presence of any complication. Results are reported using odds ratios with 95% confidence intervals. <b>Results:</b> One hundred seventy-four patients underwent flexor tendon repair. There was no association between rupture rate and surgical setting (OR 1.05 95% CI [0.30-3.78]; <i>P</i> = .94). Surgeries performed in clinic-based PRs showed a reduction in the odds of observing at least one complication (OR = 0.49 [0.24-0.97]; <i>P</i> = .041). A subanalysis of single digit cases showed a similar association between the rate of complications and surgical setting (OR = 0.39 [0.16-0.96]; <i>P</i> = .039). <b>Conclusions:</b> This study confirms the safety of performing flexor repair in clinic-based PRs. Such settings also offer the advantage of reduced cost of surgery and minimized delay between diagnosis and surgery.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241309926"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024394","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}

{"title":"Patient Perspectives of \"Failure\" in Breast Reconstruction: A Systematic Review of Qualitative Literature: Points de vue des patients sur les «échecs» de la reconstruction mammaire: Revue systématique des publications sur l'aspect qualitatif.","authors":"Caroline Hircock, Patrick Kim, Abhishek Achunair, Tara Behroozian, Lucas Gallo, Emily Dunn, Achilles Thoma","doi":"10.1177/22925503241311255","DOIUrl":"10.1177/22925503241311255","url":null,"abstract":"<p><p><b>Introduction:</b> The concept of <i>failure</i> in breast reconstruction can occur when negative outcomes dominate the patient experience. The primary objective of this review was to identify experiences of <i>failure</i> in breast reconstruction from the patient's perspective in the qualitative literature. <b>Methods:</b> MEDLINE, Embase, Psychinfo, Emcare, and CINAHL were searched on July 31, 2023 using terms related to breast reconstruction and qualitative research. Thematic analysis was performed on direct quotations from included studies. <i>Confidence in the Evidence from Reviews of Qualitative (CERQual) Research</i> was used to assess confidence of the final findings. <b>Results:</b> Forty-two studies were identified. The following themes were identified in breast reconstruction <i>failure</i>: (1) <i>failure</i> occurs when expectations of restoring the original breast are not met with reconstruction, (2) <i>failure</i> occurs when unexpected outcomes were associated with the reconstruction, and (3) healthcare providers negatively impact the experience of breast reconstruction <i>failure</i> through lack of transparency when educating patients on expected results and poor relational support in the post-operative period. The evidence supporting themes 1-3 scored high confidence with CERQual. <b>Conclusion:</b> Breast reconstruction <i>failure</i> from the patient perspective arises from the limitations and adverse outcomes of the surgery. They may also arise even when the procedure was deemed \"successful\" from the surgeon's perspective. Dissatisfaction with result is increased by procedural complications. Healthcare providers can aggravate the perception of <i>failure</i> through inadequate patient education. Incorporating these perceptions of <i>failure</i> into discussions with patients can aid in their decision making.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241311255"},"PeriodicalIF":0.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010231","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}

{"title":"Brachial Plexus Birth Injury: Treatment and Interventions.","authors":"Grace O'Shea, Sonia S Patel, Brian A Mailey","doi":"10.1177/22925503241301719","DOIUrl":"10.1177/22925503241301719","url":null,"abstract":"<p><p><b>Introduction:</b> Brachial plexus birth injury (BPBI) is a condition affecting newborns and involves damage to the nerve fibers compromising the brachial plexus during birth. Although most newborns recover spontaneously, a large subset require surgery to regain function, and others will have permanent disability despite intervention. Deciding when to pursue surgical intervention remains a challenge for clinicians treating BPBI. <b>Methods:</b> A comprehensive search of the literature was conducted using PubMed, Scopus, and MEDLINE databases. A total of 24 primary and secondary sources were chosen for inclusion following full-text assessments. All sources were analyzed to provide a comprehensive review on the development of BPBI treatments and interventions over time. <b>Results:</b> Spontaneous recovery can be achieved in many cases of BPBI, but most patients require physical therapy and other forms of treatment to avoid muscle imbalance and prevent contracture formation. In addition to physical therapy, the most common non-surgical interventions include botulinum toxin injections and splinting. In cases requiring surgery, clinicians may use several tests and diagnostic imaging to aid in decision making. Common surgical interventions for BPBI include nerve grafting, nerve transfers, and muscle and tendon transfers. <b>Conclusion:</b> Most newborns recover from BPBI within the first 3 months of life. However, some require treatment to restore optimal function. In general, non-surgical interventions should be the primary course of treatment, and surgery should be avoided unless the patient is deemed unable to recover with any other treatment.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241301719"},"PeriodicalIF":0.7,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984609","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}

