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A 50-Year Review of Congressional Membership by Health Care Professionals: Is Surgical Representation Adequate? "医疗保健专业人士担任国会成员五十年回顾:外科手术代表是否足以进行知情立法?
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-01-08 DOI: 10.1097/PRS.0000000000011285
Alice Yau, Marina A Lentskevich, Irene Yau, Iulianna Taritsa, Kaleem S Ahmed, Teeba Marlowe, Arun K Gosain

Summary: Although 100% of congressional legislators vote on health care policy, only a minority have a background in health care. A review of the participation of health care professionals (HCPs) in Congress, highlighting participation by surgeons, is critical to the future policy-making endeavors in health care. This article seeks to better understand the characteristics of HCPs who engage in advocacy and describe the trends in their representation in Congress, with commentary on participation by surgeons and its impact on current health advocacy efforts.A search of Congress.gov and the Biographical Directory of the United States Congress was performed to identify professional health care history for each congressperson, followed by review of official campaign websites for health advocacy work. Statistical analysis was performed using IBM SPSS Statistics Software for changes in representation of HCPs, physicians, and surgeons in Congress over time. Although there has been increasing representation of HCPs in Congress in the past 25 years, surgeons have the lowest increase in congressional membership. For health care reform to optimally address high costs, variable insurance coverage and reimbursement rates, and equal access to care, more physicians must make health care advocacy efforts an integral part of their careers. Incorporation of education in areas of health care advocacy and/or reform into undergraduate and graduate medical education curricula may help address deficiencies in knowledge of current health care-related events to further encourage involvement in health care legislation.

摘要:虽然 100%的国会立法者都会对医疗保健政策进行投票,但只有少数人具有医疗保健背景。回顾医疗保健专业人士 (HCP) 在国会中的参与情况,特别是外科医生的参与情况,对于未来医疗保健领域的政策制定工作至关重要。本文旨在更好地了解参与宣传的医疗保健专业人员的特点,并描述他们在国会中的代表趋势,同时对外科医生的参与情况及其对当前医疗宣传工作的影响进行评论。我们搜索了 Congress.gov 和《美国国会传记目录》,以确定每位国会议员的专业医疗保健历史,然后查看了有关医疗宣传工作的官方活动网站。使用 IBM® SPSS® 统计软件进行了统计分析,以了解医疗保健专业人士、内科医生和外科医生在国会中的代表比例随时间推移而发生的变化。要想通过医疗改革最有效地解决高成本、保险范围和报销比例不一以及平等获得医疗服务等问题,更多的医生必须将医疗宣传工作作为其职业生涯中不可或缺的一部分。将医疗保健宣传和/或改革领域的教育纳入本科生和研究生医学教育课程,可能有助于解决当前医疗保健相关事件知识不足的问题,从而进一步鼓励参与医疗保健立法。
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引用次数: 0
Discussion: The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale. 讨论:鼻整形罗塞塔石碑:使用 Rasch 分析法创建和验证 NOSE 与 SCHNOS 功能分量表之间的交叉线。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-10-26 DOI: 10.1097/PRS.0000000000011548
Zachary M Borab, Rod J Rohrich
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引用次数: 0
Artistry in Scientific Writing. 科学写作的艺术性
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-10-26 DOI: 10.1097/PRS.0000000000011555
Christine S Wang, Kevin C Chung
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引用次数: 0
Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Congenital Severe Ptosis. 联合筋膜鞘和提上睑肌复合瓣悬吊术治疗先天性重度上睑下垂的疗效。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2023-07-25 DOI: 10.1097/PRS.0000000000010947
Junhu Shi, Zhaochuan Liu, Yadi Li, Lihua Song, Yan Li, Jianwei Yang, Runhui Pang, Hongbin Zhang, Li Xiao, Ping Bai

Background: Conjoint fascial sheath (CFS) suspension has been gradually recognized and accepted for the treatment of congenital severe blepharoptosis in recent years. To address the problem of postoperative upper eyelid position regression of only CFS suspension, the authors designed and implemented a CFS combined levator muscle (LM) complex flap, and analyzed the surgical efficacy of CFS with LM (CFS+LM) compared with frontalis myofascial flap (FMF) suspension surgery.

