Aesthetic Surgery Journal最新文献

{"title":"Strategic Use of the V-Shaped Columella- Labial Incision for Reconstructive Rhinoplasty in Severely Compromised Noses.","authors":"Amir A Sazgar, Mehr A Sazgar, Rojan Zarei, Amir K Sazgar","doi":"10.1093/asj/sjaf060","DOIUrl":"https://doi.org/10.1093/asj/sjaf060","url":null,"abstract":"<p><strong>Background: </strong>Columellar incision techniques for multiply operated and/or severely compromised noses are critical in reconstructive rhinoplasty, because they impact both the final outcome and the risk of complications, such as wound dehiscence and skin flap necrosis.</p><p><strong>Objectives: </strong>The aims of the study are to evaluate the safety of the columella-labial incision in patients with previous mid-columellar scars and assess the functional and aesthetic outcomes of reconstructive septorhinoplasty using this strategic incision through patient-reported outcome measures and chart reviews.</p><p><strong>Methods: </strong>This case series included patients with previous unsuccessful rhinoplasties and mid-columellar scars who underwent open-approach reconstructive septorhinoplasty with a columella-labial incision. Collected data included demographics, medical history, operative reports, and postoperative events. Skeletal reconstruction was performed using various autografts. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively.</p><p><strong>Results: </strong>Most patients were female (68/91, 75%), with a mean age of 37.6 years and 1.74 previous rhinoplasties. The average surgery duration was 239.5 min. Autografts included auricular cartilage (64), costal cartilage (43), temporal fascia (12), and rectus fascia (24). No cases of dehiscence or vascular complications occurred, even in patients with multiple previous mid-columellar incisions. SCHNOS scores significantly improved, with obstruction scores decreasing from 52.86 to 18.43 (standard deviation [SD] = 8.33 vs 3.95) and cosmesis scores from 78.09 to 20.19 (SD = 6.44 vs 5.13).</p><p><strong>Conclusions: </strong>The V-shaped columella-labial incision does not increase the risk of vascular compromise, even in patients with mid-columellar scars. Its strategic use facilitates skeletal reconstruction while effectively improving nasal contour and columellar length with acceptable scarring.</p><p><strong>Level of evidence: 4 (therapeutic): </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perception of Changes in Functional Symptoms and Psychological Aspects Related to Rectus Muscle Diastasis in Women Who Have Undergone Reparative Abdominoplasty.","authors":"Giovanni Francesco Marangi, Marco Gratteri, Fara Desiree Romano, Vito Toto, Angelo Faiola, Matteo Pazzaglia, Lucrezia Chiacchierini, Alessandro Cocomazzi, Annalisa Cogliandro, Paolo Persichetti","doi":"10.1093/asj/sjaf057","DOIUrl":"https://doi.org/10.1093/asj/sjaf057","url":null,"abstract":"<p><strong>Background: </strong>Very little is known of how urinary symptoms and low back pain related to rectus abdominis diastasis tend to change after reparative surgery.</p><p><strong>Objectives: </strong>In this study we aimed to investigate these symptom changes in women who underwent abdominoplasty with diastasis correction, and also provide an overview on quality of life, psychosocial aspects, and patient satisfaction.</p><p><strong>Methods: </strong>A total of 78 patients underwent abdominoplasty with diastasis repair and were included in this prospective study. Urinary symptoms and low back pain were evaluated respectively by the International Consultation on Incontinence Questionnaire, Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) and the Roland-Morris questionnaire. The Derriford Appearance Scale (DAS-59) was administered for evaluation of the respondent's discomfort, as was the BODY-Q for body image and quality of life. Furthermore, the assessment of satisfaction by 3 external surgeons was obtained. Statistical analysis was conducted with Prism 9.</p><p><strong>Results: </strong>Statistically significant differences between time T0 (preoperative) and T3 (3 months postoperatively) and between time T0 and T12 (12 months postoperatively) were found for the BODY-Q, ICIQ-FLUTS, and Roland-Morris scores. No correlation was found between diastasis width and the difference from T0 to T12 in any of the symptom questionnaires. A correlation between patient and surgeon satisfaction emerged. In just 9 cases the patient was dissatisfied when the expert observer was satisfied. The mean preoperative DAS-59 value of satisfied patients and satisfied surgeons was compared with that of dissatisfied patients and satisfied surgeons, and a statistically significant difference was noted.