JPRAS Open最新文献

{"title":"Bone complications after hand and face transplantation: Mechanisms and management","authors":"Omer Dirican ,&nbsp;Bedreddin Sazoglu ,&nbsp;Zeynep Demir ,&nbsp;Naga Anvesh Kodali ,&nbsp;Ramu Janarthanan ,&nbsp;Yalcin Kulahci ,&nbsp;Fatih Zor ,&nbsp;Vijay S. Gorantla","doi":"10.1016/j.jpra.2025.12.019","DOIUrl":"10.1016/j.jpra.2025.12.019","url":null,"abstract":"<div><div>Vascularized composite allotransplantation (VCA) has expanded the frontiers of reconstructive surgery by enabling restoration of form and function in patients with devastating facial and extremity defects. While advances in surgical techniques and immunosuppression have improved short- and mid-term outcomes, bone-related complications remain a critical yet underexplored challenge. This review provides a comprehensive overview of the mechanisms and clinical manifestations of bone problems in VCA, including delayed union, nonunion, avascular necrosis, and osteoporosis. Particular emphasis is placed on the detrimental effects of long-term immunosuppressive therapy on bone metabolism and repair. Current and emerging strategies to address these issues—such as glucocorticoid-sparing regimens, pharmacological therapies like bisphosphonates and teriparatide, and regenerative medicine approaches—are also discussed. By synthesizing clinical experience, translational studies, and experimental models, this review underscores that bone complications represent a major determinant of graft integration, functional recovery, and long-term success in VCA. Greater recognition of these challenges and development of targeted management strategies are essential to optimize outcomes for recipients of bone-containing allotransplants.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 522-534"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of intravenous tranexamic acid administration on reduction mammoplasty outcomes","authors":"Stephanie Francalancia ,&nbsp;Mary Lou ,&nbsp;Kathryn Leeke,&nbsp;Margaret Wang,&nbsp;Damon McIntire,&nbsp;Nikhil Sobti,&nbsp;Daniel Kwan,&nbsp;Lauren Roussel,&nbsp;Amy Maselli,&nbsp;Rachel Sullivan,&nbsp;Paul Liu,&nbsp;Karl Breuing","doi":"10.1016/j.jpra.2026.01.002","DOIUrl":"10.1016/j.jpra.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>The growing use of tranexamic acid (TXA) in plastic surgery warrants an accurate analysis of efficacy for body contouring indications. We offer the largest cohort evaluation of intravenous TXA use in minimizing postoperative complications following reduction mammoplasty.</div></div><div><h3>Methods</h3><div>A single-institution retrospective analysis was conducted on consecutive reduction mammoplasty procedures performed between February 2023–August 2024. Patient demographics, intraoperative factors, and postoperative complications were collected and summarized using descriptive statistics. Groups were stratified based on administration of TXA, with differences assessed using Pearson’s chi-square test for categorical variables and Student’s <em>t</em>-test or Wilcoxon rank sum test for continuous variables, as appropriate. Association of perioperative intravenous TXA use with postoperative complications was analyzed by breast with multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of 406 patients (812 breasts), 213 patients (426 breasts) were administered TXA perioperatively. Neither group had significant differences in Caprini score, prior history of DVT, or anemia. Multivariable regression analysis, controlling for differences in demographics and operative characteristics, demonstrated that TXA use was significantly associated with decreased rates of dehiscence (aOR = 0.50, 95% CI 0.28–0.91, <em>p</em> = 0.023) and scar revision (aOR = 0.30, 95% CI 0.12–0.76, <em>p</em> = 0.015). Among breasts that were only closed with barbed sutures, after adjustment for demographics and operative characteristics, TXA use was significantly associated with lower rates of scar revision only (aOR = 0.16; 95% CI 0.05–0.52; <em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>Intravenous TXA use in reduction mammoplasty confers lower rates of postoperative wound complications, though its impact may be secondary to wound closure technique.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 722-734"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of scaphoid non-union characteristics on healing outcomes","authors":"Raffael Labèr,&nbsp;Géraldine Lautenbach,&nbsp;Andreas Schweizer","doi":"10.1016/j.jpra.2025.10.028","DOIUrl":"10.1016/j.jpra.2025.10.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Scaphoid non-union remains a challenging clinical condition with the potential to result in long-term functional impairment. Identifying predictive factors for postoperative healing could improve treatment strategies and patient counselling. This study aimed to evaluate the potential impact of specific scaphoid non-union characteristics on healing time and the risk of persistent non-union following surgical intervention.</div></div><div><h3>Material and methods</h3><div>We retrospectively analyzed 100 cases of surgically treated scaphoid non-unions between 2002 and 2020. The presence of scaphoid height difference, defect zone, and lateral intrascaphoid angle (LISA) and coronal intrascaphoidal angle (CISA) was documented. To determine associations with time to union and persistent non-union statistical testing used Mann-Whitney U, Spearman rank correlation, or Fisher’s exact test as appropriate. Multivariate linear regression was performed, and p-values were Bonferroni-corrected.