BMC Surgery最新文献

{"title":"Combination of age-adjusted d-dimer, platelet distribution width and other factors predict preoperative deep venous thrombosis in elderly patients with femoral neck fracture.","authors":"Yunsong Li, Pengkai Cao, Tianyi Zhu, Yaqi Wang, Fengkai Wang, Liang Li, Xiangdong Liu, Yanrong Zhang","doi":"10.1186/s12893-024-02724-5","DOIUrl":"10.1186/s12893-024-02724-5","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective cohort study aimed to identify factors associated with preoperative deep venous thrombosis (DVT) in elderly patients with femoral neck fractures, and to investigate whether combining these factors could improve the ability to predict DVT.</p><p><strong>Method: </strong>Medical records and laboratory test results were reviewed patients presenting with a femoral neck fracture and receiving routine chemoprophylaxis for DVT between January 2020 and December 2023 in a tertiary referral, university-affiliated hospital. Preoperative DVT was confirmed by Doppler ultrasound or CT venography. Demographic, injury, comorbidity, and laboratory variables were analyzed using univariate and multivariate approaches. The performance of combined predictive factors was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Among the 499 patients included, 47 (9.4%) were diagnosed with a preoperative DVT. In the univariate analysis, five variables were found to be statistically significant, including alcohol consumption (P = 0.017), history of renal disease (P < 0.001), elevated D-dimer level (both traditional and age-adjusted cut-off used) (P = 0.007 or < 0.003), increased platelet distribution width (PDW) (P < 0.001) and reduced albumin in continuous or categorical variable (P = 0.027, P = 0.002). Multivariate analysis confirmed all except alcohol consumption as independent predictors (all P < 0.05). ROC curve analysis showed that combining these four significant variables with age improved the ability to predict preoperative DVT, with an area under the curve of 0.749 (95% CI: 0.676-0.822, P < 0.001), sensitivity of 0.617, and specificity of 0.757.</p><p><strong>Conclusion: </strong>This study identified several factors associated with preoperative DVT, and combining them demonstrated improved performance in predicting DVT, which can facilitate risk assessment, stratification and improved management in clinical practice.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"426"},"PeriodicalIF":1.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for perioperative hypothermia management: advances in warming techniques and clinical implications: a narrative review.","authors":"Nan Ji, Jiangtao Wang, Xiaohui Li, Yi Shang","doi":"10.1186/s12893-024-02729-0","DOIUrl":"10.1186/s12893-024-02729-0","url":null,"abstract":"<p><p>Perioperative hypothermia is a frequent clinical complication resulting from the cold environment of the operating room and prolonged skin exposure, leading to adverse outcomes and increased healthcare burdens. To address this issue, this narrative review discusses in detail the currently common warming strategies for perioperative hypothermia .Forced air warming (FAW) systems are widely recognized as the most effective intervention for maintaining core body temperature. Additionally, alternative technologies, such as circulating-water mattresses, carbon-fiber resistive heating systems, self-regulated heated air garments, self-heating blankets, and chemical heat packs, offer diverse advantages and disadvantages. Passive warming methods, including thermal reflective blankets and cotton blankets, provide a cost-effective solution, albeit with reduced efficacy compared to active warming measures. Recent advancements have focused on improving both active and passive warming approaches to balance effectiveness and cost-efficiency. While FAW remains the gold standard, other systems offer specific benefits, such as improved portability and reduced costs, making them suitable for use in diverse clinical scenarios. Effective perioperative temperature management reduces hypothermia-related complications, decreases healthcare expenditures, and provides substantial social and organizational benefits. Thus, selecting the most appropriate warming intervention in clinical practice requires a tailored approach, considering both patient-specific needs and resource availability.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"425"},"PeriodicalIF":1.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative risk factors for osteoporosis after radical gastrectomy for gastric cancer.","authors":"Hyun-Jae Lee, Hye Seong Ahn, Dong-Seok Han","doi":"10.1186/s12893-024-02717-4","DOIUrl":"10.1186/s12893-024-02717-4","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis, a frequent complication of gastrectomy, increases with age, and the average age of gastric cancer patients continues to rise. This study aims to analyze perioperative factors of osteoporosis after radical gastrectomy.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included patients who underwent dual-energy-X-ray absorptiometry after gastrectomy due to gastric cancer between 2016 and 2019 at Seoul Boramae Medical Center. Data were analyzed from before surgery to 12 months after surgery. Statistical analyses identified osteoporosis risk factors among perioperative factors.