JPRAS Open最新文献

{"title":"Fat embolism following fat grafting: A systematic review of reported cases","authors":"Pouria Chaghamirzayi ,&nbsp;Hossein Abdi ,&nbsp;Javad Karimi Rozveh ,&nbsp;Mojtaba Ahmadi Nejad ,&nbsp;Mohammad Azizmanesh","doi":"10.1016/j.jpra.2024.10.012","DOIUrl":"10.1016/j.jpra.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review aims to consolidate and analyze reported cases of fat embolism following fat grafting, focusing on patient demographics, procedural characteristics, clinical features, diagnostic methods, management strategies, and outcomes.</div></div><div><h3>Methods</h3><div>A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted across multiple databases, including PubMed, Google Scholar, Cochrane, Embase, MEDLINE, and Scopus, up to January 31, 2024. Inclusion criteria encompassed case presentations diagnosing fat embolism or fat embolism syndrome post-fat grafting in patients over the age of 18 years. Data were extracted using EndNote® X21.</div></div><div><h3>Results</h3><div>From 1051 identified studies, 71 met inclusion criteria, encompassing 137 patients. The mean patient age was 36.22 years, with 90.5 % being female. Liposuction was the predominant fat harvesting method. Ocular signs were the most common presentation (50.8 %), followed by neurological (42.2 %) and cardiopulmonary (32.0 %) symptoms. Diagnostic methods varied, including imaging and histopathology. Supportive care was the primary management strategy. The overall mortality rate was 34.3 %, with 88.6 % of survivors experiencing permanent sequelae.</div></div><div><h3>Discussion</h3><div>This study acknowledges several limitations in evidence, including heterogeneity, recall bias, language limitations, and potential publication bias due to studies with worse outcomes. Fat embolism following fat grafting, though rare, can lead to significant morbidity and mortality. Early recognition and prompt management are crucial. This review highlights the need for standardized diagnostic and treatment protocols to improve patient outcomes in fat grafting procedures.</div></div><div><h3>Other</h3><div>This study received no external funding and was previously registered with the Prospective International Register of Systematic Reviews (PROSPERO).</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 18-55"},"PeriodicalIF":1.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704809","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":"A cross-sectional study of manually processed petroleum derivatives burns","authors":"Amjad Soltany,&nbsp;Maen Al Aissami","doi":"10.1016/j.jpra.2024.10.011","DOIUrl":"10.1016/j.jpra.2024.10.011","url":null,"abstract":"<div><div>Syrian burn centers are facing challenges dealing with burns caused by manually processed petroleum derivatives during the current war due to the lack of energy storage. We are presenting a cross-sectional study conducted at Al-Mouwasat University Hospital from January 2024 to July 2024 in Syria. Based on our results, this kind of injuries is larger in burned area, can affect multiple body parts, is associated with higher prevalence of inhalation injuries, requires more debridement sessions, is more common among young females; and thus, higher mortality and morbidity rates, compared to other burn injuries. Receiving inappropriate first aid, associated with secondary transfer and late referral was the dominant entity in this kind of burn. On the other hand, this injury can be prevented with appropriate precautions. Although the retrospective descriptive nature of the study which relies on the quality of data collected and the consistency of clinical documentation, this paper is considered one of the leading studies to include this high number of cases in relative medical literature, as so far, medical literature is lacking about this specific injury and no national database is yet established.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 380-383"},"PeriodicalIF":1.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656450","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":"Global perspectives on practices and preferences in autologous free flap breast reconstruction: From flap selection to postoperative care A descriptive quantitative study","authors":"Sanderley J. Bonafastia ,&nbsp;Lennart M. Steenbeek ,&nbsp;Dietmar J.O. Ulrich ,&nbsp;Stefan Hummelink","doi":"10.1016/j.jpra.2024.10.010","DOIUrl":"10.1016/j.jpra.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to evaluate the present-day practices in the preparation, peri-, and postoperative care for patients undergoing autologous free flap breast reconstructions (ABR) worldwide, with the aim of enhancing informed decision-making for plastic surgeons during the planning stages of ABR.</div></div><div><h3>Methods</h3><div>A global survey was conducted among 280 plastic surgeons and 39 plastic and reconstructive surgery societies worldwide, enquiring about flap and donor site selection, surgical actions, perforator imaging, and perioperative care during ABR.