Methods: Patients diagnosed with congenital severe ptosis and LM function of 4 mm or less were enrolled. The patients were assigned to either the CFS+LM group or the FMF group, to compare and statistically analyze the postoperative effects of CFS+LM versus FMF suspension.

Results: Data from 182 patients (220 eyes) were collected in this study, including 89 patients (103 eyes) in the CFS+LM group and 93 patients (117 eyes) in the FMF group. The full correction rate, patient satisfaction, postoperative upper eyelid excursion, and lagophthalmos in the CFS+LM group were significantly better than those in the FMF group. The eyelid retraction rate was significantly higher in the FMF group than in the CFS+LM group. The complication rate in the CFS+LM group was significantly lower than that in the FMF group.

Conclusions: CFS+LM suspension had better outcomes than FMF suspension. Considering that the CFS tissue could be weak in patients younger than 5 years and have poor muscle elasticity in patients with LM function less than or equal to 1 mm, FMF suspension is recommended first. For patients older than 5 years with severe ptosis, CFS+LM suspension is recommended.

Clinical question/level of evidence: Therapeutic, III.

背景:联合筋膜鞘(CFS)悬吊术是近年来逐渐被认可和接受的治疗先天性重度睑外翻的方法。为了解决仅用 CFS 悬吊术后上睑位置回缩的问题,我们设计并实施了 CFS 联合提上睑肌(CFS+LM)复合瓣。本研究旨在分析 CFS+LM 和 FMF 悬吊手术的疗效:方法:研究对象为先天性重度上睑下垂且提上睑肌功能≦4 mm的患者。根据手术方法将患者分为 CFS+LM 组和 FMF 组。比较并统计分析 CFS+LM 和 FMF 悬吊术的术后效果:本研究收集了 182 例患者(220 只眼)的数据,其中 CFS+LM 组 89 例(103 只眼),FMF 组 93 例(117 只眼)。CFS+LM组的完全矫正率、患者满意度、术后上眼睑外翻和滞后性明显优于FMF组。FMF 组的眼睑回缩率明显高于 CFS+LM 组。CFS+LM组的并发症发生率明显低于FMF组:结论:CFS+LM 悬液的疗效优于 FMF。考虑到 5 岁以下患者的 CFS 组织可能较弱,且提上睑肌功能≤1 mm 的患者肌肉弹性较差,因此首先推荐使用 FMF 悬吊术。对于 5 岁以上的重度上睑下垂患者,建议使用 CFS+LM 悬吊术。
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引用次数: 0
Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria. 性别确认手术改善了性别焦虑症患者的心理健康结果,并减少了抗抑郁药的使用。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-02-02 DOI: 10.1097/PRS.0000000000011325
Lee H Kilmer, Jesse Chou, Christopher A Campbell, Brent R DeGeorge, John T Stranix

Background: Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental health care, and gender-affirming surgery. Studies have described favorable surgical outcomes and patient satisfaction; however, the degree to which these procedures affect mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance misuse in the transgender population.

Methods: A national insurance claims-based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score-matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included postoperative antidepressant use and the prevalence of mental health conditions.

Results: A total of 3134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance misuse, and selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor use. There was an absolute decrease of 8.8% in selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor prescription after gender-affirming plastic surgery ( P < 0.001), and significant decreases were found in postoperative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol misuse (2.1%), and drug misuse (1.9%).

Conclusion: Gender-affirming surgery in appropriately selected patients with gender dysphoria is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.

Clinical question/level of evidence: Therapeutic, IV.

