JPRAS Open最新文献

{"title":"Reconstruction of an extensive gouty tophus ulceration at the wrist using a dermal matrix and autologous skin graft: A case report","authors":"Tian-Hao Zhang ,&nbsp;Zhi-Jiang Wang ,&nbsp;Jian-Hong Huang ,&nbsp;Jian Lin","doi":"10.1016/j.jpra.2025.12.027","DOIUrl":"10.1016/j.jpra.2025.12.027","url":null,"abstract":"<div><h3>Background</h3><div>Ulcerated tophaceous gout of the wrist poses a major reconstructive challenge, owing to deep tissue infiltration by urate crystals, high infection risk, and the functional demands of the joint. Although local or free flaps are frequently used, these techniques are often associated with significant donor-site morbidity, technical complexity, and prolonged immobilization that may contribute to joint stiffness. This report presents a staged approach using a dermal regeneration matrix followed by autologous skin grafting, offering a less invasive and functionally advantageous alternative for reconstructing such complex defects.</div></div><div><h3>Case Presentation</h3><div>A 60-year-old male with a 25-year history of poorly controlled, treatment-refractory tophaceous gout presented with a 7-day history of a spontaneously ruptured ulcer on the dorsoradial aspect of the wrist, measuring 8 × 5 cm. The wound exhibited three hallmark features:</div><div>1. Tendon exposure with localized tendon necrosis;</div><div>2. Active tophaceous discharge, confirmed by microscopy to contain monosodium urate (MSU) crystals exhibiting needle-shaped morphology and negative birefringence;</div><div>3. Deep tissue invasion with intraoperative evidence of radiocarpal joint involvement.</div></div><div><h3>Metabolic Parameters</h3><div>Serum uric acid levels were 630 μmol/L preoperatively (during titration of febuxostat from 40 mg to 20 mg/day) and decreased to 500 ± 15 μmol/L at 24-month follow-up.</div></div><div><h3>Aesthetic Outcomes</h3><div>The Patient and Observer Scar Assessment Scale (POSAS) patient score was 2/10 (one representing normal skin).</div></div><div><h3>Conclusion</h3><div>The staged reconstruction protocol, which combines dermal substitution with autologous skin grafting, delivers durable soft tissue coverage and functional preservation in complex wrist gout ulcerations. This approach represents a less morbid and technically feasible alternative to traditional flap surgery, particularly in high-risk patients with multiple comorbidities. Excellent mid-term outcomes were observed, including 24-month recurrence-free survival.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 706-710"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077153","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":"Outcome of HARMONIC Shears for lower limb free flap reconstruction in trauma: A retrospective cohort study","authors":"Mai Nishijo ,&nbsp;Rawan Jaibaji ,&nbsp;Calver Pang ,&nbsp;Charles Yuen Yung Loh","doi":"10.1016/j.jpra.2025.12.024","DOIUrl":"10.1016/j.jpra.2025.12.024","url":null,"abstract":"<div><h3>Background</h3><div>The HARMONIC Shears is an ultrasonic surgical device enabling precise tissue dissection with simultaneous hemostasis. Its application in lower limb free flap reconstruction following trauma is underexplored.</div></div><div><h3>Methods</h3><div>A retrospective cohort study compared nine patients undergoing lower limb free flap reconstruction with HARMONIC FOCUS™+ Shears to nine patients using conventional dissection (diathermy and LIGACLIP clips). Patients were matched by flap type and concomitant orthopedic procedures. Primary outcome was total operative time. Secondary outcomes included flap survival, postoperative complications, length of hospital stay, and a comprehensive cost analysis encompassing theater time, consumables, and inpatient stay.</div></div><div><h3>Results</h3><div>HARMONIC Shears significantly reduced operative time in cases without concomitant orthopedic procedures (262.8 ± 46.3 vs 364.2 ± 53.9 min; <em>p</em> = 0.012). Across all cases, mean operative time was shorter in the HARMONIC Shears group (322.0 ± 81.1 vs 380.4 ± 53.5 min; <em>p</em> = 0.09). Flap survival was higher with HARMONIC Shears, with higher reoperation rates in the conventional group reflecting flap failures; however, this difference was not statistically significant. Specific postoperative complications rates, including infection, wound dehiscence, and donor site morbidity, were slightly higher in the HARMONIC Shears group, but all differences were not statistically significant. Mean hospital stay was 8.5 days shorter in the HARMONIC Shears group (<em>p</em> = 0.31). Cost analysis revealed theater and inpatient savings of up to £8699 per case with the HARMONIC Shears after accounting for device costs.</div></div><div><h3>Conclusions</h3><div>HARMONIC Shears may enhance operative efficiency and reduce healthcare costs in lower limb free flap reconstruction without compromising clinical outcomes. However, findings should be interpreted cautiously given the small sample size and limited statistical power. Larger prospective studies are warranted to confirm these findings.