Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Social support holds protective value in breast reconstruction","authors":"Jacquelyn Roth,&nbsp;Bernice Z. Yu,&nbsp;Ethan Fung,&nbsp;Carol Wang,&nbsp;Maxwell Godek,&nbsp;Peter J. Taub","doi":"10.1016/j.bjps.2025.05.018","DOIUrl":"10.1016/j.bjps.2025.05.018","url":null,"abstract":"<div><h3>Background</h3><div>Social support is a recognized determinant of surgical outcomes, yet its specific impact on breast reconstruction remains unclear. The present study sought to evaluate the associations between relationship status, household composition, and the presence of support person(s) preoperatively on outcomes in breast reconstruction patients.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on breast reconstruction patients at a single institution from 2017 to 2023. The primary outcome assessed was post-operative complications. Univariable and multivariable regression analyses evaluated associations between social support characteristics and outcomes.</div></div><div><h3>Results</h3><div>Of the 1466 patients included in the study, 910 patients (62.1%) had a partner, while 556 patients (37.9%) did not; when stratified by living arrangement, 1254 patients (85.6%) lived with others, while 212 patients (14.4%) lived alone; when stratified by the presence of a support person, 1015 patients (69.2%) were accompanied at visits, while 451 (30.8%) patients were alone. Univariate regression showed that having a partner was associated with significantly reduced odds of any complication (OR: 0.712, p=0.002), dehiscence (OR: 0.480, p&lt;0.001), and necrosis (OR: 0.699, p=0.013). On multivariate analysis, controlling for patient demographics, procedure type and laterality, having a partner continued to predict any complication (aOR: 0.760, p=0.023) and dehiscence (aOR: 0.491, p&lt;0.001). Having a support person at visits and living arrangements were not predictive of any complications on regression analysis.</div></div><div><h3>Conclusion</h3><div>Having a partner predicts fewer complications following breast reconstruction, highlighting the role of social support in optimizing recovery. Incorporating social support assessments into preoperative care may reduce disparities and improve patient outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 213-220"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147625","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":"Facial reanimation in Moebius syndrome – 25-Year experience in treating bilateral facial paralysis","authors":"Paul Panzenbeck ,&nbsp;Cédric Zubler ,&nbsp;Edel de Buitleir ,&nbsp;Adriaan Ockert Grobbelaar ,&nbsp;Jonathan Ian Leckenby","doi":"10.1016/j.bjps.2025.05.013","DOIUrl":"10.1016/j.bjps.2025.05.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Moebius syndrome is a rare congenital neurological disorder characterised by bilateral facial (VII) and abducens (VI) nerve palsies, resulting in facial paralysis and impaired ocular abduction. Additional cranial nerve involvement and anomalies, such as limb deformities and neurodevelopmental abnormalities, complicate its presentation. Facial reanimation using a free functional muscle transfer is the gold standard for restoring movement and improving psychosocial outcomes. This study presents over 25 years of surgical experience in facial reanimation for Moebius syndrome management.</div></div><div><h3>Patients and methods</h3><div>A retrospective analysis of patients with Moebius syndrome who underwent bilateral facial reanimation between 1998 and 2023 was conducted. Outcomes were assessed using a surgeon’s score, independent panel scoring with the Hay’s rating scale and evaluation of spontaneous smile. We describe our surgical technique, key aspects of post-operative therapy and potential pitfalls.</div></div><div><h3>Results</h3><div>Overall, 56 patients (30 women and 26 men) underwent facial reanimation. Among them, 49 had complete Moebius syndrome. Partial latissimus dorsi muscle flaps were used in 93% of the cases, with the masseteric nerve as the neural input (91%). Facial symmetry and function were rated as excellent (n=43) or good (n=11) in 96% of the patients. A spontaneous smile was achieved in 59% of the cases, with the best outcomes in masseteric-innervated latissimus dorsi transfers.</div></div><div><h3>Conclusion</h3><div>Bilateral free functional muscle transfers are the gold standard for facial reanimation in Moebius syndrome management, yielding significant functional and aesthetic improvements, especially in children. We recommend performing bilateral facial reanimation as a single-stage procedure due to its physical and psychological benefits for this patient population.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 238-245"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170138","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":"Characterizing patient care experience among adults with lower extremity trauma","authors":"Terrence C. Tsou ,&nbsp;Natasha S. McKibben ,&nbsp;Chao Long Azad ,&nbsp;Matthew J. Heron ,&nbsp;Sabrina M. Wang ,&nbsp;Moreen W. Njoroge ,&nbsp;Franca Kraenzlin ,&nbsp;Nathan N. O’Hara ,&nbsp;Tim de Jong ,&nbsp;Scott T. Hollenbeck ,&nbsp;Mark J. Gage ,&nbsp;Lily R. Mundy","doi":"10.1016/j.bjps.2025.05.008","DOIUrl":"10.1016/j.bjps.