背景:性别焦虑症患者面临着巨大的健康差异和护理障碍。与过渡相关的护理包括激素治疗、心理保健和性别确认手术。研究描述了良好的手术效果和患者满意度,然而,这些手术对心理健康状况的影响程度还不完全清楚。本研究旨在评估性别确认整形手术对变性人群心理健康和药物滥用的影响:方法:使用基于国家保险理赔的数据库进行数据收集。根据合并症、年龄和性别,对诊断为性别焦虑症的患者进行倾向性评分匹配,以确定其接受性别确认手术的可能性(未接受手术者为对照组)。主要结果包括术后抗抑郁药的使用情况和精神健康状况的患病率:每组共有3134名性别障碍患者。手术组患者的精神健康状况、药物滥用和SSRI/SNRI使用率总体较低。性别确认整形手术后,SSRI或SNRI处方的使用率绝对下降了8.8%(p结论:经过适当选择的性别确认手术可降低性别焦虑症患者术后使用 SSRI 或 SNRI 的比例,并改善心理健康。
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引用次数: 0
Reply: Abandoning the SIEA Flap for the Dual-Plane DIEP Reduces Fat Necrosis and Flap Failure. 回复:用双平面 DIEP 放弃 SIEA 皮瓣可减少脂肪坏死和皮瓣失败。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-10-26 DOI: 10.1097/PRS.0000000000011498
Sumeet S Teotia, Nicholas T Haddock
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引用次数: 0
Lipidomic Analysis of Microfat and Nanofat Reveals Different Lipid Mediator Compositions. 微脂和纳米脂的脂质体分析揭示了不同的脂质介质组成。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-11-01 Epub Date: 2024-02-14 DOI: 10.1097/PRS.0000000000011335
Lisanne Grünherz, Sedef Kollarik, Nadia Sanchez-Macedo, Michelle McLuckie, Nicole Lindenblatt

Background: Microfat and nanofat are commonly used in various surgical procedures, from skin rejuvenation to scar correction, to contribute to tissue regeneration. Microfat contains mainly adipocytes and is well suited for tissue augmentation, and nanofat is rich in lipids, adipose-derived stem cells, microvascular fragments, and growth factors, making it attractive for aesthetic use. The authors have previously demonstrated that the mechanical processing of microfat into nanofat significantly changes its proteomic profile. Considering that mechanical fractionation leads to adipocyte disruption and lipid release, they aimed to analyze their lipidomic profiles for their regenerative properties.

Methods: Microfat and nanofat samples were isolated from 14 healthy patients. Lipidomic profiling was performed by liquid chromatography tandem mass spectrometry. The resulting data were compared against the Human Metabolome and LIPID MAPS Structure Database. MetaboAnalyst was used to analyze metabolic pathways and lipids of interest.

Results: From 2388 mass-to-charge ratio features, metabolic pathway enrichment analysis of microfat and nanofat samples revealed 109 pathways that were significantly enriched. Microfat samples revealed higher-intensity levels of sphingosines, different eicosanoids, and fat-soluble vitamins. Increased levels of coumaric acids and prostacyclin were found in nanofat.

Conclusions: This is the first study to analyze the lipidomic profiles of microfat and nanofat, providing evidence that mechanical emulsification of microfat into nanofat leads to changes in their lipid profiles. From 109 biological pathways, antiinflammatory, antifibrotic, and antimelanogenic lipid mediators were particularly enriched in nanofat samples when compared with microfat. Although further studies are necessary for a deeper understanding of the composition of these specific lipid mediators in nanofat samples, the authors propose that they might contribute to its regenerative effects on tissue.

Clinical relevance statement: Profiling the unique lipid mediators in nanofat and microfat enhances our understanding of their different therapeutic effects and allows us to link these specific mediators to antiinflammatory, pro-regenerative, or healing properties. Ultimately, this insight can advance personalized therapeutic strategies, where a specific type of fat is selected based on its optimal therapeutic effect.

