BMC Surgery最新文献

{"title":"Machine learning-based clinical models for prediction of urinary incontinence after robot-assisted laparoscopic radical prostatectomy.","authors":"Xuejing Wang, Yuan Yuan, Ping Zhou, Bin Gu, Xuping Jiang, Yan Sha, Na Li, Aiping Gan, Qingli Chen","doi":"10.1186/s12893-026-04053-1","DOIUrl":"10.1186/s12893-026-04053-1","url":null,"abstract":"<p><strong>Objective: </strong>To investigate risk factors for urinary incontinence (UI) after robot-assisted laparoscopic radical prostatectomy (RARP) using interpretable machine learning methods, establish and validate a predictive model.</p><p><strong>Methods: </strong>Clinicopathological data of 464 localized prostate cancer patients undergoing RARP at our institution (June 2022-June 2024) were retrospectively analyzed. UI status was assessed at 24-48 h, 1, 3, and 6 months post-catheter removal, with early UI defined as requiring ≥ 1 pad/day at 3 months. Patients were randomly split 7:3 into training/validation sets, patients from three external centers were used as the test set. Between-group comparisons used t-tests, Mann-Whitney U tests, or chi-square tests. Multivariate logistic regression identified risk factors in the training set, followed by construction of logistic regression and five machine learning models. Model performance was evaluated via ROC curves. The optimal model was interpreted using SHAP (Shapley additive explanations). Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>Early UI occurred in 54 (training set), 28 (validation set) patients and 19 (test set) patients, with no intergroup baseline differences (P > 0.05). Univariate analysis linked total PSA level, PI-RADS score, ISUP grade, IPSS score, underlying disease, length of membranous urethra, prostate volume, nerve sparing procedure and urinary leakage preoperative total PSA, ISUP grade, dysuria, comorbidities, urinary tract infection (UTI), and postoperative urinary leakage to early UI (P < 0.05). Multivariate analysis confirmed total PSA level, nerve sparing procedure, IPSS score, length of membranous urethra, underlying disease, preoperative urinary tract infection, and urinary leakage as independent risk factors. Among models, support vector machine (SVM) achieved the highest validation AUC of 0.882 in the validation set and AUC of 0.858 in the test set. SHAP analysis revealed PSA level as the strongest predictive feature.</p><p><strong>Conclusion: </strong>Total PSA level, nerve sparing procedure, IPSS score, length of membranous urethra, underlying disease, preoperative urinary tract infection, and urinary leakage are independent risk factors for early UI post-RARP. The SVM-based machine learning model demonstrates superior predictive performance and clinical utility.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551035","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":"Catastrophic health expenditure associated to bellwether surgery care in Northcentral Ethiopia.","authors":"Atalel Fentahun Awedew","doi":"10.1186/s12893-026-04059-9","DOIUrl":"10.1186/s12893-026-04059-9","url":null,"abstract":"<p><strong>Background: </strong>Bellwether procedures-caesarean section, laparotomy, and open fracture management- are core indicators for monitoring safe, equitable, and affordable surgical care in a country. Although effective surgical care is essential for achieving universal health coverage and the Sustainable Development Goals, spending on surgical care leading catastrophic health expenditure among surgical patients, particularly low-income and middle-income countries (LMICs). This study assesses catastrophic health expenditure (CHE) associated with bellwether surgery to quantify financial risk and inform future equitable health financing reforms.</p><p><strong>Methods: </strong>A prospective institutional-based observational cohort study was conducted at Debre Tabor Specialized Hospital, South Gondar. Using systematic random sampling, 425 patients undergoing bellwether procedures were enrolled. Catastrophic expenditures assessed with the validated Financial Risk Protection tool developed by the Harvard Program in Global Surgery and Social Change. Categorical variables were compared using χ² tests, while continuous data were evaluated for normality with the Shapiro-Wilk test and histograms. Means (± SD) and medians (± IQR) were reported accordingly. Bivariable and multivariable binary logistic regression identified predictors, with adjusted odds ratios (95% CI); p < 0.05 to declare statistical significance.