Plastic surgery最新文献

Background: In an effort to shed light on the recent resurgence of prepectoral breast reconstruction and mounting concerns regarding acellular dermal matrices (ADMs), the senior author's experience with non-ADM-assisted immediate prepectoral breast reconstruction and its associated complications are presented. Methods: A retrospective cohort study of the senior author's prepectoral breast reconstruction practice without ADM from November 2019 to May 2021 was carried out. Data regarding patient demographics, oncologic management, and surgical outcomes were recorded. Results: A total of 66 patients (88 breasts) were included, with an average follow-up of 7.8 months (SD: 5.4). Of these, 24 (36.4%) underwent immediate expander and 42 (63.6%) direct-to-implant (DTI) reconstructions. Major complications included nipple-areolar complex necrosis (2%), hematoma (3%), device exposure (2%), and periprosthetic infections (5.7%). The overall rate of implant failure was 5.7%. Minor complications included simple cellulitis (10%) and minor wound dehiscence (4.5%). Increasing implant size (p < .005) in the DTI cohort and increasing body mass index (BMI) were associated with an increased likelihood of adverse events. Postmastectomy radiation had no effect on surgical complications. Conclusions: The authors hope that in the absence of large, prospective trials, our data demonstrate the safety of immediate prepectoral breast reconstruction without ADM. Our data demonstrate that our algorithm is particularly safe in patients with a low BMI and with an implant size <500cc in DTI reconstruction. Further large prospective studies are required to further support our data in demonstrating that foregoing ADM in immediate prepectoral reconstruction is a safe option.

Purpose: Excess opioid prescribing has societal impacts including addiction, dependence, and misuse. This study aims to investigate prescribing patterns and self-reported patient experiences with opioid use, pain control, and disposal of unused medication following common breast surgeries. Methods: A total of 46 patients undergoing 5 breast procedures were identified during a predefined 14-week period. All procedures were carried out at a single tertiary care hospital by 9 plastic surgeons. Provincial narcotic monitoring program provided linked prescription information for identified patients. All patients were invited to participate in a telephone interview regarding postoperative opioid use. Results: A total of 41.6% of patients received and filled an opioid prescription following a breast procedure. Hydromorphone was the most commonly prescribed narcotic. The average number of opioid tablets dispensed following breast procedures was 31.9. Four percent of breast patients required an opioid refill. A total of 75% of breast patients used at least 1 over-the-counter analgesic, most commonly acetaminophen alone. Average self-reported pain score and total pain period were not significantly different between those using opioids and those not. A total of 6.7% and 23.1% of patients report returning excess narcotics to a pharmacy, while the majority report still having or self-disposing of excess tablets. Conclusions: Opioids are prescribed in excess for the breast procedures we analyzed. The majority of unused opioids were noted to still be at home or disposed of inappropriately. This suggests a role for reviewing opioid-prescribing patterns for common plastic surgery procedures to reduce the burden of the ongoing opioid epidemic.

Introduction: Limited palmar fasciectomy (LPF) and collagenase injection (CI) are the most common procedures to manage symptoms of Dupuytren's Disease. This randomized controlled trial (RCT) aimed to directly compare patient outcomes 12 months following CI and LPF. Methods: Twenty-two patients with Dupuytren's Disease were randomized to either LPF or CI. The primary outcome was health state measured by the Michigan Hand Questionnaire. Secondary outcomes were health status (The Health Utility Index-3), function (The Unité Rhumatologique des Affections de la Main and The Southampton Dupuytren's Scoring Scheme), and range of motion (ROM) of treated digits. Measurements were collected at baseline and 1-, 3-, 6-, and 12-months post-procedure. Results: Thirteen patients were randomized to the LPF and eight patients to the CI group. Most patients (85.7%) were male; the average age of the sample was 65.3 years. No statistically significant difference in the MHQ (mean difference [MD]: -12.4 (95% confidence interval [CI]: -30.0, 5.2)), SDSS (.9 (-4.0, 5.8)), URAM (-.9 (-14.4, 12.6)) or HUI-3 (-.04, -.2, .2)) was found between groups 12-months post-operatively. There was no statistically significant difference in 12-month loss of extension between groups at the MCP (-16.9 (-35.4, 1.7) or PIP (-2.9 (-22.9, 17.1) joints. Three CI patients and 1 LPF patient developed a contracture in the same digit requiring surgery. Conclusion: Results should be interpreted with caution given the small sample size. Available data suggests both techniques are reasonable for managing Dupuytren's Disease. Considerations for future RCTs are provided.