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 697-705"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077090","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":"Investigation of the therapeutic effect of orbital septum transfer in the reconstruction of severe eyelid defects","authors":"Jing Zhou ,&nbsp;Jun Chen ,&nbsp;Min Zhao ,&nbsp;Xiao Song ,&nbsp;Yuhong Wang","doi":"10.1016/j.jpra.2025.12.018","DOIUrl":"10.1016/j.jpra.2025.12.018","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the efficacy of skin flap and orbital septum transfer combined with allogeneic sclera transplantation for the reconstruction of full-thickness eyelid defects after malignant eyelid tumor resection.</div></div><div><h3>Methods</h3><div>Twenty one patients from our hospital who were diagnosed with malignant tumors of the eyelid through pathological examination and had severe eyelid defects after extensive tumor resection, including eleven patients with eyelid basal cell carcinoma, seven patients with sebaceous gland carcinoma and three patients with squamous cell carcinoma. The tumors were all located on the lower eyelid. The anterior layer was reconstructed using upper eyelid rotational skin flap transfer, while the posterior layer was reconstructed using autologous orbital septum transfer and allogeneic sclera transplantation. After surgery, eyelid closure, eyelid and palpebral margin morphology, transplanted skin condition, local foreign body sensation, and ocular surface condition were observed.</div></div><div><h3>Results</h3><div>All patients underwent controlled mass resection using specimen-labelled frozen sections during surgery. After that, severe eyelid defects were observed, with one patient undergoing secondary eyelid reconstruction and the remaining patients undergoing primary eyelid reconstruction. After 6-month follow-up, all the patients had satisfactory eyelid closure, satisfactory eyelid and palpebral margin morphology, no local discomfort caused by foreign bodies, smooth orbital septum, good corneal condition on the ocular surface, and no tumor recurrence.</div></div><div><h3>Conclusion</h3><div>In terms of severe eyelid defects, the use of upper eyelid rotational skin flap transfer to reconstruct the anterior layer, autologous orbital septum transfer, and allogeneic sclera transplantation to reconstruct the posterior layer is safe, effective, and reproducible.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 514-521"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924716","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":"Neurolymphatic clearance in neurodegenerative disease: Emerging mechanisms and potential translational strategies","authors":"Adriano Fabi ,&nbsp;André S. Alves ,&nbsp;Albert Neutzner ,&nbsp;Stephan Frank ,&nbsp;Ana Lariu ,&nbsp;Laurent Muller ,&nbsp;Tarek Ismail ,&nbsp;Dimitrios G. Gkotsoulias ,&nbsp;Raphael Guzman ,&nbsp;Dirk J. Schaefer ,&nbsp;Nir Grossman ,&nbsp;Marc Aurel Busche ,&nbsp;Elisabeth A. Kappos","doi":"10.1016/j.jpra.2025.12.013","DOIUrl":"10.1016/j.jpra.2025.12.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurolymphatic dysfunction has been linked to cognitive decline and implicated in the pathogenesis of neurodegenerative disorders such as Alzheimer’s Disease (AD) and Parkinson’s Disease (PD). Despite its growing recognition, the potential role of pharmacological or surgical neurolymphatic modulation remains poorly understood.</div></div><div><h3>Objectives</h3><div>This review summarizes current evidence on the neurolymphatic system’s anatomy, physiology and its involvement in neurodegenerative diseases. It also examines emerging pharmacological and lymphatic reconstructive techniques.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, yielding 187 studies related to the neurolymphatic system. Studies were screened for the following topics: (1) Anatomy and physiology of the neurolymphatic system, (2) The association between neurolymphatic dysfunction and neurodegenerative diseases, (3) Pharmacological and (4) Microsurgical neurolymphatic modulation.</div></div><div><h3>Results</h3><div>Current evidence suggests that the neurolymphatic system facilitates drainage of interstitial and cerebrospinal fluid to the deep cervical lymph nodes. Preclinical models suggest that enhancing their clearance may promote the clearance of neurotoxic proteins and potentially improve cognitive function.</div></div><div><h3>Conclusions</h3><div>Scientific evidence on neurolymphatic modulation in neurodegenerative diseases is scarce. Both pharmacological and microsurgical modulatory techniques remain experimental approaches for neurodegenerative diseases, with a significant potential to improve patients’ quality of life. However, further research is warranted to establish their safety, feasibility, and efficacy. The current knowledge gaps underscore the need for a detailed mapping of the neurolymphatic pathways, preclinical evaluation, and translational interdisciplinary trials.