</p><p><strong>Results: </strong>Among 189 patients, osteoporosis was diagnosed in 72 patients and peaked at 36 months postoperatively (46.3%; 24 out of 54) with the lowest mean T score of -3.34 although Ca and vitamin D supplements were prescribed to 157 patients (83.1%) on average 32.4 months postoperatively. In multivariate analysis, age (P = 0.002; Adjusted OR: 1.059, 95% CI: 1.020-1.098), body weight (P = 0.009; Adjusted OR: 0.950, 95% CI: 0.914-0.987), sex (P = 0.021; Adjusted OR: 2.322, 95% CI: 1.138-4.739), and serum ALP (P = 0.009; Adjusted OR: 1.023, 95% CI: 1.006-1.040) were significant preoperatively. Additionally, age (P = 0.005; Adjusted OR: 1.067, 95% CI: 1.020-1.116), serum Ca (P = 0.046; Adjusted OR: 0.357, 95% CI: 0.130-0.980), Cr (P = 0.003; Adjusted OR: 0.021, 95% CI: 0.002-0.268), and ALP (P = 0.014; Adjusted OR: 1.017, 95% CI: 1.003-1.030) were observed significantly at 12 months postoperatively.</p><p><strong>Conclusions: </strong>38.1% of patients were diagnosed with osteoporosis after radical gastrectomy, despite Ca and vitamin D supplements. Age, body weight, sex, serum Ca, Cr, and ALP correlated with osteoporosis perioperatively.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"420"},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of supplementary parenteral nutrition with different energy intakes on clinical outcomes of patients after gastric cancer surgery.","authors":"Sida Sun, Wenxing Sun, Wenhui Xie, Fuya Zhao, Xianzhong Guo, Junfeng Zhou, Qingliang He, Hanfeng Zhou","doi":"10.1186/s12893-024-02734-3","DOIUrl":"10.1186/s12893-024-02734-3","url":null,"abstract":"<p><strong>Background: </strong>To investigate the effect of postoperative supplementary parenteral nutrition (SPN) containing varying energy intake levels during the early postoperative period on the clinical outcomes of patients diagnosed with gastric cancer.</p><p><strong>Methods: </strong>Data from 237 patients, who were diagnosed with gastric cancer between January 2016 and June 2022, were retrospectively analyzed. Patients were divided into 2 groups based on mean daily SPN energy intake: low (L-SPN; < 20 kcal/kg/day); and high (H-SPN; ≥ 20 kcal/kg/day). Data regarding gender, age, body mass index, preoperative Nutrition Risk Screening 2002 (NRS 2002) score, American Society of Anesthesiologists Physical Status classification system, age-adjusted Charlson Comorbidity Index, diabetes, hypertension, chronic lung disease, and the Tumor-Node-Metastasis (TNM [Eighth edition]) classification were collected for propensity score matching (PSM). Postoperative indicators were monitored. A power analysis was performed during the design phase of this study to ensure that statistical power exceeded 80% to reliably detect differences between the 2 groups.</p><p><strong>Results: </strong>After PSM, data from 128 patients were analyzed (H-SPN, n = 64; L-SPN, n = 64). The H-SPN group experienced shorter postoperative hospital stay (8.11 ± 6.00 days vs. 10.38 ± 7.73 days; P = 0.045) and a lower number of infectious complications (36 [56.3%] vs. 60 [93.8%]; P < 0.001), particularly pulmonary infections, compared with the L-SPN group. Additionally, no increase in hospitalization costs or non-infectious complications occurred in the H-SPN group. Subgroup analysis revealed that H-SPN significantly reduced the incidence of infectious complications among those < 65 years of age (hazard ratio [HR] [95% confidence interval (CI) 0.240 0.069-0.829]; P = 0.024), NRS 2002 score ≥ 3 (HR 0.417 [95% CI 0.156-0.823]; P = 0.028), age-adjusted Charlson Complexity Index < 2 (HR 0.106 [95% CI 0.013-0.835]; P = 0.033), and TNM stage III (HR 0.504 [95% CI 0.224-0.921]; P = 0.046).</p><p><strong>Conclusions: </strong>H-SPN effectively reduced postoperative infectious complications and the length of hospital stay, suggesting that early postoperative H-SPN may be an advantageous nutritional support strategy for patients diagnosed with gastric cancer.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"424"},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the timing of drainage removal: a comprehensive analysis of different drainage removal criteria in patients undergoing short-level lumbar fusion surgery.","authors":"Peng Cui, Di Han, Xiao-Long Chen, Peng Wang, Shi-Bao Lu","doi":"10.1186/s12893-024-02726-3","DOIUrl":"10.1186/s12893-024-02726-3","url":null,"abstract":"<p><strong>Objective: </strong>To specifically evaluate the safety and benefit of different drainage removal criteria (50 ml and 100 ml per 24 h) in patients undergoing short-level lumbar fusion surgery.</p><p><strong>Methods: </strong>Patients with degenerative lumbar diseases who underwent short level lumbar fusion with instrumentation between January 2021 and January 2023 were retrospectively recruited in the study. Based on the different criteria for drainage removal, the patients were divided into 2 groups (group A and group B). To control for confounding factors, a 1:1 nearest propensity score matching of significant variation, especially age, gender, BMI, number of fused levels, intraoperative blood loss, and surgical duration, were performed between groups. Perioperative outcomes were compared between groups. Multivariate logistic regression was performed to determine the risk factors for overall complications.