Plastic and Reconstructive Surgery Global Open最新文献

Background: Surgery is the most energy-intensive healthcare practice contributing to climate change. Nail bed injuries are among the most frequently encountered types of hand injuries seen in emergency rooms; however, their environmental impact has yet to be elucidated. This study assessed the carbon footprint associated with nail bed injury treatment and proposed alternatives, where feasible, to mitigate its impact.

Methods: This retrospective study analyzed patients undergoing NBI treatment from August 2022 to August 2023 at the Royal Free Hospital. The carbon footprint was calculated perioperatively using process mapping. Emissions were quantified based on patient travel, imaging, energy consumption, consumables used, waste disposal, and product transportation. A survey was shared with members of the hand trauma clinic to identify the items used during the procedure.

Results: Out of 1569 patients, 449 met the inclusion criteria. Overall pathway emissions were equal to 1333.22 kg carbon dioxide equivalents (CO₂e) annually, or 2.97 kg CO₂e per patient. The preoperative phase contributed the most to emissions (52.7%), primarily from x-ray procedures and patient travel. Hazardous infectious waste accounted for most intraoperative emissions. Survey results revealed that several items in disposable surgical packs were routinely unused, suggesting potential for waste reduction. Minimizing the products included in the surgical packages could save approximately 13.44 kg CO₂e across included patients or 46.95 kg CO₂e annually.

Conclusions: By promoting same-day imaging, optimizing surgical packs, and enhancing surgeon education on sustainability, healthcare institutions can reduce carbon emissions, aligning with the National Health Service's net-zero goals. Small, targeted changes in common procedures can achieve significant environmental and economic benefits.

Background: The surgical removal of permanent facial fillers is often complicated by chronic inflammation, tissue distortion, and the risk of facial nerve injury. This pilot case series highlighted the use of intraoperative nerve monitoring (IONM) to enhance the safety and precision of filler removal procedures.

Methods: This single-center pilot case series included patients who underwent permanent facial filler removal using IONM to localize and protect the facial nerve branches.

Results: Four female patients (mean age 53 y; range: 48-56 y) underwent surgical removal of permanent facial fillers, with concurrent face lifting and intraoperative facial nerve monitoring. Indications included recurrent infection in 2 (50.0%) patients, chronic inflammation in 1 (25.0%) patient, and facial asymmetry in 1 (25.0%) patient. No patients had preoperative facial nerve deficits. The mean operative time was 4.5 hours, and filler removal was successful in all cases. Facial nerve function was preserved in all patients without any transient or permanent dysfunction. Two patients (50.0%) received adjunctive fat grafting (mean volume 20 mL; range: 16-25 mL). Minor complications occurred in 2 (50.0%) patients and resolved spontaneously in both. All patients (100%) reported improved facial contour and resolution of symptoms. Follow-up ranged from 5 to 12 months, with no recurrence of nodules, inflammation, or occurrence of any nerve dysfunction.

Conclusions: This pilot case series showed that surgical removal of permanent facial fillers with IONM proved safe and effective, yielding full nerve preservation, high patient satisfaction, and no major complications. However, this approach needs further study to prove its efficacy, safety, and cost-effectiveness.

Background: Repair of the alveolar cleft is essential for both functional and aesthetic reasons, particularly in syndromic individuals with inherited deformities. The aim of this work was to compare the outcomes of nanocrystalline hydroxyapatite and autogenous bone grafts in alveolar cleft grafting.

Methods: A total of 36 patients with alveolar clefts were enrolled in the study. The patients were randomly divided into 2 groups: group A, in which an autogenous iliac bone graft was used to fill the alveolar defect, and group B, in which nanocrystalline hydroxyapatite was used to fill the alveolar defect. All patients were evaluated with cone beam computed tomography at 6 months postoperatively.

Results: The main findings of the present study were that there were no significant differences in the baseline or perioperative data between the 2 groups. Group A had a significantly longer duration of surgery (100 ± 21.21 versus 61.38 ± 26.05 min; P = 0.02). Both groups had comparable postoperative success scores.

Conclusions: Nanocrystalline hydroxyapatite, an alloplastic substitute, is a good graft material for alveolar cleft repair, reducing the risk of donor site morbidity, causing less pain, and resulting in shorter operative time and hospital stay.

