Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第10页

Superior gluteal artery perforator flap for autologous breast reconstruction: Refined surgical technique, outcomes, and patient satisfaction 臀上动脉穿支皮瓣用于自体乳房重建：精细的手术技术、结果和患者满意度。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-29 DOI: 10.1016/j.bjps.2025.11.062

J.M. Buijtendijk , E.D.H. Zonnevylle , D.A. Young-Afat

Background

Deep inferior epigastric perforator (DIEP) flaps are the gold standard for autologous breast reconstructions, but alternatives are needed when the abdomen is not optional. The superior gluteal artery perforator (SGAP) flap, using the gluteal region as donor site, is such an alternative. However, SGAP-flaps are not widely used for breast reconstructions due to technical and anatomical challenges, and potential donor site deformity. This study presents a slightly modified SGAP-flap harvesting technique for breast reconstructions aimed at optimizing outcomes and describes surgical and patient-reported outcomes.

Methods

An observational study (retrospective and cross-sectional) was conducted by including all women who underwent SGAP-flap breast reconstruction between May 2012 and March 2024 in a high-volume cancer center. Patient and surgical characteristics, (un)planned surgical revision rates, and patient-reported satisfaction were assessed using BREAST-Q (91% response rate).

Results

In total, 33 SGAP-flap breast reconstructions were performed in 26 patients. Mean ischemia time was 156 min. Four major complications (12%) requiring unplanned surgical intervention occurred, with no (partial) flap loss (i.e., 100% flap survival). Four flaps underwent planned secondary corrections (12%) of the donor site. Patient-reported donor site deformity and/or dissatisfaction was infrequent (n=2). Five patients underwent SGAP-flap on one side and DIEP-flap reconstruction contralaterally (15%), with similarly high patient-reported satisfaction and well-being scores for both sides.

Conclusions

High patient-reported satisfaction, and low complication and donor site deformity rates were observed in patients undergoing autologous breast reconstruction using a slightly refined SGAP-flap technique. This technique may be considered as an acceptable alternative for DIEP-flap breast reconstructions.

背景：深下腹穿支（DIEP）皮瓣是自体乳房重建的金标准，但当腹部不可选择时，需要其他选择。臀上动脉穿支（SGAP）皮瓣，利用臀区作为供体，就是这样一种选择。然而，由于技术和解剖学上的挑战以及潜在的供区畸形，sgap皮瓣并未广泛用于乳房重建。本研究提出了一种略为改进的sgap皮瓣采集技术用于乳房重建，旨在优化结果，并描述了手术和患者报告的结果。方法：一项观察性研究（回顾性和横断面），纳入2012年5月至2024年3月在一个大容量癌症中心接受sgap皮瓣乳房重建术的所有女性。使用BREAST-Q评估患者和手术特征、（未计划的）手术翻修率和患者报告的满意度（91%的有效率）。结果：26例患者共行33例sgap皮瓣乳房重建术。平均缺血时间156 min。发生了四个主要并发症（12%），需要进行计划外的手术干预，没有（部分）皮瓣丢失（即皮瓣存活率100%）。4个皮瓣在供区进行了计划的二次矫正（12%）。患者报告供体部位畸形和/或不满意的情况很少（n=2）。5例患者接受了单侧sgap -皮瓣和对侧diep -皮瓣重建（15%），患者报告的满意度和两侧幸福感评分相似。结论：采用略为改良的sgap皮瓣技术进行自体乳房重建，患者满意度高，并发症低，供区畸形率低。该技术可被认为是diep皮瓣乳房重建的一种可接受的替代方法。

