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Both Patients and Plastic Surgeons Prefer Artificial Intelligence-Generated Microsurgical Information. 患者和整形外科医生都喜欢人工智能生成的微整形信息。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-02-21 DOI: 10.1055/a-2273-4163

Background:  With the growing relevance of artificial intelligence (AI)-based patient-facing information, microsurgical-specific online information provided by professional organizations was compared with that of ChatGPT (Chat Generative Pre-Trained Transformer) and assessed for accuracy, comprehensiveness, clarity, and readability.

Methods:  Six plastic and reconstructive surgeons blindly assessed responses to 10 microsurgery-related medical questions written either by the American Society of Reconstructive Microsurgery (ASRM) or ChatGPT based on accuracy, comprehensiveness, and clarity. Surgeons were asked to choose which source provided the overall highest-quality microsurgical patient-facing information. Additionally, 30 individuals with no medical background (ages: 18-81, μ = 49.8) were asked to determine a preference when blindly comparing materials. Readability scores were calculated, and all numerical scores were analyzed using the following six reliability formulas: Flesch-Kincaid Grade Level, Flesch-Kincaid Readability Ease, Gunning Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, Linsear Write Formula, and Automated Readability Index. Statistical analysis of microsurgical-specific online sources was conducted utilizing paired t-tests.

Results:  Statistically significant differences in comprehensiveness and clarity were seen in favor of ChatGPT. Surgeons, 70.7% of the time, blindly choose ChatGPT as the source that overall provided the highest-quality microsurgical patient-facing information. Nonmedical individuals 55.9% of the time selected AI-generated microsurgical materials as well. Neither ChatGPT nor ASRM-generated materials were found to contain inaccuracies. Readability scores for both ChatGPT and ASRM materials were found to exceed recommended levels for patient proficiency across six readability formulas, with AI-based material scored as more complex.

Conclusion:  AI-generated patient-facing materials were preferred by surgeons in terms of comprehensiveness and clarity when blindly compared with online material provided by ASRM. Studied AI-generated material was not found to contain inaccuracies. Additionally, surgeons and nonmedical individuals consistently indicated an overall preference for AI-generated material. A readability analysis suggested that both materials sourced from ChatGPT and ASRM surpassed recommended reading levels across six readability scores.

背景:随着基于人工智能的面向患者的信息越来越重要,我们将专业组织提供的显微外科特定在线信息与 ChatGPT 的信息进行了比较,并对其准确性、全面性、清晰度和可读性进行了评估:六名整形外科医生对美国整形显微外科学会(ASRM)或 ChatGPT 提出的十个显微外科相关医疗问题的回答进行了盲法评估,评估的标准是准确性、全面性和清晰度。外科医生被要求选择哪个来源提供的面向患者的显微外科信息总体质量最高。此外,还要求 30 位无医学背景的个人(年龄在 18-81 岁之间,μ=49.8)在盲比资料时确定偏好。计算可读性得分,并使用以下六种可靠性公式分析所有数值得分:Flesch-Kincaid等级水平、Flesch-Kincaid易读性、Gunning Fog指数、Simple Measure of Gobbledygook (SMOG)指数、Coleman-Liau指数、Linsear书写公式(LWF)和自动可读性指数。利用配对 t 检验对显微外科专用在线资源进行了统计分析:结果:从统计学角度看,ChatGPT 在全面性和清晰度方面具有明显优势。70.7%的外科医生盲目地选择 ChatGPT 作为提供面向患者的最高质量显微外科信息的来源。非医务人员也有 55.9% 的时间选择人工智能生成的显微外科资料。无论是 ChatGPT 还是 ASRM 生成的资料都没有发现不准确之处。在六个可读性公式中,ChatGPT 和 ASRM 材料的可读性得分均超过了患者熟练程度的建议水平,而基于人工智能的材料得分更高:结论:与 ASRM 提供的在线资料进行盲比时,外科医生更喜欢人工智能生成的面向患者的资料的全面性和清晰度。研究发现,人工智能生成的资料不存在不准确之处。此外,外科医生和非医务人员一致表示更喜欢人工智能生成的材料。可读性分析表明,来自 ChatGPT 和 ASRM 的材料在六项可读性评分中均超过了推荐的阅读水平。
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引用次数: 0
No Skin Paddle, No Problem: Burying Deep Inferior Epigastric Artery Flaps in the Immediate Setting is Safe in Select Patient Populations. 没有皮瓣就没有问题:在特定患者群体中,立即埋藏 DIEP 皮瓣是安全的。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-05-06 DOI: 10.1055/a-2320-5665

Background:  In appropriately selected patients, it may be possible to fully bury breast free flaps deep to the mastectomy skin flaps. Because this practice forgoes the incorporation of a monitoring skin paddle for the flap, and thus limits the ability for physical exam, it may be associated with an increased risk of flap loss or other perfusion-related complications, such as fat necrosis. We hypothesized that fully de-epithelialized breast free flaps were not associated with an increased complication rate and reduced the need for future revision surgery.

