Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Letter to the editor: A treatment algorithm for hyaluronic acid filler related complications of the face","authors":"","doi":"10.1016/j.bjps.2024.08.070","DOIUrl":"10.1016/j.bjps.2024.08.070","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142098461","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":"Predictors of 30-day complications, readmission, and postoperative length of stay in children undergoing autologous rib grafting for microtia","authors":"","doi":"10.1016/j.bjps.2024.08.068","DOIUrl":"10.1016/j.bjps.2024.08.068","url":null,"abstract":"<div><h3>Background</h3><p>Predictors of outcomes in pediatric microtia surgery are not well understood within the current literature. A multi-institutional database study may reveal insights into these predictors.</p></div><div><h3>Objectives</h3><p>To explore the predictors of 30-day complications, 30-day readmission, and postoperative length of stay (PLOS) in pediatric microtia patients undergoing autologous rib grafting.</p></div><div><h3>Methods</h3><p>The Pediatric National Surgical Quality Improvement Program was queried for details on patients with microtia (ICD-9/10 744.23/Q17.2) who underwent autologous rib grafting (CPT 21230) between 2012–2021. Demographics, comorbidities, inpatient status, 30-day complications, PLOS, and 30-day readmissions were analyzed. Statistical analyses were performed to compare the preoperative characteristics with postoperative outcomes.</p></div><div><h3>Results</h3><p>Overall, 667 patients met the inclusion criteria. Sixty-three (9.4%) had at least one complication, and 19 (2.9%) were readmitted. Univariate analysis showed that inpatient status (p = 0.011) and race (p = 0.023) were associated with higher complication rates. Multivariate analysis revealed that outpatient status was associated with significantly lower odds of complications (OR: 0.49, 95% CI [0.27, 0.87], p = 0.018), and developmental delay was associated with higher odds of 30-day readmission (OR: 2.80, 95% CI [1.05, 7.17], p = 0.036). Longer operative time was associated with older age (13.9% increase per five-year age increase, p &lt; 0.001) and inpatient status (35.3% increase, p &lt; 0.001). PLOS was shorter for outpatients (45.45% shorter, p &lt; 0.001) and cases performed by plastic surgeons (14.2% shorter, p &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Microtia reconstruction using autologous cartilage is a relatively safe procedure with low complication and readmission rates. Significant predictors of postoperative outcomes include inpatient status, race, developmental delay, and age. These findings highlight the importance of considering these factors in surgical planning and patient counseling.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147216","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":"Microsurgery in low- and middle-income countries: Results of 20 years of experience in Cambodia","authors":"","doi":"10.1016/j.bjps.2024.08.073","DOIUrl":"10.1016/j.bjps.2024.08.073","url":null,"abstract":"<div><h3>Background</h3><p>Microsurgical free tissue transfer is the gold standard for reconstructing major bone or soft tissue defects but requires complex training, and specific resources. Therefore, some authors have stated that microsurgery is impossible in low- and middle-income countries.</p></div><div><h3>Methods</h3><p>Patients from Khmer underwent free flap surgery at the Children’s Surgical Centre in Phnom Penh between 2004 and 2023. Two non-governmental organizations facilitated the program: <em>Rose Charities Cambodia</em> provided the facilities, patients and local staff, and <em>Doctors of the World</em> provided the surgeons, and anesthetists. At least one Khmer surgeon was trained during these operations. Digital data were collected retrospectively, and analyzed in June 2023.</p></div><div><h3>Results</h3><p>Fifty-six free flaps in 54 patients have been performed since 2004. The most frequent sites requiring reconstruction were the head and neck (35.7%), lower limbs (30.4%), and upper limbs (21.4%). The most frequent free flaps were free fibula (44.6%), gracilis (19.6%), and anterolateral thigh (16.1%). Among the 56 flaps, 41 (= 73.2%) were viable long-term and 15 (26.7%) were microsurgical failures. Sixteen flaps underwent revision in the operating room. Twenty-three flap-related complications were reported in 21 patients with mostly vascular thrombosis (n = 12), hematoma (n = 3) and infections (3). However, 83.3% had improved or were cured of their initial pathology after final surgical management.</p></div><div><h3>Conclusions</h3><p>Free flaps performed in our series as part of international surgical collaborations in a low-income country are feasible, but we experienced higher failure rates, and later revisions compared to the results in high-income countries. We identified several solutions to improve the microsurgery outcomes in low-income settings.