Plastic surgery最新文献

Background: Reduction mammaplasty is a surgical procedure performed to treat individuals with macromastia. It has been shown that a greater risk of complication is associated with higher body mass indices (BMIs). Other factors such as operative time have not been as well-studied. We sought to investigate the effect of surgery length, as well as surgeons themselves, on outcomes of a common plastic surgery operation. Methods: A retrospective chart review from a single academic institution's main teaching hospital of patients who underwent bilateral reduction mammaplasty during January 2020 to August 2024 was conducted. Multivariable regression was used to assess complications based on operative time, BMI, and surgeon. Receiver operating characteristic analysis was subsequently employed to determine the optimal model for prediction of complications. Results: There were 102 patients included in the study. They had an average BMI of 33.4 and length of surgery of 229.7 min, the latter of which varied significantly between surgeons, with an overall complication rate of 24.5%. Longer operative times, with BMI and surgeon controlled, did not significantly increase complications (95% CI for OR = [0.99, 1.01]). However, all three variables together did significantly discriminate between the presence and absence of complications (AUC = 0.65, P = 0.04). Conclusion: The data do not suggest that operative time alters the complication rate, but rather indicate that the addition of the surgeon to a predictive model that contains operative time and BMI creates a meaningful way to discriminate the presence of complications. As such, this study highlights the importance of the surgeon's role in reduction mammaplasty.

Background: Delayed care carries both clinical and psychosocial consequences for patients undergoing breast reconstruction. This study evaluated whether elevated BMI is associated with delays in post-mastectomy reconstructive care, with the aim of identifying potential contributors to outcome disparities among higher-weight patients. Methods: A single institution, retrospective review of breast reconstruction patients between 2017 and 2023 was conducted. Patients were stratified by World Health Organization BMI classifications. Outcomes comprised intervals between diagnosis and plastic and reconstructive surgery (PRS) consultation, index procedure, and final procedure. Regression models evaluated associations between BMI and clinical timelines. Results: Of the 1659 patients included, 26 were underweight (1.6%), 599 were healthy weight (36.1%), 520 were overweight (31.3%), 322 were Class I obese (19.4%), 144 were Class II obese (8.7%), and 48 were Class III obese (2.9%). On univariable analysis, prolonged intervals between diagnosis to index procedure were observed for Class I (β = 0.187, P = 0.01) and Class II (β = 0.276, P = 0.004) obesity patients; however, these findings did not persist after adjusting for demographics, operative details, and comorbidities. Intervals between diagnosis and PRS consult did not show significant differences among BMI classes. Conclusion: While extended intervals to the index reconstructive procedure among obese patients suggest care delays occur after PRS consultation, the absence of significant associations in multivariable analysis indicates that comorbidities and sociodemographic factors are the primary contributors. These findings offer reassurance that elevated BMI does not independently impede timely receipt of breast reconstruction.

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.