Methods:  A single-institution retrospective review of 206 deep inferior epigastric artery (DIEP) flaps in 142 patients was performed between June 2016 and September 2021. Flaps were grouped into buried or nonburied categories based on the absence or presence of a monitoring paddle. Patient-reported outcomes were assessed postoperatively using the BREAST-Q breast reconstruction module. Electronic medical record data included demographics, comorbidities, flap characteristics, complications, and revision surgery.

Results:  The buried flap patients (N = 46) had a lower median body mass index (26.9 vs 30.3, p = 0.04) and a lower rate of hypertension (19.5 vs. 37.5%, p = 0.04) compared with nonburied flap patients (N = 160). Burying flaps was more likely to be adopted in skin-sparing mastectomy or nipple-sparing mastectomy (p = 0.001) and in an immediate or a delayed-immediate fashion (p = 0.009). There was one flap loss in the nonburied group; complication rates were similar. There was a significantly greater revision rate in the nonburied flap patients (92 vs. 70%; p = 0.002). Buried flap patients exhibited a greater satisfaction with breasts (84.5 ± 13.4 vs. 73.9 ± 21.4; p = 0.04) and sexual satisfaction (73.1 ± 22.4 vs. 53.7 ± 29.7; p = 0.01) compared with nonburied flap patients.

Conclusion:  Burying breast free flaps in appropriately selected patients does not appear to have a higher complication rate when compared with flaps with an externalized monitoring paddle. Furthermore, this modification may be associated with a better immediate aesthetic outcome and improved patient satisfaction, as evidenced by a lower rate of revision surgery and superior BREAST-Q scores among buried DIEP flaps.

背景:由于立即埋藏游离皮瓣放弃了监测皮垫,可能会增加皮瓣脱落或其他灌注相关并发症(如脂肪坏死)的风险。我们假设,完全去表皮化的乳房游离皮瓣与并发症发生率增加无关,可减少未来翻修手术的需要,并且患者报告的结果更佳:2016年6月至2021年9月期间,对142名患者的206个DIEP皮瓣进行了单机构回顾性审查。根据监测垫的有无将皮瓣分为埋入型和非埋入型两类。术后使用 BREAST Q 乳房重建模块对患者报告的结果进行评估。电子病历数据包括人口统计学、合并症、皮瓣特征、并发症和翻修手术:与非埋入皮瓣患者(N=160)相比,埋入皮瓣患者(N=46)的中位体重指数较低(26.9 vs 30.3,P=0.04),高血压发病率较低(19.5% vs 37.5%,P=0.04)。与延迟重建相比,立即或延迟立即埋藏皮瓣的可能性更大(p=0.009)。非埋藏组有一个皮瓣脱落;并发症发生率相似。非埋藏皮瓣患者的翻修率明显更高(92% vs 70%;P=0.002)。与非埋藏皮瓣患者相比,埋藏皮瓣患者的乳房满意度(84.5  13.4 vs. 73.9  21.4; p=0.04)和性生活满意度(73.1 22.4 vs. 53.7  29.7; p=0.01)更高。结论:结论:与使用外置监测桨的乳房游离皮瓣相比,经过适当选择的患者采用埋藏式乳房游离皮瓣的并发症发生率似乎并不高。此外,埋入式 DIEP 乳房游离皮瓣的翻修手术率较低,且乳房 Q 评分较高,证明这种改良可能会带来更好的即时美学效果和患者满意度。
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引用次数: 0
Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention. 接受和未接受教育干预的 DIEP 乳房再造术患者出院后的阿片类药物门诊处方使用情况。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-03-07 DOI: 10.1055/a-2283-4775

Background:  There is limited evidence for appropriate postoperative opioid prescribing in autologous breast reconstruction. We sought to describe postoperative outpatient prescription opioid use following discharge after deep inferior epigastric perforator (DIEP) breast reconstruction with and without an educational video.

Methods:  Patients undergoing DIEP reconstruction were given a 28-day postoperative pain and medication logbook from August 2022 to June 2023. Our practice implemented an educational video upon discharge on proper opioid consumption. Descriptive statistics on patient characteristics, intraoperative and postoperative opioid consumption, and outpatient prescription opioid use after discharge were compared between the two cohorts.

Results:  A total of 53 logbooks were completed with 20 patients in the no video cohort and 33 in the video cohort. On average, the days to cessation of opiates was longer in the no video cohort (8.2 vs. 5.1 days, p = 0.003). The average number of oxycodone 5 mg equivalents consumed following discharge was 13.8 in the no video cohort and 7.8 in the video cohort, which was statistically significant (p = 0.01). Overall, the percentage of opioids prescribed that were consumed in the video cohort was 28.3% versus 67.1% in the no video cohort.

Conclusion:  For patients discharging home after DIEP reconstruction, we recommend a prescription for 12 oxycodone 5 mg tablets. With the use of an educational video regarding proper opioid consumption, we were able to reduce the total outpatient opioid use to 5 oxycodone 5 mg tablets following hospital discharge.