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>The subjective experience of receiving surgical care is an important aspect of health care delivery. We aimed to characterize the care experience following traumatic lower extremity injury using patient-reported experience measures validated for this population.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, patients with lower extremity trauma completed the LIMB-Q Satisfaction with Decision, Satisfaction with Information, and Satisfaction with Health Care Professional scales (scored 0–100, greater is better). We collected demographic, clinical, and patient-reported outcome data. Multivariable linear regression was used to identify independent predictors of LIMB-Q scores.</div></div><div><h3>Results</h3><div>We collected data from 645 patients. Their mean age was 42 years (SD 17 years), and 62% were cisgender men. Patients reported high satisfaction with their surgeon (Mean=91 [SD 14]) but less satisfaction with how decisions were made regarding their care (Mean=74 [SD 26]) and the information they received about their care (Mean=70 [SD 21]). Each decade after injury was associated with a mean 4.8-point reduction in Satisfaction with Decision score (95% CI −0.74,−0.22). Education level was inversely associated with Satisfaction with Information (p=0.03). Compared to cisgender men, transgender and nonbinary patients reported less satisfaction with treatment decisions (mean difference [MD]=−27; 95% CI −46,−7.5) and health care professionals (MD=−30; 95% CI −55,−5.1). Compared to White patients, Asian or Pacific Islander patients reported lower satisfaction with health care professionals (MD=−19; 95% CI −36,−1.8) and treatment decisions (MD=−17; 95% CI −29,−3.7).</div></div><div><h3>Conclusions</h3><div>Patients with lower extremity trauma reported high levels of satisfaction with surgeons, but less satisfaction with treatment decisions and information. Satisfaction varied with demographic factors.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 164-173"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134805","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":"Comment on: “Optimising breast implant replacement surgery: Benefits of systemic tranexamic acid on post-operative blood loss and drain time”","authors":"Pooria Teymouri Parandeh,&nbsp;Mohammadreza Zare,&nbsp;Nima Masoudi","doi":"10.1016/j.bjps.2025.05.015","DOIUrl":"10.1016/j.bjps.2025.05.015","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 221-222"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170132","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":"Automated 3D facial smile attractiveness assessment before and after orthognathic surgery using transfer learning: A preliminary study","authors":"Wen-Chung Chiang ,&nbsp;Hui-Ling Chen ,&nbsp;Hsiu-Hsia Lin","doi":"10.1016/j.bjps.2025.05.010","DOIUrl":"10.1016/j.bjps.2025.05.010","url":null,"abstract":"<div><div>The aesthetic appearance of the mouth during smiling significantly influences facial attractiveness, thereby, making smile analysis crucial in orthodontics, craniofacial surgery, and cosmetic dentistry. Accurate and quantitative evaluation of facial smile attractiveness is crucial for surgical planning and outcome assessment in orthognathic surgery (OGS). In this study, a transfer learning (TL) model using a convolutional neural network (CNN) based on three-dimensional (3D) contour line features was employed to assess facial smile attractiveness before and after OGS. A retrospective cohort study involving 135 patients was conducted between 2021 and 2024 to compare facial smile attractiveness before and after OGS. Using the 3dMD™ face system, 3D facial photos were captured in a natural head position with forward-facing eyes, relaxed facial muscles, and habitual dental occlusion, before and at least 6 months after surgery. Subsequently, 3D contour images were extracted from these photos for web-based automatic facial smile attractiveness assessment using TL with CNN model. Postoperatively, facial smile attractiveness significantly improved, with scores increasing from 2.62 to 3.27, representing a 25% enhancement as determined by the constructed machine learning model. The web-based system offered clinicians a user-friendly interface, providing rapid assessment of results and serving as an effective tool for doctor-patient communication. This study marks the first attempt to automatically evaluate facial smile attractiveness before and after surgery in an objective and quantitative manner, using a machine learning model based on the 3D contours feature map.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 193-202"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170135","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":"Is aesthetic surgery being left behind? Irish trainee perspectives and proposals for reform","authors":"Dáire T. Goodman ,&nbsp;Kenneth M. Joyce","doi":"10.1016/j.bjps.2025.05.017","DOIUrl":"10.1016/j.bjps.2025.05.017","url":null,"abstract":"<div><div>Aesthetic surgery remains a core domain within plastic surgery training in the UK and Ireland. However, limited operative exposure has led to concerns about trainee preparedness. This study aimed to assess Irish plastic surgery trainees’ perspectives on aesthetic training and identify practical solutions to address current deficits. A national cross-sectional survey was distributed to all 26 plastic surgery trainees in the Republic of Ireland, achieving an 85% response rate (n = 22). Data were collected