Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"What is the current Dutch nerve management during amputation surgery?","authors":"CPM van den Berg ,&nbsp;EW DeVinney ,&nbsp;EM van der Linde ,&nbsp;EM Brakkee ,&nbsp;JH Coert","doi":"10.1016/j.bjps.2025.06.015","DOIUrl":"10.1016/j.bjps.2025.06.015","url":null,"abstract":"<div><div>Peripheral nerve management during limb amputation is essential, as neuromas frequently form after nerve transection. Some of which are painful and impair patient quality of life. Selecting the appropriate technique for nerve management is important as it may impact the development of painful neuromas. Diagnosis is often complex, and treatments may yield limited success, highlighting the importance of careful nerve handling at the time of surgery. In this study, we questioned Dutch plastic surgeons about their knowledge and preferred technique(s) in managing nerves during amputation surgery. An email survey was distributed among Dutch (plastic) surgeons. The survey was designed in LimeSurvey. The questionnaire addressed background knowledge, preferred nerve management approaches during amputations, and subsequent neuroma treatments. Data were collected anonymously and analyzed using descriptive statistics. Of 390 surgeons, 72 responded (18.5% response rate; 91.7% plastic surgeons). Most respondents (57%) specialized in hand and wrist surgery, with 69% performing 1–10 amputations annually. Surgeons favoring traction neurectomy had less experience (p=0.027). Muscle burying (n=64) was the most familiar technique, followed by bone burying, end-to-side suturing, and targeted muscle reinnervation. Most respondents addressed nerve pain (93%) or considered revision surgery (95%) postoperatively. This study provides an overview of nerve management and neuroma treatment preferences among Dutch (plastic) surgeons. Awareness of various techniques appears widespread, underscoring the importance of training exposure to enhance procedural competence.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 134-140"},"PeriodicalIF":2.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing safety, patient experience and outcomes in an independent UK ambulatory aesthetic surgical clinic","authors":"Metin Nizamoglu,&nbsp;Nora Nugent,&nbsp;Marc Pacifico","doi":"10.1016/j.bjps.2025.06.018","DOIUrl":"10.1016/j.bjps.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>The United Kingdom has witnessed a surge in independent aesthetic surgery clinics with ambulatory operating facilities. In this context, patient safety and satisfaction remain critical benchmarks of success.</div></div><div><h3>Aim</h3><div>This study presents a detailed analysis of a private aesthetic surgery clinic’s systems to optimise patient outcomes and ensure safety in day-case surgeries under general anaesthesia.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on prospectively collected data from 428 consecutive patients who underwent general anaesthesia for aesthetic surgical procedures at the clinic. Key metrics included times to discharge, complication rates and a patient questionnaire.</div></div><div><h3>Results</h3><div>Among the 428 patients, there were only four instances of urgent return to the operating theatre: three cases of postoperative infection and one patient requiring external transfer for a delayed presentation of a pulmonary embolus within 30 days of surgery. These findings correspond to a major complication rate of less than 2% (8/428), underscoring the safety of performing general anaesthesia aesthetic surgeries as day-case procedures when robust clinical systems are implemented.</div></div><div><h3>Conclusion</h3><div>Our results demonstrate that aesthetic surgical procedures can be safely and efficiently performed in a standalone clinic setting as day-case operations, with minimal complications and high satisfaction. This model highlights the potential for redefining standards of care in ambulatory aesthetic surgery, emphasising the importance of rigorous safety protocols and patient-centred approaches.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 141-147"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The “lymphatico-lymphatic bridge” technique: Maximising lymphatic drainage in challenging scenarios in supermicrosurgical lymphaticovenous anastomosis","authors":"Chad Chang ,&nbsp;Johnson Chia-Shen Yang","doi":"10.1016/j.bjps.2025.06.013","DOIUrl":"10.1016/j.bjps.2025.06.013","url":null,"abstract":"<div><div>Proximal lymphaticovenous anastomosis (LVA) achieves superior limb decompression; however, recipient veins in this region are often deep and disproportionately large in caliber relative to small lymphatic vessels (LVs). The resulting size mismatch frequently forces surgeons to forgo anastomoses with several LVs, undermining drainage, and no current technique reliably resolves this constraint.</div><div>We developed the Lymphatico-Lymphatic Bridge (LLB), a sequential end-to-side method that uses an adjacent LV as an autologous conduit, linking otherwise unreachable LVs to a single recipient vein. The LLB was added to &gt; 2,800 LVAs when LVs were distant or undersized.</div><div>The procedure avoids extra incisions or vein grafts and may enhance antegrade washout while reducing venous reflux. Preliminary follow-up results show limb-volume reduction comparable to that of standard LVA.