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 438-449"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883770","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":"Comparison of methods for inframammary fold fixation of deep inferior epigastric perforator flap breast reconstruction","authors":"Tomohiro Kojimahara ,&nbsp;Hiroki Mori ,&nbsp;Sayuri Kato ,&nbsp;Kyoichi Murakami ,&nbsp;Nanami Hamasaki ,&nbsp;Koji Kanayama ,&nbsp;Noriko Uemura ,&nbsp;Kentaro Tanaka","doi":"10.1016/j.jpra.2026.01.020","DOIUrl":"10.1016/j.jpra.2026.01.020","url":null,"abstract":"<div><h3>Background</h3><div>Various methods for inframammary fold (IMF) fixation in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction have been reported. This quantitative study focused on the comparison of IMF fixation results between immediate one-stage (internal fixation), delayed one-stage (de-epithelialized method), and two-stage (capsule fixation) reconstruction.</div></div><div><h3>Methods</h3><div>A retrospective study of 34 patients who underwent unilateral DIEP flap reconstruction was conducted. The IMF height, grouped by reconstruction methods, was measured from the standardized clinical photographs &gt;6 months after the DIEP flap reconstruction (post-DIEP) and &gt;6 months after the flap revision surgery (final), and compared with the healthy side.</div></div><div><h3>Results</h3><div>In the order of immediate one-stage, delayed one-stage, and two-stage reconstruction, respectively, the average (± standard deviation) post-DIEP IMF heights were −1.60 ± 0.65 cm, −0.19 ± 1.16 cm, and −1.40 ± 1.11 cm, and the average final IMF heights were −1.20 ± 0.44 cm, −0.19 ± 0.52 cm, and −0.68 ± 0.98 cm.</div></div><div><h3>Conclusion</h3><div>After DIEP flap breast reconstruction, the IMF of the reconstructed side tends to be lower than the healthy side. The de-epithelialized method used in delayed one-stage reconstruction showed relatively good IMF fixation after DIEP flap reconstruction compared with other reconstruction methods. By performing additional IMF procedures during flap revision surgery, the average IMF height ranged from −1.2 to −0.19 cm compared with the healthy side.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 801-811"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187651","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":"Cross face nerve grafting for reinnervation of nasal and tongue mucosa following trigeminal nerve injury","authors":"Jennifer Greenhowe ,&nbsp;Adi Friedman ,&nbsp;Jocelyne Copeland ,&nbsp;Ronald M Zuker ,&nbsp;Gregory H Borschel","doi":"10.1016/j.jpra.2026.01.010","DOIUrl":"10.1016/j.jpra.2026.01.010","url":null,"abstract":"<div><div>Central injury to the trigeminal pathways can cause debilitating facial anesthesia, mucosal anesthesia, taste alteration and neurotrophic keratopathy, leading patients and physicians to seek treatments for these deficits. A patient presented with complete left hemifacial anesthesia and recurrent epistaxis following resection of a left posterior fossa astrocytoma. She subsequently was treated with cross-face nerve grafting using input from the contralateral unaffected trigeminal nerve branches to provide sensation to the hemitongue, nasal mucosa, cornea, and the V2 and V3 dermatomes. WEST facial set Semmes-Weinstein Monofilament testing was performed pre-operatively and at 4, 13, 18 and 24 months post-operatively, along with subjective light-touch evaluation of the nasal septum and tongue. By 3 months the patient reported subjective early signs of sensation to the tongue, teeth, buccal mucosa, and cornea but no changes in cutaneous sensation. Cutaneous sensation was returning by her 5-month post-operative review, with no subjective or objectively measurable deficit in any contralateral donor nerve distributions. Her cutaneous and mucosal sensation improved postoperatively. The cycle of recurrent epistaxis was halted. Our findings shows that deficits in hemitongue and nasal mucosal afferent innervation may be reconstructed using cross-face nerve grafts. Such procedures may be combined to address multiple deficits simultaneously.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 812-816"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187807","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":"Do not neglect jaw swellings, clinical and radiological view","authors":"Zilefac Brian Ngokwe,&nbsp;Atanwo Nita Lise Dongmo","doi":"10.1016/j.jpra.2025.12.010","DOIUrl":"10.1016/j.jpra.2025.12.010","url":null,"abstract":"","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 609-612"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976295","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 replantation of severely crushed and contaminated amputated limbs in children: Case reports and surgical insights","authors":"Man Duc Minh Phan ,&nbsp;Phi Duong Nguyen","doi":"10.1016/j.jpra.2025.12.031","DOIUrl":"10.1016/j.jpra.2025.12.031","url":null,"abstract":"<div><div>Severely crushed and contaminated pediatric amputations present unique challenges for limb salvage, especially when critical structures are damaged. We report two pediatric cases—one hand and one foot amputation—successfully replanted using meticulous microsurgical techniques. A key component of our approach was microsurgical debridement under high magnification, which enabled removal of deeply embedded contaminants without sacrificing additional tissue. Both patients achieved limb survival and functional recovery after long-term follow-up. Detailed sensory outcomes, range of motion, skin coverage management, postoperative microbiological findings, and antibiotic regimens are presented. These cases underscore the importance of precise debridement, early revascularization, and comprehensive postoperative care in pediatric contaminated crush amputations.