Annals of Plastic Surgery最新文献

{"title":"Large Language Model Misinformation: Could it Put Patients at Risk?","authors":"Robert Browne, Kevin C Cahill","doi":"10.1097/SAP.0000000000004428","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004428","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing 90-Day Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Direct-to-Implant or Autologous Reconstructions.","authors":"Kathryn E Royse, Tina M Smith, Cissy M Tan, Eric Y Lin, Robert G Neumann, Jessica E Harris, Elizabeth W Paxton, Winnie Tong","doi":"10.1097/SAP.0000000000004421","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004421","url":null,"abstract":"<p><strong>Background: </strong>In recent years, breast reconstruction following mastectomy has gained popularity. This study aimed to compare short-term unplanned return to the operating room (OR) for women undergoing breast reconstruction after mastectomy for malignancy by reconstruction timing, delayed compared to immediate (IBR). Subcategories of direct-to-implant and primarily autologous reconstruction were analyzed.</p><p><strong>Methods: </strong>Data from an integrated electronic medical record system identified patients undergoing breast reconstruction after mastectomy at Kaiser Permanente facilities between 2010-2022. Reconstruction timing was the exposure of interest, with stratification based on reconstructive techniques including tissue expander followed by either implant or autologous reconstruction, direct-to-implant, or primarily autologous reconstruction. Univariable and multivariable logistic regression models assessed the association between reconstruction timing and 90-day reoperations in direct-to-implant or primarily autologous reconstruction, using delayed reconstruction as the reference.</p><p><strong>Results: </strong>A total of 23,272 cases were identified (immediate = 18,248, delayed = 5025). The IBR patients exhibited higher odds of reoperations [odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.65-2.33, P < 0.0001] compared to delayed reconstruction after covariate adjustment. Among patients with expanders, IBR increased reoperation odds (OR = 1.83, 95% CI = 1.43-2.33, P < 0.0001). Immediate direct-to-implant reconstruction had the highest reoperation odds (OR = 5.55, 95% CI = 2.08-4.67, P = 0.039). No significant differences were observed between immediate and delayed approaches in autologous reconstruction, regardless of whether it was conducted in a single- or 2-stage process.</p><p><strong>Conclusions: </strong>Immediate reconstruction, involving expanders or direct-to-implant reconstructions, showed increased 90-day reoperation risks compared to delayed reconstruction. Conversely, no significant differences were identified between IBR and delayed reconstruction with autologous reconstruction conducted in a single- or 2-stage process.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Industry Payments Received by Plastic Surgeons at the American Association of Plastic Surgeons 2022 Meeting.","authors":"Ariel J Harsinay, Zachary Tamweber, Katherine Kozlowski, Eric Shuren, Jordan Frey","doi":"10.1097/SAP.0000000000004417","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004417","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the financial relationships held by attendees of the American Association of Plastic Surgery (AAPS) conference in 2022 utilizing the Center for Medicare and Medicaid Services (CMS) Open Payments database.</p><p><strong>Methods: </strong>Plastic surgeons practicing in the United States who were listed in the AAPS 2022 program were included in the study. Internet searches were used to obtain demographic information for each participant, including sex, region, fellowship training, years of practice, and practice setting. Industry payments for the year 2022 were collected. Statistical analyses were completed in SPSS.</p><p><strong>Results: </strong>A total of $11,107,403.13 was received in general payments by the 390 plastic surgeons included in this study, with the 10 highest paid physicians encompassing 84% of these total payments. A total of 120 companies provided payments to included physicians. Surgical Innovation Associates, Inc., was responsible for 71.6% of payments made. Over 50% of plastic surgeons included in the AAPS program received payments from the second highest paying company, Allergan Inc. Males with 16-20 years of practice received the greatest industry payments; practice setting, fellowship training, and R1 institution affiliation were not reliable predictors of industry payments.</p><p><strong>Conclusions: </strong>The average plastic surgeon who contributed to the 2022 AAPS program earned significantly more in industry payments compared to the average plastic surgeon nationwide, warranting concerns that conference content may be influenced by the financial relationships held by these speakers.