anonymously via REDCap and analysed descriptively. Eighty-one percent of trainees desired more aesthetic exposure, yet only 18% felt confident in reaching the required aesthetic competencies by completion of training. The principal barriers included a lack of aesthetic procedures in public hospitals (86%) and difficulty attending private lists due to service commitments (82%). Half of the respondents rotated through posts with private sector aesthetic exposure, but access was ad hoc and variable. Aesthetic surgery was the most commonly chosen subspecialty interest (50%), and 68% expressed interest in a funded national fellowship. Despite the inclusion of aesthetic surgery within the Intercollegiate curriculum, the mismatch between training structure and trainee aspirations risks producing underprepared graduates. International models—such as resident-led clinics and private sector rotations—have improved confidence and competence abroad and may be adaptable to the Irish context. We propose three strategies: structured collaboration with private providers, development of resident-led clinics, and a national aesthetic fellowship. These findings underscore the need for targeted reforms to improve training quality, align with certification standards, and support future workforce needs in aesthetic surgery.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 145-147"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115831","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":"Evolution and practice pattern in microsurgical breast reconstruction—A European multicenter study","authors":"Laura Cosima Siegwart ,&nbsp;Lisanne Grünherz ,&nbsp;Laurenz Weitgasser ,&nbsp;Maximilian Mahrhofer ,&nbsp;Nour Abu Abdallah ,&nbsp;Sonia Fertsch ,&nbsp;Andreas Wolter ,&nbsp;Laura Schneider ,&nbsp;Johanna Moncher ,&nbsp;Stella Erdmann ,&nbsp;Amir Khosrow Bigdeli ,&nbsp;Nicole Lindenblatt ,&nbsp;Thomas Schoeller ,&nbsp;Steffen Ulrich Eisenhardt ,&nbsp;Gottfried Wechselberger ,&nbsp;Christoph Andree ,&nbsp;Ulrich Kneser","doi":"10.1016/j.bjps.2025.05.011","DOIUrl":"10.1016/j.bjps.2025.05.011","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the evolution and practice pattern in microsurgical breast reconstruction.</div></div><div><h3>Methods</h3><div>A retrospective multicenter study was conducted including all patients who underwent microsurgical breast reconstruction in 6 European medical centers (January 2010 to December 2019). Patients were grouped according to the flap in the abdominal or alternative group. The patient and outcome data were merged for comparative analysis. Linear regression analysis was used to objectify the evolution in microsurgical breast reconstruction. A multiple mixed effects logistic regression model was applied to identify the predictors for the flap choice.</div></div><div><h3>Results</h3><div>A total of 4025 microsurgical breast reconstructions were performed in 3344 patients. Among them, 2891 (86%) patients with 3440 flaps were included in the abdominal group and 453 (14%) patients with 585 flaps were included in the alternative group. There was a significant increase (3.7% per year, p = 0.019) in microsurgical breast reconstruction and alternative flaps usage (12.6% per year, p &lt; 0.001). The deep inferior epigastric perforator, transverse musculocutaneous gracilis, and muscle-sparing - transverse rectus abdominis muscle flap were used in &gt;90% cases. The groups differed significantly in characteristics, perioperative, and postoperative parameters. Age, body mass index, radiotherapy, breast reconstruction laterality, the type of mastectomy, and previous implant failure were significant predictors for the flap choice.</div></div><div><h3>Conclusions</h3><div>This multicenter study outlined a significant increase in microsurgical breast reconstruction and continuous evolution to alternative flaps since 2010. It objectivized the relation of surgical and adjuvant breast cancer therapy on future options in microsurgical breast reconstructions and showed that customized concepts allow each patient in her unique situation to choose natural breast reconstruction.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 254-264"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178177","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":"Masseter nerve transfer with dual function for smile and eye closure","authors":"Katie Hicks ,&nbsp;Christine B. Novak ,&nbsp;Moaath Saggaf ,&nbsp;Amir Wachtel ,&nbsp;Daniel Antflek ,&nbsp;Larry Robinson ,&nbsp;Ronald M. Zuker ,&nbsp;Heather L. Baltzer","doi":"10.1016/j.bjps.2025.05.007","DOIUrl":"10.1016/j.bjps.2025.05.007","url":null,"abstract":"<div><div>In patients with facial nerve palsy, the masseter nerve (MN) transfer may be used to improve orbicularis oculi (OO) resting tone and eye closure. This study evaluated OO muscle function after “selective” MN transfer compared to upper cross face nerve graft (CFNG) in patients with facial nerve palsy.</div><div>This retrospective study included adults with facial nerve palsy who underwent CFNG and selective MN transfer for dual reinnervation of OO and zygomaticus major. Outcomes included electromyography evidence of OO reinnervation, clinical assessment, Sunnybrook Facial Grading System to assess symmetry, synkinesis, resting and dynamic eyelid position, and eMotrics for eye closure assessment.