Plastic surgery最新文献

Introduction: Treatment of breast cancer requires a multimodal approach with numerous independent specialists. Immediate breast reconstruction (IBR) adds another layer of coordination to comprehensive breast cancer care. To optimize health outcomes for patients seeking IBR, it is essential to efficiently coordinate the temporal sequence of care modalities inclusive of reconstruction. Methods: In this cross-sectional study, patients undergoing IBR following complete or partial mastectomy at one health centre from 2015 to 2021 were included. Patients were categorized into two main groups defined by the first treatment modality received, namely surgery first and Neoadjuvant Chemotherapy. Primary outcome measures were wait times for diagnostic investigations, initiation of treatment, and transitions between therapeutic modalities. Results: Of 195 patients, 158 underwent surgery first, and 37 underwent neoadjuvant chemotherapy. Median wait time from first consultation to first treatment initiated in the neoadjuvant cohort was shorter by 11.5 days as compared to the Surgery First cohort (21.5 +/- 19 vs 33.0 +/- 28 days; P = 0.001). Twenty-three (82%) of the surgery first and 11 (38%) of the neoadjuvant cohort patients waited longer than 8 weeks for initiation of radiotherapy (P = 0.001). Following surgical intervention, the majority of patients failed to meet target benchmarks for transition to chemotherapy (n = 25, 53%) and transition to radiotherapy (n = 26, 93%; P < 0.001). Conclusion: Patients undergoing IBR may incur delays in the setting of upfront surgery and in transitioning to adjuvant therapies. In the setting of breast reconstruction, further efforts are required to achieve target wait-times in multimodal breast cancer care.

Background: Traditionally, surgical repair of phalanx fractures was performed under general anesthesia. However, the emergence of regional and local anesthesia, otherwise known as Wide-awake Local Anesthesia No Tourniquet, provides an alternative approach where general anesthesia is undesirable. The choice of anesthetic approach resides with clinicians, though it is important to factor in the evidence that regional/local provides not only an alternative anesthesia approach but also potentially avoids comorbidities associated with general anesthesia. This study hypothesizes that the use of local/regional anesthesia for phalanx fracture/dislocation has comparable outcomes to general anesthesia and provides for fewer adverse events. Methods: To answer the research purpose, the investigators designed and implemented a retrospective cohort study of consecutive cases reported to the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database between January 1, 2015, and December 31, 2019. The study population included patients in the NSQIP database who underwent operative fixation of a phalanx fracture or dislocation in 2 cohorts, those with local/regional anesthesia or general anesthesia. The predictor variables were preoperative patient demographic data, including age, gender, surgical specialty, elective surgery, diabetes, smoking, hypertension, and open wound. Results: A total of 2831 patients were identified in the NSQIP database between January 1, 2015, and December 31, 2019. Local/regional anesthesia was performed in 13% of patients with the remaining 87% receiving general anesthesia. Surgical site occurrences were not clinically significant between the 2 groups. Overall, 30-day post-operative complications in the local/regional cohort included one patient with a deep vein thrombosis (0.03%) and pulmonary embolus (0.02%). Overall, 30-day post-operative complications in the general anesthesia cohort included pneumonia (0.12%) and stroke (0.08%). Conclusions: Surgery using the regional/local anesthesia techniques for patients with phalanx fractures or dislocations is safe and can be used in situations where general anesthesia is undesirable as post-operative 30-day complications are similar to those with general anesthesia.

Background: Reports on benign peripheral nerve sheath tumour extirpation over the last number of decades describe varying patient outcomes. We present our outcomes following excision of solitary extremity schwannoma over a 20-year period. Methods: A regional histopathology review was conducted for, "benign nerve sheath tumour" and schwannoma between 2000 and 2020. This search provided 131 histologically confirmed schwannomas that were excised from the extremities of 123 patients. Individual charts were reviewed retrospectively to establish presenting features and post-operative outcomes. Results: One hundred and twenty three patients underwent schwannoma excision, including 8 patients with synchronous tumours. The mean age at presentation was 49 years (range 11-92 years). The most common presenting symptoms were the following: palpable mass (88%), pain (70%), paraesthesia (21%), numbness (13%), and motor deficit (4%). Post-operative follow-up ranged from 1 to 168 months (mean 12.3 months) (N  =  99). Fifty-eight cases reported complete resolution of symptoms by end of outpatient follow-up (59%). The remaining reported either residual or new numbness (21%), paraesthesia (11%), pain (10%), weakness (4%), hypertrophic or keloid scar (3%), or a combination. Thirty patients (30%) developed new symptoms post-operatively including numbness (13%), paraesthesia (10%), pain (2%), and weakness (2%). There was a trend towards higher risk of post-operative pain, numbness or paraesthesia in patients undergoing excision of schwannomas on larger mixed nerves than in patients undergoing excision on smaller sensory nerves (P  =  .0531). Conclusion: Surgical excision of benign schwannomas is a successful procedure, especially for pain management, however, complete symptom resolution cannot be guaranteed, and the risk of new or persisting numbness, paraesthesia, pain, and weakness should be highlighted to patients during the consent process.