</p><p><strong>Results: </strong>A total of 1004 eligible patients were reviewed in this study with 676 patients in group A and 328 patients in group B. After propensity score matching, 616 patients, 308 in each group were included in the final analysis. There were significantly more patients getting drainage removed on POD 2 (23.1% vs. 32.1%, p = 0.012) and POD 3 (37.0% vs., 45.1%, p = 0.041) in group B. In addition, patients in group B had earlier postoperative timing of ambulation (3.87 ± 1.12 vs. 2.41 ± 1.34, p = 0.012). No significant difference in symptomatic hematoma and surgical site infection was observed, but there were significant fewer overall complications (10.39% vs. 5.19%, p = 0.016) in the group B. Multivariate logistic regression indicated that postoperative timing of ambulation (OR 2.38, 95% CI 1.19-3.97, p < 0.001) was independently associated with overall complications.</p><p><strong>Conclusion: </strong>In this study, we found that the relaxation of the criteria for drainage removal could significantly shorten the length of stay, in addition, it could promote early postoperative ambulation of patients and thus reduce the occurrence of perioperative overall complications.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"422"},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of Side-to-End and End-to-End intestinal anastomosis techniques: insights from a rat model study.","authors":"Azita Shishegar, Mahyar Tahmasian, Ali Ashjaei, Iraj Mirzaii-Dizgah, Esmaeil Samizadeh","doi":"10.1186/s12893-024-02622-w","DOIUrl":"10.1186/s12893-024-02622-w","url":null,"abstract":"<p><strong>Background: </strong>Optimal selection of anastomosis technique is crucial in colectomy surgeries to ensure success and minimize postoperative complications. Various methods, both manual and stapler-assisted, are employed for intestinal anastomosis. This study aims to compare two surgical methods of intestinal anastomosis through macroscopic and microscopic examination.</p><p><strong>Methods: </strong>Twenty-five albino Wistar rats were randomly divided into two groups: the first group (n = 10) underwent Side-to-End anastomosis, while the second group (n = 15) underwent End-to-End anastomosis. After a 5-day observation period under uniform laboratory conditions, both groups underwent a second surgery. Anastomoses were assessed for adhesion and leakage, followed by histopathological examination of excised samples using the oxygenal method. Data were analyzed using the Mann-Whitney statistical method with a significance level of p < 0.05.</p><p><strong>Results: </strong>Following the initial surgery, the second group exhibited a higher mortality rate compared to the first group. Based on our data, the mortality of the rats was unrelated to the type of anastomosis or the surgical procedure. The higher mortality rate in one group was due to other factors. Additionally, the second group demonstrated significantly greater adhesion formation. Histopathological examination revealed no significant difference between the groups, although neovascularization and collagen accumulation appeared more pronounced in the Side-to-End group.</p><p><strong>Conclusion: </strong>Histopathologically, Side-to-End anastomosis showed superior repair conditions compared to End-to-End anastomosis. However, due to the limited sample size, statistical significance was not achieved. Conversely, Side-to-End anastomosis was associated with increased adhesion formation. These findings suggest the need for further comprehensive studies with larger sample sizes conducted in well-equipped centers to ascertain the preferred distal colon anastomosis technique and to achieve statistically significant results that can be more reliably generalized.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"421"},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of frailty on outcomes following coronary artery bypass grafting: a systematic review and meta-analysis.","authors":"Saiya Chen, Shengjing Zhang, Shengsheng Cai, Huanfen Wang","doi":"10.1186/s12893-024-02728-1","DOIUrl":"10.1186/s12893-024-02728-1","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) remains the preferred treatment for complex multi-vessel coronary artery disease, offering substantial long-term benefits. Non-cardiac comorbidities such as frailty may significantly affect the outcomes of this procedure. However, the exact impact of frailty on CABG outcomes remains unclear, particularly given its exclusion from many pivotal revascularization trials. This systematic review and meta-analysis aimed to consolidate existing data to evaluate the impact of frailty on short- and long-term outcomes following CABG.