{"title":"Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action-Part II.","authors":"Emma Avery, Chantal R Valiquette, Syena Moltaji, Laura Snell","doi":"10.1177/22925503241307650","DOIUrl":"10.1177/22925503241307650","url":null,"abstract":"<p><p><b>Background:</b> In May 2022, we challenged our colleagues to evaluate their educational approaches, policies, recruitment strategies, and leadership organizations with an Equity, Diversity, and Inclusion (EDI) lens. <b>Methods:</b> Two virtual national round table meetings were held in 2023 to discuss approaches to integration of the EDI principles into current Canadian plastic surgery training programmes. Additionally, integrative documents and processes were established within our programme to act as a guide for integration of the principles of EDI in the areas of resident education, recruitment, and retention. <b>Results:</b> There is an increasing awareness amongst Canadian plastic surgeons of the importance of integrating EDI education into our plastic surgery training programmes, yet there is a lack of experience and/or lack of resources available to facilitate these changes. Our taskforce (Division of Plastic Surgery at the University of Toronto) implemented an EDI curriculum in our programme in 2 main domains: Education and Recruitment Strategies. <b>Conclusions:</b> Breaking down some of the long-entrenched inequities in our healthcare system is an ongoing process. More work needs to be done toward increasing our trainee and faculty exposure to EDI principles, so that they can integrate these skills into their clinical practice, leadership, and beyond. Our taskforce's successes and challenges can act as a useful resource to other programmes desiring to initiate similar change.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241307650"},"PeriodicalIF":0.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953535","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}

{"title":"How Can Non-Hospital Surgical Centres Improve Their Environmental Footprint (and Reduce Costs)?","authors":"Barinder Bajwa, Zach Zhang, Young Ji Tuen, Rebecca Courtemanche, Jugpal S Arneja","doi":"10.1177/22925503241305635","DOIUrl":"https://doi.org/10.1177/22925503241305635","url":null,"abstract":"<p><strong>Introduction: </strong>Every industry has greenhouse gas emissions, with healthcare a significant contributor. In Canada, the healthcare sector is directly and indirectly responsible for 4.6% of the country's greenhouse gas emissions. Operating rooms (ORs) are major contributors to hospital waste, making the OR low hanging fruit for analyzing environmental practices. The OR can adopt a green mindset to reduce its carbon footprint, yet barriers to going green exist. Herein we study non-hospital surgical centres in British Columbia to assess current green practices, attitudes towards environmental sustainability, and barriers to implementation.</p><p><strong>Methods: </strong>All accredited non-hospital surgical centres in BC were invited to complete a survey on current practices and plans to reduce their environmental impact.</p><p><strong>Results: </strong>Of 56 non-hospital surgical centres contacted, 18 responded, with 89% willing to adapt their practice to promote environmental sustainability, yet lacked current knowledge (56%) and formal plans (0%). The wide use of anesthetic gases with high global warming potential (64%) and disposable drapes/ gowns (78%/ 67%) were noted. Barriers to adopting green practices included: cost (44%), infrastructure (44%), regulatory guidelines (39%), knowledge (39%), and safety (28%).</p><p><strong>Conclusions: </strong>Transitioning to more environmentally sustainable practices in ORs can enhance healthcare value by reducing both costs and greenhouse gas emissions. The greatest effect can be achieved through prudent choice of anesthetic gas agent, followed by reusable linens and drapes. Education and regulatory leadership were identified as crucial for overcoming these barriers. This study underscores the need for education, guidelines, and economically viable options to transition from awareness to action.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241305635"},"PeriodicalIF":0.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932498","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}

{"title":"Are We Training Plastic Surgeons for the Future Needs of the Canadian Population?","authors":"Achilles Thoma","doi":"10.1177/22925503241310231","DOIUrl":"https://doi.org/10.1177/22925503241310231","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241310231"},"PeriodicalIF":0.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932477","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}