</div></div><div><h3>Results</h3><div>Eighty-two responses were received, among which 71% (n=58) were completed questionnaires. The preferred flap of choice was the deep inferior epigastric perforator flap (85%, n=51), with the internal mammary artery as the most commonly used recipient vessel. Preoperative imaging for ABR was typically performed using computed tomography angiography (75%, n=44) and often combined with a handheld Doppler. Handheld Doppler was the most frequently used modality to localize perforator vessels during surgery (33%, n=19), with the majority using either one (47%, n=24) or two (51%, n=26) perforators intraoperatively. These preferences were consistent across all clinic types.</div><div>Postoperatively, flap monitoring was primarily performed by the nursing staff, initially every hour on the first day and at reduced frequencies on subsequent days.</div><div>The most commonly used modality for monitoring flap viability was the handheld Doppler. The average length of hospital stay was 5 days.</div></div><div><h3>Conclusion</h3><div>This study provides valuable insights into the current preparations and peri- and postoperative care in ABR procedures worldwide, aiding in the development of standardized practices and potentially improving patient outcomes.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 169-179"},"PeriodicalIF":1.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932874","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":"Surgical management of a patient with severe and complex maxillofacial injuries caused by a bear mauling in the forest: A case report from Thailand","authors":"Nutthawut Akaranuchat ,&nbsp;Boonyaporn Kotistienkul ,&nbsp;Wanchalerm Chungsiriwattana","doi":"10.1016/j.jpra.2024.10.009","DOIUrl":"10.1016/j.jpra.2024.10.009","url":null,"abstract":"<div><div>A 60-year-old Thai male sustained severe and complex maxillofacial injuries, along with superficial neck and abdominal injuries, from being mauled by a black bear in Thailand. The accident caused massive injury to the face, including the right eye and periorbital soft tissue, right cheek, total nose, total upper lip, partial lower lip, and underlying bone structures. A computed tomography scan showed comminuted pan-facial fractures. Lifesaving procedures were performed at nearby hospitals, and then he was referred to our center one month after the injury. Our initial multi-stage surgical management strategy for treating this patient included debridement, right eyeball enucleation, coverage of the entire defect with anterolateral thigh with vastus lateralis chimeric free flap, and gastrostomy tube insertion to ensure appropriate nutrition. The next phase of treatment involved total nasal reconstruction with the two-stage folded paramedian forehead flap with cadaveric costal cartilage grafts. The outcomes of treatments provided the patient with spontaneous breathing via neonostrils and eating directly through his mouth. This case report demonstrates that satisfactory results can be achieved using a well-planned multi-stage reconstruction strategy.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 344-349"},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656449","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":"Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: A two years retrospective analysis","authors":"Gerrit Freund ,&nbsp;Benedikt Schäfer,&nbsp;Justus P. Beier,&nbsp;Anja M. Boos","doi":"10.1016/j.jpra.2024.07.013","DOIUrl":"10.1016/j.jpra.2024.07.013","url":null,"abstract":"<div><div>Over the past few years, treatment of burn injuries has evolved beyond primary surgical therapy with the development of enzymatic debridement and new types of skin replacement materials by providing complex personalized therapy concepts aimed at preserving and replacing the dermal layer of the skin.</div><div>The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and evaluate the outcomes of individualized combined treatment of mixed depth burn wounds with enzymatic debridement and decellularized fish skin.</div><div>A total of 18 patients with a mean age of 34.8 years and mean follow-up of 447.6 days were included. The mean total burn surface area was 12.3%. All patients received enzymatic debridement and an average area of 247.2 cm² of decellularized fish skin. Days until complete epithelization were 49.4 ± 25.79 days. No patient developed scar contracture or keloid. The Patient and Observer Scar Assessment Scale (POSAS) observer scale showed an overall impression average of 2.2 ± 0.83. The POSAS patient scale showed an overall impression average 2 ± 0.7. The Vancouver Scar Scale showed an average score of 1.89 ± 1.45. In conclusion, combined treatment using enzymatic debridement and decellularized fish skin, polylactide membrane, or split skin grafts allows for a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result in terms of the overall outcome of the developed scar tissue and could lead to a reduction in the area that requires autologous transplantation.