</p><p><strong>Methods: </strong>Searches across PubMed, Cochrane Library, Embase, and Scopus were done to identify studies that were published up to March 31, 2024, had detailed preoperative frailty assessments and compared frail versus non-frail adult patients undergoing CABG. Primary outcomes were all-cause mortality and major adverse cardiac events within one year. Secondary outcomes included hospital readmission rates and length of stay. A random-effects model was used to account for heterogeneity. Results were reported as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Our meta-analysis, involving data from 14 studies, revealed a significant increase in both 30-day (OR 2.52; 95% CI: 2.07 to 3.07) and 1-year mortality (OR 2.58; 95% CI: 1.49 to 4.45) among frail patients. The risk of acute cardiac and cerebrovascular complications was comparable in all patients (OR 1.03; 95% CI: 0.89 to 1.19). However, frailty was associated with a significant increase in the risk of acute kidney injury (OR 2.31; 95% CI: 1.26 to 4.23). Frail patients were more likely to have longer hospital stays and higher readmission rates compared to their non-frail counterparts.</p><p><strong>Conclusion: </strong>Our study confirms the critical impact of frailty on mortality and morbidity in CABG patients and advocates for the integration of frailty assessments into the preoperative evaluation process. Addressing frailty can lead to more individualized patient care and better outcomes, urging a paradigm shift towards comprehensive, patient-centric management in cardiac surgery.</p><p><strong>Prospero register: </strong>CRD42024521327.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"419"},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical comparative study of robot-assisted and traditional laparoscopic surgery in patients with cervical cancer: a retrospective cohort study.","authors":"Lijuan Zhang, Lihong Yang, Yan Wang, Minghong Sun, Yi Tao","doi":"10.1186/s12893-024-02716-5","DOIUrl":"10.1186/s12893-024-02716-5","url":null,"abstract":"<p><strong>Background: </strong>A new era in minimally invasive surgery has been ushered in by Leonardo's robot surgical system, but the safety and effectiveness in cervical cancer is lake of evidence. This study aimed to compare the safety, effectiveness, and cost-effectiveness of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in patients with cervical cancer.</p><p><strong>Methods: </strong>Patients with cervical cancer who had radical surgery at the first affiliated Hospital of Chongqing Medical University between January 2017 and June 2022 were enrolled. Patients in the LRH and RRH groups were matched 1:1 using propensity score matching (PSM), all patients were followed up to September 2023, cancer recurrence occurred or death, whichever came first.</p><p><strong>Results: </strong>522 cervical cancer patients were enrolled in this study, 261 of whom were in the LRH group and 261 of whom were in the RRH group. Univariate analysis showed that the RRH group had less intraoperative blood loss, shorter operation time and hospital stay, lower incidence of composite complications and urinary retention, but had higher hospitalization costs. Multivariate Logistic regression analysis showed that LRH was an independent protective factor for composite complications (OR 1.531; 95%CI,1.022 to 2.295; P = .039). Cox regression analysis with cancer recurrence as the endpoint showed that LRH (HR 0.320; 95%CI,0.255 to 0.401; P < .001) and longer operation time (HR 0.995; 95%CI,0.993 to 0.997; P < .001) reduced 68% and 5% risk of cancer recurrence ; results also indicated that the older age (HR 1.017; 95%CI,1.007 to 1.027; P = .001) and postoperative complications (HR 22.410; 95%CI,16.019 to 31.350; P < .001) would increase 224% recurrence risk of cancer recurrence.</p><p><strong>Conclusions: </strong>Both LRH and RRH demonstrated good short-term efficacy, with RRH outperforming LRH in terms of reduced intraoperative bleeding, shorter hospital stays and operation times, and fewer composite complications. However, the RRH group faces a higher risk of early cancer recurrence and incurs greater expenses. In summary, comprehensive long-term prospective studies are needed to thoroughly explore the effectiveness and safety of both LRH and RRH.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"423"},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to specialist plastic surgery in rural vs. Urban areas of Africa.","authors":"Nadine Mugisha, Olivier Uwishema, Rawan Noureddine, Boluwatife Samuel Fatokun, Clever Byiringiro, Lolita Fawaz, Laura Ghanem, Victoire Mukamitari, Jack Wellington","doi":"10.1186/s12893-024-02735-2","DOIUrl":"10.1186/s12893-024-02735-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Plastic surgery is an essential yet underdeveloped field in many African nations, especially in rural areas. The demand for plastic surgery is increasing, but differences in access to respective services between rural and urban domiciles remain ever existent, despite the exponentiation of trauma, burns, and congenital disorders. According to this review, urban areas have access to better facilities and specialized surgeons, while rural areas frequently lack infrastructure, educated healthcare personnel, and medical resources. This review compares the quality and accessibility of plastic surgery services in African rural and urban settings in order to determine the variables influencing said differences in access.