Plastic surgery最新文献

Background: Body contouring procedures, including reduction mammoplasty (RM) and panniculectomy, enhance several quality-of-life indicators such as comfort, hygiene, exercise capability, and body shape. However, the extended metabolic implications of these interventions remain underexplored. This study examined the potential long-term metabolic benefits of RM and panniculectomy, particularly reductions in total cholesterol, hemoglobin A1C, and weight. Methods: An institutional chart review was performed to identify all patients who underwent RM and panniculectomy between 2010 and 2021, with follow-up weights of approximately 6 months, 1 year, and 2 years. Preoperative weight, body mass index (BMI), total cholesterol, and HbA1C were compared at the 3 postoperative time points. Results: One hundred thirty-two patients were included in the study. Of these, 87% underwent RM, and 13% underwent panniculectomy. The cohort was predominantly female (94.7%, N = 125) within the 40 to 65 age range (58.3%, N = 77). Among all patients, 22% (N = 29) had diabetes. Weight, BMI, LDL, HDL, total cholesterol, and A1C levels collectively did not change over the 2-year postoperative period (P < .05). Conclusion: At the long-term follow-up, patients who underwent RM or panniculectomy showed no significant changes in weight, glucose control, or total cholesterol levels. Although these procedures primarily target enhancements in comfort, body shape, and hygiene, our findings suggest that changes in metabolic parameters did not occur.

Introduction: Arm and forearm tourniquets are routinely used in hand surgery to provide a "bloodless" operating field. Though not yet widely adopted, wrist tourniquets have been reported to be a more comfortable option compared to other tourniquet locations. Thus, the primary purpose of this study was to review the use of upper extremity tourniquets in awake hand surgery and report any tourniquet-related outcomes. Methods: Following PRISMA-ScR guidelines, Medline and Embase were searched for primary studies published from inception to August 22, 2024, reporting on the use of upper extremity tourniquets in adult patients undergoing hand surgery with local anesthetic. Tourniquet time and tourniquet tolerance, represented by visual analog scale (VAS) scores, were the main extracted outcomes. Results: Two hundred of 1528 studies were reviewed at the full-text level by 2 reviewers, and 26 studies were included. Four studies incldued both forearm and upper arm tourniquets and were treated as individual studies. Of these, there were 19 studies that used an upper arm tourniquet (n = 931 procedures), 9 studies that used a forearm tourniquet (n = 657 procedures), and 2 studies that used a wrist tourniquet (n = 130 procedures). Average tourniquet time for upper arm, forearm, and wrist tourniquets was 11.4, 11.6, and 16.5 min, respectively, and mean VAS score for tourniquet pain were 4.0, 3.3, and 0.4, respectively. Conclusions: We reviewed the use of upper extremity tourniquets for hand surgery and associated outcomes. While limited, the literature suggests that wrist tourniquets are the most comfortable tourniquet location and are well tolerated by both patients and surgeons. Future comparative clinical studies are required to better assess such outcomes.

Introduction: Large language models (LLMs) like ChatGPT are used by medical trainees and professionals for learning and clinical support. This study determined how Canadian plastic surgery residents utilize and perceive LLMs for their training. Methods: A cross-sectional survey was distributed to all Canadian, English-speaking plastic surgery trainees (N = 100). Descriptive statistics and conventional content analysis were used to describe quantitative and free-text responses, respectively. Results: A total of n = 36 responses were collected (36% response rate) from Canadian plastic surgery residents. Among residents, 83.3% reported using LLMs for any purpose, and 63.8% reported using the technology for plastic surgery education. The most frequently utilized LLMs include ChatGPT (83.3%), BingAI (11.1%), and Gemini (8.3%). More than half of residents reported using LLMs a minimum of once per week (50.1%). The most common applications included explaining concepts (58.3%), explaining procedures (33.3%), answering lecture questions (27.8%), and creating presentations (27.8%). Of respondents, 94.4% reported not having received education or training on the use of LLMs, and 37.1% reported concerns with the use of the technology for plastic surgery learning. The themes that emerged from the free-text responses were categorized into 3 groups: (1) advantages, including time-efficiency and summarization, (2) disadvantages, including concerns of inaccuracies, confidentiality, and over-reliance, and (3) recommendations, such as didactic teaching sessions and workshops. Conclusions: LLMs are commonly used by Canadian plastic surgery residents for a variety of purposes. Most residents have not been trained on the optimal use of the technology, and surgical residency programs should consider formal LLM instruction to leverage the capabilities of this tool and mitigate potential harms.