Background: Lymphoedema is a chronic, progressive disorder characterized by tissue swelling, inflammation, subcutaneous tissue fibrosis, and recurrent cellulitis. It can cause significant consequences and disrupt daily activities. This study evaluated the level of awareness and knowledge regarding plastic surgery interventions for lymphedema among residents of Al-Baha, Saudi Arabia.

Methods: An observational, cross-sectional, community-based study was carried out over 6 months in Al-Baha. A structured survey was used to collect information from adult participants recruited through social media. Four hundred six participants were enrolled in the study.

Results: A total of 406 participants completed the survey, of whom 349 (86%) were nonhealthcare practitioners, and the rest (14%) were healthcare practitioners. The majority of participants were women (61.3%). The healthcare practitioner group had a better knowledge level than the other participants. The mean total score of knowledge regarding lymphedema was 34.56 ± 7.50; of these, 193 (47.5%) and 213 (52.2%) participants had high and low knowledge, respectively. There was a significant difference between the 2 groups based on the level of knowledge regarding age group, occupation, and previous knowledge about lymphedema. Meanwhile, sex, education level, and prior history of lymphedema had no effects on the level of knowledge.

Conclusions: The public knowledge of lymphedema in Al-Baha is low, particularly about surgical management by plastic surgery. These findings highlight the need for educational courses and awareness campaigns to improve the general population's knowledge of lymphedema, its nature and complications, and the role of plastic surgery in its management.

Background: This study investigated dynamic deep inferior epigastric artery perforator flap perfusion in an ex vivo perfusion model using dynamic infrared thermography (DIRT) and indocyanine green fluorescence angiography (ICG-FA) and compared the results with static perfusion imaging using color dye injection technique and computed tomography angiography (CTA).

Methods: Individual vessels were perfused with modified Krebs-Henseleit buffer (pH 7.4) in an isolated-perfused human abdominal skin flap perfusion model. Their perfusion patterns were sequentially evaluated with all 4 imaging techniques.

Results: Perfusion patterns of 37 vessels in 19 hemi-deep inferior epigastric perforator (DIEP) flaps and 1 cross-midline DIEP flap were examined. DIRT and ICG-FA measurements of perforators displayed similar perfusion patterns and corresponded well with the colored skin area after dye injection. CTA showed equivalent 3-dimensional images of the selected perforator. Lateral and medial perforators had variable perfusion patterns but often drained into the superficial veins; and sometimes perfused both the medial and lateral flap zones. CTA revealed true anastomosis connecting 2 different perforators, whereas the other imaging modalities showed a large overlap on the skin. DIRT showed that the venous drainage can be rerouted between the ipsilateral and contralateral superficial inferior epigastric vein when 1 superficial inferior epigastric vein is obstructed in the cross-midline DIEP flap.

Conclusions: DIRT and ICG-FA provided comparable and reproducible results that could easily be related to the skin perfusion area in the color dye experiments and CTA 3-dimensional reconstruction, supporting the use of DIRT and ICG-FA for evaluating and investigating DIEP flap perfusion in clinical and research settings.

Background: The opioid epidemic is a critical issue in the adult and pediatric populations. This study examined the change in perioperative and discharge prescribing of opioids in adolescent breast surgical patients at a tertiary pediatric hospital in response to statewide opioid-limiting legislation.

Methods: Adolescent breast surgical encounters between 2014 and 2023 were grouped into 3 cohorts: breast asymmetry, breast reduction, and gynecomastia. Primary outcomes included the quantity of oral morphine equivalents (OMEs) consumed while inpatient, prescription size at discharge, and adherence to state-limiting opioid legislation. Secondary outcomes included risk factors for opioid use and the proportion of patients using nonopioid alternatives.

Results: A total of 330 surgical encounters were identified. Median (interquartile range) inpatient opioid consumption in breast reduction patients was greater (11.3 [6.00-22.5] OMEs, P < 0.001) than breast asymmetry (5.00 [0.00-15.0] OMEs) and gynecomastia (0.00 [0.00-5.00] OMEs) patients. On multivariable regression, admission length and body mass index were associated with increased inpatient opioid consumption, and surgeon-administered local anesthesia was associated with decreased inpatient opioid use. Adjusted cumulative inpatient OME consumption by hospital admission length to hourly OME revealed that gynecomastia patients receive significantly fewer OMEs (P = 0.014). At discharge, operating length contributed to an increased discharge prescription quantity, whereas implementation of state legislation was associated with a reduced discharge quantity.

