Journal of plastic, reconstructive & aesthetic surgery : JPRAS最新文献

{"title":"Pain relief after surgical neurolysis in Gazan patients with peripheral nerve injuries: A report amidst the ongoing conflict.","authors":"Abd Al-Karim Sammour, Deema Muhaisen, Ruba Musallam, Rahaf Abudagga, Nour Alshaer, Faten Braika, Mohammed Tabash, Ezz Lulu, Anas Al-Shembari, Mohammed Tahir","doi":"10.1016/j.bjps.2025.06.024","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.024","url":null,"abstract":"<p><strong>Introduction: </strong>Neuropathic pain from peripheral nerve injuries (PNIs) poses a major challenge, especially in conflict zones. Surgical neurolysis is a known intervention for pain due to nerve scarring and compression, but its impact in resource-limited settings remains underreported. This study evaluates pain outcomes following neurolysis in a conflict-affected region.</p><p><strong>Methods: </strong>A prospective case series was conducted in three major hospitals in Gaza from May to August 2024. Patients with severe neuropathic pain (VAS >7) persisting >3 months despite medical therapy underwent neurolysis by a single peripheral nerve surgeon. Data included demographics, injury mechanisms, operative findings, and VAS scores preoperatively and at 2 weeks and 3 months postoperatively. Analgesic use and statistical significance (p<0.05) were analyzed using SPSS.</p><p><strong>Results: </strong>Seventy-five patients (62 males, 13 females; mean age 31.2 years) were included. Injuries were caused by shrapnel (80%) and gunshots (16%). Mean VAS score decreased from 9.2 (SD 1.2) preoperatively to 2.9 (SD 2.7) at 2 weeks and 2.7 (SD 2.5) at 3 months (p<0.001), representing 68% and 71% reductions, respectively. Analgesic use dropped from 73% preoperatively to 8% at 3 months. No significant differences were noted based on age, sex, or nerve affected. Pain reduction >2 points on the VAS, the threshold for clinical significance per EFNS guidelines, was achieved in 94.7% of patients.</p><p><strong>Conclusion: </strong>Surgical neurolysis significantly reduces neuropathic pain and analgesic reliance in PNI patients, highlighting its effectiveness and the need to expand surgical capacity in conflict zones.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteogenesis rate and success of secondary alveolar bone grafting: A 3D volumetric prognostic value.","authors":"Siqi Wei, Guang Zhang, Qian Wu, Yongqian Wang","doi":"10.1016/j.bjps.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.029","url":null,"abstract":"<p><strong>Background: </strong>Secondary alveolar bone grafting (SABG) is a critical intervention for restoring anatomical integrity and functional capacity in patients with alveolar clefts. Despite advancements in surgical techniques and imaging, the optimal indicator for postoperative outcome evaluation remains undefined.</p><p><strong>Methods: </strong>In this retrospective study, 126 patients with unilateral alveolar clefts who underwent SABG between 2016 and 2023 were analyzed. Preoperative and six-month postoperative craniofacial CT data were used to calculate preoperative bone defect volume, residual postoperative bone defect volume, osteogenesis volume, and osteogenesis rate using three-dimensional volumetric analysis. Surgical success was defined by imaging-based criteria assessing vertical height, labiopalatal width, and nasal floor symmetry. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the prognostic performance of each 3D metric.</p><p><strong>Results: </strong>The mean osteogenesis rate was 0.48±0.16, with a threshold of 0.507 yielding the highest diagnostic accuracy (AUC = 0.921; sensitivity = 0.894, specificity = 0.785). Among all evaluated parameters, osteogenesis rate demonstrated the strongest predictive capability for SABG success. However, it lacked direct representation of bone continuity and buccopalatal thickness.</p><p><strong>Conclusion: </strong>Osteogenesis rate is a reliable and efficient prognostic marker for assessing SABG outcomes. Nevertheless, it should be interpreted alongside structural and clinical indicators to ensure comprehensive evaluation. Incorporating volumetric and morphological assessments into a multimodal framework may enhance clinical decision-making and long-term treatment success.