</p><p><strong>Conclusions: </strong>Abdominoplasty with correction of rectus muscle diastasis may improve women's quality of life. From the patient's point of view, voiding and incontinence symptoms and back pain tended to improve after surgery regardless of the width of the diastasis.</p><p><strong>Level of evidence: 3 (therapeutic): </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Case Series Study of Illegal Cosmetic Iatrogenic Botulism: Outbreak Analysis and Response Lessons.","authors":"He Qiu, Jiang Shen, Yali Tang, Qiang Ji, Xiaoqun Lin, Dongmei Wu","doi":"10.1093/asj/sjaf088","DOIUrl":"https://doi.org/10.1093/asj/sjaf088","url":null,"abstract":"<p><strong>Background: </strong>Botulism is a rare and possibly life-threatening neuroparalytic syndrome. Recent large-scale outbreaks of iatrogenic botulism, primarily linked to cosmetic injections, have garnered significant attention.</p><p><strong>Objectives: </strong>This study discusses the factors that may lead to the outbreak of cosmetic iatrogenic botulism (CIB), provides the epidemiological description of CIB cases and puts forward response measures.</p><p><strong>Methods: </strong>All clinical data, laboratory investigations, and therapeutic procedures of CIB patients in a large single-center retrospective cohort (2014-2024) were reviewed and analyzed.</p><p><strong>Results: </strong>Over a 10 year period, 161 cases of CIB were identified, of which 81 (50.31%) were hospitalized and 80 (49.69%) were outpatient cases. Most patients received botulinum toxin (BoNT) injections of unknown origin from unlicensed practitioners in non-medical settings. Severe and moderate cases of CIB accounted for up to 60%, with the majority of outbreaks occurring in 2024. The median time from botulism onset was 0 to 17 days, with the highest incidence occurring within 3 days following the injection. Hospitalized patients were discharged after a mean of 11.64 ± 9.40 days (range: 1 to 39 days), and symptoms resolved in botulism patients within a mean of 24.85 ± 11.67 days following treatment. Treatments included antitoxin administration, hyperbaric oxygen therapy, pyridostigmine, other symptomatic treatment and supportive care.</p><p><strong>Conclusions: </strong>This represents the largest reported outbreak of illicit CIB worldwide, highlighting the risks associated with counterfeit BoNT, non-compliant practices, and underscoring the critical need for stringent surveillance of BoNT distribution. Clinicians should be adept at recognizing and adhering to the diagnosis, treatment, and follow-up management of CIB.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of an AI-driven Classification of Tuberous Breast Deformity: A Siamese Network Approach with a Continuous Tuberosity Score.","authors":"Stefano Vaccari, Alberto Paderno, Simone Furlan, Mattia Federico Cavallero, Alessandro Marco Lupacchini, Riccardo Di Giuli, Marco Klinger, Francesco Klinger, Valeriano Vinci","doi":"10.1093/asj/sjaf090","DOIUrl":"https://doi.org/10.1093/asj/sjaf090","url":null,"abstract":"<p><strong>Background: </strong>Tuberous breast deformity (TBD) is a congenital condition characterized by constriction of the breast base, parenchymal hypoplasia, and areolar herniation. The absence of a universally accepted classification system complicates diagnosis and surgical planning, leading to variability in clinical outcomes. Artificial intelligence (AI) has emerged as a powerful adjunct in medical imaging, enabling objective, reproducible, and data-driven diagnostic assessments.</p><p><strong>Objectives: </strong>This study introduces an AI-driven diagnostic tool for tuberous breast deformity (TBD) classification using a Siamese Network trained on paired frontal and lateral images. Additionally, the model generates a continuous Tuberosity Score (ranging from 0 to 1) based on embedding vector distances, offering an objective measure to enhance surgical planning and improved clinical outcomes.</p><p><strong>Methods: </strong>A dataset of 200 expertly classified frontal and lateral breast images (100 tuberous, 100 non-tuberous) was used to train a Siamese Network with contrastive loss. The model extracted high-dimensional feature embeddings to differentiate tuberous from non-tuberous breasts. Five-fold cross-validation ensured robust performance evaluation. Performance metrics included accuracy, precision, recall, and F1-score. Visualization techniques, such as t-SNE clustering and occlusion sensitivity mapping, were employed to interpret model decisions.