导言:关于自体乳房再造术后适当使用阿片类药物的证据有限。我们试图描述下腹穿孔器(DIEP)乳房再造术后出院时使用和未使用教育视频的术后门诊处方阿片类药物的情况:从 2022 年 8 月到 2023 年 6 月,对接受 DIEP 重建术的患者进行了为期 28 天的术后疼痛和用药记录。我们在患者出院时播放了关于正确使用阿片类药物的教育视频。我们对两组患者的特征、术中和术后阿片类药物消耗量以及出院后门诊处方阿片类药物使用情况进行了描述性统计比较:共完成了 53 份日志,其中无视频队列中有 20 名患者,有视频队列中有 33 名患者。平均而言,无视频队列中停止使用阿片类药物的天数更长(8.2 天对 5.1 天,P=0.003)。无视频队列在出院后平均消耗的 5 毫克羟考酮当量为 13.8 毫克,有视频队列为 7.8 毫克,差异有统计学意义(P=0.01)。总体而言,视频队列中处方阿片类药物的消耗比例为 28.3%,而无视频队列中为 67.1%:结论:对于 DIEP 重建术后出院回家的患者,我们建议处方 12 片 5 毫克的羟考酮。通过使用关于正确使用阿片类药物的教育视频,我们能够将出院后门诊阿片类药物的总用量减少到五片 5 毫克羟考酮。
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引用次数: 0
Delayed Commissuroplasty Increases Interincisal Distance in Buccogingival Cancer Patients Treated with Free Flap Reconstruction of the Oral Commissure. 延迟颊龈成形术可增加颊龈癌患者口腔颊突游离瓣重建术的颊龈间距
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-03-18 DOI: 10.1055/s-0044-1782659

Background:  Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to evaluate the implications of primary versus delayed commissuroplasty on drooling, and interincisal distance outcomes in this cohort.

Methods:  A retrospective query of head and neck cancer patients operated by a single surgeon from 2017 to 2020 was performed. Patients were included if they underwent free flap reconstruction of the oral commissure, had an immediate or delayed commissuroplasty, and had 2 years of follow-up data including Thomas-Stonell and Greenberg drooling rating scales and interincisal distance measurements.

Results:  Thirty-five patients were included in the review. Twelve patients received immediate commissuroplasty and 23 patients had delayed commissuroplasty. Interincisal distance was similar at baseline, although significantly varied between immediate and delayed commissuroplasty groups at 1 month and 2 years postoperative. Drooling scores were significantly elevated in the group treated with delayed commissuroplasty, but eventually normalized after staged surgery and follow-up. Patients treated with adjunct radiation therapy had lower interincisal distance than patients who did not have radiation.

Conclusion:  Delayed commissuroplasty increased interincisal distance and normalize drooling in patients who required full-thickness excision of the buccal mucosa and oral commissure and free tissue reconstruction. The presented data can help to educate patients on expected postoperative outcomes and likely advocates for a second-stage procedure after completion of adjunct radiotherapy to achieve optimal commissural placement and oral competence.

背景:口腔癌需要切除口腔会厌并进行游离皮瓣重建,通常需要进行会厌成形术来控制口腔失禁。我们的目的是评估初级与延迟的咬合面成形术对流口水和咬合间距结果的影响:我们对 2017 年至 2020 年由一名外科医生手术的头颈部癌症患者进行了回顾性查询。如果患者接受了口腔会厌游离瓣重建术,进行了即刻或延迟的会厌成形术,并有2年的随访数据,包括Thomas-Stonell和Greenberg流口水评分量表和incisal间距测量结果,则被纳入研究:共有 35 名患者接受了复查。12名患者接受了即刻颊突成形术,23名患者接受了延迟颊突成形术。基线时的齿间距离相似,但在术后 1 个月和 2 年时,即刻颊突成形术组和延迟颊突成形术组之间存在显著差异。接受延迟颊裂成形术治疗的患者流口水评分明显升高,但在分期手术和随访后最终恢复正常。与未接受放射治疗的患者相比,接受辅助放射治疗的患者齿间距离较低:结论:对于需要全层切除颊粘膜和口腔颊突并进行游离组织重建的患者,延迟颊突成形术可增加颊突间距离并使流口水情况恢复正常。所提供的数据有助于让患者了解预期的术后效果,并主张在完成辅助放疗后进行第二阶段手术,以达到最佳的颊黏膜位置和口腔功能。
{"title":"Delayed Commissuroplasty Increases Interincisal Distance in Buccogingival Cancer Patients Treated with Free Flap Reconstruction of the Oral Commissure.","authors":"Shao Yu Hung, Curtis Hanba, Tommy Nai-Jen Chang, Yan-Lin Chen, Johnny Chuieng-Yi Lu","doi":"10.1055/s-0044-1782659","DOIUrl":"10.1055/s-0044-1782659","url":null,"abstract":"<p><strong>Background: </strong> Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to evaluate the implications of primary versus delayed commissuroplasty on drooling, and interincisal distance outcomes in this cohort.</p><p><strong>Methods: </strong> A retrospective query of head and neck cancer patients operated by a single surgeon from 2017 to 2020 was performed. Patients were included if they underwent free flap reconstruction of the oral commissure, had an immediate or delayed commissuroplasty, and had 2 years of follow-up data including Thomas-Stonell and Greenberg drooling rating scales and interincisal distance measurements.</p><p><strong>Results: </strong> Thirty-five patients were included in the review. Twelve patients received immediate commissuroplasty and 23 patients had delayed commissuroplasty. Interincisal distance was similar at baseline, although significantly varied between immediate and delayed commissuroplasty groups at 1 month and 2 years postoperative. Drooling scores were significantly elevated in the group treated with delayed commissuroplasty, but eventually normalized after staged surgery and follow-up. Patients treated with adjunct radiation therapy had lower interincisal distance than patients who did not have radiation.</p><p><strong>Conclusion: </strong> Delayed commissuroplasty increased interincisal distance and normalize drooling in patients who required full-thickness excision of the buccal mucosa and oral commissure and free tissue reconstruction. The presented data can help to educate patients on expected postoperative outcomes and likely advocates for a second-stage procedure after completion of adjunct radiotherapy to achieve optimal commissural placement and oral competence.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"707-712"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications. 当好皮瓣变坏时:游离皮瓣并发症的时间预测模型。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-03-28 DOI: 10.1055/s-0044-1782671