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This literature review was performed using electronic search databases comprising PubMed/MEDLINE, Google Scholar, and Africa Journals online (AJOL). Regional medical journals were also reviewed using keywords and associated Boolean operators pertaining to \"plastic surgery\", \"plastic surgery in rural\" and plastic surgery in urban\" by selecting studies based on their relevance and content quality. Studies focusing on plastic surgery in Africa were included. A total of 37 articles were analyzed to provide insights into the disparities between rural and urban access to plastic surgery services in Africa. Studies not focusing on plastic surgery were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The review highlighted significant disparities in access to plastic surgery services between Africa's rural and urban areas. Rural areas usually lack medical resources, specialized surgeons, infrastructure, while urban areas have access to better facilities and specialized surgeons. Urban regions not only hail more training opportunities for surgeons but also foster further specialized facilities, greater training options, access to modern surgical equipment, sterile facilities and advanced instruments, contributing to clinical and surgical excellence alongside patient satisfaction and outcomes. However, there is a scarcity of qualified plastic surgeons in rural regions, including antiquated technology and a dearth of resources and expertise. Besides, socioeconomic variables that hinder said indifference between rural and urban areas, such as poverty, education, money, and cultural attitudes, precipitated limited access to critical surgical intervention in rural populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Further research should be done on how plastic surgery services differ in urban and rural areas. Availability of financial expertise and specialists who can provide specialized care in rural settings is recommended. To enhance patient outcomes, the implementation of technological innovation, improved healthcare infrastructure, and effective training initiatives should be implemented in rural Africa. Also, in the field of plastic surgery, emphasizing the use of telemedicine and mobile su","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"418"},"PeriodicalIF":1.6,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11670430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of pedicled supraclavicular flaps in hypopharyngectomy with preservation of laryngeal function.","authors":"Weihua Zhou, Junliang Li, Huajun Feng, Shengen Xu, Tianzhen Liu, Dingting Wang, Gang Qin","doi":"10.1186/s12893-024-02733-4","DOIUrl":"10.1186/s12893-024-02733-4","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of pedicled supraclavicular flaps in hypopharyngectomy reconstruction, with a focus on preserving laryngeal function.</p><p><strong>Methods: </strong>From August 2019 to June 2022, 14 patients with primary hypopharyngeal carcinoma who met the inclusion and exclusion criteria and underwent the repair of hypopharyngeal defects using pedicled supraclavicular flaps were included retrospectively. Relevant clinical evaluation indicators include patient characteristics, defect sizes, flap sizes, flap harvesting time, postoperative hospital stay, postoperative complications, recurrence, and survival outcomes.</p><p><strong>Results: </strong>Among the 14 patients, pyriform sinus carcinoma (n = 10) and posterior hypopharyngeal wall carcinoma (n = 4) were present, with stages T2 (n = 7), T3 (n = 4), T4 (n = 3), N0 (n = 3), N1 (n = 1), and N2 (n = 10). The average defect size was 7.0 (4.0-12.6) cm in the longitudinal diameter and 4.1 (2.8-7.5) cm in the transverse diameter. The mean flap size was 8.4 (5.0-14.0) cm in length and 6.5 (4.0-9.0) cm in width. The mean time for flap harvesting was 37.0 (29.0-51.0) min. The mean postoperative hospital stay was 24.0 (12.0-48.0) days. The mean follow-up period was 20.3 (4.0-47.0) months, and one of the 14 patients was lost during follow-up. Short-term postoperative complications included partial flap necrosis (n = 1), subcutaneous hematoma at the donor site (n = 1), and pharyngeal fistula (n = 4). Long-term complications encompassed pharyngoesophageal anastomotic stenosis (n = 2) and shoulder elevation dysfunction (n = 2). Tumor recurrence occurred in 3 patients. 1 patient succumbed to massive hemorrhage resulting from neck infection due to pharyngeal fistula during chemoradiotherapy. 2 patients succumbed to tumor-related causes. The gastric tube was removed in 13 patients, and the tracheal tube was extracted in 10 patients.</p><p><strong>Conclusion: </strong>The supraclavicular flap offers a promising alternative for reconstruction during hypopharyngectomy with preservation of laryngeal function. It can be utilized to reshape the morphology of the pyriform fossa, aryepiglottic wall, and laryngeal cavity, thereby restoring the functionality of the laryngopharynx.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"417"},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}