Anterior cutaneous nerve entrapment syndrome (ACNES) is an underdiagnosed cause of chronic abdominal wall pain. It results from the entrapment of the cutaneous branches of the thoracoabdominal nerves. We describe the case of a 54-year-old female who developed ACNES following Fotona laser tightening treatment of the abdomen. She underwent a neurectomy of the T6 and T10 intercostal nerves during body contouring surgery and reported complete resolution of ACNES symptoms.

Introduction: Firearm-related extremity trauma with nerve injury can lead to life-altering impairment and disability. This study evaluated the frequency of nerve injury in firearm-related extremity injuries at a Level 1 trauma centre, and the rate of nerve transection in firearm-related peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs). Methods: Following Ethics Board approval, institutional trauma and emergency databases (from 2000 to 2020) were used to identify adults with firearm-related PNI or BPI treated at a Level 1 trauma center. Each case of nerve injury was verified by chart review and excluded isolated digital nerve and other cutaneous nerve injuries. Medical charts were reviewed to retrieve patient and injury data. Results: In total, 1957 patients were identified with firearm injuries; the nerve injury study sample included 86 patients (95% males) and 98 nerves injured. The most common upper extremity nerve injured was the radial and/or posterior interosseous nerve (n = 30, 25%) and in the lower extremity, the sciatic nerve (n = 15, 13%). Nerve transection was confirmed in 21% of cases by surgical exploration (n = 19) or ultrasound imaging (n = 2). Axonotmetic injuries were confirmed in 20% of cases and in total only 41% of patients had full spontaneous functional recovery. Compared to neurapraxia, neurotmesis injuries had a significantly increased likelihood of concomitant vascular injury (P = .007) but not skeletal injuries (P = .65). Injury severity score was not associated with nerve injury severity (P = .27). Conclusion: Nerve transections due to firearm-related trauma occur more frequently than previously believed. Early identification and surgical management of nerve transection injuries is imperative.

Introduction: The necessity of postoperative drains in gender-affirming mastectomy remains unclear, with no consensus on their role in reducing complications such as seroma formation. Given this paucity of evidence, the use of drains is often at the discretion and judgment of the surgeon. Understanding patient preferences and quantifying patient risk tolerance for seroma formation and secondary procedures that may be associated with drainless mastectomy may aid in surgical decision-making and facilitate patient-centered discussions. Methods: Adolescent patients considering or having undergone gender-affirming mastectomy were surveyed. A modified standard gamble approach assessed risk tolerance for seroma formation requiring aspiration and the need for a secondary procedure. Results: Thirty participants were recruited (mean age 17.6 ± 1.3 years). Eighty percent identified as transmale, 17% as nonbinary, and 3% as gender nonconforming; 47% had a prior mastectomy. The median risk tolerance for seroma formation was 15% (interquartile range [IQR]: 5.5%-25%), and for secondary procedures, 10% (IQR: 1%-15%). Risk tolerance did not significantly differ by history of prior surgery or age. Supplementary survey findings provided insight into factors influencing concerns related to both the use of drain and drainless procedures. Conclusions: Risk tolerance for seroma and secondary procedures varies among patients, emphasizing the need for shared decision-making in gender-affirming mastectomy. Balancing patient preferences with surgical risks is essential to optimizing outcomes.