Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Post-operative complications in combined versus staged breast reconstruction and risk-reducing gynecologic surgeries: A multi-institution multi-surgeon analysis","authors":"Kassra Garoosi ,&nbsp;Nargis Kalia ,&nbsp;Jubril Adepoju ,&nbsp;Maria J. Escobar-Domingo ,&nbsp;Codi Horstman ,&nbsp;Riley Kahan ,&nbsp;Quinn Fitzpatrick ,&nbsp;Yoo Jin Ahn ,&nbsp;John B. Park ,&nbsp;Ben Grobman ,&nbsp;Daniela Lee ,&nbsp;Deana S. Shenaq ,&nbsp;David Kurlander ,&nbsp;Mamtha Raj ,&nbsp;Sarah Tevis ,&nbsp;Jaime Arruda ,&nbsp;Julian Winocour ,&nbsp;George Kokosis ,&nbsp;Bernard T. Lee ,&nbsp;David W. Mathes ,&nbsp;Christodoulos Kaoutzanis","doi":"10.1016/j.bjps.2025.06.033","DOIUrl":"10.1016/j.bjps.2025.06.033","url":null,"abstract":"<div><h3>Background</h3><div>Combined breast reconstruction and risk-reducing gynecologic procedures (RRGPs) have emerged as an alternative to the traditional staged approach, offering potential advantages such as reduced cumulative surgical burden and streamlined recovery. However, conflicting outcomes in the literature highlight the need for multi-institutional analyses to guide clinical decision-making.</div></div><div><h3>Methods</h3><div>This multi-institutional, retrospective cohort study evaluated postoperative complications within 90 days of surgery among patients undergoing combined versus staged breast reconstruction and RRGPs. Data from three academic centers spanning 2010 to 2023 were analyzed. The primary outcome was the occurrence of complications, stratified by reconstruction type and gynecologic procedures. Secondary outcomes included emergency department visits, reoperations, readmissions, and hospital length of stay. Multivariable analyses controlled for confounding variables, including BMI, prior radiation therapy, and comorbidities.</div></div><div><h3>Results</h3><div>Among 348 patients, 96 underwent combined procedures and 252 underwent staged procedures. Overall complication rates were comparable between groups after adjustment (adjusted OR: 0.85, 95% CI: 0.66–1.10, p = 0.220). Combined procedures were associated with shorter operative times and hospital stays compared to staged surgeries (median 296 vs. 386 min, p &lt; 0.001; mean: 1 day vs. 2 days, p &lt; 0.001). Subgroup analysis revealed a significantly higher risk of seroma/hematoma in tissue expander-based reconstruction within the combined cohort (45% vs. 13%, p = 0.020), while direct-to-implant and autologous reconstructions had similar complication rates between groups. Gynecologic complications were infrequent and did not differ significantly between cohorts.</div></div><div><h3>Conclusions</h3><div>Combined procedures provide a viable alternative to staged approaches, offering logistical advantages without increasing overall complication rates. Careful patient selection and perioperative planning remain critical, particularly for tissue expander-based reconstruction, where complication risk may be higher in combined surgeries. Further prospective studies are needed to refine patient selection criteria and optimize outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 258-266"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568282","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":"Efficacy of closed-incision negative pressure wound therapy in abdominal-based autologous breast reconstruction: A systematic review and meta-analysis","authors":"Ahmad Abul ,&nbsp;Ali Abel ,&nbsp;Mohammad Al-Saffar ,&nbsp;Sara Iskeirjeh ,&nbsp;Saif Badran","doi":"10.1016/j.bjps.2025.06.032","DOIUrl":"10.1016/j.bjps.2025.06.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Abdominal-based free tissue transfers, such as the Deep Inferior Epigastric Perforator (DIEP) flap, are widely utilized in autologous breast reconstruction. These procedures are often complicated by wound healing issues at the donor site, including wound dehiscence, seroma formation, and surgical site infections (SSIs). Closed Incision Negative Pressure Wound Therapy (ciNPWT) has been suggested to improve healing outcomes and reduce the incidence of postoperative complications. This synthesis evaluated the efficacy of ciNPWT compared to standard dressings in abdominal-based autologous breast reconstruction.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials and observational studies assessing ciNPWT versus standard dressings in patients undergoing abdominal-based free flap breast reconstruction were included. Primary and secondary outcomes analyzed were wound dehiscence, SSIs, seroma formation, and length of stay. Data from multiple databases were independently reviewed and synthesized using Review Manager 5.4 and Microsoft Excel. Studies were rigorously selected and assessed for risk of bias.</div></div><div><h3>Results</h3><div>Of the 348 identified articles, 13 studies met the inclusion criteria, comprising three randomized controlled trials and 10 observational studies, totaling 2882 patients. The ciNPWT group showed a 42% reduction in wound dehiscence (OR 0.58, 95% CI 0.42–0.79; p = 0.0007), with moderate heterogeneity (I² = 36%). No significant differences were found for surgical site infections (OR 0.77, 95% CI 0.50–1.18; p = 0.23) and seroma formation (OR 0.66, 95% CI 0.38–1.12; p = 0.15). Variations in length of stay data prevented quantitative analysis.</div></div><div><h3>Conclusion</h3><div>ciNPWT demonstrates a significant reduction in wound dehiscence, highlighting its value in enhancing postoperative care, especially for high-risk patients. However, further research involving larger, multicenter randomized controlled trials is necessary to fully elucidate ciNPWT's role in reducing other complications and its broader clinical applicability.