</p><p><strong>Results: </strong>A total of 425 patients undergoing bellwether procedures were included, representing all woredas and city administrations of South Gondar, Northwest Ethiopia. The median age was 36 years (IQR 24-52), and the majority were classified as ASA I/II. Emergency laparotomy accounted for the largest proportion of procedures (55.8%). Within the three-delay framework, the median duration of Delay 1 (care-seeking) was 12.0 h (IQR 6-24). The overall postoperative complication rate was 21.3%, while in-hospital mortality was 0.9%. At the 10% threshold, catastrophic health expenditure (CHE) was observed in 76.0% of households lacking community-based insurance or free health initiatives. CHE at this threshold was significantly associated with referral delay (Delay 2; adjusted odds ratio [AOR] 1.06, 95% CI 1.01-1.10 per hour), emergency bone fixation (AOR 22.9, 95% CI 7.4-70.4), and emergency laparotomy (AOR 3.3, 95% CI 1.6-6.9).</p><p><strong>Conclusion: </strong>Approximately two-thirds of patients undergoing bellwether surgery experienced catastrophic health expenditure, declined to one-third among those enrolled in community-based or family health insurance. Catastrophic health expenditure was greatest with delayed presentation, rural residence, long travel distance, and prolonged hospital stay. Expanding insurance coverage, improving access, and integrating surgical services into primary health care are essential to achieve safe, timely, and affordable surgery in line with global targets.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550760","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":"Prevalence and determinants of low anterior resection syndrome following rectal cancer resection: a cross-sectional study.","authors":"Khadije Gorgi, Maryam Aramesh, Seyed Vahid Hosseini, Matin Emami, Sara Shojaei-Zarghani, Mohammad Mohammadianpanah","doi":"10.1186/s12893-026-04071-z","DOIUrl":"10.1186/s12893-026-04071-z","url":null,"abstract":"<p><strong>Background: </strong>Low anterior resection syndrome (LARS) is a debilitating bowel dysfunction that frequently follows sphincter-preserving surgery for rectal cancer. This study aimed to assess the prevalence of LARS and identify its associated determinants in a cohort of rectal cancer survivors.</p><p><strong>Methods: </strong>In this cross-sectional study, patients who underwent sphincter-preserving surgery for rectal cancer at least one year prior were recruited from the Shiraz Colorectal Cancer Surgery (SCORCS) registry. Based on symptom severity assessed via the LARS score, patients were categorized as having no, minor, or major LARS. Multivariable logistic regression analyses were employed to identify determinants associated with any LARS (minor or major vs. none) and major LARS (vs. no and minor combined).</p><p><strong>Results: </strong>The prevalence of LARS was 53.7% (58/108), comprising minor LARS in 31.5% and major LARS in 22.2% of patients. Multivariable analysis identified older age (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.08) and neoadjuvant radiotherapy (OR: 4.38, 95% CI: 1.54-12.45) as determinants for any LARS. For major LARS, independent determinants were older age (OR: 1.05, 95% CI: 1.01-1.10) and female sex (OR: 2.97, 95% CI: 1.02-8.60). There was no significant difference in quality-of-life domains across LARS severity groups.</p><p><strong>Conclusion: </strong>This study confirms a high prevalence of LARS among rectal cancer survivors. Neoadjuvant radiotherapy, older age, and female sex were identified as determinants of LARS in this cohort; however, due to the study's limitations, the findings should be interpreted cautiously.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550990","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 Charlson Comorbidity Index (CCI) on Enhanced Recovery after Surgery (ERAS) in colorectal surgery development of an exploratory risk-stratification algorithm.","authors":"Marionna Cathomas, Anas Taha, Otto Kollmar, Nicole Kunst, Andres Heigl, Robert Rosenberg","doi":"10.1186/s12893-026-04051-3","DOIUrl":"10.1186/s12893-026-04051-3","url":null,"abstract":"<p><strong>Introduction: </strong>Enhanced recovery after surgery (ERAS) is a widely accepted program aimed at improving short-term outcomes in patients undergoing colorectal surgery. To achieve good postoperative outcomes, adherence of at least 75% to ERAS principles is required, which is particularly challenging during the postoperative period.</p><p><strong>Methods: </strong>Patients undergoing colorectal resection between May 2016 and October 2022 were prospectively enrolled in the ERAS protocol and stratified according to the retrospectively assessed CCI. Patients with ≥ 5% missing data were excluded. The primary outcome was to evaluate the predictive value of the Charlson Comorbidity Index (CCI) for achieving adequate postoperative ERAS adherence (≥ 75%).