{"title":"Superior gluteal artery perforator flap for autologous breast reconstruction: Refined surgical technique, outcomes, and patient satisfaction","authors":"J.M. Buijtendijk , E.D.H. Zonnevylle , D.A. Young-Afat","doi":"10.1016/j.bjps.2025.11.062","DOIUrl":"10.1016/j.bjps.2025.11.062","url":null,"abstract":"<div><h3>Background</h3><div>Deep inferior epigastric perforator (DIEP) flaps are the gold standard for autologous breast reconstructions, but alternatives are needed when the abdomen is not optional. The superior gluteal artery perforator (SGAP) flap, using the gluteal region as donor site, is such an alternative. However, SGAP-flaps are not widely used for breast reconstructions due to technical and anatomical challenges, and potential donor site deformity. This study presents a slightly modified SGAP-flap harvesting technique for breast reconstructions aimed at optimizing outcomes and describes surgical and patient-reported outcomes.</div></div><div><h3>Methods</h3><div>An observational study (retrospective and cross-sectional) was conducted by including all women who underwent SGAP-flap breast reconstruction between May 2012 and March 2024 in a high-volume cancer center. Patient and surgical characteristics, (un)planned surgical revision rates, and patient-reported satisfaction were assessed using BREAST-Q (91% response rate).</div></div><div><h3>Results</h3><div>In total, 33 SGAP-flap breast reconstructions were performed in 26 patients. Mean ischemia time was 156 min. Four major complications (12%) requiring unplanned surgical intervention occurred, with no (partial) flap loss (i.e., 100% flap survival). Four flaps underwent planned secondary corrections (12%) of the donor site. Patient-reported donor site deformity and/or dissatisfaction was infrequent (n=2). Five patients underwent SGAP-flap on one side and DIEP-flap reconstruction contralaterally (15%), with similarly high patient-reported satisfaction and well-being scores for both sides.</div></div><div><h3>Conclusions</h3><div>High patient-reported satisfaction, and low complication and donor site deformity rates were observed in patients undergoing autologous breast reconstruction using a slightly refined SGAP-flap technique. This technique may be considered as an acceptable alternative for DIEP-flap breast reconstructions.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 547-555"},"PeriodicalIF":2.4,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Usage patterns of regional anesthesia for panniculectomy in the United States 区域麻醉在美国胰腺切除术中的使用模式。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.054

Angad S. Sidhu , George S. Corpuz , Nikola Vuckovic , Dylan K. Kim , Ivan Hadad

Regional anesthesia (RA) reduces opioid consumption, improves postoperative pain control, and facilitates recovery. Although racial and ethnic disparities in RA use have been documented in various surgical fields, limited data exist on its use in plastic surgery and body contouring procedures. We aimed to evaluate the utilization of RA and potential disparities among patients undergoing panniculectomies. We conducted a retrospective cohort study using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2014 to 2020. Patients who underwent panniculectomies were analyzed, and adjunct peripheral nerve block use was evaluated. Multivariate logistical regression was used to evaluate associations between patient characteristics and RA usage. Among 8779 patients, 594 (6.8%) received RA for panniculectomies. Unadjusted analysis showed Black patients had significantly lower odds of receiving RA compared to White patients (OR 0.77, 95% CI 0.61–0.96, p=0.023), whereas patients classified as “Other” had higher odds (OR 2.64, 95% CI 1.50–4.62, p<0.001). After adjustment for age, sex, race, ethnicity, BMI, smoking status, diabetes, hypertension, chronic steroid use, COPD, CHF, dialysis, cancer, bleeding, and ASA class, no statistically significant differences in RA receipt for panniculectomy were observed by race or ethnicity. In this national cohort of patients undergoing abdominal body contouring surgery, no statistically significant racial or ethnic disparities in RA use were observed after adjustment. The low overall utilization of RA may suggest underuse in panniculectomies and highlights opportunities to optimize prophylactic pain management strategies for patients.