Background:  Microsurgical cases are complex plastic surgery procedures with a significant risk of acute postoperative complications. In this study, we use a large-scale database to investigate the temporal progression of complications after microsurgical procedures and the risk imparted by acute postoperative complications on subsequent reconstructive outcomes.

Methods:  Microsurgery cases were extracted from the National Surgical Quality Improvement Program database by Current Procedural Terminology codes. Postoperative complications were collected for 30 days after surgery and stratified into four temporal periods (postoperative days [PODs] 0-6, 7-13, 14-20, 21-30). Postoperative complication occurrences were incorporated into a weighted multivariate logistic regression model to identify significant predictors of adverse outcomes (p < 0.05). Separately, a regression model was calculated for the time between index operation and reoperation and additional complications.

Results:  The final cohort comprised 19,517 patients, 6,140 (31.5%) of which experienced at least one complication in the first 30 days after surgery. The occurrence of prior complications in the postoperative period was a significant predictor of future adverse outcomes following the initial week after surgery (p < 0.001). Upon predictive analysis, overall model performance was highest in PODs 7 to 13 (71.1% accuracy and the area under a receiver operating characteristic curve 0.684); 2,578 (13.2%) patients underwent at least one reoperation within the first 2 weeks after surgery. The indication for reoperation (p < 0.001) and number of days since surgery (p = 0.0038) were significant predictors of future complications after reoperation.

Conclusion:  Prior occurrence of complications in an earlier postoperative week, as well as timing and nature of reoperation, were shown to be significant predictors of future complications.

背景:显微外科手术是复杂的整形外科手术,术后出现急性并发症的风险很大。在本研究中,我们利用大规模数据库调查显微外科手术后并发症的时间进展以及术后急性并发症对后续重建结果的风险:方法:根据当前手术术语代码从国家外科质量改进计划数据库中提取显微外科病例。术后并发症收集时间为术后 30 天,并分为四个时间段(术后第 0-6 天、第 7-13 天、第 14-20 天、第 21-30 天)。术后并发症发生率被纳入加权多变量逻辑回归模型,以确定不良结局的重要预测因素(P 结果:最终队列由 19,517 名患者组成,其中 6,140 人(31.5%)在术后 30 天内至少出现过一次并发症。术后一周内出现并发症是术后未来不良预后的重要预测因素(P P = 0.0038),也是未来再次手术后并发症的重要预测因素:结论:在术后较早一周出现的并发症以及再次手术的时间和性质都是未来并发症的重要预测因素。
{"title":"When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications.","authors":"Dylan K Kim, Seth Z Aschen, Christine H Rohde","doi":"10.1055/s-0044-1782671","DOIUrl":"10.1055/s-0044-1782671","url":null,"abstract":"<p><strong>Background: </strong> Microsurgical cases are complex plastic surgery procedures with a significant risk of acute postoperative complications. In this study, we use a large-scale database to investigate the temporal progression of complications after microsurgical procedures and the risk imparted by acute postoperative complications on subsequent reconstructive outcomes.</p><p><strong>Methods: </strong> Microsurgery cases were extracted from the National Surgical Quality Improvement Program database by Current Procedural Terminology codes. Postoperative complications were collected for 30 days after surgery and stratified into four temporal periods (postoperative days [PODs] 0-6, 7-13, 14-20, 21-30). Postoperative complication occurrences were incorporated into a weighted multivariate logistic regression model to identify significant predictors of adverse outcomes (<i>p</i> < 0.05). Separately, a regression model was calculated for the time between index operation and reoperation and additional complications.</p><p><strong>Results: </strong> The final cohort comprised 19,517 patients, 6,140 (31.5%) of which experienced at least one complication in the first 30 days after surgery. The occurrence of prior complications in the postoperative period was a significant predictor of future adverse outcomes following the initial week after surgery (<i>p</i> < 0.001). Upon predictive analysis, overall model performance was highest in PODs 7 to 13 (71.1% accuracy and the area under a receiver operating characteristic curve 0.684); 2,578 (13.2%) patients underwent at least one reoperation within the first 2 weeks after surgery. The indication for reoperation (<i>p</i> < 0.001) and number of days since surgery (<i>p</i> = 0.0038) were significant predictors of future complications after reoperation.</p><p><strong>Conclusion: </strong> Prior occurrence of complications in an earlier postoperative week, as well as timing and nature of reoperation, were shown to be significant predictors of future complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"694-706"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140318458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postparetic Synkinesis: Objective and Subjective Comparisons of Depressor Anguli Oris Myectomies versus Depressor Anguli Oris and Buccinator Myectomies. 瘫痪后的同步运动:下压角肌(DAO)切除术与下压角肌和颊肌切除术的客观和主观比较。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-02-21 DOI: 10.1055/a-2273-4327