</p><p><strong>Results: </strong>A total of 572 patients were included (CCI 0: 223 [39.0%], CCI 1: 41 [7.2%], CCI 2: 150 [26.2%], CCI 3: 71 [12.4%], CCI ≥ 4: 87 [15.2%]). Patients with a CCI score of 0 had a median postoperative ERAS adherence of 84.6% (range: 15.4-100) compared with 69.2% (range: 16.7-100) in patients with a CCI score of ≥ 4 (p < 0.001). Increasing CCI was significantly associated with a higher complication index (p < 0.001) and a longer length of hospitalization stay (p < 0.001). In the multivariate analysis, CCI ≥ 2 was an independent predictor of failure to achieve adequate postoperative ERAS adherence (≥ 75%).</p><p><strong>Conclusion: </strong>Higher CCI was associated with lower postoperative ERAS adherence. Based on these findings, an exploratory risk-stratification algorithm is proposed to facilitate the preoperative identification of patients at increased risk for inadequate postoperative ERAS adherence.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537028","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 laparoscopic internal ring reinforcement combined with high ligation versus double-loop high ligation in the treatment of pediatric giant inguinal hernia.","authors":"Qingbao He, Hongjia He, Kaisheng Li, Xiaoyang Liu","doi":"10.1186/s12893-026-04056-y","DOIUrl":"10.1186/s12893-026-04056-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the clinical outcomes of laparoscopic internal ring reinforcement combined with high ligation and double-loop high ligation in the treatment of pediatric giant inguinal hernia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included 381 children with giant inguinal hernia who underwent laparoscopic repair at the Children's Hospital Affiliated to Shandong University between February 2021 and April 2025. Patients were categorized into three groups according to the surgical technique employed. Group A (n = 155) underwent laparoscopic internal ring reinforcement by suturing the iliopubic tract to the lower margin of the transversus abdominis arch combined with high ligation of the hernia sac. Group B (n = 130) underwent laparoscopic double-loop high ligation, whereas the control group (n = 96) underwent conventional single high ligation. Perioperative outcomes, including operative time, intraoperative subperitoneal hematoma, 24-hour postoperative pain score, and recurrence within 12 months, were compared among the groups. Given the retrospective nature of the study and the potential for treatment-selection bias, an exploratory subgroup analysis was additionally performed in patients with an internal ring diameter of 1.5-2.0 cm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No significant differences were observed among the three groups with respect to age, sex, laterality, or history of incarceration (all P &gt; 0.05). Using a 2.0-cm threshold derived from institutional experience, patients with an internal ring diameter ≥ 2.0 cm preferentially underwent reinforcement-based procedures. Operative time was significantly longer in Groups A and B than in the control group (P &lt; 0.001). During the 12-month follow-up period, no recurrence was observed in either reinforcement group, whereas three recurrences occurred in the control group, resulting in a significant difference among the groups (P = 0.015). No significant differences were identified in the incidence of intraoperative subperitoneal hematoma or 24-hour postoperative pain scores (P = 0.946 and P = 0.589, respectively). In the exploratory subgroup analysis of patients with an internal ring diameter of 1.5-2.0 cm, recurrence remained less frequent in the reinforcement groups, while postoperative pain scores and hematoma rates were comparable among the three groups. Exploratory odds ratio analysis also suggested a potential association between reinforcement-based procedures and a lower observed recurrence rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In children with giant inguinal hernia, reinforcement-based laparoscopic procedures may be associated with a lower observed recurrence rate than conventional single high ligation, without an apparent increase in operative morbidity. Double-loop high ligation may represent a feasible reinforcement option when excessive tension is encountered after single high ligation. These findings suggest a potential benefit of a","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550948","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":"Delayed aspergillus endocarditis and septic pulmonary embolism caused by a retained transcardiac foreign body.","authors":"Lu Tong, Cheng Zhou, Nianguo Dong, Fei Li","doi":"10.1186/s12893-026-04055-z","DOIUrl":"10.1186/s12893-026-04055-z","url":null,"abstract":"<p><strong>Background: </strong>Retained intravascular or intracardiac foreign bodies are rare but well-recognized in the surgical literature. However, delayed septic pulmonary embolism resulting from a retained transcardiac foreign body has not been previously reported.