区域麻醉（RA）减少阿片类药物的消耗，改善术后疼痛控制，促进康复。尽管在不同的外科领域中，类风湿关节炎的使用存在种族和民族差异，但在整形外科和身体轮廓手术中，类风湿关节炎的使用数据有限。我们的目的是评估RA的使用情况以及在输卵管切除术患者中的潜在差异。我们使用美国外科医师学会-国家手术质量改进计划（ACS-NSQIP）数据库从2014年至2020年进行了一项回顾性队列研究。我们分析了接受胰腺小管切除术的患者，并评估了辅助周围神经阻滞的使用。多变量逻辑回归用于评估患者特征与RA使用之间的关系。在8779例患者中，594例（6.8%）接受了输卵管切除术。未经调整的分析显示，与白人患者相比，黑人患者接受RA的几率明显较低（OR 0.77, 95% CI 0.61-0.96, p=0.023），而归类为“其他”的患者的几率较高(OR 2.64, 95% CI 1.50-4.62, p

{"title":"Usage patterns of regional anesthesia for panniculectomy in the United States","authors":"Angad S. Sidhu , George S. Corpuz , Nikola Vuckovic , Dylan K. Kim , Ivan Hadad","doi":"10.1016/j.bjps.2025.11.054","DOIUrl":"10.1016/j.bjps.2025.11.054","url":null,"abstract":"<div><div>Regional anesthesia (RA) reduces opioid consumption, improves postoperative pain control, and facilitates recovery. Although racial and ethnic disparities in RA use have been documented in various surgical fields, limited data exist on its use in plastic surgery and body contouring procedures. We aimed to evaluate the utilization of RA and potential disparities among patients undergoing panniculectomies. We conducted a retrospective cohort study using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2014 to 2020. Patients who underwent panniculectomies were analyzed, and adjunct peripheral nerve block use was evaluated. Multivariate logistical regression was used to evaluate associations between patient characteristics and RA usage. Among 8779 patients, 594 (6.8%) received RA for panniculectomies. Unadjusted analysis showed Black patients had significantly lower odds of receiving RA compared to White patients (OR 0.77, 95% CI 0.61–0.96, <em>p</em>=0.023), whereas patients classified as “Other” had higher odds (OR 2.64, 95% CI 1.50–4.62, <em>p</em><0.001). After adjustment for age, sex, race, ethnicity, BMI, smoking status, diabetes, hypertension, chronic steroid use, COPD, CHF, dialysis, cancer, bleeding, and ASA class, no statistically significant differences in RA receipt for panniculectomy were observed by race or ethnicity. In this national cohort of patients undergoing abdominal body contouring surgery, no statistically significant racial or ethnic disparities in RA use were observed after adjustment. The low overall utilization of RA may suggest underuse in panniculectomies and highlights opportunities to optimize prophylactic pain management strategies for patients.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 575-581"},"PeriodicalIF":2.4,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Machine learning and computer vision for detection and classification of pain in lower extremity amputees 机器学习和计算机视觉在下肢截肢者疼痛检测和分类中的应用。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.052

Arya S. Rao , Floris V. Raasveld , Omar Moussa , Benjamin R. Johnston , Anna Luan , Zihe Zhang , Clifford J. Woolf , Krystle R. Tuaño , Ian L. Valerio , Kyle R. Eberlin

Objective

Pain sketches help visualize neuropathic pain patterns in amputees and may predict surgical outcomes following targeted muscle reinnervation (TMR). Current manual interpretation introduces subjectivity and potential bias. Machine learning offers potential for automated, objective classification of these sketches. Therefore, we aimed to develop and evaluate a machine learning approach for automated classification of pain sketches from lower extremity amputees who underwent targeted muscle reinnervation (TMR).

Methods

Here, 588 pain sketches from 206 lower extremity amputees (2021–2024) were analyzed. Convolutional neural networks were trained to perform binary classifications between pain categories (focal, radiating, diffuse, and no pain). Unsupervised hierarchical clustering was used to identify novel pain distribution patterns.

Results

Binary classification models achieved the highest performance distinguishing no pain versus diffuse pain (AUROC: 0.799). Other models showed AUROCs between 0.587–0.760. Hierarchical clustering revealed distinct pain distribution patterns based on anatomical location and extent, providing insights beyond traditional classification schemes.