Background:  Muscles affected by postparetic synkinesis have imbalanced tonicity that limit perioral mimetic movement and inhibit the ability to smile. The depressor anguli oris (DAO) muscle has been a common myectomy target for the treatment of perioral synkinesis. While addition of buccinator myectomies to DAO myectomies has risen, no studies have analyzed the effects of buccinator myectomies. The goal of this study was to evaluate and compare the effects of a DAO myectomy with and without concomitant buccinator myectomy through objective facial metrics and subjective patient-reported outcomes.

Methods:  This study is a retrospective review of patients with postparetic synkinesis who underwent DAO myectomy (DAO myectomy group) or DAO myectomy with buccinator myectomy (DAO + Buccinator myectomies group). Outcomes included postoperative differences in objective smile measures (smile angle, excursion, and dental show) using validated software and patient-reported outcomes using the Facial Disability Index (FDI) questionnaire and a myectomy-specific questionnaire.

Results:  After chart review, 18 patients were included in the DAO myectomy group and 19 in the DAO + Buccinator myectomies group. There were no significant postoperative differences between the groups in (1) smile excursion, angle, or dental show at resting, closed smile, or open smile (p > 0.05), (2) FDI physical and social scores, p = 0.198 and 0.932, respectively, or (3) myectomy-specific questionnaire responses (p > 0.05).

Conclusion:  The addition of a buccinator myectomy to a DAO myectomy does not provide significant clinical benefit when compared with an isolated DAO myectomy, based on objective measures and subjective patient-reported outcomes.

背景:受疼痛后同步肌影响的肌肉具有不平衡的强直性,从而限制了口周模仿运动并抑制了微笑能力。口角下压肌(DAO)一直是治疗口周肌张力障碍的常见肌肉切除目标。虽然在 DAO 肌肉切除术的基础上增加了颊舌肌切除术,但还没有研究对颊舌肌切除术的效果进行分析。本研究的目的是通过客观面部指标和患者主观报告结果,评估和比较在进行 DAO 肌肉切除术的同时进行和不进行颊侧肌肉切除术的效果:本研究是一项回顾性研究,研究对象是接受了DAO肌切除术(DAO肌切除术组)或DAO肌切除术联合颊侧肌切除术(DAO+颊侧肌切除术组)的麻痹性滑膜炎术后患者。结果包括术后使用有效软件进行的客观微笑测量(微笑角度、偏移和牙齿显示)的差异,以及使用面部残疾指数(FDI)问卷和颌骨切除术专用问卷进行的患者报告结果:经过病历审查,18 名患者被纳入 DAO 骨髓切除术组,19 名患者被纳入 DAO+Buccinator 骨髓切除术组。两组患者术后在以下方面无明显差异:1.微笑偏移、角度或静态、闭合微笑或开放微笑时的牙齿显示(P>.05);2.FDI生理和社交评分,分别为P=.198和P=.932;3.颌骨切除术特定问卷回答(P>.05):结论:根据客观测量和患者主观报告结果,与单独的DAO myectomy切除术相比,在DAO myectomy切除术的基础上增加颊侧myectomy切除术不会带来显著的临床益处。
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引用次数: 0
A Systematic Review of the Complications Associated with Free Fibular Flaps in Adult and Pediatric Spinal Reconstruction. 成人和小儿脊柱重建中游离腓骨瓣相关并发症的系统性综述
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-10-30 DOI: 10.1055/a-2434-5882
Katherine J Zhu, Annie M Cho, Joel S Beckett, Luke Macyszyn, David Mathes, Phuong Nguyen, Timothy Irwin, Christodoulos Kaouzanis, Jason W Yu

Background:  Free fibular flaps have been suggested as a modality of reconstruction for complex spinal deformities. However, there is limited data that describes associated postoperative outcomes. The purpose of this systematic review was to characterize outcomes after spinal reconstruction using the free fibular flap for both adults and children.

Methods:  Thirty-nine articles among four databases were identified as having met inclusion criteria. Patient demographics, indications for spinal reconstruction as well as location and anastomosis, history of chemotherapy and radiation therapy, and postoperative outcomes including complications were identified. Major complications were defined as complications requiring reoperation, while minor complications were those that did not require reoperation. Systemic complications were defined as complications affecting sites or organ systems beyond the local donor and recipient sites. Statistical analysis was performed using Fischer's exact, chi-squared, and t-tests.

Results:  We identified 218 adult patients (mean age 47.7 years, 56.4% male) and 27 pediatric patients (mean age 12.7 years, 55.6% male). While there was no significant difference in the rates of bony union between the two groups (adults: 90.8%, children: 90%, p > 0.9), adults had significantly higher rates of major (27% vs. 7.4%, p = 0.026), minor (26.1% vs. 7.4%, p = 0.032), and systemic (14.2% vs. 0%, p = 0.047) complications.