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 662-668"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037066","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":"Poly‑D,L‑lactic acid (PDLLA) scalp microinjection protocol with optional light microneedling priming for non‑scarring alopecia: A prospective pilot case series","authors":"Olena Sydorchuk ,&nbsp;Jino Kim ,&nbsp;Jong Keun Song ,&nbsp;Nilesh H. Pawar ,&nbsp;Isabella Rosellini ,&nbsp;Han Earl Lee ,&nbsp;Massimo Vitale ,&nbsp;Kyu-Ho Yi","doi":"10.1016/j.jpra.2026.01.030","DOIUrl":"10.1016/j.jpra.2026.01.030","url":null,"abstract":"<div><h3>Background</h3><div>PDLLA demonstrates angiogenic and regenerative properties that may support hair regrowth by enhancing perifollicular perfusion. Objective: To evaluate clinical improvement after PDLLA scalp microinjection in 20 patients using standardized photography and Global Aesthetic Improvement Scale (GAIS) rated by two independent physicians.</div></div><div><h3>Methods</h3><div>Twenty adults with non scarring alopecia received PDLLA scalp microinjections at baseline and week 4 (optional booster at week 8). Optional light microneedling priming (0.5–0.8 mm) was performed immediately before PDLLA injection in 14/20 patients to facilitate distribution. Primary endpoint was physician rated GAIS at week 12; secondary endpoints included patient GAIS and safety. Images were acquired with fixed camera to scalp distance and lighting.</div></div><div><h3>Results</h3><div>Physician GAIS improved in 90% of patients at week 12 (mean ± SD 3.3 ± 0.6) and was maintained at week 24 (3.1 ± 0.7). Patient reported GAIS was 3.2 ± 0.7 at week 12. No serious adverse events occurred.</div></div><div><h3>Conclusions</h3><div>In this pilot uncontrolled case series, PDLLA scalp microinjections were associated with physician‑rated GAIS improvement over 12–24 weeks with favorable short‑term tolerability. Given the subjective endpoint, the absence of a comparator arm, and optional microneedling priming in a subset of patients, the findings are preliminary and require confirmation in controlled studies with objective trichologic measurements and longer follow‑up.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 914-923"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277258","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":"Mastectomy in transgender patients: The experience of a Portuguese reference center","authors":"Inês Catalão,&nbsp;José M. Azevedo,&nbsp;Miguel Sítima,&nbsp;Gonçalo Tomé,&nbsp;Sara Ramos","doi":"10.1016/j.jpra.2026.01.044","DOIUrl":"10.1016/j.jpra.2026.01.044","url":null,"abstract":"<div><div>Gender-affirming mastectomy represents a fundamental procedure in the transition process for transgender patients, substantially contributing to psychosocial well-being. This study presents the 13-year experience of the only reference center in Portugal and aims to analyze surgical techniques, outcomes, complications and patient-reported satisfaction following chest wall masculinization.</div><div>A retrospective review was conducted of all trans men who underwent gender-affirming mastectomy between October 2011 and December 2024. Surgical techniques were selected based on breast size, ptosis and skin elasticity. Demographics, operative details, complications, and revision procedures were recorded, and postoperative satisfaction was assessed.</div><div>A total of 87 patients underwent chest wall masculinization surgeries, including 174 mastectomies. Inframammary mastectomies with nipple-areolar complex grafts were performed in 55%, concentric periareolar in 34%, and hemiperiareolar in 9.2% of cases. Mean body mass index was higher in the inframammary group (25.8 vs. 22.8 kg/m²; <em>p</em> &lt; 0.001). The overall complication rate was low. Hematoma occurred in 13%, hypertrophic scarring in 11% (significantly associated with inframammary technique; <em>p</em> &lt; 0.05), and no infections were recorded. Secondary revision surgery was required in 8.0% of patients. Among survey respondents (47%), the mean satisfaction score was 8.5/10, with no reports of regret.</div><div>Gender-affirming mastectomy is a safe and effective procedure that provides significant aesthetic and psychosocial outcomes. Individualized surgical technique selection based on anatomical features yields high patient satisfaction and low complication rates.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 924-932"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277302","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}