Annals of Plastic Surgery最新文献

{"title":"Investigating the Impact of Operative Time on Breast Augmentation Outcomes.","authors":"Samuel Knoedler, Filippo A G Perozzo, Marina T Dietrich, Sarah Friedrich, Joanna Kempa, Giuseppe Sofo, Thomas Schaschinger, Jennifer A Watson, Sören Könneker, Dennis P Orgill, Adriana C Panayi, Bong-Sung Kim","doi":"10.1097/SAP.0000000000004405","DOIUrl":"10.1097/SAP.0000000000004405","url":null,"abstract":"<p><strong>Background: </strong>Breast augmentation is a widely performed aesthetic surgery, yet the impact of operative time on postoperative outcomes remains unclear. While longer operative times have been linked to increased risks across a wide array of surgical disciplines, this association has not been thoroughly validated in breast augmentation. This multi-institutional study aims to investigate the relationship between operative time and outcomes after breast augmentation with implants.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database (2008-2022) was queried to identify adult female patients who underwent elective breast augmentation with implants. Preoperative, intraoperative, and postoperative variables, including operative time and 30-day complications, were evaluated. Multivariable logistic regression was used to assess the impact of operative time, analyzing it as both a continuous and a dichotomized variable.</p><p><strong>Results: </strong>A total of 6531 female patients with a mean age of 34.9 ± 10.1 years and a mean body mass index of 22.9 ± 4.0 kg/m 2 were included. One hundred eighteen patients (1.8%) experienced complications, the majority of which were reoperations (n = 69; 1.1%) and surgical complications (n = 30; 0.5%). Multivariable analysis revealed a significant association between operative time and both surgical complications (odds ratio [OR] = 1.01, P = 0.0003) and any complications (OR = 1.01, P = 0.003). For every 10-minute increase in operative time, the risk of surgical and any complications increased by 7.2% and 4.5%, respectively. A critical threshold of 91 minutes was identified, beyond which the odds of complications increased significantly (OR = 1.93, P = 0.001).</p><p><strong>Conclusions: </strong>Prolonged operative time is associated with an increased risk of complications following breast implant augmentation. A threshold of 91 minutes was identified, implying that procedures exceeding this duration carry higher postoperative morbidity. These findings underscore the importance of optimizing surgical efficiency to minimize risks and enhance patient outcomes after breast augmentation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"247-252"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118637","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":"Use of Antibiotic Prophylaxis for Surgical Site Infection Prevention in Nononcologic Breast Surgery: A Scoping Review.","authors":"Erin N Abbott, Brittany G Lively, Andrew J James, Ricardo A Torres-Guzman, Benjamin L Savitz, Anvith P Reddy, Ronald M Cornely, Barite Gutama, Galen Perdikis, William C Lineaweaver","doi":"10.1097/SAP.0000000000004474","DOIUrl":"10.1097/SAP.0000000000004474","url":null,"abstract":"<p><strong>Background: </strong>The practice of systemic antibiotic prophylaxis to prevent surgical site infection (SSI) in breast surgery remains debated. The aim of this review is to provide a comprehensive overview of the literature evaluating the current evidence on the efficacy of antibiotic prophylaxis in nononcologic breast surgery, including risk-reducing mastectomy, gender-affirming mastectomy, augmentation, and reduction.</p><p><strong>Methods: </strong>A literature search of PubMed and Cochrane databases of 1990-2025 was conducted to identify studies evaluating antibiotic prophylaxis and SSI outcomes in nononcologic breast surgery. Included studies were screened and analyzed by procedure type, study design, and outcomes.</p><p><strong>Results: </strong>The impact of antibiotic prophylaxis varied by procedure type. For risk-reducing mastectomy, the results were mixed. Multiple clinical trials indicated no significant reduction in SSI with antibiotic prophylaxis, while one meta-analysis and one cohort study suggested that antibiotics may decrease the risk of SSI. Additionally, one randomized controlled trial in overweight or obese patients indicated that antibiotic prophylaxis significantly decreased SSI in risk reducing mastectomy. In gender-affirming mastectomy, infection rates were low (approximately 3%-5%), and evidence supports single-dose preoperative prophylaxis. For breast reduction, multiple systematic reviews and clinical trials indicated a significant reduction in SSI with prophylactic treatment. Two randomized controlled trials indicated that extending antibiotic prophylaxis into the postoperative period had no significant impact on SSI. For breast augmentation, systematic reviews and clinical studies found no significant reduction in SSI with prophylactic antibiotic treatment. While one systematic review suggested SSI reduction in implant-based reconstruction, this was not observed in breast augmentation.