Conclusion:  Free fibular flaps are effective for spinal reconstruction for both adults and children, as evidenced by the high rates of bony union. However, adults exhibited significantly higher complication rates. Further research is required to better understand the patient and clinical risk factors associated with increased rate of complications.

背景游离腓骨瓣被认为是重建复杂脊柱畸形的一种方式。然而,描述相关术后效果的数据非常有限。本系统性综述旨在描述成人和儿童使用游离腓骨瓣重建脊柱后的效果。方法 在四个数据库中筛选出符合纳入标准的 39 篇文章。确定了患者的人口统计学特征、脊柱重建的适应症、位置和吻合口、化疗和放疗史以及包括并发症在内的术后效果。主要并发症是指需要再次手术的并发症,轻微并发症是指不需要再次手术的并发症。全身并发症是指影响供体和受体局部以外的部位或器官系统的并发症。统计分析采用费舍尔精确检验、卡方检验和 t 检验。结果 我们确认了 218 名成人患者(平均年龄 47.7 岁,56.4% 为男性)和 27 名儿童患者(平均年龄 12.7 岁,55.6% 为男性)。虽然两组患者的骨结合率没有明显差异(成人:90.8%,儿童:90%,P>0.9),但成人的主要并发症(27% vs. 7.4%,P=0.026)、次要并发症(26.1% vs. 7.4%,P=0.032)和全身并发症(14.2% vs. 0%,P=0.047)发生率明显更高。结论 游离腓骨瓣对成人和儿童的脊柱重建都很有效,骨结合率高就是证明。然而,成人的并发症发生率明显更高。要更好地了解与并发症发生率增加相关的患者和临床风险因素,还需要进一步的研究。
{"title":"A Systematic Review of the Complications Associated with Free Fibular Flaps in Adult and Pediatric Spinal Reconstruction.","authors":"Katherine J Zhu, Annie M Cho, Joel S Beckett, Luke Macyszyn, David Mathes, Phuong Nguyen, Timothy Irwin, Christodoulos Kaouzanis, Jason W Yu","doi":"10.1055/a-2434-5882","DOIUrl":"10.1055/a-2434-5882","url":null,"abstract":"<p><strong>Background: </strong> Free fibular flaps have been suggested as a modality of reconstruction for complex spinal deformities. However, there is limited data that describes associated postoperative outcomes. The purpose of this systematic review was to characterize outcomes after spinal reconstruction using the free fibular flap for both adults and children.</p><p><strong>Methods: </strong> Thirty-nine articles among four databases were identified as having met inclusion criteria. Patient demographics, indications for spinal reconstruction as well as location and anastomosis, history of chemotherapy and radiation therapy, and postoperative outcomes including complications were identified. Major complications were defined as complications requiring reoperation, while minor complications were those that did not require reoperation. Systemic complications were defined as complications affecting sites or organ systems beyond the local donor and recipient sites. Statistical analysis was performed using Fischer's exact, chi-squared, and <i>t</i>-tests.</p><p><strong>Results: </strong> We identified 218 adult patients (mean age 47.7 years, 56.4% male) and 27 pediatric patients (mean age 12.7 years, 55.6% male). While there was no significant difference in the rates of bony union between the two groups (adults: 90.8%, children: 90%, <i>p</i> > 0.9), adults had significantly higher rates of major (27% vs. 7.4%, <i>p</i> = 0.026), minor (26.1% vs. 7.4%, <i>p</i> = 0.032), and systemic (14.2% vs. 0%, <i>p</i> = 0.047) complications.</p><p><strong>Conclusion: </strong> Free fibular flaps are effective for spinal reconstruction for both adults and children, as evidenced by the high rates of bony union. However, adults exhibited significantly higher complication rates. Further research is required to better understand the patient and clinical risk factors associated with increased rate of complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Investigating the Association between Preflap Negative-Pressure Wound Therapy and Surgical Outcomes in Extremity Free Flap Reconstruction: A Systematic Review. 调查皮瓣前负压伤口治疗与四肢游离皮瓣重建手术结果之间的关联:系统回顾。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-10-29 DOI: 10.1055/a-2434-5798
Madeline C Rocks, Meagan Wu, Victoria Comunale, Nikhil Agrawal, Rebecca S Nicholas, Ali Azad, Jacques H Hacquebord

Background:  While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction.

Methods:  A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups.

Results:  A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%).

Conclusion:  Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.