背景:微脂和纳米脂常用于各种外科手术,从嫩肤到疤痕矫正,以促进组织再生。微脂主要含有脂肪细胞,非常适合用于组织增量,而纳米脂肪则富含脂质、脂肪衍生干细胞、微血管碎片和生长因子,使其在美容方面具有吸引力。作者曾证实,将微脂机械加工成纳米脂肪会显著改变其蛋白质组特征。考虑到机械分馏会导致脂肪细胞破坏和脂质释放,他们旨在分析其脂质组谱,以了解其再生特性:方法:从 14 名健康患者身上分离出微脂和纳米脂样本。方法:从 14 名健康患者身上分离出微脂和纳米脂样本,采用液相色谱串联质谱法进行脂质组学分析。所得数据与人类代谢组和 LIPID MAPS 结构数据库进行了比较。MetaboAnalyst 用于分析代谢途径和感兴趣的脂质:结果:从 2388 个质量电荷比特征中,对微脂和纳米脂样本进行了代谢途径富集分析,发现有 109 个途径显著富集。微脂样本中的鞘磷脂、不同的二十烷酸和脂溶性维生素含量较高。结论:这是首次分析微脂和纳米脂脂质组学特征的研究,为微脂机械乳化成纳米脂导致其脂质特征发生变化提供了证据。从 109 种生物途径来看,与微脂相比,纳米脂肪样本中抗炎、抗纤维化和抗黑色素生成的脂质介质尤其丰富。虽然要更深入地了解纳米脂肪样本中这些特定脂质介质的组成还需要进一步研究,但作者认为它们可能有助于纳米脂肪对组织的再生作用:剖析纳米脂肪和微脂中独特的脂质介质有助于加深我们对其不同治疗效果的理解,并使我们能够将这些特定介质与抗炎、促进再生或愈合特性联系起来。最终,这种洞察力可以推进个性化治疗策略,即根据最佳治疗效果选择特定类型的脂肪。
{"title":"Lipidomic Analysis of Microfat and Nanofat Reveals Different Lipid Mediator Compositions.","authors":"Lisanne Grünherz, Sedef Kollarik, Nadia Sanchez-Macedo, Michelle McLuckie, Nicole Lindenblatt","doi":"10.1097/PRS.0000000000011335","DOIUrl":"10.1097/PRS.0000000000011335","url":null,"abstract":"<p><strong>Background: </strong>Microfat and nanofat are commonly used in various surgical procedures, from skin rejuvenation to scar correction, to contribute to tissue regeneration. Microfat contains mainly adipocytes and is well suited for tissue augmentation, and nanofat is rich in lipids, adipose-derived stem cells, microvascular fragments, and growth factors, making it attractive for aesthetic use. The authors have previously demonstrated that the mechanical processing of microfat into nanofat significantly changes its proteomic profile. Considering that mechanical fractionation leads to adipocyte disruption and lipid release, they aimed to analyze their lipidomic profiles for their regenerative properties.</p><p><strong>Methods: </strong>Microfat and nanofat samples were isolated from 14 healthy patients. Lipidomic profiling was performed by liquid chromatography tandem mass spectrometry. The resulting data were compared against the Human Metabolome and LIPID MAPS Structure Database. MetaboAnalyst was used to analyze metabolic pathways and lipids of interest.</p><p><strong>Results: </strong>From 2388 mass-to-charge ratio features, metabolic pathway enrichment analysis of microfat and nanofat samples revealed 109 pathways that were significantly enriched. Microfat samples revealed higher-intensity levels of sphingosines, different eicosanoids, and fat-soluble vitamins. Increased levels of coumaric acids and prostacyclin were found in nanofat.</p><p><strong>Conclusions: </strong>This is the first study to analyze the lipidomic profiles of microfat and nanofat, providing evidence that mechanical emulsification of microfat into nanofat leads to changes in their lipid profiles. From 109 biological pathways, antiinflammatory, antifibrotic, and antimelanogenic lipid mediators were particularly enriched in nanofat samples when compared with microfat. Although further studies are necessary for a deeper understanding of the composition of these specific lipid mediators in nanofat samples, the authors propose that they might contribute to its regenerative effects on tissue.</p><p><strong>Clinical relevance statement: </strong>Profiling the unique lipid mediators in nanofat and microfat enhances our understanding of their different therapeutic effects and allows us to link these specific mediators to antiinflammatory, pro-regenerative, or healing properties. Ultimately, this insight can advance personalized therapeutic strategies, where a specific type of fat is selected based on its optimal therapeutic effect.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 5","pages":"895e-905e"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-dimensional facial morphology in patients with craniofacial microsomia and microtia. 颅面小畸形和小耳症患者的三维面部形态。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-10-30 DOI: 10.1097/PRS.0000000000011831
Elsa M Ronde, Guido A de Jong, Jitske W Nolte, Marloes E L Nienhuijs, Neil W Bulstrode, Thomas J J Maal, Alfred G Becking, Corstiaan C Breugem

Introduction: Craniofacial microsomia (CFM) is classified using the subjective Orbit, Mandible, Ear, Nerve and Soft tissue (OMENS) tool. Digital stereophotogrammetry (i.e. three-dimensional [3D] photography) can be used to capture facial shape objectively. This case-control study assessed the applicability of 3D photography in distinguishing between patients with CFM and individuals without craniofacial conditions, as well as classifying the severity of facial involvement.