</div><div>The study included 16 patients (mean age at surgery: 53 years; mean time from injury to surgery: 6.7 months; mean follow-up, clinical: 29.4 months and video: 20.6 months). Postoperatively, there were significant improvements in resting symmetry for the cheek (p&lt;0.001), and symmetry of voluntary gentle eye closure (p=0.004) and smile (p&lt;0.0001). Postoperative synkinesis was observed with gentle eye closure and open mouth smile (mean score 0.44). Postoperative electromyography revealed innervation of OO via MN transfer in all patients (n=13) and CFNG in 5 patients. Postoperative eyelid position was significantly different at the marginal reflex distance with MN transfer activation (p&lt;0.01).</div><div>Selective MN transfer is effective in facilitating eye closure via functional innervation of the OO with the activation of the nerve transfer. Owing to the importance of eye closure for corneal protection, the selective MN transfer should be considered in patients undergoing surgery for facial reanimation.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 303-309"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189699","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":"Change in perception of non-operated body areas after abdominoplasty in massive weight loss patients – A prospective multicenter study","authors":"Jakub Opyrchal ,&nbsp;Anne van Beek ,&nbsp;Maarten Hoogbergen ,&nbsp;Lisa van den Berg ,&nbsp;Julie Verkaar ,&nbsp;Marek Paul","doi":"10.1016/j.bjps.2025.05.005","DOIUrl":"10.1016/j.bjps.2025.05.005","url":null,"abstract":"<div><div>As obesity becomes more prevalent worldwide, the demand for obesity-related treatments, including bariatric surgeries and Body Contouring Surgery (BCS) has surged<strong>.</strong> While bariatric surgery effectively induces weight loss, most patients are left with excess skin<strong>.</strong> As a result, the demand for BCS has steadily increased. Studies consistently report improvements in Health-Related Quality of Life (HRQoL) and body satisfaction of the operated areas after body contouring surgery. However, little research has investigated how BCS affects the perception of untreated body areas.</div><div>A total of 241 patients were enrolled in the prospective study, 144 (34% Polish, 66% Dutch) completed the BODY-Q questionnaire preoperatively and one year postoperatively. The Total Weight Loss (TWL) before BCS was 40.3% (SD ± 9.1). Our results show that body contouring surgery positively impacts both satisfaction with surgically treated areas and overall HRQoL. The indirect body area scales demonstrated significant improvements in all non-operated body areas, except for inner thigh satisfaction, which did not reach significance at twelve months (p=0.09).</div><div>In conclusion, this study shows that a single body contouring procedure after massive weight loss can significantly improve patients' perception of their entire body, enhancing whole body image and health-related quality of life.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 108-113"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098871","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 anatomical sequence of arterial calcification in peripheral vascular disease and its implications for free flap reconstruction","authors":"John M. Felder ,&nbsp;Kenan Tawaklna ,&nbsp;Emmanuel Nageeb ,&nbsp;Patrick Geraghty","doi":"10.1016/j.bjps.2025.05.004","DOIUrl":"10.1016/j.bjps.2025.05.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Lower extremity (LE) free tissue transfer (FTT) in patients with peripheral vascular disease (PVD) is complicated by arterial calcification, which may occur in free flap pedicle vessels as well as recipient vessels. However, no studies have examined the likelihood of encountering calcification in common flap pedicles or the anatomical sequence in which this process occurs.</div></div><div><h3>Methods</h3><div>Computed tomography (CT) and x-ray (XR) imaging were obtained in PVD patients undergoing LE FTT. Using software designed for cardiac vessel calcium analysis, calcium volume was quantified in flap pedicles of the trunk, upper extremity, pelvis, and lower extremity on CT images. Descriptive statistics were used to identify flap vessels most affected by calcification. A novel scoring system (Qual Calc) was developed to predict the likelihood of flap pedicle calcification by examining the qualitative presence of vascular calcification on plain foot XR.</div></div><div><h3>Results</h3><div>Trunk pedicles (subscapular) showed statistically significantly lower calcification rates and volumes than lower extremity pedicles. LE flap pedicles were most likely to be calcified, with the lateral femoral circumflex artery being the most frequently calcified. Qual Calc score was highly predictive of quantified calcium volume in workhorse flaps of the upper and lower extremity.</div></div><div><h3>Conclusion</h3><div>Arterial calcification proceeds anatomically from the lower extremity cephalad towards the chest. Flaps based on the subscapular system are least affected by calcification and represent a safer reconstructive choice than thigh-based flaps for limb salvage in vasculopathic patients. Simple foot x-rays can be used to predict flap pedicle calcification with a reasonable degree of accuracy.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 148-155"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115830","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}