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 151-161"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557415","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: Preoperative perforator mapping of anterolateral thigh perforators via Projected Augmented Reality and Dynamic Infrared Thermography","authors":"Mehreen Qureshi,&nbsp;Febisayo Sidiku,&nbsp;Ramesh Vidyadharan","doi":"10.1016/j.bjps.2025.05.048","DOIUrl":"10.1016/j.bjps.2025.05.048","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 271-272"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568280","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":"Saving millions: The economic impact of switching to waterless surgical hand scrubs in plastic and reconstructive surgery","authors":"Agustin N. Posso ,&nbsp;Joshua Bloom ,&nbsp;Micaela Tobin ,&nbsp;Audrey Mustoe ,&nbsp;Morvarid Mehdizadeh ,&nbsp;Khoa N. Nguyen ,&nbsp;Maria J. Escobar-Domingo ,&nbsp;Sarah Karinja ,&nbsp;Samuel J. Lin ,&nbsp;Bernard T. Lee","doi":"10.1016/j.bjps.2025.06.027","DOIUrl":"10.1016/j.bjps.2025.06.027","url":null,"abstract":"<div><h3>Background</h3><div>Alcohol-based surgical hand scrubs are a safe, environmentally friendly, and cost-effective alternative to traditional water-based hand antisepsis, supported by the World Health Organization (WHO). These advantages make alcohol-based hand scrubs ideal for various plastic and reconstructive surgery settings. This study evaluates the potential financial savings of transitioning to alcohol-based surgical scrubs within a division of plastic and reconstructive surgery.</div></div><div><h3>Methods</h3><div>Data was collected from a division of plastic and reconstructive surgery at a single institution. Water consumption for traditional surgical hand scrub was measured according to WHO guidelines. Water costs were calculated based on the Boston Water and Sewer Commission rates. The costs of alcohol solution and impregnated brushes were obtained from the hospital’s perioperative services. Annual surgical volume data were used to estimate water consumption and consumable costs. Time savings were calculated based on WHO protocols and converted into cost savings.</div></div><div><h3>Results</h3><div>The average water consumption per scrub was 7.62 L, with an average of 36.17 L used per surgery. If every plastic surgery procedure used traditional wet scrubs, the annual water consumption would be 87,233.76 L. The cost of water per scrub was $0.05. The consumable cost per scrub was $0.20 for alcohol-based scrubs and $0.52 for wet scrubs. Annually, transitioning to alcohol-based scrubs would save $3090.96 in consumable costs. Adopting waterless scrubs and decreasing scrub time could result in savings of $1316,445.48 annually in our division.</div></div><div><h3>Conclusion</h3><div>Transitioning to alcohol-based surgical hand scrub in plastic and reconstructive surgery may provide significant environmental and economic benefits.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 148-150"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549573","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":"Response to Letter Re: Preoperative perforator mapping of anterolateral thigh perforators via Projected Augmented Reality and Dynamic Infrared Thermography","authors":"Eva L. Meier,&nbsp;Tim de Jong,&nbsp;Dietmar J.O. Ulrich,&nbsp;Stefan Hummelink","doi":"10.1016/j.bjps.2025.06.030","DOIUrl":"10.1016/j.bjps.2025.06.030","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 273-274"},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568283","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":"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":"Predicting complications in breast reconstruction: External validation of a machine learning model","authors":"Anne M. Meyer ,&nbsp;Hyung Bae Kim ,&nbsp;Jin Sup Eom ,&nbsp;Lauren Sinik ,&nbsp;Sterling Braun ,&nbsp;Hyun Ho Han ,&nbsp;James A. Butterworth","doi":"10.1016/j.bjps.2025.06.020","DOIUrl":"10.1016/j.bjps.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction provides aesthetic and psychosocial benefits, but nipple-areolar complex (NAC) necrosis remains a significant risk. This study externally validated a previously developed machine learning (ML) model that predicted NAC necrosis with 97% accuracy on institutional data.</div></div><div><h3>Methods</h3><div>This retrospective cohort study identified an initial 394 patients who underwent NSM with immediate breast reconstruction at Asan Medical Center (January 2021 - August 2022). Though there were 6 incomplete patient profiles, which resulted in 388 cases being used for statistical analysis, as demonstrated in Table 1. Demographic, oncologic, and surgical data were collected, with complications defined as post-operative events occurring within 90 days. A previously validated random forest ML model was applied to predict NAC necrosis. Model performance was assessed using accuracy, area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and predictive values.</div></div><div><h3>Results</h3><div>Of 388 patients, 19 (4.9%) developed NAC necrosis. Significant risk factors included older age (mean age: 51.3 vs. 46.2 years, p = 0.015), higher BMI (mean BMI: 24.2 vs. 22.4, p = 0.024), active smoking (p = 0.008), and cumulative smoking exposure (mean pack-years: 3.3 vs. 0.2, p &lt; 0.0001). Mastectomy specimen weight was significantly associated with NAC necrosis (mean: 394.2 g vs. 313.4 g, p = 0.021). The ML model achieved a predictive accuracy of 96%, with an AUC-ROC of 0.70 (95% CI: 0.55–0.85), indicating moderate discriminative ability.</div></div><div><h3>Conclusions</h3><div>The externally validated ML model accurately predicted NAC necrosis in a distinct patient population, demonstrating its potential for personalized risk assessment in NSM candidates. Future validation in diverse populations is needed.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 176-181"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572370","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":"Institutional support for plastic surgery applicants: Letter in response to recently published manuscript, “Characterizing the past 5 years of integrated plastic surgery applicants: A Texas STAR analysis”","authors":"Emily E. Zona,&nbsp;Alisha S. Khosla,&nbsp;Kirsten A. Gunderson,&nbsp;Jacqueline S. Israel","doi":"10.1016/j.bjps.2025.06.019","DOIUrl":"10.1016/j.bjps.2025.06.019","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"107 ","pages":"Pages 192-195"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595552","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}