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Engels E, et al. A Meta-analysis of Breast Implant Irrigation Solution's Effect on Infection and Capsular Contracture Frequencies (Annals of Plastic Surgery 94(4S):P S315-S321, April 2025.","authors":"Ted Eisenberg","doi":"10.1097/SAP.0000000000004424","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004424","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pectoralis Major Flaps for Sternal Reconstruction: Multidisciplinary Considerations and Patient Outcomes.","authors":"David Chi, Rachel Skladman, Reme E Arhewoh, Sarah N Chiang, Linh Vuong, Ryan J Sachar, Muhammad F Masood, Ida K Fox","doi":"10.1097/SAP.0000000000004409","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004409","url":null,"abstract":"<p><strong>Background: </strong>Sternal wounds following cardiothoracic surgery are a challenging surgical problem, and pectoralis muscle flaps are a mainstay for reconstruction. Multiple variations of this strategy exist, and this study seeks to characterize key decision factors and patient outcomes to increase accessibility of this technique to surgeons.</p><p><strong>Materials and methods: </strong>This is a retrospective cohort study of adult sternal wound patients at a tertiary referral center between 2010-2020. Patient demographics, comorbidities, wound characteristics, and perioperative data were collected. Multinomial logistic regression determined factors significantly associated with reconstructive technique. Binomial logistic regression was used to analyze 90-day readmission and reoperation for sternal wounds.</p><p><strong>Results: </strong>In total, 114 patients underwent reconstruction with pectoralis flaps. Bilateral advancement flaps were the most common strategy (64%) followed by bilateral advancement/turnover (15%), unilateral advancement (11%), unilateral turnover (8%), and bilateral turnover (2%). The absence of the internal mammary artery was significantly associated with bilateral vs unilateral pectoralis flap reconstruction (P < 0.01). Deep space sternal wounds were most likely to be treated with a turnover flap component (P < 0.001). Type of flap reconstruction was associated with sternal wound recurrence (P < 0.03). However, multivariable logistic regression modeling identified coronary artery disease [odds ratio (OR) = 8.18, P < 0.02], prior cardiothoracic surgeries (OR = 2.95, P < 0.01), and discharge before plastic surgery consultation (OR = 3.73, P < 0.04) as significant predictors of 90-day readmission or reoperations for sternal wound recurrence.</p><p><strong>Conclusions: </strong>Multiple configurations of the pectoralis major can be utilized for treating sternal wounds. The absence of the internal mammary artery is an important factor given its association with bilateral flap reconstruction, while the turnover pectoralis is more frequently used for deep space wounds. Internal mammary artery patency should be clearly communicated to improve multidisciplinary management of these challenging problems.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of Diabetes and Metformin on Painful Neuromas After Lower Extremity Amputations.","authors":"Isabel Snee, Keith T Kuo, Rachana Suresh, Alec J Chen, Abel Lindley, Abdul Jabar Chekfa, Sami H Tuffaha, Ala Elhelali","doi":"10.1097/SAP.0000000000004419","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004419","url":null,"abstract":"<p><strong>Background: </strong>Painful neuromas are common cause of residual limb pain following lower extremity amputation, yet its incidence in diabetic populations remains unestablished. While diabetes is thought to reduce neuroma risk due to impaired nerve regeneration, the role of metformin on this process remains unclear. This study aims to explore the association of diabetes severity and metformin therapy on painful neuroma formation following lower extremity amputations.</p><p><strong>Methods: </strong>This retrospective cohort study used TriNetX Research Network to identify adult patients (≥18 years) who underwent lower extremity amputation between January 2016 to February 2024. Patient cohorts were identified using International Classification of Disease-10 and Current Procedural Terminology codes. Patients were stratified by diabetic status, hemoglobin A1c levels, and metformin use. Propensity score matching was performed and adjusted for demographics, comorbidities, and medications. Risk differences, risk ratios, and odds ratios with corresponding 95% confidence intervals were calculated to quantify the association between the exposure and the outcome. Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>A total of 16,090 patients underwent lower extremity amputation, 9994 (62.1%) were diabetic, while 6096 (37.9%) were nondiabetic. The overall incidence of symptomatic neuromas was lower in diabetic patients (0.61%) compared to the nondiabetic group (1.67%). After propensity score matching, 5196 diabetic and 5104 nondiabetic amputees were identified. Diabetes was associated with a significant reduction in neuroma risk [risk difference of -0.893% (95% CI: -1.29% to -0.496%); P < 0.0001]. Patients using metformin at the time of surgery had a higher incidence of painful neuroma (0.718%) compared to nonusers (0.424%) (P = 0.127, odds ratio = 1.69). There was no significant difference in neuroma rates between those with hemoglobin A1c levels 6.5%-8.0%, 8.1%-10%, and >10%.