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

{"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}

{"title":"Response re: A rebuttal of Caprini scores and chemoprophylaxis to reduce venous thromboembolism risk in autologous breast reconstruction patients.","authors":"Ioannis Kyriazidis, Moustapha Hamdi","doi":"10.1016/j.bjps.2025.05.045","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.05.045","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287676","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":"End-to-side neurorrhaphy of the sural nerve to the superficial fibular nerve: An anatomically feasible technique for restoring sensation following sural nerve harvest.","authors":"Anhelina Khadanovich, Michal Benes, Radek Kaiser, Henk Giele, David Kachlik","doi":"10.1016/j.bjps.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.bjps.2025.04.022","url":null,"abstract":"<p><p>The sural nerve is commonly used as an autologous nerve graft. Its harvest results in a sensory deficit in the corresponding distribution area. End-to-side neurorrhaphy of the distal sural nerve stump to the superficial fibular nerve could address the problem of sensory loss in the dorsolateral foot without altering the donor nerve. The purpose of our study is to elaborate on a technique for sural nerve-to-superficial fibular nerve end-to-side neurorrhaphy. Fourteen legs from seven formaldehyde-preserved cadavers were dissected. The sural nerve was transected two centimeters above the distal tip of the lateral malleolus (LM) and mobilised to reach the intermediate dorsal cutaneous nerve (IDCN) and the medial dorsal cutaneous nerve (MDCN). The measurements were taken to localise the coaptation points with the nerves. The distal stump of the sural nerve had to be mobilised 18.0 (8.6-24.9) mm distally in relation to the distal tip of LM in order to reach the IDCN. The coaptation point with the IDCN was 18.9 (15.3-22.8) mm above the distal tip of the LM on the anterior margin of the LM. Mobilisation of 33.7 (25.5-38.8) mm was required for reaching the MDCN. The coaptation point with the MDCN was 19.9 (15.8-27.0) mm above the distal tip of the LM, overlaying the lateral margin of the extensor digitorum longus muscle. The end-to-side neurorrhaphy of the sural nerve to the superficial fibular nerve is anatomically feasible and can be performed on both IDCN and MDCN. We recommend using the MDCN due to its larger diameter.</p>","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004085","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":"Does post-mastectomy radiation therapy worsen outcomes in immediate autologous breast flap reconstruction? A systematic review and meta-analysis.","authors":"Belle Liew, C. Southall, M. Kanapathy, D. Nikkhah","doi":"10.7244/cmj.2021.04.001.1","DOIUrl":"https://doi.org/10.7244/cmj.2021.04.001.1","url":null,"abstract":"BACKGROUND\u0000There is great uncertainty regarding the practice of immediate autologous breast reconstruction (IBR) when post-mastectomy radiotherapy (PMRT) is indicated. Plastic surgery units differ in their treatment protocols, with some recommending delayed breast reconstruction (DBR) following PMRT. IBR offers significant cosmetic and psychosocial benefits; however, the morbidity of flap exposure to radiation remains unclear.\u0000\u0000\u0000OBJECTIVE\u0000The aim of this review was to comprehensively analyze the existing literature comparing autologous flaps exposed to PMRT and flaps with no radiation exposure.\u0000\u0000\u0000METHODS\u0000A comprehensive search in MEDLINE, EMBASE and CENTRAL databases was conducted in November 2020. Primary studies comparing IBR with and without adjuvant PMRT were assessed for the following primary outcomes: clinical complications, observer-reported outcomes and patient-reported satisfaction rates. Meta-analysis was performed to obtain pooled risk ratios of individual complications.\u0000\u0000\u0000RESULTS\u0000Twenty-one articles involving 3817 patients were included. Meta-analysis of pooled data gave risk ratios for fat necrosis (RR = 1.91, p < 0.00001), secondary surgery (RR = 1.62, p = 0.03) and volume loss (RR = 8.16, p < 0.00001) favoring unirradiated flaps, but no significant difference was observed in all other reported complications. The no-PMRT group scored significantly higher in observer-reported measures. However, self-reported aesthetic and general satisfaction rates were similar between groups.\u0000\u0000\u0000CONCLUSION\u0000IBR should be offered after mastectomy to patients requiring PMRT. The higher risks of fat necrosis and contracture appear to be less clinically relevant as corroborated by positive scores from patients developing these complications. Preoperative and intraoperative measures should be taken to further optimize reconstruction and mitigate post-radiation sequel. Careful management of patients' expectations is also imperative.\u0000\u0000\u0000LEVEL OF EVIDENCE\u0000Level III.","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88109816","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 Role of Social Media in Disseminating Plastic Surgery Research: The Relationship between Citations, Altmetrics and Article Characteristics","authors":"Michael C. Grant, K. Scott-Bridge, R. Wade","doi":"10.1101/2020.08.26.20182337","DOIUrl":"https://doi.org/10.1101/2020.08.26.20182337","url":null,"abstract":"Background: Social media (SoMe) enables publishers and authors to disseminate content immediately and directly to interested end-users, on a global scale. Alternative metrics (altmetrics) are non-traditional bibliometrics which describe the exposure and impact of an article on freely available platforms such as Twitter, Facebook, Wikipedia and the news. Altmetrics are strongly associated with ultimate citation counts in various medical disciplines, except plastic surgery which represents the rational for this study. Methods: Altmetric explorer was used to extract altmetrics and citation rates for articles published during 2018 in Plastic and Reconstructive Surgery (PRS), the Journal of Plastic, Reconstructive and Aesthetic Surgery, the Annals of Plastics Surgery and Plastic Surgery (also known as Chirurgie Plastique). Multivariable negative binomial regression was used to estimate the relationship between citations and predictors (presented as the incidence rate ratio, IRR with 95% confidence interval, CI). Results: Overall, 1215 plastic surgery articles were captured which were cited 3269 times. There was a strong and independent association between the number of mentions in SoMe and the number of times an article was cited (adjusted IRR 1.01 [95% CI 1.01, 1.1]), whereby each mention in SoMe (e.g. Tweets or Facebook posts) translated to one additional citation. Evidence synthesis articles (e.g. systematic reviews) were cited twice as often as other articles and again, the use of SoMe to advertise these outputs was independently associated with more citations (IRR 2.0 [95% CI 1.3, 3.2]). Conclusions: Dissemination of plastic surgery research through social media channels increases an articles impact as measured by citations.","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":"35 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75873061","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":"Use of a purified collagen membrane to aid closure of palatal fistulae.","authors":"D. Atherton, J. Boorman","doi":"10.1016/j.bjps.2016.02.009","DOIUrl":"https://doi.org/10.1016/j.bjps.2016.02.009","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":"25 1","pages":"1003-7"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85231766","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 anatomic basis of the internal mammary artery perforator flap: a cadaver study.","authors":"Manfred Schmidt, O. Aszmann, H. Beck, M. Frey","doi":"10.1016/j.bjps.2008.09.019","DOIUrl":"https://doi.org/10.1016/j.bjps.2008.09.019","url":null,"abstract":"","PeriodicalId":94104,"journal":{"name":"Journal of plastic, reconstructive & aesthetic surgery : JPRAS","volume":"185 1","pages":"191-6"},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78566093","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}