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163924","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":"Porcine submucosal extracellular matrix wrapping of the ulnar nerve in revision cubital tunnel surgery","authors":"","doi":"10.1016/j.bjps.2024.08.072","DOIUrl":"10.1016/j.bjps.2024.08.072","url":null,"abstract":"<div><p>The wrapping technique aims to protect the nerve when the nerve bed is compromised or more commonly to prevent the recurrence of scar tethering following neurolysis. A wrap provides a physical barrier to scar and helps restore the paraneurial gliding layer. This study aimed to evaluate the results of the AxoGuard® nerve protector, a porcine-derived submucosal extracellular matrix (PECM), used as an adjunct in persistent or recurrent cubital tunnel syndrome (CuTS). This retrospective cohort study evaluated patients diagnosed, between 2012 and 2020, with neuropathic pain who underwent revision surgery. Patients were categorised into Group A (revision surgery only) and Group B (revision surgery and adjunctive PECM nerve wrapping). Disease severity was scored at the baseline and six months post-operatively using the McGowan classification. A linear regression model was used to assess the effect of wrapping the ulnar nerve on the clinical outcome at six months. Fifty-nine nerves were treated; among them, adjunctive PECM wrapping was used in 32 nerves. Disease severity at baseline was similar between the groups. After adjusting for differences in baseline characteristics, participants in Group B improved with a significant difference of 0.43 McGowan points over Group A (95% CI (0.01–0.86), p = 0.049). There were no implant-related complications. Group B improved with excellent or good outcomes in 84.4% patients at the final follow-up. Persistent or recurrent CuTS were associated with neuropathic pain and significant nerve scar tether. The use of PECM appears to lead to improved clinical symptoms, possibly by reducing adhesions and encouraging physiological glide.</p></div><div><h3>Level of evidence</h3><p>Level III evidence.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172391","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":"Ergonomic practices and interventions in plastic and reconstructive surgery: A systematic review","authors":"","doi":"10.1016/j.bjps.2024.05.061","DOIUrl":"10.1016/j.bjps.2024.05.061","url":null,"abstract":"<div><h3>Introduction</h3><p>Ergonomics have significant implications for the surgical workforce that performs at the interface between human-operated equipment and patient anatomy to achieve clinical results. This systematic review evaluated the literature discussing ergonomics in plastic surgery to explore current knowledge, evaluate trends, and identify prime gaps for future study.</p></div><div><h3>Methods</h3><p>A systematic search strategy was developed by a licensed librarian and plastic surgeon to query all manuscripts evaluating ergonomics in plastic and reconstructive surgery. Two independent reviewers screened abstracts, evaluated full texts, and extracted data.</p></div><div><h3>Results</h3><p>Forty-six studies were ultimately included. The number of published studies increased significantly over time when evaluated by year (ρ = 0.660, <em>p</em> &lt; 0.001), with 17 (36.9%) written since 2020. Studies more commonly discussed musculoskeletal pain/disorders (n = 23) compared to surgical instrumentation or technology (n = 18, <em>p</em> = 0.390), operative posture (n = 14, <em>p</em> = 0.041), surgical technique (n = 6, <em>p</em> = 0.002), peri-surgical practices (n = 5, <em>p</em> &lt; 0.001), and surgeon physiology (n = 3, <em>p</em> &lt; 0.001). Among the 19 studies, including interventions, approaches more frequently involved novel instrumentation or technology (n = 14, 73.4%) compared to peri-surgical practices (n = 3, 6.5%, <em>p</em> &lt; 0.001) or operative posture (n = 2, 4.3%, <em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Ergonomics in plastic surgery has gained significant interest over time, with recent years representing a large proportion of published literature. Although most studies discuss musculoskeletal pain, the proportion of studies addressing posture and surgical practices are comparatively underrepresented, suggesting an opportunity for future intervention.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142209684","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":"Exploring the transcriptomic and metabolomic profiles of adipose tissues: Insights and implications for fat grafting","authors":"","doi":"10.1016/j.bjps.2024.08.066","DOIUrl":"10.1016/j.bjps.2024.08.066","url":null,"abstract":"<div><h3>Background</h3><p>Expanding on previous research on murine fat grafts’ metabolic shift, this study delved deeper into the metabolic profiles of human adipose tissues, specifically the superficial subcutaneous adipose tissue (SSAT) and deep subcutaneous adipose tissue (DSAT).</p></div><div><h3>Methods</h3><p>Utilizing RNA sequencing, metabolomics, and metabolic flux analyses, SSAT and DSAT samples obtained during deep inferior epigastric perforator flap breast reconstructions were examined. Transcript data underwent unsupervised hierarchical clustering and Gene Set Enrichment Analysis. Metabolomics involved analyzing samples for cationic and anionic metabolites via capillary electrophoresis time-of-flight mass spectrometry, followed by principal component analysis (PCA) and heat map generation. Primary adipocytes from SSAT and DSAT were assessed using the Seahorse® extracellular flux analyzer.</p></div><div><h3>Results</h3><p>PCA and heat map analyses highlighted distinct transcriptomic and metabolomic differences between SSAT and DSAT. SSAT predominantly upregulated genes linked to adipogenesis [false discovery rate (FDR) q &lt; 0.0001], oxidative phosphorylation (FDR q &lt; 0.0001), fatty acid metabolism (FDR q &lt; 0.0001), and glycolysis (FDR q = 0.001). In contrast, DSAT showed a significant upregulation in inflammatory response genes (FDR q &lt; 0.05). Metabolite analysis revealed an abundance of glycolytic metabolites in SSAT, whereas DSAT was rich in metabolites associated with fatty acid metabolism and oxidative phosphorylation. Cellular flux analysis further confirmed SSAT’s elevated glycolysis and spare oxidative phosphorylation capacities.