</p><p><strong>Conclusions: </strong>Diabetes was associated with a lower painful neuroma risk after amputation, suggesting a possible protective role of hyperglycemia-induced nerve regeneration alterations. Metformin use had no significant impact on painful neuroma rates. These findings challenge assumptions about glycemic control and neuroma formation, highlighting the need for further research on metabolic influences in postamputation nerve healing and pain management.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatments of Ex Vivo Vascularized Composite Allografts: A Scoping Review.","authors":"Caroline E Baker, Thor S Stead, Dominika Pullmann, Alay R Shah, Sachin Chinta, David L Tran, Hilliard T Brydges, Matteo Laspro, Bruce E Gelb, Eduardo D Rodriguez, Piul S Rabbani","doi":"10.1097/SAP.0000000000004420","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004420","url":null,"abstract":"<p><strong>Purpose: </strong>The various physiological profiles comprising vascularized composite allografts (VCAs) pose unique challenges to preservation. Minimizing ischemia, reperfusion injury, and rejection remains a primary focus of graft pretreatments (PTs). Currently, the gold standard PT consists of flushing the graft and placing it in static cold storage in the University of Wisconsin solution. With this method, graft viability is limited to 4 to 6 hours. Prolonging this time limit will increase donor allocation radius, access to care, and positive patient outcomes. We aimed to evaluate novel PTs that could potentially enhance and lengthen VCA viability.</p><p><strong>Methods: </strong>Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, we conducted a comprehensive literature search of EMBASE, Cochrane, and PubMed. Studies had to be published prior to June 15, 2022. PTs had to target cell physiology, rather than immunogenicity. We extracted data including study design, PT details, evaluation metrics, and outcomes.</p><p><strong>Results: </strong>We identified 13 studies, categorized into 3 groups: solution-based alterations to the gold standard, ex vivo perfusion, and other novel techniques. The incorporation of hydrogen sulfide and Perfadex as solutions in the gold standard protocol demonstrated a 6-day delay in rejection and limited reperfusion injury markers, respectively. In an ex vivo perfusion study, after 24 hours of PT and 12 hours posttransplant, VCA muscle contractility remained close to normal. The gold standard PT did not demonstrate the same success. However, graft weight gain, up to 50% of baseline among the reviewed articles, is a prominent adverse effect of perfusion. Another technique, cryopreservation, displayed 90% graft failure by venous thrombosis, despite high free graft viability following 2 weeks of storage.</p><p><strong>Conclusions: </strong>This study of PT modalities found a variety of encouraging preservation techniques for grafts with high levels of tissue diversity. Ex vivo perfusion dominated PT innovation with promising results in preserving the viability and functionality of muscle, which is central to the restoration of movement. Future studies are necessary to evaluate long-term graft outcomes and to optimize PT protocols for extended preservation times to ensure clinical relevance.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Point-of-Care Image Application Into the Clinical Setting: Introducing a Viable Approach.","authors":"Sandra Scharfetter, Karl Schwaiger, Gottfried Wechselberger","doi":"10.1097/SAP.0000000000004243","DOIUrl":"10.1097/SAP.0000000000004243","url":null,"abstract":"<p><strong>Abstract: </strong>Photo documentation is an invaluable tool in many medical specialties, particularly in plastic surgery. Although camera-enabled smartphones have become omnipresent, point-of care clinical image applications are not established in most hospitals, especially smaller institutions with fewer means. To solve the problem, we decided to collaborate with an external company with an already existing and certified medical photo capturing mobile application. This point-of care image application provided us to implement a standardized photo documentation pathway without the need to invest means on the development of a new application.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6","pages":"627-629"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Annals of Plastic Surgery Introduction to the SESPRS Supplement.","authors":"Bruce A Mast","doi":"10.1097/SAP.0000000000004413","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004413","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S485"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinguishing Authentic Voices in the Age of ChatGPT: Comparing AI-Generated and Applicant-Written Personal Statements for Plastic Surgery Residency Application: Erratum.","authors":"","doi":"10.1097/SAP.0000000000003756","DOIUrl":"10.1097/SAP.0000000000003756","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"704"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}