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-operative complications in combined versus staged breast reconstruction and risk-reducing gynecologic surgeries: A multi-institution multi-surgeon analysis.","authors":"Kassra Garoosi, Nargis Kalia, Jubril Adepoju, Maria J Escobar-Domingo, Codi Horstman, Riley Kahan, Quinn Fitzpatrick, Yoo Jin Ahn, John B Park, Ben Grobman, Daniela Lee, Deana S Shenaq, David Kurlander, Mamtha Raj, Sarah Tevis, Jaime Arruda, Julian Winocour, George Kokosis, Bernard T Lee, David W Mathes, Christodoulos Kaoutzanis","doi":"10.1016/j.bjps.2025.06.033","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.033","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 < 0.001; mean: 1 day vs. 2 days, p < 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","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, Febisayo Sidiku, Ramesh Vidyadharan","doi":"10.1016/j.bjps.2025.05.048","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.05.048","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","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, Tim de Jong, Dietmar J O Ulrich, Stefan Hummelink","doi":"10.1016/j.bjps.2025.06.030","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.030","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Letter Re: \"Orbital exenteration in the management of orbital and periorbital tumours: factors related to treatment outcome.\" Methodological blind spots in orbital exenteration research: The overlooked role of reconstruction. Surgical outcomes and stratification.","authors":"Paula Niinimäki, Jyrki Vuola, Tero T Kivelä, Antti A Mäkitie, Marita Uusitalo","doi":"10.1016/j.bjps.2025.06.022","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.022","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hypercoagulable state in COVID-19 and implications for free flap surgery in the lower limb: A retrospective multi-centre study.","authors":"David Stark, Susan Hendrickson, Chaninda Dejsupa, Erik Lenguerrand, Johann Jeevaratnam, Grace Chaplin, Victoria Giblin, David Wallace, Valdone Kolaityte, George Wheble","doi":"10.1016/j.bjps.2025.06.017","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.017","url":null,"abstract":"<p><strong>Aims: </strong>Hypercoagulability in severe COVID-19 infection and COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia have been widely documented. Most evidence pertains to macrovascular thrombosis. Little is known about the impact of previous (including mild or asymptomatic) COVID-19 infection or vaccination on microvascular thrombosis in free tissue transfer. This study compared the rate of thrombotic complications in lower limb free flap patients in the pre- and post-COVID era.</p><p><strong>Methods: </strong>This study retrospectively collected data for patients who underwent lower limb free flap surgery for two 6-month periods at three major trauma centres. Eligible patients included adults with a minimum follow-up of 90 days. Modified Poisson regressions were used to compare the complication rates between cohorts who had and had not had previous COVID-19 infection, and between those who had and had not had previous COVID-19 vaccination.</p><p><strong>Results: </strong>Complete data was collected for 198 free flaps. Two of ten patients who had a COVID-19 infection prior to surgery suffered a microvascular complication compared to 16 of 188 patients who had never had a COVID-19 infection (8.5%). Similarly, 12% of vaccinated patients experienced microvascular complications compared to 7% of unvaccinated patients.</p><p><strong>Conclusions: </strong>Previous COVID-19 infection and/or vaccination do not appear to have a statistically significant impact on the development of microvascular complications in the context of lower limb free flap surgery, despite the well-documented impact on macrovascular complications, and additional thromboprophylaxis is unlikely to be necessary. Surgeons should continue to be mindful of the impact of serious systemic infection on thromboembolic disease when planning major surgery.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clostridium difficile induced coagulopathy: Implications for microsurgery in the setting of limb salvage.","authors":"Rachel N Rohrich, Karen R Li, Roxana S Azimi, Alexandra Junn, Sami Ferdousian, Ryan P Lin, Woori Lee, Meghan E Currin, Richard C Youn, Christopher E Attinger, Cameron M Akbari, Karen K Evans","doi":"10.1016/j.bjps.