Conclusions

Machine learning can effectively automate pain sketch classification in lower extremity amputees, offering potential clinical utility for preoperative planning. This approach may help standardize interpretation and improve surgical decision-making for TMR procedures.

Level of Evidence

IV—Therapeutic

目的：疼痛草图有助于可视化截肢者的神经性疼痛模式，并可预测靶向肌肉神经移植（TMR）后的手术结果。目前的人工口译引入了主观性和潜在的偏见。机器学习为这些草图的自动、客观分类提供了潜力。因此，我们旨在开发和评估一种机器学习方法，用于对接受靶向肌肉神经移植（TMR）的下肢截肢者的疼痛草图进行自动分类。方法：对206例下肢截肢患者（2021-2024）588张疼痛草图进行分析。卷积神经网络被训练成在疼痛类别（局灶性、辐射性、弥漫性和无痛）之间进行二元分类。采用无监督分层聚类来识别新的疼痛分布模式。结果：二元分类模型在区分无疼痛和弥漫性疼痛方面表现最佳（AUROC: 0.799）。其他模型的auroc在0.587-0.760之间。分层聚类揭示了基于解剖位置和程度的不同疼痛分布模式，提供了超越传统分类方案的见解。结论：机器学习可以有效地自动化下肢截肢患者的疼痛草图分类，为术前规划提供潜在的临床应用价值。这种方法有助于规范TMR手术的解释和改进手术决策。证据等级：iv -治疗性。

{"title":"Machine learning and computer vision for detection and classification of pain in lower extremity amputees","authors":"Arya S. Rao , Floris V. Raasveld , Omar Moussa , Benjamin R. Johnston , Anna Luan , Zihe Zhang , Clifford J. Woolf , Krystle R. Tuaño , Ian L. Valerio , Kyle R. Eberlin","doi":"10.1016/j.bjps.2025.11.052","DOIUrl":"10.1016/j.bjps.2025.11.052","url":null,"abstract":"<div><h3>Objective</h3><div>Pain sketches help visualize neuropathic pain patterns in amputees and may predict surgical outcomes following targeted muscle reinnervation (TMR). Current manual interpretation introduces subjectivity and potential bias. Machine learning offers potential for automated, objective classification of these sketches. Therefore, we aimed to develop and evaluate a machine learning approach for automated classification of pain sketches from lower extremity amputees who underwent targeted muscle reinnervation (TMR).</div></div><div><h3>Methods</h3><div>Here, 588 pain sketches from 206 lower extremity amputees (2021–2024) were analyzed. Convolutional neural networks were trained to perform binary classifications between pain categories (focal, radiating, diffuse, and no pain). Unsupervised hierarchical clustering was used to identify novel pain distribution patterns.</div></div><div><h3>Results</h3><div>Binary classification models achieved the highest performance distinguishing no pain versus diffuse pain (AUROC: 0.799). Other models showed AUROCs between 0.587–0.760. Hierarchical clustering revealed distinct pain distribution patterns based on anatomical location and extent, providing insights beyond traditional classification schemes.</div></div><div><h3>Conclusions</h3><div>Machine learning can effectively automate pain sketch classification in lower extremity amputees, offering potential clinical utility for preoperative planning. This approach may help standardize interpretation and improve surgical decision-making for TMR procedures.</div></div><div><h3>Level of Evidence</h3><div>IV—Therapeutic</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 713-720"},"PeriodicalIF":2.4,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Social and environmental predictors for dog bites in Wales: A retrospective study 威尔士狗咬伤的社会和环境预测因素：一项回顾性研究。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.059

Lewis Price, Rob Duncan, Nick Wilson-Jones

Aims

Dog bites are a significant burden on the individual and NHS. This study aimed to identify social and environmental predictors to aid treatment, planning and prevention.