Methods: 3D photographs of patients with CFM and/or microtia from the Amsterdam UMC, Radboudumc and the Great Ormond Street Hospital and of individuals without craniofacial conditions were assessed. Differences between patients and controls were explored through asymmetry index (ASI) and facial signature (FS) scores, as well as a principal components (PC) analysis of FS scores and logistic regression. Correlations between OMENS scores and ASI, FS and PC scores were evaluated.

Results: A total of 179 patients and 210 controls were analyzed. ASI and FS scores differed significantly between patients and controls (p<0.001), and were correlated with several OMENS subscales. The logistic regression model distinguishing between patients and controls showed increasing asymmetry of the mandible and orbits with increasing Pruzansky-Kaban score. Patients with isolated microtia deviated from controls in the midface.

Conclusion: Clinically significant differences in the facial morphology of patients with CFM and microtia were found compared to controls, suggesting that 3D photography can be used to assess the severity of facial involvement in a novel, objective and safe way in these patients.

简介颅面小畸形(CFM)是通过主观的眼眶、下颌骨、耳朵、神经和软组织(OMENS)工具进行分类的。数字立体摄影测量(即三维摄影)可用于客观捕捉面部形状。这项病例对照研究评估了三维摄影在区分 CFM 患者和无颅面疾病患者以及划分面部受累严重程度方面的适用性。方法:评估阿姆斯特丹 UMC、Radboudumc 和大奥蒙德街医院 CFM 和/或小耳症患者以及无颅面疾病患者的三维照片。通过不对称指数(ASI)和面部特征(FS)评分、FS评分的主成分(PC)分析和逻辑回归,探讨了患者和对照组之间的差异。评估了 OMENS 评分与 ASI、FS 和 PC 评分之间的相关性:结果:共分析了 179 名患者和 210 名对照组。ASI和FS评分在患者和对照组之间存在显著差异(p结论:与对照组相比,CFM 和小耳症患者的面部形态有明显的临床差异,这表明三维摄影可用于以一种新颖、客观和安全的方式评估这些患者面部受累的严重程度。
{"title":"Three-dimensional facial morphology in patients with craniofacial microsomia and microtia.","authors":"Elsa M Ronde, Guido A de Jong, Jitske W Nolte, Marloes E L Nienhuijs, Neil W Bulstrode, Thomas J J Maal, Alfred G Becking, Corstiaan C Breugem","doi":"10.1097/PRS.0000000000011831","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011831","url":null,"abstract":"<p><strong>Introduction: </strong>Craniofacial microsomia (CFM) is classified using the subjective Orbit, Mandible, Ear, Nerve and Soft tissue (OMENS) tool. Digital stereophotogrammetry (i.e. three-dimensional [3D] photography) can be used to capture facial shape objectively. This case-control study assessed the applicability of 3D photography in distinguishing between patients with CFM and individuals without craniofacial conditions, as well as classifying the severity of facial involvement.</p><p><strong>Methods: </strong>3D photographs of patients with CFM and/or microtia from the Amsterdam UMC, Radboudumc and the Great Ormond Street Hospital and of individuals without craniofacial conditions were assessed. Differences between patients and controls were explored through asymmetry index (ASI) and facial signature (FS) scores, as well as a principal components (PC) analysis of FS scores and logistic regression. Correlations between OMENS scores and ASI, FS and PC scores were evaluated.</p><p><strong>Results: </strong>A total of 179 patients and 210 controls were analyzed. ASI and FS scores differed significantly between patients and controls (p<0.001), and were correlated with several OMENS subscales. The logistic regression model distinguishing between patients and controls showed increasing asymmetry of the mandible and orbits with increasing Pruzansky-Kaban score. Patients with isolated microtia deviated from controls in the midface.</p><p><strong>Conclusion: </strong>Clinically significant differences in the facial morphology of patients with CFM and microtia were found compared to controls, suggesting that 3D photography can be used to assess the severity of facial involvement in a novel, objective and safe way in these patients.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
The Evolution of Unicoronal Synostosis Correction: Long-Term Aesthetic Outcomes of Fronto-Orbital Distraction Versus Traditional Advancement. 单冠并合矫正术的演变:眶前牵引与传统推进术的长期美学效果。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-10-28 DOI: 10.1097/PRS.0000000000011844
Meagan Wu, Benjamin B Massenburg, Dillan F Villavisanis, Ashley E Chang, Dominic J Romeo, Jinggang J Ng, Joseph A Napoli, Scott P Bartlett, Jordan W Swanson, Jesse A Taylor

Introduction: This study compares the long-term aesthetic outcomes of patients with unicoronal synostosis (UCS) who underwent fronto-orbital distraction osteogenesis (FODO) versus traditional fronto-orbital advancement and remodeling (FOAR).