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 79-91"},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757409","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":"Postmastectomy Breast Reconstruction in Irradiated Patients: A 12-year follow-up of Deep Inferior Epigastric Perforator and Latissimus Dorsi Flap Outcomes","authors":"Åsa Edsander-Nord ,&nbsp;Armin Assareh ,&nbsp;Martin Halle ,&nbsp;Ann-Charlott Docherty Skogh","doi":"10.1016/j.jpra.2024.10.008","DOIUrl":"10.1016/j.jpra.2024.10.008","url":null,"abstract":"<div><div>The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who underwent postmastectomy breast reconstruction with deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD)-flaps with implant.</div><div>The follow-up involved 67% of the patients from the original cohort (17 DIEP and 13 LD). Patient-reported outcome measures (PROMS) were measured using the BREAST-Q, SF-36, a satisfaction form, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Aesthetics were evaluated by a board of independent plastic surgeons.</div><div>The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. The BREAST-Q and satisfaction questionnaires showed no group difference. SF-36 showed no group difference but had significantly higher values in both groups compared to the general population with regard to the physical role limitations (p=0.034 and p=0.004, respectively). The DASH scores showed minimal shoulder function impact in the LD group.</div><div>Aesthetic evaluations revealed a discrepancy between the opinions of the patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0.012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, the patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural aging process associated with autologous reconstruction. This underscores the importance of long term follow-up studies.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 361-369"},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656558","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":"An Optimal Scalp Rotation Flap Design: Mathematical and Bio-Mechanical Analysis","authors":"Paul Machado ,&nbsp;Terry Le ,&nbsp;Warren M. Rozen ,&nbsp;David J. Hunter-Smith ,&nbsp;Vachara Niumsawatt","doi":"10.1016/j.jpra.2024.10.007","DOIUrl":"10.1016/j.jpra.2024.10.007","url":null,"abstract":"<div><div>The design and implementation of successful rotational flaps of the scalp remains a complex process. There are several described techniques, all of which are based on a two-dimension surface, absent consideration of the convexity, and thereby three-dimensional nature of the scalp. This has contributed to flaps that are either too small or unnecessarily large in a bid to compensate. Mathematical analysis using trigonometric and algebraic formulas was used to derive the relationship between the defect, triangulation, the contour of the scalp, the radius of the arc of rotation for the flap, and scalp skin tension. Polyurethane models were used to test the applicability of the resultant formula, and a consecutive clinical case series is presented. Rotation flap dimensions were calculated using an apex angle of 30° depicted as a two-dimensional construct. The contour of the defect was then measured as the depth of depression with radius of the rotation flap calculated based on the changes in flap surface area across the defect. Finite element analysis was used to measure redistribution of tension along the flap reconstructing the defect, and the efficacy of the approach was confirmed in the consecutive clinical series. This study provides a reliable flap design based on mathematical analysis, with evidence-based application to the clinical setting.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 251-264"},"PeriodicalIF":1.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984926","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":"From Novel Facial Measurements to Facial Implantology: A Systematic Review","authors":"Helena Baecher ,&nbsp;Alexandra Scheiflinger ,&nbsp;Katya Remy ,&nbsp;Niklas Straub ,&nbsp;Bhagvat Maheta ,&nbsp;Khalil Sherwani ,&nbsp;Can Deniz ,&nbsp;Samuel Knoedler ,&nbsp;Ali-Farid Safi ,&nbsp;Martin Kauke-Navarro ,&nbsp;Max Heiland ,&nbsp;Leonard Knoedler","doi":"10.1016/j.jpra.2024.10.005","DOIUrl":"10.1016/j.jpra.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Facial implants have emerged as pivotal tools for both reconstructive and aesthetic skull bone augmentation. Contemporary manufacturing techniques, such as computer-aided design and manufacturing (CAD-CAM) systems, have revolutionized facial implants production, providing the advantages of high-level individualization. However, the absence of standardized facial measurements complicates the ability to accurately compare outcomes across various techniques. This systematic review investigates the strengths and limitations of various facial measurements employed in facial implants, with a particular focus on their impact on aesthetic outcomes and potential complications.