背景:尽管之前的研究建议在四肢创伤软组织重建时应在受伤后 72 小时内立即进行皮瓣覆盖,但最近在先进伤口护理技术背景下的证据不再强调立即覆盖的必要性。负压伤口疗法(NPWT)是延长软组织明确覆盖时间的重要工具。本研究旨在阐明术前使用 NPWT 对显微外科重建成功的影响:方法:使用以下数据库进行文献检索,检索时间从开始到 2023 年 2 月:PubMed、OVID 数据库(Embase 和 Cochrane 图书馆)、Web of Science 和 Scopus。在已确定的 301 篇文章中,161 篇经过评估,24 篇被纳入。根据术前是否使用 NPWT 对病例进行了划分。记录了最终覆盖的时间、损伤细节和基本人口统计学特征。比较各组皮瓣失败、感染、骨不连、再次手术和并发症的发生率:共纳入了1027名患者和1047个皮瓣,其中894人(85.39%)接受了皮瓣前NPWT治疗。NPWT组和非NPWT组的最终覆盖平均时间分别为16天和18天。与非 NPWT 组相比,NPWT 组的术后并发症发生率较低,但深部感染除外。与非 NPWT 组相比,NPWT 组的任何皮瓣失败率(3.69% 对 9.80%)和部分皮瓣失败率(2.24% 对 6.54%)均较低:术前 NPWT 与术后并发症的减少有关,其中最重要的是皮瓣失败率。结论:术前 NPWT 可减少术后并发症,尤其是皮瓣失败率,这值得在创伤性四肢重建的决策过程中进一步研究。未来的前瞻性研究需要采用标准化方案并进行更长时间的随访,以更好地了解术前使用 NPWT 在软组织重建中的潜在有益作用。
{"title":"Investigating the Association between Preflap Negative-Pressure Wound Therapy and Surgical Outcomes in Extremity Free Flap Reconstruction: A Systematic Review.","authors":"Madeline C Rocks, Meagan Wu, Victoria Comunale, Nikhil Agrawal, Rebecca S Nicholas, Ali Azad, Jacques H Hacquebord","doi":"10.1055/a-2434-5798","DOIUrl":"10.1055/a-2434-5798","url":null,"abstract":"<p><strong>Background: </strong> While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction.</p><p><strong>Methods: </strong> A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups.</p><p><strong>Results: </strong> A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%).</p><p><strong>Conclusion: </strong> Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical Complications after Targeted Muscle Reinnervation at a Safety-Net Hospital. 在一家安全网医院进行靶向肌肉神经再支配术后的手术并发症。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-10-29 DOI: 10.1055/a-2435-7410
Chioma G Obinero, Jackson C Green, Kylie R Swiekatowski, Chimdindu V Obinero, Arvind Manisundaram, Matthew R Greives, Mohin Bhadkamkar, Yuewei Wu-Fienberg, Erik Marques

Background:  Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) can reduce neuroma formation and phantom limb pain (PLP) after lower extremity (LE) amputation. These techniques have not been studied in safety-net hospitals. This study aims to examine the surgical complication rates after TMR and/or RPNI at an academic safety-net hospital in an urban setting.

Methods:  This was a retrospective review of patients older than 18 years who had prior above-knee guillotine amputation (AKA) or below-knee guillotine amputation (BKA) and underwent stump formalization with TMR and/or RPNI from 2020 to 2022. Demographics, medical history, and operative and postoperative characteristics were collected. The primary outcome was any surgical complication, defined as infection, dehiscence, hematoma, neuroma, or reoperation. Univariate analysis was conducted to identify variables associated with surgical complications and PLP.

Results:  Thirty-two patients met the inclusion criteria. The median age was 52 years, and 75% were males. Indications for amputation included diabetic foot infection (71.9%), necrotizing soft tissue infection (25.0%), and malignancy (3.1%). BKA was the most common indication for formalization (93.8%). Most patients (56.3%) had formalization with TMR and RPNI, 34.4% patients had TMR only, and 9.4% had RPNI alone. The incidence of postoperative complications was 46.9%, with infection being the most common (31.3%). The median follow-up time was 107.5 days. There was no significant difference in demographics, medical history, or operative characteristics between patients who did and did not have surgical complications. However, there was a trend toward higher rates of PLP in patients who had a postoperative wound infection (p = 0.06).

Conclusion:  Overall complication rates after LE formalization with TMR and/or RPNI at our academic safety-net hospital were consistent with reported literature. Given the benefits, including reduced chronic pain and lower health care costs, we advocate for the wider adoption of these techniques at other safety-net hospitals.

背景有针对性的肌肉神经再支配(TMR)和再生周围神经接口(RPNI)可以减少下肢(LE)截肢后神经瘤的形成和幻肢痛(PLP)的发生率。然而,这些技术尚未针对安全网医院的患者进行过研究。本研究的目的是检查安全网医院 TMR 和/或 RPNI 术后的手术并发症发生率。方法 这是一项回顾性研究,研究对象是 2020 年至 2022 年期间年龄大于 18 岁、曾接受过膝上(AKA)或膝下(BKA)铡刀截肢手术并通过 TMR 和/或 RPNI 进行残端正规化的患者。研究人员收集了人口统计学、病史、手术和术后特征。主要结果是任何手术并发症,即感染、开裂、血肿、神经瘤或再次手术。进行单变量分析以确定与手术并发症和 PLP 相关的变量。结果 32名患者符合纳入标准。中位年龄为 52 岁,75% 为男性。BKA 是最常见的正式手术指征(93.8%)。大多数患者(56.3%)接受了TMR和RPNI手术,34.4%的患者仅接受了TMR手术,9.4%的患者仅接受了RPNI手术。术后并发症的发生率为 46.9%,其中最常见的是感染(31.3%)。出现和未出现手术并发症的患者在人口统计学、病史或手术特征方面没有明显差异。然而,术后伤口感染的患者发生 PLP 的几率有升高的趋势(几率比 6.2,95% CI 0.70-84.6,P = 0.06)。结论 在我们的安全网医院,使用 TMR 和/或 RPNI 进行 LE 正规化术后的总体并发症发生率与文献报道相似。鉴于这些手术技术的益处,包括减少慢性疼痛和降低医疗成本,我们认为这些技术应在其他安全网医院广泛采用。
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引用次数: 0
Electrophysiological Signal Validation of Regenerative Peripheral Nerve Interface at Nerve Ending: A Preliminary Rat Model Experiment. 神经末梢再生外周神经接口(RPNI)的电生理信号验证:初步大鼠模型试验。
IF 2.2 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1055/a-2434-4605
Jeongmok Cho, Hyunsuk Peter Suh, Changsik Pak, Joon Pio Hong