</div><div>By incorporating additional proximal LVs, the LLB broadens indications for proximal LVA and may augment lymphatic pressure, thereby improving early patency. These findings support a proximal-first strategy for LVA surgery and warrant prospective controlled evaluation.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 130-133"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A framework for the development and implementation of open trauma guidelines: A Delphi consensus validation","authors":"Juan Enrique Berner ,&nbsp;Carl Heneghan ,&nbsp;Jagdeep Nanchahal ,&nbsp;Abhilash Jain","doi":"10.1016/j.bjps.2025.06.014","DOIUrl":"10.1016/j.bjps.2025.06.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Lower limb open fractures are severe injuries that can lead to long-term sequelae. Clinical guidelines for managing these patients are associated with expedited treatment and better outcomes. However, few countries have implemented guidelines for open lower limb fractures. The aim of this study was to develop and validate a framework for the introduction of clinical guidelines in settings that do not have one at present.</div></div><div><h3>Methods</h3><div>Using the qualitative analysis for the Limitations to the Implementation of Open Trauma Guidelines (LINEAGE) study, a framework proposal was designed. This included 4 clusters of inter-related concepts, including clinician, team, health and cultural factors. To validate this framework a modified Delphi study was devised. The elements of the framework were translated into 12 statements that were compiled in a Delphi questionnaire. A panel of orthopaedic and plastic surgeons was assembled to obtain structured feedback and assess the degree of consensus regarding the framework proposal.</div></div><div><h3>Results</h3><div>Using purposive sampling, 43 clinicians enrolled in an international expert panel, including 20 orthopaedic and 23 plastic surgeons based in countries with no guidelines at present. Following three Delphi rounds, 11 out of the 12 assessed statements achieved the threshold for validation. The single statement that did not reach consensus status was then removed from the framework.</div></div><div><h3>Discussion</h3><div>Frameworks are a well-described aid in implementation science, being able to describe complexity and propose strategies for improvement. We present the first validated framework for the development and implementation of open fracture guidelines.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 93-100"},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle versus fasciocutaneous flaps in fracture healing: A scoping review of basic science evidence","authors":"Umar Arshad ,&nbsp;Matthew J. Heron ,&nbsp;Isabel A. Snee ,&nbsp;Jennifer Lee ,&nbsp;Ray Kung ,&nbsp;Kowsar Ahmed ,&nbsp;Augustine M. Saiz ,&nbsp;Lily R. Mundy","doi":"10.1016/j.bjps.2025.06.009","DOIUrl":"10.1016/j.bjps.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Open extremity fractures with extensive soft tissue damage may require reconstruction with a soft tissue flap. While either muscle or fasciocutaneous flaps may be used, clinical studies have not definitively determined which results in lower infection rates. Therefore, we aimed to review the basic science literature on muscle and fasciocutaneous flaps to identify translational evidence supporting the use of one flap type over another for extremity reconstruction.</div></div><div><h3>Methods</h3><div>We conducted a scoping review of PubMed, Embase, Scopus, and Web of Science to identify non-clinical studies of soft tissue reconstruction for fractures or other osseous defects. Outcomes of interest included vascularity, infection, and biomechanical strength, as well as the molecular and cellular characteristics of the healed bone.</div></div><div><h3>Results</h3><div>We included 19 studies. Eleven studies reported exclusively on muscle flaps, and 8 studies compared muscle and fasciocutaneous flaps. Most studies modeled extremity fractures. Fractures managed with muscle flaps demonstrated enhanced angiogenesis, fewer infections, greater biomechanical strength, increased stem cell recruitment, and greater growth factor concentration compared to fasciocutaneous flaps.</div></div><div><h3>Conclusions</h3><div>The basic science literature suggests that muscle flaps are superior to fasciocutaneous flaps across several key outcomes pertaining to traumatic lower extremity fractures. These findings underscore the discrepancy between basic science and clinical evidence and emphasize the need for prospective clinical trials on flap reconstruction that control for injury severity.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 119-129"},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of oral feeding following head and neck mucosal free flap reconstruction – A systematic review and meta-analysis","authors":"Brandon He ,&nbsp;Jake Chia ,&nbsp;Faruque Riffat ,&nbsp;Huang-Kai Kao ,&nbsp;Frank Hsieh","doi":"10.1016/j.bjps.2025.06.004","DOIUrl":"10.1016/j.bjps.