Plastic surgery最新文献

Introduction: Panniculectomy is recognized to have a high complication rate with up to 56% of patients having postoperative wound healing problems. As they are generally elective procedures, surgeons have the chance to optimize preoperative variables. We reviewed the relationship between preoperative serum albumin and BMI with short-term postoperative panniculectomy complications. Methods: Patients undergoing panniculectomy between January 2005 and December 2019 were identified via CPT code 15830 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate logistic regression was performed on intra/postoperative bleeding and postoperative wound infection against preoperative serum albumin, diabetes status, age, body mass index (BMI), and smoking status. Odds ratios were adjusted for comorbidities. We established statistical significance at p value <0.01. Results: Out of 1472 patients, 69 sustained intra/postoperative bleeding and 31 suffered wound infection. Lower preoperative albumin levels (R2 = 16.3%, p < 0.0001) and elevated BMI (R2 = 9.4%, p < 0.0001) were both significantly associated with increased likelihood of wound infection. For every 1 g/dL decrease in albumin, patients' odds of bleeding increased 1.85 (OR = 1.85, CI 95%= [1.14-2.99]) times, and odds of wound infection increased 5.03 (OR = 5.03, CI 95%= [2.78-9.10]) times (p < 0.0001). BMI and albumin were weakly correlated (r = -0.28) suggesting each had independent effects on complications. Conclusion: In patients undergoing panniculectomy, preoperative albumin level is significantly inversely associated with postoperative bleeding and wound complications. More research is needed to evaluate whether proactively optimizing albumin may reduce complications.

Purpose: Gender-affirming mastectomy surgery is highly desired within both transmasculine and nonbinary patient populations. The development of cardiac arrhythmias has been reported within this population. Acute intraoperative bradycardia in patients undergoing gender-affirming mastectomy has not been well described previously. This study aimed to describe the frequency of acute intraoperative relative bradycardia in patients undergoing gender-affirming mastectomies and identify potential risk factors that contribute to its occurrence. Methods: A retrospective review was performed for all patients who underwent gender-affirming mastectomy at a single institution. Data regarding patient demographics, comorbidities, and perioperative course were collected. Patients were separated into those who did and did not develop acute intraoperative bradycardia. The definition of relative intraoperative bradycardia was a heart rate below sixty beats per minute. Logistic regression was performed to determine which variables were predictive of bradycardia. Results: A total of 337 patients underwent gender-affirming mastectomy between January 2018 and January 2023. Of these patients, 144 (42.7%) experienced acute intraoperative relative bradycardia, with 97 (67.4%) requiring anesthetic intervention and 5 (3.5%) requiring halting or abortion of surgery. Two patients (1.4%) required compressions for asystole. Fluoxetine as an outpatient medication (OR: 2.63, P = .002) and harvest of a nipple graft (OR: 2.77, P = .018) were associated with a significantly increased risk of developing acute intraoperative bradycardia. Conclusion: Acute intraoperative relative bradycardia may be a unique phenomenon in patients undergoing gender-affirming mastectomies due to variables specific to this patient population. A future study comparing patients undergoing gender-affirming mastectomy to those undergoing elective breast surgeries is forthcoming to assess further risk factors.

Purpose: The purpose of this study is to gather the practices and perceptions among upper extremity surgeons regarding the use of musculoskeletal ultrasound for diagnostic and therapeutic intervention. Methods: A 36-question survey was developed from a literature review and author consensus. This survey was then piloted among a small group of hand surgeons prior to distribution. The survey included respondent characteristics, use of ultrasound in their current practice, referral patterns for ultrasound, and interest in incorporating ultrasound into practice and residency training. The refined survey was distributed to the Canadian Society of Plastic Surgeons, and Wrist and Elbow Society of Canada, as well as plastic surgery training programs. A reminder email was sent at 3 weeks and again at 8 weeks. Results: There were 152 responses after 505 survey invitations (30% response rate). Of these responses, 140 were complete (92%). Diagnostic ultrasound was used by 16 respondents (11%) for a myriad of pathologies. Only 5% used ultrasound for guided injections in a clinic or office setting. Money, time, lack of training, and lack of billing code were the major barriers to ultrasound implementation for 124 (89%) hand surgeons. Most respondents (84%) believe that ultrasound training should be incorporated into residency training. Ninety-one respondents (60%) are interested or very interested in incorporating ultrasound into their current practice. Conclusions: Ultrasound is a valuable resource that is seldom used as a point of care by Canadian hand surgeons due to several barriers. Survey results suggest that upper extremity surgeons are keen to have ultrasonography be part of residency education and most wish to adopt it into their future practice.

Purpose: Psychoactive substance use is often a complicating factor in injury that requires an emergency room visit. The present study examined data recorded in the National Electronic Injury Surveillance System (NEISS) database for patients who presented to an Emergency Department (ED) and had psychoactive substance involvement, requiring management by plastic surgery. Methods: A retrospective cohort study was performed using the NEISS database, from 2019 to 2021. Data from patients aged 0 to 102 who suffered burns (46, 47, 48, 49, 51, and 73), face injuries (76), hand injuries (34, 82, and 92), and had psychoactive substance use were queried. Data regarding the specific substances involved were collected. Analysis was performed using SAS to compare the incidence of various substances and the differences in admission status with psychoactive substance use. Results: According to the NEISS estimates, in the United States, 597,916 patients visited the ED for burns, 3,671,677 for facial injuries, and 6,230,087 for hand injuries from January 2019 to December 2021. Across this population, psychoactive substance use was noted in 5605 patients with burn (0.9%), 31,198 with facial (0.8%), and 26,174 with hand (0.4%) injuries. Across all 3 injury types, the total rate of admission was 20% in the substance-use population, and 5% in the nonsubstance-use population. Conclusions: For injuries presenting to the ED that require plastic surgery management, patients with documented psychoactive substance use have higher rates of admission. Given these higher rates of admission, it is important for providers to be aware of differences in the incidences of various substances and the potential for withdrawal.

Background: Many people are still infected with coronavirus disease 2019 (COVID-19), and the use of home test kits for diagnosis is becoming common. The misuse of the kits may cause unexpected patient harm. Purpose: The purpose of this case study was to report a rare case of facial skin necrosis caused by contact with a reagent in a COVID-19 Ag home test kit due to misuse of the kit. Case Study: A 50-year-old male patient with pain, redness, and swelling throughout the nose, right ocular area, and forehead visited the emergency room of the hospital. The symptoms were caused by using a COVID-19 Ag home test kit in the wrong way. Initially, partial skin color change and ulcerative skin lesions with pus-like discharge were observed throughout the wound. Finally, partial skin necrosis progressed and was treated using appropriate dressing treatment, antibiotics, and steroids. Conclusion: The use of COVID-19 Ag home test kits that can be easily used will gradually increase. As in this case, it should be kept in mind that problems due to incorrect use of COVID-19 Ag home test kits can occur, and initial treatment is important to prevent systemic infection or scar formation.