</div></div><div><h3>Results</h3><div>Of the 100 cases, 90 healed uneventfully, while 10 demonstrated persistent non-union at final follow-up. The median healing time was 73 days (interquartile range: 57–111 days). No statistically significant association was found between the assessed characteristics—scaphoid height difference, defect zone, LISA or CISA—and either time to union or persistent non-union.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the four principal radiographic characteristics of scaphoid non-union do not significantly influence postoperative healing. These features may therefore be considered negligible in the prognostic assessment of surgical outcomes, supporting a more streamlined approach to preoperative evaluation.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 24-29"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in robotic assisted microsurgery: Exploring the MUSA robot in reconstructive microsurgical and supermicrosurgical procedures","authors":"Hendrikje Bettens,&nbsp;Raphael Timmerman,&nbsp;Shan Shan Qiu,&nbsp;René van der Hulst,&nbsp;Tom van Mulken","doi":"10.1016/j.jpra.2025.11.033","DOIUrl":"10.1016/j.jpra.2025.11.033","url":null,"abstract":"<div><div>Robotic assistance in microsurgery offers increased precision, tremor elimination, motion scaling, and improved ergonomics. Although robots are widely used in other surgical fields, their integration into reconstructive microsurgery has been limited. The MUSA robot is the first robot specifically designed for microsurgery to address this unmet need. This report presents a comprehensive overview of the clinical indications and experiences with the MUSA2 robot at our center, including lymphatico-venous anastomosis, free flap breast reconstruction, free flaps reconstruction of the lower extremity, digital nerve repair, and finger replantation.</div><div>Robotic assistance has great potential for its use in microsurgery. Challenges such as higher cost and setup times could be addressed by the evolution of the systems. Due to its compatibility with standard instrumentation and short learning curve the MUSA robot has promising initial results. This stimulates further research into robotic assistance as a tool in complex microsurgical procedures.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 386-396"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot study on the functional relevance of single versus double toe transfer in monodactyly: Analysis on functional integration and grasping","authors":"Veronica Fasoli,&nbsp;Chiara Parolo,&nbsp;Elisa Rosanda,&nbsp;Rossella Pagliaro,&nbsp;Silvia Minoia,&nbsp;Francesca Tolosa,&nbsp;Luigi Troisi,&nbsp;Giorgio Eugenio Pajardi","doi":"10.1016/j.jpra.2025.12.021","DOIUrl":"10.1016/j.jpra.2025.12.021","url":null,"abstract":"<div><div>Monodactyly is a rare congenital anomaly of the upper limb, characterized by the presence of an isolated thumb. Although toe-to-hand transfer is a well-established surgical reconstructive procedure, there are currently no universally accepted guidelines clearly defining the optimal number of digits to be transferred. The aim of this pilot study is to evaluate whether performing a double toe transfer offers a significant functional advantage over a single toe transfer. We collected seven cases which were divided into two groups based on the number of digits transferred. All patients underwent the same standardized surgical and rehabilitative protocol. During follow-up, the motor patterns of each patient and the integration of the transferred digits during grasping were systematically evaluated.</div><div>In our series, while double toe transfer has enhanced grasp and function by providing a three-digit pinch, a single transferred toe combined with a structured thumb appeared able to perform most daily activities.</div><div>The second transferred digit has often shown to be stiffer as compared to the first toe transfer, limiting function while increasing donor site morbidity and operative time. Careful preoperative assessment of residual anatomy and spontaneous grasp strategies should guide surgical planning to maximize functional integration and minimize unnecessary morbidity. This study highlights the need for a selective, patient-specific approach in toe-to-hand transfer reconstruction in children affected by monodactyly.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 585-592"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical reconstruction after foot eumycetoma excision: Description of two cases","authors":"Matilde Mariani ,&nbsp;Martin Lhuaire ,&nbsp;Etienne Canoui ,&nbsp;Patrick Knipper ,&nbsp;Ignacio Garrido ,&nbsp;David Biau ,&nbsp;Laurent A. Lantieri ,&nbsp;Victor Pozzo","doi":"10.1016/j.jpra.2025.11.019","DOIUrl":"10.1016/j.jpra.2025.11.019","url":null,"abstract":"","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 561-566"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexor tendon avulsion and PIP joint fracture-dislocation in a 17-year-old football player: A case report","authors":"Summer Aldabbeh ,&nbsp;Taylor Calicchia ,&nbsp;Andrew Esterle","doi":"10.1016/j.jpra.2025.12.015","DOIUrl":"10.1016/j.jpra.2025.12.015","url":null,"abstract":"<div><div>We present a rare case of flexor digitorum superficialis (FDS) avulsion and dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint with an intact flexor digitorum profundus (FDP) in a 17-year-old high school football player. This unusual injury pattern, sustained during a sports collision, required prompt surgical intervention to restore tendon continuity and joint congruity. Early rehabilitation and an aggressive return-to-sport protocol yielded a successful outcome, with full functional recovery. A literature review reveals limited documentation of similar cases, underscoring the clinical importance of early recognition and operative management in athletes.