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Timing of oral feeding following head and neck mucosal free-flap reconstruction is a highly contentious issue. The typical 6–12 days “nil-by-mouth’ primarily revolves around the concern for post-operative complications. Conversely, early feeding has been shown to reduce the patient’s stress response, optimise physiological function, and facilitate recovery and healing. Nevertheless, the optimum time of oral feeding is unknown, and the impact of early feeding on post-operative complications and length of hospital stay (LOS) remains controversial.</div></div><div><h3>Methods</h3><div>A systematic review was conducted across the databases; Medline (Pubmed), EMBASE, Cochrane Central, and Scopus for studies comparing the outcomes of early (≤5 days) and/or late (&gt;5 days) oral feeding following reconstructive head and neck surgery involving mucosal free-flaps. Fixed and random-effects meta-analyses were utilised.</div></div><div><h3>Results</h3><div>The search yielded 1283 articles, of which thirteen met the inclusion criteria, encompassing a total of 1657 patients. Early feeding was significantly associated with lower risk of fistulas (3.66% vs 11.35%) (RR 0.37, 95%CI 0.22 to 0.64; P = 0.0004) and lower risk of pneumonia (6.31% vs 12.38%) (RR = 0.53, 95%CI 0.33 to 0.87; P = 0.011) compared to late feeding. Early feeding significantly reduced LOS compared to late feeding (x̄=9.85 vs 13.11 days) (MD −4.10, 95%CI −7.07 to −1.14; P=0.0067). The incidence of flap-failure, haematoma and dehiscence was similar between the two groups.</div></div><div><h3>Conclusions</h3><div>Early oral feeding initiation appears to be safe and associated with improved or similar patient outcomes and reduced LOS. Surgeons should consider early oral feeding in a carefully selected population.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 49-67"},"PeriodicalIF":2.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal preservation versus dorsal reduction rhinoplasty techniques for aesthetic and functional outcomes: a systematic review and meta-analysis","authors":"Luiz Fábio Silva Ribeiro ,&nbsp;Lucas Rezende De Freitas ,&nbsp;Ofonime Chantal Udoma-Udofa ,&nbsp;Rafael Mateus Correa ,&nbsp;Pedro Henrique Reginato ,&nbsp;Lucas Kreutz-Rodrigues ,&nbsp;Uldis Bite ,&nbsp;Karim Bakri","doi":"10.1016/j.bjps.2025.05.044","DOIUrl":"10.1016/j.bjps.2025.05.044","url":null,"abstract":"<div><h3>Background</h3><div>The differences in outcomes between dorsal preservation (DP) and dorsal reduction (DR) techniques in rhinoplasty remain unclear. This meta-analysis evaluates the DP and DR in terms of functional and aesthetic outcomes, revisions surgeries, dorsal irregularities, and residual and recurrent hump.</div></div><div><h3>Methods</h3><div>We searched PubMed, Cochrane, and Embase up to January 20th, 2025, for studies comparing DP versus DR. Primary outcome was standardized functional scores in the long-term postoperative period. Secondary outcomes were: short-term standardized functional outcomes, subjective aesthetic outcomes (sort-term and long-term), long-term standardized aesthetic outcome and total SCHNOS, revisions surgeries needed, dorsal irregularities, and residual and recurrent hump. Subgroup analyses were performed to evaluate different scales (SCHNOS, NOSE, VAS and UQ).</div></div><div><h3>Results</h3><div>Ten studies (1339 patients) were included. DP showed a significantly higher satisfaction in the UQ subgroup for short-term subjective aesthetic outcome (MD 1.13 points [95% CI: 0.74–1.52]; p &lt; 0.001; I² = 0%), a significant reduction in dorsal irregularities (RR 0.28 [95% CI: 0.10–0.78]; p = 0.01; I² = 0%), and a significantly higher rate of residual and recurrent hump (RR 2.94 [95% CI: 1.23–7.03]; p = 0.02; I² = 0%), compared to the DR group. No significant differences were found in standardized functional outcomes, subjective aesthetic outcomes, standardized aesthetic outcomes, total SCHNOS, or revision surgeries.</div></div><div><h3>Conclusion</h3><div>DP was associated with greater short-term aesthetic satisfaction (UQ), fewer dorsal irregularities, and a higher risk of residual and recurrent hump compared to DR. There were no significant differences between the groups in the other outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 101-118"},"PeriodicalIF":2.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Re: Hypospadias: The lay of the land","authors":"Ewelina Wojciechowska,&nbsp;Hanna Garnier","doi":"10.1016/j.bjps.2025.05.043","DOIUrl":"10.1016/j.bjps.2025.05.043","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 71-72"},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: Evaluating large language model’s accuracy in current procedural terminology coding given operative note templates across various plastic surgery sub-specialties","authors":"Georgios Karamitros,&nbsp;Michael P. Grant,&nbsp;Gregory A. Lamaris","doi":"10.1016/j.bjps.2025.05.042","DOIUrl":"10.1016/j.bjps.2025.05.042","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 35-36"},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding “Sustainability in breast surgery: An eco-audit of the breast implant pathway”","authors":"Qi Xu","doi":"10.1016/j.bjps.2025.05.041","DOIUrl":"10.1016/j.bjps.2025.05.041","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 37-38"},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}