</p><p><strong>Conclusions: </strong>The use of antibiotic prophylaxis within nononcologic breast surgery remains poorly defined, with reported effectiveness varying depending on the type of surgery, duration of treatment, and risk factors of the patient. Further high-quality clinical trials are warranted to fully evaluate the role of prophylactic antibiotic use in nononcologic breast surgery.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S6-S10"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005904","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":"The Political and Human Impact of Major Burn Incidents: A Global Analysis of Mass Casualty Events Between 2010 and 2020.","authors":"Kayvan Shokrollahi, Ascanio Tridente, Nina Dempsey","doi":"10.1097/SAP.0000000000004396","DOIUrl":"10.1097/SAP.0000000000004396","url":null,"abstract":"<p><strong>Introduction: </strong>Worldwide, burn injuries cause approximately 180,000 deaths annually. Contributing to these figures are those deaths that occur following major burn incidents and explosions. Morbidity and mortality can be significantly high following such events, and well-equipped, specialized burns services are crucial to minimizing the human impact. Notably, major burn incidents are not merely medical emergencies, but catalysts for significant social and political change. We aimed to explore the human and political consequences of major burn incidents, with a view to highlighting the true significance of specialized burn care as a crucial component of disaster preparedness.</p><p><strong>Methods: </strong>We screened the gray literature for reports of major burn incidents across the globe over a 10-year period from 2010 to 2020. We gathered data on the nature of the incident, the geographical location, the number of resulting injuries and deaths, and any resultant political fallout.</p><p><strong>Results: </strong>Twenty-three major burn incidents were identified, across 15 different countries. Incidents included chemical plant explosions, factory and warehouse fires, wildfires, housing block fires, and shopping center fires. The total number of deaths across the 23 reports was 2321. The median number of deaths per incident was 78 (interquartile range, 39-127), whereas the median number of injuries was 321 (interquartile range, 148-557). Eight of these 23 incidents (35%) resulted in the resignation of entire governments or key figures within the government, evidencing the major political fallout from such disasters. Collation of the individual reports revealed many instances of insufficient resource allocation and highlighted broader issues of institutional weakness and the need for comprehensive political reforms.</p><p><strong>Conclusion: </strong>Major burn incidents are often pivotal moments that can expose systemic safety failures, highlight critical infrastructure vulnerabilities, demand comprehensive preventative strategies, and ultimately trigger governmental accountability. Governmental recognition of burn care as a crucial component of disaster preparedness as well as improved resource allocation for burn centers is crucial to ensuring they are better equipped to handle mass casualty events, thereby reducing morbidity and mortality and reducing government accountability following such events. Governments would be well advised to maintain healthy funding and staffing of burn services.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"237-244"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155973","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":"Trainee Perspectives After Nonvoluntary Plastic Surgery Program Closures: Lessons Learned and Steps Forward.","authors":"Puja M Jagasia, Nicholas O'Sick, Megan E Fracol, Arya Andre Akhavan, Brian C Drolet, Matthew E Pontell","doi":"10.1097/SAP.0000000000004397","DOIUrl":"10.1097/SAP.0000000000004397","url":null,"abstract":"<p><strong>Background: </strong>In the last decade, only 3 plastic surgery programs have faced nonvoluntary closure by the Accreditation Council of Graduate Medical Education. These closures all occurred unexpectedly in April 2021 and affected 23 trainees. Although the dust has largely settled from this event, the insights of the affected trainees remain uncharacterized.</p><p><strong>Methods: </strong>The Program Closure Working Group of the American Society of Plastic Surgery's Resident Council created a 30-item questionnaire and distributed it to displaced trainees 1 year after program closures to capture their perspectives.</p><p><strong>Results: </strong>Seventeen trainees (84%) responded to the survey with respondents from all postgraduate year years, including incoming interns. Only 24% (4/17) trainees were notified of program closure on the day of closure decision, and 18% (3/17) never received official notice from their program. All trainees (100%, 17/17) reported that their home institution did not provide guidance regarding the relocation process, which cost a median of $10,000 and up to $50,000. No incoming intern was informed about potential program closure prior to rank list submission. The most difficult part of the relocation process was mental hardship (59%, 10/17), followed by finding an available residency spot (47%, 8/17). Department/division chairs (76%, 13/17) and program directors (71%, 12/17) were predominantly viewed as unsupportive and antagonistic.