</p><p><strong>Results: </strong>The model achieved an average accuracy of 96.2% ± 5.5%, with balanced precision and recall. The Tuberosity Score, derived from the Euclidean distance between embeddings, provided a continuous measure of deformity severity, correlating well with clinical assessments.</p><p><strong>Conclusions: </strong>This AI-based framework offers an objective, high-accuracy classification system for TBD. The Tuberosity Score enhances diagnostic precision, potentially aiding in surgical planning and improving patient outcomes.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Satisfaction With Minimally Invasive Aesthetic Treatments With the SKIN-Q Treatment Outcome Scale.","authors":"Anne F Klassen, Charlene Rae, Lucas Gallo, Stefan Cano, Manraj Kaur, Steven Dayan, Katie Armstrong, Lotte Poulsen, Elena Tsangaris, Katherine B Santosa, Andrea L Pusic","doi":"10.1093/asj/sjaf075","DOIUrl":"https://doi.org/10.1093/asj/sjaf075","url":null,"abstract":"<p><strong>Background: </strong>A key outcome in aesthetic treatments is the patient's view of how their skin looks and feels after a treatment.</p><p><strong>Objectives: </strong>To add a Treatment Outcome scale to the SKIN-Q patient-reported outcome measure.</p><p><strong>Methods: </strong>Concept elicitation interviews were performed with patients recruited from clinics in Canada and the USA. Data were coded, analyzed, and used to draft a Treatment Outcome scale. The scale was refined with patient and expert feedback and field tested in an online sample (i.e., Prolific). Rasch measurement and classical test theory psychometric analyses were performed to examine scale reliability and validity.</p><p><strong>Results: </strong>The concept elicitation interviews included 26 participants. The first draft of the Treatment Outcome scale included 32 items that assessed changes in appearance (e.g., look better) and wellbeing (e.g., feel more confident). Items were revised with input from 12 experts, 11 patients, and 174 online participants who had aesthetic face and/or body treatments and provided 180 survey responses, resulting in 36 items. Prolific data were collected from 499 participants who provided 542 assessments. The sample comprised 80.6% women; 78.8% had a facial treatment, 11.4% had a body treatment, and 9.8% had both a facial and body treatment. Data for a final 10-item Treatment Outcome scale fit the Rasch model (Chi-square = 50.46, df=40, p=0.124). The scale evidenced high reliability, with a person separation index and Cronbach alpha values >0.87. A total of 20/22 (91%) pre-defined construct validation hypotheses were accepted. A total of 136 participants completed the Treatment Outcome scale a second time within 7-14 days. The intraclass correlation coefficient for the test-retest was 0.89 (95% CI 0.85, 0.92).</p><p><strong>Conclusions: </strong>This new SKIN-Q scale can be used alongside other patient-centered outcome tools to measure how patients look and feel after minimally invasive aesthetic treatments for the body and/or face.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Safety and Effectiveness of Cold-Crosslinked Hyaluronic Acid Fillers: Multicenter, Randomized, Controlled, Double-Blind Study.","authors":"Michael S Kaminer, Rui L Avelar, Leslie Baumann, Valerie Callender, Steven H Dayan, Jeremy B Green, Steven K Grekin, Sebastien Guyon","doi":"10.1093/asj/sjaf080","DOIUrl":"https://doi.org/10.1093/asj/sjaf080","url":null,"abstract":"<p><strong>Background: </strong>EVOLYSSE FORM (EVLF) and EVOLYSSE SMOOTH (EVLS) are new hyaluronic acid fillers created using an innovative cold crosslinking process.</p><p><strong>Objectives: </strong>To collect safety and effectiveness data on new cold-crosslinked fillers to support US approval for the correction of moderate to severe dynamic facial wrinkles and folds.</p><p><strong>Methods: </strong>In this randomized, controlled, split-face study, 140 subjects with moderate to severe nasolabial folds received a cold-crosslinked filler in 1 nasolabial fold (EVLF = 70, EVLS = 70) and a traditionally-crosslinked filler, Restylane-L (RESL), in the contralateral fold and were followed through 12 months with an optional retreatment at that timepoint and subsequent 3 months of safety follow-up.