Conclusions: This study described shifts in prescriber patterns for adolescent breast surgery following the enactment of opioid restriction legislation. These findings provide valuable targets for quality improvement initiatives and the generation of standardized procedure-specific prescribing guidelines.

Background: This study aimed to develop a machine learning model to predict seroma risk following prepectoral breast reconstruction.

Methods: Two methodologies were used to develop machine learning models for predicting seroma formation based on a retrospective review of institutional data with 2-stage prepectoral breast reconstruction. Method 1 used a dataset including all preoperative patient attributes and operative details, whereas method 2 focused only on variables that were statistically significant on univariate logistic regression. Six algorithms were trained in both methods: logistic regression, Naive Bayes, support vector machine, k-nearest neighbors, decision tree, and random forest.

Results: Chart review identified 318 breasts that underwent prepectoral reconstruction, with a seroma rate of 25.58%. Univariate analysis found that body mass index, mastectomy specimen weight, hypertension, neoadjuvant chemotherapy, and skin-sparing mastectomy were positively associated with seroma. Method 1 identified the decision tree to have the highest accuracy (0.81) and area under the receiver operating characteristic curve (0.81). Method 2 improved model performance. The random forest achieved the best results, with an accuracy of 0.81 and an area under the receiver operating characteristic curve of 0.83. A web application was then created using the random forest model to provide real-time seroma risk predictions.

Conclusions: Machine learning models offer a valuable tool for improving clinical decision-making by accurately predicting patient-specific seroma risk in breast reconstruction. Our models outperformed traditional methods in identifying high-risk patients, allowing for tailored surgical techniques and intensified follow-up care.

In this study, we report a novel reconstructive procedure for mandibular defects following resection. From 2021 to 2025, a single fibular osteocutaneous flap, folded in half while preserving its blood supply, was performed in 7 patients. The inclusion criteria for the study required a preoperative computed tomography scan demonstrating a 2-fold difference between the heights of the mandible and fibula. Among the participants, 5 were men and 2 were women, aged 40-67 years (mean age: 57.9 y) at the time of surgery. The original diagnoses included 1 case of ameloblastoma and 6 cases of mandibular gingival cancer. The mean length of the bone defect was 6.4 cm (range: 6-7 cm). In 5 of the 7 cases, the defect was classified as a straight defect. In the remaining 2 cases, the bone exhibited a single fold at the transition between the anterior and lateral portions of the mandible. In 3 of the 4 cases evaluated more than 2 years after reconstructive surgery, it was possible to place implants in the grafted bone of the folded area. This approach, which uses a single fibular osteocutaneous flap folded in half while maintaining its blood supply, seems to be an effective reconstructive method, achieving excellent cosmetic and functional outcomes in patients with bone defects.

Background: Deep vein thrombosis is a complication that can be fatal if left untreated, especially after a surgical procedure. In a previous case-control study, we identified thrombogenic factors generated during cosmetic surgery procedures and found a high incidence of thrombosis. Subsequently, following a consensus of experts and with the participation of 22 judges, the thrombosis risk scale (Appert Total Thrombosis Risk Scale) was developed.

Methods: This was a descriptive, prospective, observational study of patients who underwent aesthetic plastic surgery in a 3-year period from June 2021 to June 2024. Demographic variables, such as age and sex, as well as the use of chemoprophylaxis, the result of the Appert scale, the presence of complications, defined as thrombosis events (deep vein thrombosis or pulmonary embolism), and postoperative bleeding, were considered.

Results: Statistical associations were evaluated using the Pearson χ² test; when expected frequencies were less than 5 in more than 20% of the cells, the Fisher exact test was used. Statistical significance was set at a P value of less than 0.05. A total of 345 patients who underwent aesthetic plastic surgery were included in the analysis. According to the dichotomous classification of the Appert scale, 46.4% of patients were classified as low risk and 53.6% as moderate risk. All complications occurred in the moderate-risk group, whereas no events were reported in the low-risk group.

Conclusions: This finding suggested a possible clinical relationship between the level of risk identified using the Appert scale and the occurrence of complications.