Methods

Data were collected for all incidences of people bitten/struck by dogs in Wales from April 2018 to March 2023, including age, sex, location, and socioeconomic status. Archived meteorological data for Wales was analysed, including maximum daily temperature, humidity, pressure and lunar phase. Finally, weekday/weekend, school holidays, season and COVID restrictions were also included as potential predictors.

Results

Overall, 3167 bites were identified (mean age = 40.2 years; 52.9% female). Poisson regression, ANOVA and Chi-squared tests were used to analyse different variables. An increase in dog bites was observed on weekends vs weekdays (p=0.033), during school holidays (p<0.001), on days with higher temperatures (p<0.001), when there were no COVID restrictions (p<0.001), post-COVID (p<0.001) and in summer vs winter and spring (p=0.015, p<0.001). Primary school children were more likely to be bitten in the most deprived areas (p<0.001), densely populated areas (p=0.002), and summer months (p<0.001).

Conclusions

These findings suggest that public health campaigns aimed at awareness surrounding the higher risk of dog bites in socially deprived areas, on warmer days, school holidays, on weekends and during the summer may help to reduce the burden of dog bites in Wales.

目的：狗咬伤是个人和NHS的重大负担。这项研究旨在确定社会和环境的预测因素，以帮助治疗、计划和预防。方法：收集2018年4月至2023年3月威尔士所有被狗咬伤/撞伤的人的数据，包括年龄、性别、地点和社会经济地位。他们分析了威尔士存档的气象数据，包括最高日温度、湿度、压力和月相。最后，工作日/周末、学校假期、季节和COVID限制也被列为潜在的预测因素。结果：共发现咬伤3167例，平均年龄40.2岁，女性占52.9%。采用泊松回归、方差分析和卡方检验对不同变量进行分析。在周末与工作日相比，在学校假期期间，狗咬伤事件有所增加（p=0.033）。结论：这些发现表明，旨在提高人们对社会贫困地区狗咬伤风险较高的认识的公共卫生运动，在温暖的日子、学校假期、周末和夏季，可能有助于减轻威尔士狗咬伤的负担。

{"title":"Social and environmental predictors for dog bites in Wales: A retrospective study","authors":"Lewis Price, Rob Duncan, Nick Wilson-Jones","doi":"10.1016/j.bjps.2025.11.059","DOIUrl":"10.1016/j.bjps.2025.11.059","url":null,"abstract":"<div><h3>Aims</h3><div>Dog bites are a significant burden on the individual and NHS. This study aimed to identify social and environmental predictors to aid treatment, planning and prevention.</div></div><div><h3>Methods</h3><div>Data were collected for all incidences of people bitten/struck by dogs in Wales from April 2018 to March 2023, including age, sex, location, and socioeconomic status. Archived meteorological data for Wales was analysed, including maximum daily temperature, humidity, pressure and lunar phase. Finally, weekday/weekend, school holidays, season and COVID restrictions were also included as potential predictors.</div></div><div><h3>Results</h3><div>Overall, 3167 bites were identified (mean age = 40.2 years; 52.9% female). Poisson regression, ANOVA and Chi-squared tests were used to analyse different variables. An increase in dog bites was observed on weekends vs weekdays (p=0.033), during school holidays (p<0.001), on days with higher temperatures (p<0.001), when there were no COVID restrictions (p<0.001), post-COVID (p<0.001) and in summer vs winter and spring (p=0.015, p<0.001). Primary school children were more likely to be bitten in the most deprived areas (p<0.001), densely populated areas (p=0.002), and summer months (p<0.001).</div></div><div><h3>Conclusions</h3><div>These findings suggest that public health campaigns aimed at awareness surrounding the higher risk of dog bites in socially deprived areas, on warmer days, school holidays, on weekends and during the summer may help to reduce the burden of dog bites in Wales.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 428-434"},"PeriodicalIF":2.4,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Doppler ultrasound versus computed tomography angiography prior to deep inferior epigastric perforator flap breast reconstruction: An updated systematic review and meta-analysis 多普勒超声与腹部下穿支皮瓣乳房重建前的计算机断层血管造影：最新的系统回顾和荟萃分析。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.053