Methods: Patients treated for nonsyndromic UCS from 2009 to 2023 were retrospectively reviewed. Perioperative and complication characteristics were compared between all patients who underwent FOAR, open FODO, and endoscopic-assisted FODO ("endo-FODO"). Aesthetic outcomes at greater than five years postoperatively were compared between patients who underwent FODO and a contemporaneous cohort of age-matched controls who underwent FOAR. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, orbital dystopia angle (ODA), and frontal bossing angle were calculated, with positive differences representing postoperative improvement.

Results: Forty-one patients were treated at a median age of 9.7, 5.4, and 5.4 months in the FOAR, open FODO, and endo-FODO groups, respectively. Among 28 patients photographed at a median of 6.3 years postoperatively, the FODO cohort demonstrated greater margin-to-reflex distance 1 symmetry (6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5], p=0.010) and canthal tilt symmetry (0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°], p=0.004) postoperatively as well as ODA correction (5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°], p=0.027) compared to the FOAR cohort. Fewer patients in the FODO cohort exhibited temporal hollowing postoperatively compared to the FOAR cohort (14% vs. 71%, p=0.002).

Conclusions: Compared to FOAR, FODO was associated with greater periorbital symmetry, greater orbital dystopia correction, and reduced temporal hollowing in the long-term. Follow-up to cranial maturity is needed to adequately compare the two techniques.

简介:本研究比较了接受眶前牵引成骨术(FODO)和传统眶前推进重塑术(FOAR)的单冠突合症(UCS)患者的长期美学效果:方法:对2009年至2023年期间接受非综合征UCS治疗的患者进行回顾性研究。比较了所有接受 FOAR、开放式 FODO 和内窥镜辅助 FODO("endo-FODO")的患者的围手术期和并发症特征。对接受 FODO 手术的患者和同时接受 FOAR 手术的年龄匹配对照组患者术后五年以上的美学效果进行了比较。计算了术前和术后眶周对称性比率、眼窝倾斜对称性、眶距角(ODA)和额颢角之间的差异,正差异代表术后改善:41名患者在中位年龄9.7、5.4和5.4个月时分别接受了FOAR组、开放式FODO组和内科FODO组的治疗。在术后中位 6.3 年拍照的 28 名患者中,FODO 组显示出更高的边缘到反射距离 1 对称性(6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5],P=0.与 FOAR 队列相比,FOD 患者术后的腱反射距离 1 对称性(6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5],p=0.010)和胼胝体倾斜对称性(0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°],p=0.004)以及 ODA 矫正(5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°],p=0.027)更高。与 FOAR 组相比,FODO 组术后出现颞部凹陷的患者较少(14% vs. 71%,p=0.002):结论:与FOAR相比,FODO与更大的眶周对称性、更大的眶内斜视矫正以及长期的颞部凹陷减少有关。要充分比较这两种技术,还需要对颅骨成熟度进行随访。
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引用次数: 0
Long-term volume retention of breast augmentation with fat grafting depends on weight changes: a three-year prospective MRI study. 脂肪移植隆胸术的长期容积保持取决于体重变化:一项为期三年的前瞻性磁共振成像研究。
IF 3.2 2区 医学 Q1 SURGERY Pub Date : 2024-10-28 DOI: 10.1097/PRS.0000000000011841
Mathias Ørholt, Tim K Weltz, Mathilde N Hemmingsen, Andreas Larsen, Erik E F Bak, Caroline B Norlin, Liv Hart, Jens Jørgen Elberg, Peter V Vester-Glowinski, Mikkel Herly

Background: Fat grafting is increasingly used for breast augmentation. However, long-term volume retention, time to reach steady state, and the effect of postoperative weight changes on these outcomes are not fully understood.

Methods: In this prospective study, we included patients undergoing breast augmentation with fat grafting and examined them with MRI preoperatively and up to three years postoperatively. We modeled fat graft retention over time and calculated the time to volumetric steady state of the fat graft. Secondly, we used our model to assess the effect of postoperative weight changes on fat graft retention and to determine the association between the graft/recipient volume ratio and the percentage breast augmentation at steady state. Finally, we assessed patient satisfaction using the BREAST-Q questionnaire.