</p><p><strong>Case description: </strong>This case report describes a 57-year-old woman who presented with fever and cough for one month and worsening dyspnea over three days. Two years prior, she had been struck by a metallic object from a lawnmower but did not seek medical attention. Chest radiography demonstrated a linear metallic foreign body in the right lower lung field. Transthoracic echocardiography showed a rod-shaped structure confined to the right atrium, with vegetations surrounding the foreign body and extending into the right ventricle. CT angiography was subsequently performed, which identified a metallic foreign body traversing the diaphragm from the liver into the right heart, as well as emboli in the distal branches of the right pulmonary artery. Surgical exploration via median sternotomy confirmed a metallic rod measuring 10 cm in length and 0.5 cm in diameter penetrating the liver, diaphragm, and right atrium. The rod was successfully removed together with the pulmonary emboli. Pathological analysis demonstrated Aspergillus infection. The patient was discharged in stable condition and completed postoperative oral voriconazole therapy.</p><p><strong>Conclusions: </strong>Although penetrating cardiac foreign bodies may initially be nonfatal, the present case illustrates their potential for late-onset fungal colonization and embolic complications, highlighting the importance of timely surgical removal and vigilant follow-up.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537042","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":"Evaluation of pancreatic stump binding and ligation in reducing postoperative pancreatic fistula after distal pancreatectomy: a retrospective cohort study.","authors":"Zi-Ang Jiang, Xiang-Yu Lu, Hang Deng, Xu Wang, Jian Xu, Jie Zhang, Yao Zhou, Jun Gong, Ke Dong, Yan Dai, Hao Zhang","doi":"10.1186/s12893-026-04052-2","DOIUrl":"10.1186/s12893-026-04052-2","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the efficacy of pancreatic stump binding and ligation (PSBL) in reducing postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).</p><p><strong>Methods: </strong>A retrospective cohort analysis included 217 patients undergoing DP between 2015 and 2022. Patients were classified into two groups: those receiving PSBL (B-Group, n = 96) and those without (NB-Group, n = 121). The primary outcome was incidence of clinically relevant POPF (Grade B/C).</p><p><strong>Results: </strong>The B-Group demonstrated lower POPF rates (11.5% vs. 28.9%, P = 0.003) compared to the NB-Group, with grade B fistulas particularly reduced (P = 0.002). Multivariate analysis identified independent risk factors for POPF: BMI ≥ 28 kg/m² (OR = 14.105, P < 0.001), Preoperative Hypoalbuminemia (OR = 7.031, P < 0.001), Manual Method of Stump Closure (OR = 2.558, P = 0.020), and non-PSBL Technique (OR = 4.463, P < 0.001).</p><p><strong>Conclusions: </strong>In this retrospective cohort, PSBL is a promising, feasible technique associated with reduced clinically relevant POPF incidence after DP. Given the retrospective design, these findings are hypothesis-generating and warrant prospective, multicenter validation.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498282","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":"Surgical management of arcuate (proximal fibular head) avulsion fractures: a scoping review of techniques and outcomes.","authors":"Mohammadreza Dolikhani, Ghazaleh Shakibamaram, Shayan Amiri, Pooya Hosseini Monfared, Mohammad Azizi, Seyed Morteza Kazemi","doi":"10.1186/s12893-026-04046-0","DOIUrl":"10.1186/s12893-026-04046-0","url":null,"abstract":"<p><strong>Purpose: </strong>This scoping review aims to map and describe the range of surgical techniques used in the management of arcuate fractures (proximal fibular head avulsion fractures) and to summarize their reported outcomes and complications.</p><p><strong>Methods: </strong>A scoping review was conducted using a literature search across Embase, Scopus, Cochrane Library, PubMed, and Web of Science, up to 8 December 2025, following PRISMA-ScR reporting guidelines. All eligible studies were case reports or small case series. Eligibility criteria included English-language articles reporting the surgical management of arcuate fractures and postoperative outcomes.</p><p><strong>Results: </strong>Twelve studies involving 90 patients were included. Three fixation strategies were recorded: suture anchor fixation in 29 patients (32.2%), tension-based techniques in 23 patients (25.6%), and screw-and-washer fixation in 38 patients (42.2%). Radiographic union was explicitly reported in 25 of 29 anchor-treated patients, 18 of 24 fractures treated with tension-based constructs, and all screw-and-washer cases; however, reporting was incomplete and nonuniform. Complications and reoperations were most frequently described in tension-based reports, which also included severe and heterogeneous injury patterns. Standardized patient-reported outcomes were sparse, and rehabilitation protocols varied. Methodological appraisal identified recurrent limitations in case selection, completeness of reporting, and outcome assessment.