Plastic surgery最新文献

Introduction: Most pediatric hand fractures are treated nonoperatively, yet the majority of these children are managed by plastic surgeons. Our institution developed a protocol, deemed the Simple Fracture Protocol (SFP), which streamlines pediatric hand fracture care by redirecting patients with simple fractures to occupational therapists for management. This qualitative study evaluated parental satisfaction with the SFP. Methods: A semistructured telephone interview was administered to parents of children with hand fractures treated under the SFP between March 1, 2024, and May 31, 2024. Interviews were audio recorded, anonymized, and transcribed. Interviews were completed until data saturation was reached. Inductive content analysis was performed and reviewed by the research team to confirm key themes. Results: Of the 78 families contacted, 40 parents participated in the study. Parents reported high satisfaction with the care provided; 100% felt their care expectations were met. Four key themes were identified (1) communicating clearly, (2) creating a calm and comfortable environment, (3) setting expectations, and (4) streamlining clinical processes. Most patients, 67.5%, recovered within the expected 6 weeks. Delays in healing were often due to early return to sports or nonadherence to recovery guidelines. Conclusions: The SFP has been well-received by parents. Adjustments in the care instructions provided to patients partaking in high contact sports may further enhance the patient/family experience. This model offers a valuable framework for other institutions seeking to optimize pediatric fracture care.

Introduction: Language barriers can impair communication and affect perioperative outcomes. This study examines the perioperative impact of limited English proficiency (LEP) on opioid consumption for pain management and clinical outcomes in both autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR). Methods: A retrospective cohort study (2019-2023) utilized electronic health records to categorize breast reconstruction patients by primary language proficiency. Outcomes included opioid consumption (postoperative and total morphine milligram equivalents [MME]), complications, reoperations, emergency department visits, and readmissions. Analyses used comparative tests and multivariate regressions. Subgroup analyses were conducted for reconstruction type. Results: Among 1706 patients (15% non-English-speaking), non-English speakers demonstrated significantly lower postoperative (58 ± 77 vs 88 ± 121, p < .001) and total (166 ± 121 vs 207 ± 146, p < .001) opioid consumption, with Cantonese speakers having the lowest odds of opioid consumption. In ABR, non-English speakers had reduced postoperative (74 ± 89 vs 115 ± 147, p < .001) and total (203 ± 126 vs 256 ± 166, p < .001) opioid requirements (β= -40, p = .026) but higher odds of seroma formation (OR = 2.78, p = 0.030). In IBR, non-English speakers similarly used fewer opioids postoperatively (28 ± 35 vs 56 ± 70, p < .001) and in total (98 ± 73 vs 152 ± 94, p < .001), and also demonstrated increased odds of seroma formation (OR = 4.66, p = .018). Conclusion: Language proficiency is associated with differences in opioid consumption and clinical outcomes following breast reconstruction. These findings underscore the importance of considering language barriers when designing pain management strategies for patients with LEP.

Introduction: Emergency departments (EDs) have been under substantial strain in recent years, far exceeding current capacities and attracting media attention and calls for improved staffing and resources. A portion of patients presenting to EDs include postoperative patients. We sought to identify the proportion of patient presenting postoperatively to the ED after common plastic surgery elective procedures to identify target populations and presentations for diversion from the ED. This study investigates the incidence and etiology of postoperative ED presentations in the bilateral reduction mammoplasty (BBR) population, the most common general anesthetic plastic surgery procedure in our jurisdiction. Methods: This retrospective healthcare-utilization study collected all ED visits across a single province from April 2016 to March 2022 within 90 days postoperatively from BBR. Visit timing, frequency, chief complaint, diagnosis, and discharge destination from ED were recorded and analyzed for relationships to the index surgery and for predictable patterns. Results: Of the 452 patients who underwent bilateral breast reduction mammoplasty between 2016 and 2022, 75 (16.6%) patients presented to the ED within 90-day postoperatively. Of these 75 patients, 49 were directly related to the primary surgery (10.8% surgical ED return rate) for complaints of surgical site infection (36.7%), pain (30.6%), wound check (22.4%), swelling (20.4%), and bleeding (20.4%). Conclusion: After routine reduction mammoplasty, 10.8% of patients presented to the ED for surgery-specific concerns. This study describes targets to assist in diverting routine postoperative visits from the ED back toward the surgeon's office. Enhanced patient education, improved follow-up infrastructure, and pain control education are possible areas for intervention.