</p><p><strong>Conclusion: </strong>The plastic surgery community needs to be proactive in ensuring the support of trainees during nonvoluntary program closures. Fortunately, these events are rare, but when they do occur, they can be devastating. Moving forward, we propose tasking a single party to be responsible for ( a ) timely dispersion of information during program closures, ( b ) creating a protocol for leadership, ( c ) allocating a relocation stipend for trainees, and ( d ) facilitating the delivery of mental health resources to trainees.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"233-236"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155977","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":"Hematological Biomarkers at Admission as Predictors of Outcome in Severe Burns: Experience From a South Indian Tertiary Care Hospital.","authors":"Harshavardhan Shetty, Birva Shah, Joseph Thomas, Sushma Berlukar, Tanvi Rao, Swathi Prabhu, Carlsen Bernard Pereira","doi":"10.1097/SAP.0000000000004470","DOIUrl":"10.1097/SAP.0000000000004470","url":null,"abstract":"<p><strong>Background: </strong>Burns are associated with significant morbidity and mortality, with several factors determining mortality. Identifying reliable early predictors of mortality is crucial for guiding treatment decisions and improving outcomes. This study evaluates the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting mortality in patients with severe burns.</p><p><strong>Methods: </strong>A retrospective study was conducted on 91 adult patients (aged ≥18 years) with severe burns (TBSA ≥20%) admitted within 48 hours of injury. Clinical, etiological, and laboratory parameters were analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of NLR, PLR, and total body surface area (TBSA) for mortality, with the area under the curve (AUC) indicating their discriminative ability.</p><p><strong>Results: </strong>The mean age of the cohort was 47.6 years (range: 18-89 years), with a male predominance (57.1%). Thermal burns were the most common etiology (86.8%), followed by electrical burns (11%) and chemical burns (2.2%). The median TBSA of the entire cohort was 42%, of which nonsurvivors had significantly higher median TBSA involvement (52% vs 30%, P = 0.0005) and median duration of hospitalization (DOH) (4 vs 23 days, P = 0.0005). The mean NLR was significantly higher in nonsurvivors (15.2 vs 8.4, P = 0.005). ROC curve analysis identified an optimal NLR cutoff value of 8.19 (AUC = 0.614, 95% CI: 0.497-0.731, P = 0.061) with 56.5% sensitivity and 55.6% specificity. The optimal PLR cutoff value was 186.57 (AUC = 0.461, 95% CI: 0.341-0.581, P = 0.520) with 50% sensitivity and 51% specificity. TBSA cutoff value of 41% was strongly associated with mortality (AUC = 0.86, 95% C.I: 0.781-0.940, P = 0.0005), with 82.6% sensitivity and 77.8% specificity.</p><p><strong>Conclusions: </strong>Higher TBSA involvement and elevated NLR are significant predictors of mortality in severe burn patients. Although TBSA >41% is the most reliable prognostic indicator, PLR did not show significant predictive value. Early assessment of these parameters may aid in risk stratification and management of burn patients.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S70-S74"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005843","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":"\"Precision\" Hybrid Rhinoplasty: Balancing Tradition and Innovation.","authors":"Patrick E Assi, Samuel J Lin","doi":"10.1097/SAP.0000000000004468","DOIUrl":"10.1097/SAP.0000000000004468","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S68-S69"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005815","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":"Introduction to Vanderbilt Lectures.","authors":"Laxminarayan Bhandari, William Lineweaver","doi":"10.1097/SAP.0000000000004488","DOIUrl":"10.1097/SAP.0000000000004488","url":null,"abstract":"<p><strong>Abstract: </strong>We are delighted to present Vanderbilt lectures- a special supplement of Annals of Plastic Surgery that brings together distinguished orations from renowned plastic surgery programs. These lectures serve not only as tributes to the legacy of leaders in the field but also as platforms for advancing scholarship, mentorship, and international collaboration.