</div></div><div><h3>Methods</h3><div>We identified 13 studies in our comprehensive search across PubMed/MEDLINE, Web of Science, EMBASE, and CENTRAL databases.</div></div><div><h3>Results</h3><div>In total, 620 patients were included. The majority of the chosen studies focused on aesthetic purposes (69%). Primarily, mandibular (46%) or nasal regions (23%) were investigated, with porous polyethylene (31%), silicone (23%), and polyetheretherketone (23%) being the most utilized materials. Despite considerable heterogeneity in measurement approaches, including variations in reference points and angles, complications such as surgical site infections and nerve-related injuries were reported in the included studies.</div></div><div><h3>Conclusion</h3><div>Our review highlights the importance of standardized facial analysis for optimal implant planning. Future research should prioritize the development of uniform measurement concepts tailored to diverse implant applications to enhance outcomes and patient satisfaction in facial implantation.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 1-17"},"PeriodicalIF":1.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704201","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":"Semiautomatic Quantitative Assessment of DIEP Flap Volume and Thickness for Breast Reconstruction using CTA Data and Implications in Postoperative Complications","authors":"María A. Cerón Hurtado ,&nbsp;Sergi Barrantes ,&nbsp;Antonio Sánchez Egea ,&nbsp;Farners Armengol Siñol ,&nbsp;Hernán González Rojas ,&nbsp;Anna Padullés-Escarré ,&nbsp;Jose A Jerez-Gonzalez ,&nbsp;Anna López Ojeda ,&nbsp;Joan Fontdevila Font","doi":"10.1016/j.jpra.2024.10.003","DOIUrl":"10.1016/j.jpra.2024.10.003","url":null,"abstract":"<div><div>Accurately assessing flap volume and thickness is a crucial aspect of breast reconstruction using the deep inferior epigastric perforator (DIEP) flap, especially in challenging cases such as thin or large-breasted women or bilateral reconstruction. To address this, we present an innovative image processing tool utilizing computed tomography angiography (CTA) to measure DIEP flap volume and thickness. Our approach incorporates an elliptical equation validated on DIEP reconstruction patients. Preoperative abdominal CTA images were obtained from 70 patients who underwent DIEP flap breast reconstruction at Hospital Universitari de Bellvitge from 2017 to 2021. The image processing tool was employed for preoperative quantification, utilizing elliptical approximations, to determine the volume to be harvested and assess the central thickness of the flap. Subsequently, a non-parametric statistical retrospective analysis was conducted to examine these parameters in relation to immediate complications. The mean maximum recruitable volume (MRV) was 1017.15 ± 325.51 cm³, with a mean thickness of 3.65 ± 1.14 cm. No significant correlation was found between postoperative complications and MRV or thickness values. The processing tool offers a reliable solution for accurately measuring the volume and thickness of the DIEP flap from CTA images, aiding surgeons in breast reconstruction decision-making. This innovative approach enhances surgical planning by addressing quantitative values of thickness and volume of the DIEP flap, which is critical for accurate flap assessment.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 370-379"},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656559","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":"Salvage of anterolateral thigh (ALT) flap with indocyanine green assessment of a flap pedicle and subsequent perforator-to-perforator anastomosis","authors":"Petko Shtarbanov ,&nbsp;Nianhe Luo ,&nbsp;Ahmed Yassin ,&nbsp;Dariush Nikkhah","doi":"10.1016/j.jpra.2024.10.001","DOIUrl":"10.1016/j.jpra.2024.10.001","url":null,"abstract":"<div><div>Indocyanine green (ICG) fluorescence angiography has emerged as an intraoperative method to accurately assess real-time tissue vascularity, perfusion and anastomotic patency in flap surgery. We illustrate a complex case of elbow reconstruction in an elderly patient with a free anterolateral thigh flap, which relied on intraoperative ICG to evaluate the flap pedicle and map the site of arterial occlusion. Supermicrosurgical instrumentation was employed to perform complex perforator-to-perforator anastomosis following resection of the vascular site of the lesion. These unique applications in a patient of known surgical risk enabled immediate flap salvage, and after 6 months postoperatively, the flap remained healthy with adequate wound healing.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 329-333"},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573052","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}