</p><p><strong>Conclusion: </strong>Evidence for operative FHAF management remains limited to heterogeneous case reports and small case series. Radiographic healing was frequently reported across fixation constructs, but inconsistent reporting and variation in injury severity, associated procedures, and rehabilitation preclude reliable comparison between techniques. Fixation should be individualized according to fragment size and morphology, fragment quality, soft-tissue repairability, and associated ligamentous injuries. Standardized multicentre studies are needed.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473762","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":"Heart-shaped tension-reducing suturing versus conventional interrupted suturing alleviates perineal pain, accelerates resolution of suture reactions, and improves scar quality in primiparous women undergoing perineal repair.","authors":"Ju Li, Ling Li, Hui Zhou, Ya Nan Shao, Hong Mei Zhu, Yue Ning Zhu, Jing Wang, Tie Cheng Sun, Li Lin","doi":"10.1186/s12893-026-04050-4","DOIUrl":"10.1186/s12893-026-04050-4","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of the heart-shaped tension-reducing suture (HSTRS) versus interrupted suture (IS) in scar quality and postoperative pain relief in primiparous women.</p><p><strong>Methods: </strong>In this study, 142 women were allocated to HSTRS (n = 61) or IS (n = 81). Pain score was assessed via NRS at multiple timepoints; suture reactions were graded (0-III), and scar quality was evaluated using VSS, OSAS, and PSAS at 42 days, 90 days, and 180 days.</p><p><strong>Results: </strong>The HSTRS group showed significantly lower pain scores (P < 0.0001), faster resolution of suture reactions, and superior scar outcomes across all scales and timepoints (P < 0.01).</p><p><strong>Conclusions: </strong>HSTRS significantly improves perineal scar quality, alleviates postoperative perineal pain, and accelerates resolution of suture reactions compared with interrupted suturing, supporting its application for better postpartum perineal recovery.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473826","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":"Free-style perforator-based hatchet flap: a novel and innovative approach for superior aesthetic outcomes in facial defect reconstruction.","authors":"YiChun Ding, TingTing Wang, Lin Zhang, Hao Ding, XinYi Li, XiaoJing Li","doi":"10.1186/s12893-026-04054-0","DOIUrl":"10.1186/s12893-026-04054-0","url":null,"abstract":"<p><strong>Background: </strong>The face, with its distinct subunits, demands particularly high aesthetic standards for defect reconstruction. Although traditional hatchet flaps are commonly used, they are limited by a constrained rotation arc and susceptibility to dog-ear deformities, compromising aesthetic outcomes. This study introduces and investigates a novel free-style perforator-based hatchet flap technique designed to overcome these limitations and enhance aesthetic outcomes.</p><p><strong>Patients and methods: </strong>Patients treated at a single center between October 2020 and April 2024 were included. The key innovation involves preoperative Doppler ultrasound mapping of perforating vessels combined with a \"free-style\" design principle, liberating the flap from constrained rotation and reducing the risk of dog-ear deformities associated with traditional hatchet methods. This approach enables an increased rotational arc. Outcomes were evaluated at follow-up using the Visual Analog Scale (VAS), Observer Scar Assessment Scale (OSAS), and Patient Scar Assessment Scale (PSAS).</p><p><strong>Results: </strong>This retrospective analysis included 65 patients (32 free-style, 33 traditional). All free-style flaps survived, whereas partial necrosis occurred in three traditional flaps. The free-style group showed improved aesthetic outcomes, including higher VAS scores, lower OSAS scores, shorter mean scar length, and lower PSAS scores, indicating greater patient satisfaction with scar appearance.</p><p><strong>Conclusion: </strong>The free-style perforator-based hatchet flap, facilitated by preoperative perforator mapping, was associated with better aesthetic outcomes and higher patient satisfaction compared to the traditional technique in this retrospective cohort.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473740","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}