Bernardo Gabriele Collaco , Raquel Nogueira , Pedro Lucas Machado Magalhães , Syed Ali Haider , Gabriel Cavalcante Lima Chagas , Amanda Rangel , Bruno Lins de Souza , Alessandra Marjorye Maia Leitão , Adekunle I. Elegbede

Background

Preoperative perforator mapping is essential for optimizing outcomes in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Computed tomography angiography (CTA) and Doppler ultrasound (US) are widely used, but their relative effectiveness remains uncertain. Previous reviews were limited by small numbers of randomized trials and inconsistent outcome reporting.

Methods

PubMed, Embase, and Cochrane Library were searched through May 2025. Eligible studies compared CTA imaging with Doppler US, reporting flap loss, reoperation, or operative time. Risk of bias was assessed using RoB 2 and ROBINS-I. Subgroup and sensitivity analyses explored heterogeneity and study design effects.

Results

Twelve studies involving 1784 patients were included, incorporating two additional RCTs in comparison with previous meta-analyses. CTA was associated with lower flap loss (RR 0.37; 95% CI 0.18–0.78) and reoperation rates (RR 0.55; 95% CI 0.33–0.89), and shorter operative time (MD –65 min; 95% CI –101 to –29) compared to Doppler US. This review is the first to meta-analyze reoperation as an endpoint and provide comprehensive sensitivity analyses, confirming the robustness of the findings. Subgroup analyses revealed that observed benefits were driven largely by observational studies, whereas pooled RCTs did not show significant differences.

Conclusions

This expanded review strengthens prior evidence by including additional RCTs, analyzing reoperation as a key outcome, and applying more rigorous subgroup and sensitivity approaches. CTA appears to improve efficiency and reduce complications, but randomized evidence remains limited. CTA and Doppler US may be appropriate depending on surgeon expertise and institutional resources, highlighting the need for larger, high-quality RCTs.

背景：术前穿支定位是优化上腹部深下穿支（DIEP）皮瓣乳房重建效果的关键。计算机断层血管造影（CTA）和多普勒超声（US）被广泛使用，但它们的相对有效性仍不确定。先前的综述受到随机试验数量少和结果报告不一致的限制。方法：检索至2025年5月的PubMed、Embase和Cochrane图书馆。符合条件的研究比较了CTA成像与多普勒超声，报告皮瓣丢失、再手术或手术时间。使用rob2和ROBINS-I评估偏倚风险。亚组分析和敏感性分析探讨了异质性和研究设计效果。结果：纳入了12项研究，涉及1784例患者，与先前的荟萃分析相比，纳入了2项额外的rct。与多普勒超声相比，CTA与较低的皮瓣损失（RR 0.37; 95% CI 0.18-0.78）和再手术率（RR 0.55; 95% CI 0.33-0.89）以及较短的手术时间（MD -65分钟；95% CI -101至-29）相关。这篇综述首次以再手术为终点进行meta分析，并提供了全面的敏感性分析，证实了研究结果的稳健性。亚组分析显示，观察到的益处主要是由观察性研究驱动的，而合并的随机对照试验没有显示出显著差异。结论：通过纳入额外的随机对照试验，分析再手术作为关键结果，并采用更严格的亚组和敏感性方法，本扩展的综述加强了先前的证据。CTA似乎可以提高效率并减少并发症，但随机证据仍然有限。CTA和多普勒超声可能是合适的，这取决于外科医生的专业知识和机构资源，强调需要更大、高质量的随机对照试验。