The authors present a case report of a rare upper extremity mycotic aneurysm in a 36-year-old male with multiple comorbidities, including diabetes, end-stage renal disease, and prior infections. Initially, the patient presented with ischemic symptoms in the right small finger and underwent successful surgical debridement of the radial and ulnar arteries. Subsequently, the patient suffered a cardiac arrest five weeks postoperatively and underwent radial arterial line placement, which led to worsening vascular symptoms in the affected extremity. A second surgery revealed a diagnosis of mycotic aneurysm of the distal ulnar artery. The diseased artery was resected and reconstructed using vein grafts. Following reconstruction, the patient recovered with restored perfusion and resolution of pain. This case highlights the clinical course of diagnosing upper limb mycotic aneurysm and reconstruction of upper limb arteries, stressing the importance of clinical suspicion and timely surgical intervention.

Background: Hypertrophic and keloid scars are chronic fibroproliferative disorders with major psychosocial impact. Conventional assessment tools-Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS)-are limited by subjectivity and poor reproducibility. Artificial intelligence (AI), especially convolutional neural networks (CNNs), offers opportunities for more objective scar evaluation. Objective: To systematically review AI applications in hypertrophic and keloid scar assessment, focusing on model types, imaging inputs, performance metrics, clinical endpoints, and translational readiness. Methods: A PRISMA-compliant search of online databases identified peer-reviewed AI studies on hypertrophic or keloid scar evaluation. Non-AI, non-English, and editorial articles were excluded. Two reviewers independently screened all records, with strong inter-rater reliability (κ = 0.94). Results: Among 1520 records, 24 studies met inclusion criteria. CNNs were the most common models, followed by support vector machines (SVMs) and hybrid approaches. Imaging modalities included smartphone photography, dermoscopy, thermal imaging, second-harmonic generation microscopy, and structured light. Clinical applications involved scar classification, segmentation, recurrence prediction, and treatment monitoring. Reported performance varied widely: accuracy (63%-98.5%), sensitivity (14.9%-99.7%), specificity (80%-99.9%), AUC (0.342-1.0), Dice coefficient (0.5-0.952), and r² (0.234-0.998). Larger datasets and multimodal imaging generally improved model performance. Small or low-quality datasets produced more variable results. External validation occurred in approximately 58% of studies and typically resulted in modest performance drops, indicating overfitting. Conclusions: CNN-based models using mobile or dermoscopic imaging shows promise for objective scar assessment. Key barriers to adoption include limited external validation, explainability, and regulatory integration.

Background: Carbon emissions associated with patient travel for hospital visits contribute to climate change. This study estimated carbon emissions from patients travelling for in-person visits and carbon emissions associated with virtual health visits at the BC Children's and Women's Hospital Campus in 2021-2022. Methods: Anonymized visit data categorized by in-person/virtual, and aggregated by patients' home city/town, and fiscal quarter was obtained. Mode of travel assumptions were based on economic region and seasonality. Carbon dioxide equivalent emissions (CO_2e) for a realistic scenario and alternative scenarios were calculated using equations derived from reference data. Results: There were 397,962 patient visits (19% virtual) associated with an estimated 10,001 metric tons of CO_2e. Alternative scenarios showed that if patients from Northern or Interior regions travelled by plane during the winter, emissions decreased (-14%). While the proportion of visits that were virtual ranged from 16% to 40% by region, if all regions had 40% virtual visits, emissions would decrease by 14%. The largest reduction in carbon emissions (-26%) was found in the scenario where patients from Northern and Interior regions travelled by plane in the winter and the proportion of virtual visits increased to 40%. Conclusion: These findings underscore the need to raise awareness of the carbon footprint of healthcare related travel. The study urges a thoughtful consideration of planetary health when choosing between in-person and virtual visits, recognizing the ability to lower emissions by conducting virtual visits where appropriate.

Background: The optimal surgical management of complex pressure injuries (PIs) relies on adequate education during residency. However, both classroom-based and clinical exposure to these injuries may be inconsistent across training programs. This study aimed to evaluate Ontario surgical residents' exposure to PI management and identify deficiencies in current curricula. Methods: A cross-sectional survey was developed and distributed to general, orthopaedic, and plastic surgery residents across Ontario. The survey collected data on didactic and clinical exposure to PI management, confidence in debridement and reconstruction, and perceptions of current training. Statistical analyses included descriptive statistics and comparisons between surgical specialties. Results: Forty-nine responses were obtained (response rate = 14%). Results demonstrated limited didactic and clinical exposure to PI management in nonplastic surgery residency programs. Most nonplastic surgery residents did not anticipate feeling comfortable performing PI debridement as part of their future practice following residency completion. In contrast, plastic surgery residents reported greater confidence in performing debridement but lacked confidence in selecting appropriate surgical candidates for reconstruction. Conclusions: Exposure to PI reconstruction for plastic surgery residents appears to be limited. Both nonplastic and plastic surgery residents expressed strong interest in additional educational initiatives focused on the surgical management of PIs. This study highlights the need for enhanced educational opportunities, including structured curricula and increased clinical exposure, to ensure surgical trainees develop the necessary competencies for managing PIs effectively.