</p><p><strong>Results: </strong>The primary endpoint of mean Wrinkle Severity Rating Scale change from baseline to Month 6 as rated by photographic review panel demonstrated non-inferiority and statistical superiority for the cold-crosslinked fillers. Blinded evaluator Wrinkle Severity Rating Scale assessments showed a mean change from baseline that was statistically significantly better than RESL for EVLF at all visits through 12 months and for EVLS at 6 and 9 months. Most subjects were responders on the Global Aesthetic Improvement Scale throughout the study according to ratings by blinded evaluators, treating investigators, and subjects. The FACE-Q Appraisal of Nasolabial Folds overall mean score showed significant improvement from baseline (p < 0.0001) at all timepoints through Month 12 for all treatment groups. All treatments were well tolerated.</p><p><strong>Conclusions: </strong>The new cold-crosslinked fillers were shown to be safe and effective for correction of nasolabial folds, with results lasting for 1 year.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Patient Involvement in Implant Size Selection on Satisfaction With Breast Size: An Analysis of 1,840 Primary Augmentations.","authors":"Jerzy Kolasinski, Malgorzata Kolenda, Szymon Kolacz, Anna Kasielska-Trojan","doi":"10.1093/asj/sjaf085","DOIUrl":"https://doi.org/10.1093/asj/sjaf085","url":null,"abstract":"<p><strong>Background: </strong>Aesthetic breast surgery is a specific field, in which the aim is not to achieve any universally defined standard, but to meet the patient's expectations.</p><p><strong>Objectives: </strong>The aim of the study was to determine the proportion of women who were dissatisfied with breast size following primary breast augmentation and decided for revision. The study presents and verifies an algorithm for breast implant selection which involves the patient in the decision-making process.</p><p><strong>Methods: </strong>A retrospective analysis was performed of medical charts from January 2012 to December 2022 from one private center. The final analysis included 1840 patients. All had implants chosen according to the Patient Decision-Making Process on Implant Size Selection (PIS).</p><p><strong>Results: </strong>Of the studied cases, 18 decided for implant exchange due to dissatisfaction with breast size (0.98%). This group differed significantly from the controls (n=1822) in the following aspects: lower BMI during primary procedure, lower mean implant volume and shorter follow-up. In all but two women, mean BMI increased by 1 unit before revisional surgery (from 19.7 to 20.6).</p><p><strong>Conclusions: </strong>Dissatisfaction with breast implant size is a rare cause of revision in breast augmentation surgery when the patient is involved in the final decision on the volume of the implants. The presented algorithm (PIS) yielded less than 1% dissatisfaction with breast size in a long-term follow-up.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing Generative Text-to-Image AI Models to Explore Race, Gender, and Age in Plastic and Aesthetic Surgery.","authors":"Maissa Trabilsy, Arianna Genovese, Srinivasagam Prabha, Sahar Borna, Cesar A Gomez-Cabello, Syed Ali Haider, Cui Tao, Antonio J Forte","doi":"10.1093/asj/sjaf084","DOIUrl":"10.1093/asj/sjaf084","url":null,"abstract":"<p><strong>Background: </strong>It is unclear how representative and inclusive of various patient populations generative text-to-image AI models are.</p><p><strong>Objectives: </strong>This project explores the diversity of race, gender, and age in the images generated by AI models: DALL-E3, Midjourney, and Adobe Firefly, in response to prompts focused on liposuction, blepharoplasty, and rhinoplasty.</p><p><strong>Methods: </strong>Prompts were designed to prompt the AI model to generate images of surgical outcomes for liposuction, blepharoplasty, and rhinoplasty for each gender, race and age combination: male vs. female, Caucasian or white, Black or African American, Latino or Hispanic, and age groups: 20-30 years, 31-45 years, and 46+ years. Each generated image was evaluated for representation of skin color by Fitzpatrick and Monk scales, sex parity using a 4-item questionnaire, and the incorporation of Westernized beauty standards. Analysis was then conducted, utilizing the Kruskal-Walis test or the Fischer's exact test between the 3 models (p<0.05).</p><p><strong>Results: </strong>There was no significant difference between the representation of light skin color (Fitzpatrick I-III & Monk 1-5) vs. dark skin color (Fitzpatrick IV-VI & Monk 6-10) between the models (p=0.26 & p=0.31). A significant difference was found between the models and between females vs. males regarding aging (p<0.0001 & p=0.0009). There were also significant differences found for the depiction of clear skin (p <0.0001), large and/or light-colored eyes (p=0.0010), and narrow noses (p<0.0001).