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S1"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005868","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":"10.1097/SAP.0000000000004424","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"338"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","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":"Understanding Research Trends in Facial Synkinesis: A Bibliometric Analysis of the 100 Most Impactful Studies.","authors":"Elena Millesi, Leo F Nonnenbroich, Julian S Rechberger, Carrie E Robertson, Waleed Gibreel, Samir Mardini","doi":"10.1097/SAP.0000000000004410","DOIUrl":"10.1097/SAP.0000000000004410","url":null,"abstract":"<p><strong>Background: </strong>Facial synkinesis is characterized by involuntary co-contraction of facial muscles during voluntary movements, impairing both function and aesthetics following facial paralysis. It affects approximately 21% of individuals following Bell's palsy, with symptoms such as involuntary eye closure when smiling. While the pathophysiology remains unclear, therapeutic options range from conservative approaches like botulinum toxin to surgical interventions. A bibliometric analysis offers insights into research trends, key contributors, and knowledge gaps in this field.</p><p><strong>Materials methods: </strong>A systematic search was conducted in the Scopus database up to July 2024, identifying 100 most-cited articles on facial synkinesis. Articles were categorized as basic science (BSc), clinical (CL), or review articles, with additional data extracted on study focus, journal type, citation metrics, and authorship. Statistical analyses included Pearson's χ 2 and Wilcoxon rank sum tests.</p><p><strong>Results: </strong>The articles spanned 1952-2020, with the highest publication frequency in 2017. Clinical studies constituted 76%, focusing on conservative treatments (35%), diagnostics (28%), and surgical interventions (19%). Plastic surgery and ENT journals accounted for 76% of publications. The most-cited article, published in neurology (1975), investigated electrophysiologic diagnostics. Citation metrics revealed a mean citation count of 38.3 and a median publication year of 2010. The 50 newer articles demonstrated a trend toward surgical management of synkinesis.</p><p><strong>Conclusions: </strong>This bibliometric analysis highlights the evolution of research on facial synkinesis, emphasizing the predominance of clinical studies, focus on conservative treatments and gaps in basic science research. Further research is needed to fill knowledge gaps to improve outcomes for affected patients.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"327-337"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324346","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":"A Systematic Review of Helium Plasma Radiofrequency (Renuvion).","authors":"Eric Swanson","doi":"10.1097/SAP.0000000000004479","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004479","url":null,"abstract":"<p><strong>Background: </strong>Helium plasma radiofrequency (Renuvion, previously J-Plasma) is a new energy-based device that causes coagulation of the subcutaneous fat. The device has recently received 501(k) clearance by the Food and Drug Administration (FDA) for soft tissue contraction after liposuction. A systematic review has not been previously published.</p><p><strong>Methods: </strong>An electronic search was undertaken to identify publications describing clinical experience with this technique. The US government clinical trials website and the FDA website were queried. The CMS Open Payments database was accessed to evaluate financial bias.</p><p><strong>Results: </strong>Twenty-five publications contained patient data with sufficient information for tabulation. Treatment areas included the face, neck, female and male breasts, trunk, and extremities, usually in combination with liposuction. Studies typically reported subjective surgeon evaluations of photographs and surveys. None of the studies provided standardized photographs with measurements comparing Renuvion to traditional methods. Measurements on matched photographs of breasts treated with Renuvion did not substantiate the authors' claims. The findings of an ultrasound study of the abdominal fat layer were undermined by incorrect labeling of the tissue planes. Most studies were funded by the manufacturer and most investigators had financial conflicts. Few studies mentioned subcutaneous emphysema. Four case reports described patients who suffered helium-induced pneumothorax, pneumomediastinum, pneumoperitoneum, and pneumomastia. Adverse events reported to the FDA included 15 life-threatening events and 3 fatalities. Full-thickness burns were frequently reported. The number and severity of the adverse events greatly exceeded those reported for radiofrequency and ultrasound devices.</p><p><strong>Discussion: </strong>No evidence supports a claim of skin tightening beyond that which may be achieved using traditional or ultrasonic liposuction. Helium gas may permeate body cavities, with serious repercussions.</p><p><strong>Conclusions: </strong>Marketing has taken precedence over science and safety considerations. This technology introduces serious safety risks to patients, including death, with no proven compensatory benefit.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793321","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}