Background:  As the number of extremity amputations continues to rise, so does the demand for prosthetics. Emphasizing the importance of a nerve interface that effectively amplifies and transmits physiological signals through peripheral nerve surgery is crucial for achieving intuitive control. The regenerative peripheral nerve interface (RPNI) is recognized for its potential to provide this technical support. Through animal experiment, we aimed to confirm the actual occurrence of signal amplification.

Methods:  Rats were divided into three experimental groups: control, common peroneal nerve transection, and RPNI. Nerve surgeries were performed for each group, and electromyography (EMG) and nerve conduction studies (NCS) were conducted at the initial surgery, as well as at 2, 4, and 8 weeks postoperatively.

Results:  All implemented RPNIs exhibited viability and displayed adequate vascularity with the proper color. Clear differences in latency and amplitude were observed before and after 8 weeks of surgery in all groups (p < 0.05). Notably, the RPNI group demonstrated a significantly increased amplitude compared with the control group after 8 weeks (p = 0.031). Latency increased in all groups 8 weeks after surgery. The RPNI group exhibited relatively clear signs of denervation with abnormal spontaneous activities (ASAs) during EMG.

Conclusion:  This study is one of few preclinical studies that demonstrate the electrophysiological effects of RPNI and validate the neural signals. It serves as a foundational step for future research in human-machine interaction and nerve interfaces.

背景 随着四肢截肢人数的不断增加,对假肢的需求也在不断增加。强调通过外周神经手术有效放大和传输生理信号的神经接口对于实现直观控制的重要性至关重要。再生外周神经接口(RPNI)被认为具有提供这种技术支持的潜力。我们旨在通过动物实验证实信号放大的实际发生。方法 将大鼠分为三个实验组:对照组、腓总神经横断组和 RPNI 组。每组都进行了神经手术,并在手术初期、术后 2 周、4 周和 8 周进行了肌电图(EMG)和神经传导研究(NCS)。结果 所有实施的 RPNI 均显示出活力,并显示出足够的血管和适当的颜色。所有组别在手术前后八周的潜伏期和振幅都有明显差异(P < 0.05)。值得注意的是,与对照组相比,RPNI 组在八周后的振幅明显增加(p = 0.031)。术后八周,所有组的潜伏期都有所增加。RPNI 组表现出相对明显的神经支配迹象,在肌电图中出现异常自发活动 (ASA)。结论 本研究是为数不多的临床前研究之一,证明了 RPNI 的电生理效应并验证了神经信号。它为未来的人机交互和神经接口研究迈出了奠基性的一步。
{"title":"Electrophysiological Signal Validation of Regenerative Peripheral Nerve Interface at Nerve Ending: A Preliminary Rat Model Experiment.","authors":"Jeongmok Cho, Hyunsuk Peter Suh, Changsik Pak, Joon Pio Hong","doi":"10.1055/a-2434-4605","DOIUrl":"10.1055/a-2434-4605","url":null,"abstract":"<p><strong>Background: </strong> As the number of extremity amputations continues to rise, so does the demand for prosthetics. Emphasizing the importance of a nerve interface that effectively amplifies and transmits physiological signals through peripheral nerve surgery is crucial for achieving intuitive control. The regenerative peripheral nerve interface (RPNI) is recognized for its potential to provide this technical support. Through animal experiment, we aimed to confirm the actual occurrence of signal amplification.</p><p><strong>Methods: </strong> Rats were divided into three experimental groups: control, common peroneal nerve transection, and RPNI. Nerve surgeries were performed for each group, and electromyography (EMG) and nerve conduction studies (NCS) were conducted at the initial surgery, as well as at 2, 4, and 8 weeks postoperatively.</p><p><strong>Results: </strong> All implemented RPNIs exhibited viability and displayed adequate vascularity with the proper color. Clear differences in latency and amplitude were observed before and after 8 weeks of surgery in all groups (<i>p</i> < 0.05). Notably, the RPNI group demonstrated a significantly increased amplitude compared with the control group after 8 weeks (<i>p</i> = 0.031). Latency increased in all groups 8 weeks after surgery. The RPNI group exhibited relatively clear signs of denervation with abnormal spontaneous activities (ASAs) during EMG.</p><p><strong>Conclusion: </strong> This study is one of few preclinical studies that demonstrate the electrophysiological effects of RPNI and validate the neural signals. It serves as a foundational step for future research in human-machine interaction and nerve interfaces.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of reconstructive microsurgery
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