Introduction: To recruit enough patients to achieve adequate statistical power in clinical research, investigators often rely on financial incentives. The use of these incentives, however, remains controversial as they may cause patients to overlook risks associated with research participation. This concern is amplified in the context of plastic surgery where aesthetic procedures are often more desirable and are not typically covered by public or private insurance plans. Despite this, the ethical debate regarding the use of incentives has largely been absent from plastic surgery journals; therefore, efforts to summarize the existing literature in the context of plastic surgery are necessary. Methods: A narrative review of the peer-reviewed published literature was performed to identify existing articles pertaining to financial incentives in plastic surgery-related health research. Results: While incentives have the potential to improve sample sizes and promote the recruitment of under-represented patient populations, undue inducement and biased recruitment are possible. At present, there exists a paucity of empirical evidence to substantiate this. Efforts should be taken by investigators and research ethics boards (REBs) to limit the potential negative impacts of monetary compensation. Investigators should place reasonable limits on the value of incentives as well as select models associated with lower risks of undue influence and enrollment bias. When financial remuneration is offered, additional care should be taken by investigators to ensure participants are adequately informed of the risks associated with research participation. Conclusion: Current best practice recommendations suggest that proposals submitted to REBs justify the incentives used. Information regarding incentives should also be included within study consent forms and communicated as part of the informed consent process.

Introduction: A breast cancer diagnosis may result in disabling effects which may persist after treatment. The aim of this study was to identify patient factors that are associated with increased cancer worry, fatigue, and impact on work. Methods: Women with a history of breast cancer, aged ≥18 years, and English-speaking were recruited through the Love Research Army between October and November 2019. Participants completed demographic and clinical questions alongside the BREAST-Q Cancer Worry, Fatigue, and Impact on Work scales. Univariable and multivariable regression analyses were used to identify participant characteristics associated with each scale. Results: Cancer Worry, Fatigue, and Impact on Work scales were completed by n = 1680, n = 1037, and n = 873 participants, respectively. Most participants were older than 50 (n = 1,470, 87.5%), married (n = 1229, 73.2%), white (n = 1557, 92.7%), and had undergone surgery for cancer treatment (n = 1,472, 87.6%). Increased Cancer Worry was significantly associated (P < .04) with younger age, less time since diagnosis, pain related to cancer/treatment, recurrence, prior chemotherapy, and ongoing breast edema. Increased Fatigue was significantly associated (P < .01) with elevated BMI, less time since diagnosis, ethnicity, employment status, recurrence, prior chemotherapy, ongoing pain, and difficulty sleeping secondary to treatment. Decreased Impact on Work scores was significantly associated (P < .04) with chemotherapy administration, shorter time since diagnosis, employment, fatigue related to treatment, breast edema, and ongoing pain. Conclusion: This study reveals patient characteristics associated with increased cancer worry, fatigue, and a negative impact on work following a breast cancer diagnosis. These findings can inform clinical and research initiatives to better support patients through treatment and survivorship.

Allergic contact dermatitis (ACD) is a delayed-type hypersensitivity reaction that presents as a pruritic eczematous rash occurring 24 to 48 h after allergen exposure. It is a surgical complication that can impact people's quality of life after plastic surgeries. A 44-year-old female with right breast cancer presented with three recurrent episodes of severe pruritic cutaneous eczematous eruption over her right breast extending down to her trunk and vulva each time soon after her multiple breast surgeries. She was labeled as having allergies to several intravenous antibiotics received perioperatively. She was then patch tested with a positive reaction to bacitracin, a component of a modified double antibiotic solution used for pocket irrigation intraoperatively. It highlights the need for plastic surgeons to consider ACD to bacitracin in patients with dermatitis soon after having bacitracin for pocket irrigation or implant soaking during breast surgeries. Comprehensive patch testing can delineate the cause of surgery-related ACD.

Introduction: A suture enlocation (SE) approach is proposed to manage comminuted intra-articular mandibular condyle fractures not amenable to open reduction internal fixation approaches. The SE approach is an effective operative option for the treatment of condylar fractures with the combination of fracture dislocation, malocclusion, comminution, and inadequate surface area for open fixation techniques. This study describes the SE approach, outcomes, and complications. Methods: The SE technique is described, and the health records of patients treated with the SE approach are reviewed. Outcome data were collected for diet, interincisal opening, occlusion, pain, and complications. Results: Technique: The SE approach involves reducing the fractured condylar fragment using a hole drilled through the fragment to secure it to the periosteum with a polydioxanone suture. This allows the reduced fragment to be managed as a nondisplaced fracture with mandibulomaxillary fixation and class 2 elastics. Outcomes: A chart review involving 8 patients (11 condyles) illustrates the outcomes of the SE approach from 2006 to 2021. Age at the time of injury ranged from 12 to 51 years and the follow up ranged from 2 to 68 months. At final follow up, 7 patients were eating a regular diet, 7 had normal interincisal opening, 4 had normal occlusion, and 4 reported ongoing mandibular discomfort. Failure of fixation occurred in 1 case, which required further operative management. Conclusions: The SE technique shows promise as an effective way to reduce fracture components, manage occlusion, and facilitate secondary bone healing in comminuted and displaced mandibular condyle fractures.