Results: The study included 28 patients (46 breasts). The time to steady state was 253 days (95%CI 185-283) postoperatively, with a volume retention of 46% (95%CI 35-58). Patients with a weight loss of one BMI point after surgery had a volume retention of 22% (95%CI 4.7-38) while those increasing one and two BMI points had retention rates of 57% (95%CI 45-69) and 85% (95%CI 72-98), respectively. Increasing graft/recipient volume ratio was associated with higher percentage augmentation with no plateau in this relationship even up to ratios of 2:1. Postoperative satisfaction with breasts and sexual well-being increased substantially.

Conclusions: Breast augmentation with fat grafting reached volumetric steady state after 8 months with a volume retention of 46%. Weight loss following fat grafting leads to significantly lower volume retention.

背景:脂肪移植越来越多地被用于隆胸手术。然而,长期的容积保持、达到稳定状态的时间以及术后体重变化对这些结果的影响尚不完全清楚:在这项前瞻性研究中,我们纳入了接受脂肪移植隆胸术的患者,并在术前和术后三年内对他们进行了核磁共振成像检查。我们建立了脂肪移植随时间保留的模型,并计算了脂肪移植达到体积稳定状态的时间。其次,我们使用模型评估了术后体重变化对脂肪移植物保留的影响,并确定了移植物/受体体积比与稳定状态下隆胸百分比之间的关联。最后,我们使用 BREAST-Q 问卷评估了患者的满意度:研究共纳入 28 名患者(46 个乳房)。术后达到稳定状态的时间为 253 天(95%CI 185-283),体积保持率为 46%(95%CI 35-58)。术后体重下降一个 BMI 点的患者的容积保留率为 22%(95%CI 4.7-38),而体重增加一个和两个 BMI 点的患者的容积保留率分别为 57%(95%CI 45-69)和 85%(95%CI 72-98)。移植物/受体容积比的增加与较高的隆胸比例有关,即使比例达到 2:1,这种关系也没有达到顶峰。术后对乳房和性生活的满意度大幅提高:结论:脂肪移植隆胸术在 8 个月后达到体积稳定状态,体积保持率为 46%。脂肪移植后体重减轻会导致体积保持率明显降低。
{"title":"Long-term volume retention of breast augmentation with fat grafting depends on weight changes: a three-year prospective MRI study.","authors":"Mathias Ørholt, Tim K Weltz, Mathilde N Hemmingsen, Andreas Larsen, Erik E F Bak, Caroline B Norlin, Liv Hart, Jens Jørgen Elberg, Peter V Vester-Glowinski, Mikkel Herly","doi":"10.1097/PRS.0000000000011841","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011841","url":null,"abstract":"<p><strong>Background: </strong>Fat grafting is increasingly used for breast augmentation. However, long-term volume retention, time to reach steady state, and the effect of postoperative weight changes on these outcomes are not fully understood.</p><p><strong>Methods: </strong>In this prospective study, we included patients undergoing breast augmentation with fat grafting and examined them with MRI preoperatively and up to three years postoperatively. We modeled fat graft retention over time and calculated the time to volumetric steady state of the fat graft. Secondly, we used our model to assess the effect of postoperative weight changes on fat graft retention and to determine the association between the graft/recipient volume ratio and the percentage breast augmentation at steady state. Finally, we assessed patient satisfaction using the BREAST-Q questionnaire.</p><p><strong>Results: </strong>The study included 28 patients (46 breasts). The time to steady state was 253 days (95%CI 185-283) postoperatively, with a volume retention of 46% (95%CI 35-58). Patients with a weight loss of one BMI point after surgery had a volume retention of 22% (95%CI 4.7-38) while those increasing one and two BMI points had retention rates of 57% (95%CI 45-69) and 85% (95%CI 72-98), respectively. Increasing graft/recipient volume ratio was associated with higher percentage augmentation with no plateau in this relationship even up to ratios of 2:1. Postoperative satisfaction with breasts and sexual well-being increased substantially.</p><p><strong>Conclusions: </strong>Breast augmentation with fat grafting reached volumetric steady state after 8 months with a volume retention of 46%. Weight loss following fat grafting leads to significantly lower volume retention.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
期刊
Plastic and reconstructive surgery
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