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 638-643"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biodegradable Temporizing Matrix (BTM) resilience to wound infection: A consecutive case series","authors":"Sasha Wilson,&nbsp;Edward Muscat,&nbsp;Olivia Smith,&nbsp;Alex Noakes,&nbsp;Christopher Wearn","doi":"10.1016/j.jpra.2025.07.007","DOIUrl":"10.1016/j.jpra.2025.07.007","url":null,"abstract":"<div><div>PolyNovo® Biodegradable Temporizing Matrix (BTM) has gained favor for reconstructing non-graftable wound beds amid suggestions it is inherently resistant to infection. Evidence is limited to multiple case series and currently the rates of BTM colonization, infection and loss remain unestablished. We report our case series which includes a diverse case-mix of complex wounds successfully reconstructed with BTM, with a novel focus on the rate of infection and related microbiology profile. Our case series included all patients treated with BTM at Southmead Hospital between October 2021 and November 2023. In our cohort, 22 patients had their wounds reconstructed with BTM. Microbiological growth was observed in 76 % of available pre-BTM swabs and subsequently only 14 % (3/22) of all patients experienced clinical infection of BTM. In the case of infection, 66 % (2/3) of patients had successful salvage of BTM. Only one patient (5 %) in the cohort experienced partial BTM loss, with the remainder achieving total wound healing at 3 months. Our study makes a case that microbiological wound swabs prior to BTM application is of limited clinical value. In our experience, salvage techniques can be applied empirically in the case of clinical infection and the vast majority of patients will have successful integration of the BTM.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 95-105"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smiling in the East and the West: Anatomical, cultural and sociological considerations in facial reanimation surgery","authors":"Stefanos Tsallas ,&nbsp;Andres Rodriguez-Lorenzo ,&nbsp;Chieh-Han John Tzou","doi":"10.1016/j.jpra.2025.10.033","DOIUrl":"10.1016/j.jpra.2025.10.033","url":null,"abstract":"<div><div>The importance of the smile as a means of communicative and metacommunicative signal in social engagement has been known and highlighted in studies dating back to the early 19th century. It remains a cornerstone of reconstructive surgeries for the paralyzed face. This paper calls attention to the differences between the Eastern and Western smile. Anatomical, cultural, and sociological peculiarities inform the way these populations smile and the way smiling itself is perceived. Reconstructive surgery of today would benefit from considering these aspects and allowing them to individualize the goals of reanimation procedures.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 111-116"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prepectoral and subpectoral direct-to-implant breast reconstruction yield high cosmetic scores: Surgeon ratings favor prepectoral placement—secondary results from a randomized controlled trial","authors":"Frederik Gulmark Hansen ,&nbsp;Diana Lydia Dyrberg ,&nbsp;Camilla Bille ,&nbsp;Jens Ahm Sørensen ,&nbsp;Jørn Bo Thomsen","doi":"10.1016/j.jpra.2025.10.008","DOIUrl":"10.1016/j.jpra.2025.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Direct-to-implant (DTI) breast reconstruction is increasingly used following mastectomy, with implants placed in a subpectoral or prepectoral plane. While subpectoral placement has been the conventional approach, prepectoral reconstruction is gaining popularity due to reduced risk of breast animation deformity (BAD) and potentially improved patient comfort. However, comparative data on cosmetic outcomes remain limited.</div></div><div><h3>Objectives</h3><div>To compare patient- and surgeon-reported cosmetic outcomes following prepectoral and subpectoral DTI breast reconstruction as a secondary analysis of a randomized controlled trial.</div></div><div><h3>Methods</h3><div>Forty-two patients undergoing post-mastectomy DTI breast reconstruction were randomized to receive either subpectoral or prepectoral implant placement. Cosmetic outcomes were evaluated using a 10-point numeric rating scale (NRS) by both patients and two consultants in plastic surgery at 3 and 12 months postoperatively. Data were analyzed using independent t-test.</div></div><div><h3>Results</h3><div>A total of 60 breasts were reconstructed: 27 subpectoral and 33 prepectoral. At 3 months, patient NRS scores were 8.0 ± 1.9 (subpectoral) vs. 8.5 ± 1.9 (prepectoral) (<em>p</em> = 0.4).At 12 months, scores were 7.8 ± 1.7 and 8.4 ± 1.4, respectively (<em>p</em> = 0.2).Surgeon NRS scores were 8.2 ± 1.1 (subpectoral) vs. 8.8 ± 1.4 (prepectoral) at 3 months (<em>p</em> = 0.1), and 7.5 ± 1.2 vs. 8.7 ± 1.2 at 12 months (<em>p</em> = 0.0004).</div></div><div><h3>Conclusion</h3><div>Cosmetic satisfaction was high in both groups at any given time point. While patient ratings were comparable, surgeons evaluated prepectoral implant placement superior at 12 months. These findings support prepectoral DTI reconstruction as a cosmetically favorable option in eligible patients.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 12-17"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}