</p><p><strong>Conclusions: </strong>Although there is fair representation of light skin colors and dark skin colors across the models, the depiction of gender bias and Westernized beauty standards can be improved.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Medicolegal Challenges of Facial Plastic Surgery: A Systematic Review.","authors":"Saule A Mussabekova, Yuliya Menchisheva, Álvaro Varela Morillas","doi":"10.1093/asj/sjaf082","DOIUrl":"10.1093/asj/sjaf082","url":null,"abstract":"<p><p>Facial plastic surgery is associated with a growing number of medico-legal challenges, particularly due to postoperative complications and patient dissatisfaction. This systematic review aimed to examine the medico-legal challenges associated with facial plastic surgery, focusing on postoperative complications, patient dissatisfaction, litigation cases, and medico-legal risk factors. A comprehensive literature search was conducted in MEDLINE (National Library of Medicine; Bethesda, MD), EMBASE (Elsevier; Amsterdam, the Netherlands), Cochrane Library (Wiley; Hoboken, NJ), PubMed (National Library of Medicine), Web of Science (Clarivate Analytics; Philadelphia, PA), SCOPUS (Elsevier), and Google Scholar (Alphabet Inc., Mountain View, CA) from 2020 to 2024. Medico-legal cases related to facial aesthetic surgeries were included. In total, 27 studies met the inclusion criteria. The leading causes of litigation included unsatisfactory aesthetic outcomes, failure of informed consent, technical surgical errors, and inadequate postoperative follow-up. The highest litigation rates were reported in countries with high volumes of plastic surgery cases and stringent regulations. This review highlights the increasing medico-legal burden in aesthetic surgery. Informed consent, postoperative monitoring, and technical precision are crucial for mitigating risks and preventing malpractice claims. The study synthesized medico-legal trends across all major facial aesthetic surgeries. It incorporated a global perspective, analyzing litigation data from over 10 countries, which is uncommon in most similar studies.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal Morphine vs Paravertebral Nerve Blocks for Analgesia After Breast Reconstruction With Abdominally Based Free Flaps.","authors":"Matthew W Swisher, Austin T Nguyen, Miriam Becker, Jacklynn F Sztain, Wendy B Abramson, Paige S Tsuda, Brenton S Alexander, Chris M Reid, Engy T Said","doi":"10.1093/asj/sjaf043","DOIUrl":"10.1093/asj/sjaf043","url":null,"abstract":"<p><strong>Background: </strong>Breast reconstruction with abdominally based free flaps can be associated with more significant acute pain and longer hospital stays than implant-based techniques. As new pain management strategies are developed, there have not been any studies conducted to analyze the analgesic effects of intrathecal morphine (ITM) for patients undergoing abdominally based free flap reconstruction.</p><p><strong>Objectives: </strong>The primary outcome analyzed in this retrospective study was opioid consumption, which was measured from the postoperative anesthesia care unit (PACU) through postoperative day (POD) 2. Secondary outcomes of the study analyzed included factors such as pain scores, hospital length of stay (LOS), and adverse effects.</p><p><strong>Methods: </strong>Fifty-one patients presented for breast reconstruction with abdominally based free flaps and received ITM for postoperative analgesia. Results obtained were compared with a cohort that included an equal number of patients who received paravertebral nerve blocks (PVBs).</p><p><strong>Results: </strong>Results showed that patients who received ITM displayed a lower median consumption in the PACU (0 mg vs 12.5 mg MEQ; P = .009), from PACU to POD 1 (0 mg vs 7.5 mg MEQ; P = .046), and POD 1 to POD 2 (7.5 mg vs 30 mg MEQ; P = .002) when compared with those who received PVBs. Those who received ITM also had lower median pain scores in the PACU and from PACU to POD 1 and a decreased LOS. There were similar rates of adverse events.</p><p><strong>Conclusions: </strong>ITM improves postoperative analgesia after abdominally based free flaps when compared to PVBs and may facilitate recovery and earlier discharge.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"605-610"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}