{"title":"Doppler ultrasound versus computed tomography angiography prior to deep inferior epigastric perforator flap breast reconstruction: An updated systematic review and meta-analysis","authors":"Bernardo Gabriele Collaco , Raquel Nogueira , Pedro Lucas Machado Magalhães , Syed Ali Haider , Gabriel Cavalcante Lima Chagas , Amanda Rangel , Bruno Lins de Souza , Alessandra Marjorye Maia Leitão , Adekunle I. Elegbede","doi":"10.1016/j.bjps.2025.11.053","DOIUrl":"10.1016/j.bjps.2025.11.053","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative perforator mapping is essential for optimizing outcomes in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Computed tomography angiography (CTA) and Doppler ultrasound (US) are widely used, but their relative effectiveness remains uncertain. Previous reviews were limited by small numbers of randomized trials and inconsistent outcome reporting.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane Library were searched through May 2025. Eligible studies compared CTA imaging with Doppler US, reporting flap loss, reoperation, or operative time. Risk of bias was assessed using RoB 2 and ROBINS-I. Subgroup and sensitivity analyses explored heterogeneity and study design effects.</div></div><div><h3>Results</h3><div>Twelve studies involving 1784 patients were included, incorporating two additional RCTs in comparison with previous meta-analyses. CTA was associated with lower flap loss (RR 0.37; 95% CI 0.18–0.78) and reoperation rates (RR 0.55; 95% CI 0.33–0.89), and shorter operative time (MD –65 min; 95% CI –101 to –29) compared to Doppler US. This review is the first to meta-analyze reoperation as an endpoint and provide comprehensive sensitivity analyses, confirming the robustness of the findings. Subgroup analyses revealed that observed benefits were driven largely by observational studies, whereas pooled RCTs did not show significant differences.</div></div><div><h3>Conclusions</h3><div>This expanded review strengthens prior evidence by including additional RCTs, analyzing reoperation as a key outcome, and applying more rigorous subgroup and sensitivity approaches. CTA appears to improve efficiency and reduce complications, but randomized evidence remains limited. CTA and Doppler US may be appropriate depending on surgeon expertise and institutional resources, highlighting the need for larger, high-quality RCTs.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 532-543"},"PeriodicalIF":2.4,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A practical method for flap perforator selection: Qualitative hemodynamic evaluation with conventional and portable ultrasound 一种实用的皮瓣穿支选择方法：常规和便携式超声定性血流动力学评价。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.056

Paloma Malagón , Takumi Yamamoto

引用次数: 0

Patient-reported outcomes and complications of flexor tendon tenolysis following prior A1 pulley release: A cohort of 139 patients 先前A1滑轮释放后屈肌腱松解的患者报告的结果和并发症：139例患者队列。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-27 DOI: 10.1016/j.bjps.2025.11.057

Jaimy E. Koopman , Caroline A. Hundepool , Jeroen Smit , Robbert M. Wouters , Ruud W. Selles , J. Michiel Zuidam , Hand-Wrist Study Group

Background

Following surgical A1 pulley release, approximately 0.5% of patients require reoperation due to flexor tendon adhesions. However, literature evaluating outcomes following flexor tendon tenolysis is scarce.

Objective

This study assessed the effectiveness and safety of tenolysis following prior A1 pulley release.

Methods

This is a cohort study of patients who underwent tenolysis following A1 pulley release. We included patients who completed baseline questionnaires, the Michigan Hand outcomes Questionnaire (MHQ), and Satisfaction with the Treatment Result questionnaire at 3 months postoperatively. Additionally, we retrospectively reviewed medical records to identify postoperative complications.

Results

Our cohort of 139 patients demonstrated an improvement in self-reported hand function and pain from baseline to 3 months postoperatively, although individual outcomes varied considerably. For example, 60% of patients demonstrated an improvement exceeding the minimally important change, whereas 20% demonstrated a deterioration in MHQ scores. Furthermore, 10% of patients underwent reoperation, the majority of which were repeat tenolysis.