Introduction: Three different methods are described in the literature for the evaluation of carpal collapse. Measurements of carpal collapse by different people may affect the results. We aimed to investigate the inter and intraobserver reliability of three different methods used in carpal height measurement and to review the reference ranges for each method in healthy individuals. Methods: 179 wrist radiographs were evaluated by an orthopedist and a radiologist. Two observers made their evaluations independently of each other and unaware of each other's measurement results. They measured the carpal height ratio, the revised carpal height ratio, and the distance between the capitate-radius on each radiograph. One month later, all radiographs were reevaluated by two observers. Results: Results were analyzed by calculating the intraclass correlation coefficient. All methods had very high reproducibility. Interobserver reliability of the CH and RCH ratios were similar, and both had higher interobserver reliability scores than the CR index. In intraobserver reliability, the score of the CH ratio was higher in all measurements, and the lowest score was in the CR index. However, there was no statistical difference between the three methods in terms of inter- and intraobserver reliability. Conclusion: All three methods can be used in cases where the healthy extremity is desired to be used as a reference point in the evaluation of carpal height. Although the reliability scores of the CH ratio were found to be higher in this study, the practitioner can choose the desired method by evaluating the advantages and disadvantages of each method.

Background: Free tissue transfer is a valuable surgical option for the reconstruction of a myriad of complex lower extremity defects. Currently, there is a paucity of data that examines the risks of complications for each of these unique indications. Methods: Patients undergoing lower extremity free flap reconstruction from the ACS-NSQIP 2011-2019 database were stratified into groups based on the etiology and indication for reconstruction. Rates of major, surgical wound, and medical complications were compared over the first post-operative month. Multivariable logistic regression was used to identify complication predictors. Results: 425 lower extremity free flaps were analyzed. The most common indications for lower extremity free flap reconstruction were wound-related (29%), malignancy (21%), and trauma (17%). Seventeen percent of free flaps had a major post-operative complication, 9% had a surgical wound complication, and 16% had a medical complication. There were no significant differences in major complications between the indications. However, the independent risk factors for major complications varied widely. Those with an indication of malignancy and those who received a musculocutaneous free flap were significantly more likely to have a surgical wound complication compared to the remaining cohort (p < 0.05). Those requiring free flap reconstruction for orthopedic hardware related concerns as well as those with wound related indications were significantly more likely to have a post-operative medical complication (p < 0.05). Conclusion: Understanding the unique risk profiles between the various indications and populations of patients undergoing lower extremity free flap reconstruction is critical for providing accurate risk estimations and optimizing post-operative outcomes and monitoring. Keywords microsurgery, lower extremity free flap, free flap reconstruction.

Purpose: Despite the advances of modern operating rooms, surgeons often experience work environments that rival those of industrial workers with regard to the risk of musculoskeletal (MSK) injuries or disorders. Such injuries may result in loss of hours, decreased surgical volume, or premature retirement. This study aimed to investigate the prevalence and impact of MSK injuries among Canadian plastic surgeons and trainees. Methods: A cross-sectional, online survey was disseminated among Canadian plastic surgeons, defined as those registered as members of the Canadian Society of Plastic Surgeons, the Royal College of Physicians and Surgeons of Canada, or Plastic Surgery Residents. Results: This survey was disseminated to 604 Canadian plastic surgeons, fellows, and residents, of whom 139 responded (response rate 23.0%). Of the responders, 49.6% were male, 23.0% were >35 years of age, and 46.1% had been in practice for >10 years. The majority (72.7%) of respondents endorsed experiencing MSK symptoms after operating. Moreover, 18.7% of respondents felt their MSK symptoms had direct consequences on their performance as a surgeon. When MSK symptoms were reported to department heads, system change was only seen 44.4% of the time. Unsurprisingly, neck (76.2%), back (72.2%), and shoulders (48.5%) were the areas of pain most reported. Exercise was not shown to significantly reduce the impact of MSK symptoms resulting from operating (P  =  .06). Conclusions: Musculoskeletal symptoms are common among plastic surgeons and directly impact the performance of a large proportion of surgeons. Besides traditional efforts to reinforce good posture while operating, best practice policies and operating room optimization with regard to ergonomics are warranted.

Introduction: Despite increasing advocacy for family leave policies, few studies have described the current landscape and attitudes around family planning in Canadian plastic surgery. The purpose of this study was to survey Canadian plastic surgeons and trainees to examine their experience with family planning, parental leave, and breastfeeding. Methods: An anonymized survey was distributed to all members of the Canadian Society of Plastic Surgeons and all Canadian Plastic Surgery residents through their program administrators. Survey responses were recorded and analyzed through a customized REDCap™ database. Results were reported using descriptive statistics. Results: A total of 87 plastic surgeons and trainees completed the surgery. We found 72.3% of respondents had children; 67.8% felt their colleagues were supportive of parental leave; 45.6% felt that financial concerns affected their decision to take parental leave; 61.6% felt that their career did not influence the number of children they chose to have; 21.0% accessed fertility services and 9.8% used assisted-reproductive technologies; 80% of respondents who breastfeed felt they did not have enough time to pump at work, however, 79% did not experience any discrimination or criticism for pumping at work. Conclusion: Canadian plastic surgeons most often have children after completing training and choose to take shorter parental leaves as their careers progress. Parental leave and breastfeeding practices in the workplace are reported to have increased support from colleagues compared to previous literature. However, Canadian plastic surgeons continue to struggle with infertility and seek fertility services at rates higher than the general population.