</p></div><div><h3>Conclusion</h3><p>Results highlighted the metabolic uniqueness of SSAT and DSAT in humans, with SSAT exhibiting superior metabolic flexibility. The implications of these metabolic differences, especially in fat grafting procedures, necessitate further research and exploration in future studies.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147213","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":"Unknown effects of nicotine pouches (snus) in Plastic Surgery: Lessons from a systematic review","authors":"","doi":"10.1016/j.bjps.2024.08.069","DOIUrl":"10.1016/j.bjps.2024.08.069","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129164","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":"Coffee, chocolate, pillows and pints of blood: Debunking the mantras and myths of microsurgery","authors":"","doi":"10.1016/j.bjps.2024.08.067","DOIUrl":"10.1016/j.bjps.2024.08.067","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129165","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":"Understanding healing complications in implant-based breast reconstruction using novel metrics for indocyanine green angiography","authors":"","doi":"10.1016/j.bjps.2024.08.062","DOIUrl":"10.1016/j.bjps.2024.08.062","url":null,"abstract":"<div><h3>Introduction</h3><p>Indocyanine green (ICG) angiography for the intraoperative evaluation of tissue perfusion is commonly used in implant-based breast reconstruction (IBR). The assessment of ICG images depends on the surgeon’s interpretation and is qualitative or semiqualitative in nature. To quantify ICG metrics, this study aimed to apply a novel assessment of fill-rate dynamics to predict wound-healing complications and provide pragmatic assessment tools in IBR.</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study of patients who underwent IBR with ICG using the photodynamic eye (PDE-Neo II) qualitative imaging system between April 2021 and September 2023. ICG recordings were reviewed to quantify the relative surface area and fluorescence intensity of visual perfusion deficits using ImageJ. The primary outcome was the incidence of wound-healing complications. t-tests and logistic regression were performed for statistical testing.</p></div><div><h3>Results</h3><p>A total of 112 patients (201 breasts) were included. The incidence of wound-healing complications was 12.9%. A higher relative surface area of ischemic regions was significantly associated with wound-healing complications (3.3% vs. 0.90%; p = 0.001). The rate of change in the surface area of ischemic regions was significantly associated with wound-healing complications (0.35% per second vs. 1.29% per second; p = 0.003%). On average, the duration of transient ischemic areas was significantly longer in breasts with wound-healing complications (46.0 s vs. 36.0 s, p = 0.01).</p></div><div><h3>Conclusion</h3><p>A transient ischemic area of &gt; 5% of the breast and/or failure to resolve transient ischemic areas after 60 s may predict wound-healing complications and inform surgical reconstructive decision-making in IBR.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099585","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":"Evaluating the benefit of progressive tension sutures at the donor site in autologous breast reconstruction – A retrospective comparative cohort study","authors":"","doi":"10.1016/j.bjps.2024.08.064","DOIUrl":"10.1016/j.bjps.2024.08.064","url":null,"abstract":"<div><h3>Background</h3><p>As seroma formation is a common donor site complication following autologous breast reconstruction, we adapted the surgical protocol by introducing progressive tension sutures (PTS). This study aimed to evaluate the influence of PTS at the donor site in autologous breast reconstruction on seroma formation. Additionally, an exploratory analysis on patient satisfaction and aesthetic outcome was performed.</p></div><div><h3>Methods</h3><p>This retrospective cohort study analyzed data of 400 patients who received autologous breast reconstruction between 2018 and 2022. Among them, 204 patients received traditional donor site closure, and 188 patients received PTS with or without drain placement. Proportional incidence of seroma was described and multivariable logistic regression was used to assess the risk factors for seroma formation. At the deep inferior epigastric artery perforator donor site, patient satisfaction was further explored by administering the BREAST-Q and the aesthetic outcome was graded by three blinded participants.</p></div><div><h3>Results</h3><p>Overall, 514 breast reconstructions were performed on 400 patients. The incidence of seroma formation was lower in the PTS group compared with that in the traditional closure group. Multivariable analysis showed that patients who received PTS were 40% less likely to develop seroma. Aesthetic outcome was considered more pleasing objectively and subjectively if PTS were performed. Regarding patient satisfaction, no difference was found in the post-operative physical well-being between the two groups.</p></div><div><h3>Conclusions</h3><p>In this large cohort, we found reduced incidence of seroma when PTS were performed. PTS were also associated with reduced odds of seroma formation and were described to be aesthetically more pleasing. PTS should be considered in autologous breast reconstruction.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129163","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}