{"title":"Perspectives of Canadian Plastic Surgeons on the Surgical Management of Pressure Injuries.","authors":"Erika Opingari, Romain Laurent, Ho Yee Wan, David L Wallace, Alan D Rogers","doi":"10.1177/22925503241308541","DOIUrl":"10.1177/22925503241308541","url":null,"abstract":"<p><p><b>Introduction:</b> Pressure injuries, particularly among patients with spinal cord injuries and the elderly, significantly contribute to morbidity, mortality, and financial sequelae. Surgical interventions, including debridement and flaps, may improve outcomes, especially for stage 3 and 4 pressure injuries. This survey assesses Canadian plastic surgeons' perspectives and practices regarding the surgical management of these injuries. <b>Methods:</b> A web-based survey was distributed to 405 registered members of the Canadian Society of Plastic Surgeons (CSPS) and remained open for a 6-week period. The 16-question survey explored management practices for pressure injuries and the training associated with resident education. <b>Results:</b> Responses from 129 surgeons (31.8%) were analyzed. Of these, 85% manage stage 3 or 4 pressure injuries, though only 67.5% performed both debridement and flap coverage. The majority believe care should ideally occur in community facilities with plastic surgery coverage rather than being centralized in academic centers, although careful patient selection, perioperative planning, and rehabilitation are critical to justify the surgical investment. Most respondents (83%) agreed that plastic surgery residents should be proficient in both debridement and flap coverage by the end of their training. <b>Conclusion:</b> The survey indicates that most surgeons prefer managing pressure injuries in facilities with adequate plastic surgery support rather than exclusively at academic centers. However, structured management pathways and enhanced training in pressure injury care remain crucial. Future healthcare policy and research should focus on improving care delivery and patient outcomes, ensuring that all facilities involved in this care are equipped with the necessary resources and multidisciplinary expertise.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241308541"},"PeriodicalIF":0.7,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885988","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}

{"title":"Call for Mandatory Reporting of Serious Adverse Events in Aesthetic Medicine: \"You Can't Manage What You Don't Measure\".","authors":"Kaitlyn M Enright, Andreas Nikolis","doi":"10.1177/22925503241307665","DOIUrl":"10.1177/22925503241307665","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241307665"},"PeriodicalIF":0.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877870","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}

{"title":"Factors Influencing Practice Decisions Among Plastic Surgery Residents and Early-Career Plastic Surgeons in Canada.","authors":"Sarah C Hunt, Aaron Grant, Andrew M Simpson","doi":"10.1177/22925503241305637","DOIUrl":"10.1177/22925503241305637","url":null,"abstract":"<p><p><b>Introduction:</b> Trends within the Canadian plastic surgery workforce demonstrated that most work in academic or medium-large community practice. Recent studies observed more plastic surgeons are incorporating aesthetics into their practice. This study aims to identify factors influencing how plastic surgery residents and early-career plastic surgeons in Canada choose their eventual practice with respect to practice type and practice location. <b>Methods:</b> A REDCap survey was distributed to plastic surgery residents and early-career plastic surgeons across Canada between February and May 2024. Demographics, training information, career information, and Likert-scale questions for factors involved in decision-making were surveyed. Data analysis included descriptive statistics and Fisher exact tests. <b>Results:</b> There were 45 residents and 30 early-career plastic surgeon respondents. Mixed practices that included aesthetics were the most popular practice types among residents (73%) and early-career surgeons (77%). Half (53%) of early-career surgeons were working in urban settings with more than 1 million people, and 44% of residents desired these locations. Hometown factors heavily influenced practice type and location (<i>P</i> < .0001), more than training experiences. Positive interactions (94%), operating time (90%), partner opinion (87%), and hospital resources (86%) were ranked as the most important factors involved in practice decisions. <b>Conclusion:</b> Mixed practices that include aesthetics were the most popular among our up-and-coming Canadian workforce, especially in urban settings. These changing practice trends may impact our ability as a specialty to adequately meet the needs of the Canadian population. Recruitment efforts should focus on promoting a supportive workplace and local environment, with adequate operating time and resources.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241305637"},"PeriodicalIF":0.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877914","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}