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>Studies have demonstrated a correlation between Clostridium difficile infection (CDI) and hypercoagulability. This study evaluates CDI in patients undergoing lower extremity (LE) free tissue transfer (FTT) and quantifies its impact on microsurgical outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study of patients receiving LE FTT from July 2011 to June 2024 was conducted. Patients who tested positive for C. difficile within 15 days of their FTT were identified and compared to those who did not.</p><p><strong>Results: </strong>A total of 356 LE FTT were performed. Six patients (1.7%) contracted CDI. Groups had similar comorbidity and wound profiles. Flap takeback occurred at significantly higher rates in the CDI group (66.7% vs. 6.3%; p<0.001), as did microvascular pedicle thrombosis (33.3% vs. 3.1%; p=0.017). Flap complications were also significantly higher in the CDI group (100.0% vs. 27.7%; p=0.001), specifically partial flap necrosis (50.0% vs. 3.1%; p=0.001) and infection (66.7% vs. 12.6%; p=0.004). By a median follow-up of 15.7 months, major LE amputation rates were similar between CDI and Non-CDI groups (33.3%, n=2 vs. 12.6%, n=44; p>0.05). Multivariate regression models adjusting for statistically and clinically significant covariates demonstrated CDI to be independently associated with flap takeback (OR: 46.4, 95% CI: 7.2-297.4, p<0.001) and microvascular thrombosis (OR: 26.4, CI: 3.5-197.3, p=0.001).</p><p><strong>Conclusion: </strong>Our results suggest a possible association between C. Diff infection and increased risk for microvascular thrombotic complications in LE FTT. Microvascular plastic surgeons should be aware of the immediate microvascular risks associated with C. Diff infection. Further research is required to fully understand the clinical management of this population.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical reconstruction of severe pressure ulcers in England from 01/04/2011 to 30/09/2018: Retrospective cohort study using routinely collected data.","authors":"Barnaby C Reeves, Jessica M Harris, Maria Pufulete, Jo C Dumville, Una Adderley, Ross Atkinson, Madeleine Clout, Nicky Cullum, Abby O'Connell, Stephen Palmer, Jeremy Rodrigues, Jason Kf Wong","doi":"10.1016/j.bjps.2025.06.012","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.06.012","url":null,"abstract":"<p><strong>Introduction: </strong>We identified patients in England admitted to hospital with severe pressure ulcers (SPUs), quantified how many had surgical reconstruction (SR) to close SPUs and described their outcomes.</p><p><strong>Methods: </strong>Using Hospital Episode Statistics (2010ꟷ2019), we identified adults with SPU who had undergone SR. Outcomes were: length of stay; time-to-next-admission with SPU diagnosis; repeat SR; death from any cause (Office for National Statistics). Maximum and minimum numbers of SRs to close SPUs (the latter comprising a subset about whom we had greatest confidence) were estimated by applying increasingly specific filters.</p><p><strong>Results: </strong>A minimum of 404 and maximum of 1018 patients with SPUs had SR over 7.5 years. Patients in the minimum subset were younger than the entire SR group (median 52 versus 58 years), had fewer comorbidities and were more likely to have a cause of impaired mobility. In the subset and entire group, median hospital stays after SR were 26 (IQR 13ꟷ48) and 42 (IQR 17ꟷ90) days. By one year, more patients in the subset had a further admission with SPU (24.4%, 95% CI 20.5%ꟷ29.0% versus 21.7%, 95%CI 19.2%ꟷ24.5% vs) and fewer had died (4.0%, 95%CI 2.5%ꟷ6.4% versus 14.6%, 95%CI 12.6%ꟷ16.7%); by two years, more had a second SR (10.7%, 95%CI 7.8%ꟷ14.5% versus 7.4%, 95%CI 5.7%ꟷ9.5%). Half the entire number of SRs (505/1018) were performed by 10 of 124 English hospitals.</p><p><strong>Conclusion: </strong>Patients in the subset most likely had SR to close their SPUs. Their outcomes provide evidence that SR to close an SPU is effective for such patients.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rebuttal of Caprini scores and chemoprophylaxis to reduce venous thromboembolism risk in autologous breast reconstruction patients.","authors":"Eric Swanson","doi":"10.1016/j.bjps.2025.04.056","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.04.056","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}