Discussion

This study shows that tenolysis, on an average, resulted in a clinically relevant improvement in hand function and pain in short- and long-term, although individual outcomes varied considerably. Additionally, 10% of patients underwent another reoperation, the majority of which were repeat tenolysis. These findings underscore the challenges associated with tenolysis procedures. Further insight into factors contributing to the failure of tenolysis procedures is needed to improve the selection of patients that may benefit from tenolysis following A1 pulley release.

Level of evidence

III

背景：手术解除A1滑轮后，大约0.5%的患者由于屈肌腱粘连需要再次手术。然而，评估屈肌腱松解后结果的文献很少。目的：本研究评估先前A1滑轮松解后肌腱松解的有效性和安全性。方法：这是一项针对A1滑轮释放后肌腱松解的患者的队列研究。我们纳入了在术后3个月完成基线问卷、密歇根手结局问卷（MHQ）和治疗结果满意度问卷的患者。此外，我们回顾了医疗记录，以确定术后并发症。结果：我们的139例患者队列显示，自基线到术后3个月，自我报告的手功能和疼痛有所改善，尽管个体结果差异很大。例如，60%的患者表现出的改善超过了最低限度的重要变化，而20%的患者表现出MHQ评分的恶化。此外，10%的患者再次手术，其中大多数是重复肌腱松解。讨论：本研究表明，平均而言，肌腱松解术可导致短期和长期手部功能和疼痛的临床相关改善，尽管个体结果差异很大。此外，10%的患者再次接受手术，其中大多数是重复肌腱松解。这些发现强调了与肌腱松解术相关的挑战。需要进一步了解导致肌腱松解手术失败的因素，以改进选择可能受益于A1滑轮释放后肌腱松解的患者。证据水平：III。

{"title":"Patient-reported outcomes and complications of flexor tendon tenolysis following prior A1 pulley release: A cohort of 139 patients","authors":"Jaimy E. Koopman , Caroline A. Hundepool , Jeroen Smit , Robbert M. Wouters , Ruud W. Selles , J. Michiel Zuidam , Hand-Wrist Study Group","doi":"10.1016/j.bjps.2025.11.057","DOIUrl":"10.1016/j.bjps.2025.11.057","url":null,"abstract":"<div><h3>Background</h3><div>Following surgical A1 pulley release, approximately 0.5% of patients require reoperation due to flexor tendon adhesions. However, literature evaluating outcomes following flexor tendon tenolysis is scarce.</div></div><div><h3>Objective</h3><div>This study assessed the effectiveness and safety of tenolysis following prior A1 pulley release.</div></div><div><h3>Methods</h3><div>This is a cohort study of patients who underwent tenolysis following A1 pulley release. We included patients who completed baseline questionnaires, the Michigan Hand outcomes Questionnaire (MHQ), and Satisfaction with the Treatment Result questionnaire at 3 months postoperatively. Additionally, we retrospectively reviewed medical records to identify postoperative complications.</div></div><div><h3>Results</h3><div>Our cohort of 139 patients demonstrated an improvement in self-reported hand function and pain from baseline to 3 months postoperatively, although individual outcomes varied considerably. For example, 60% of patients demonstrated an improvement exceeding the minimally important change, whereas 20% demonstrated a deterioration in MHQ scores. Furthermore, 10% of patients underwent reoperation, the majority of which were repeat tenolysis.</div></div><div><h3>Discussion</h3><div>This study shows that tenolysis, on an average, resulted in a clinically relevant improvement in hand function and pain in short- and long-term, although individual outcomes varied considerably. Additionally, 10% of patients underwent another reoperation, the majority of which were repeat tenolysis. These findings underscore the challenges associated with tenolysis procedures. Further insight into factors contributing to the failure of tenolysis procedures is needed to improve the selection of patients that may benefit from tenolysis following A1 pulley release.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 411-418"},"PeriodicalIF":2.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying transfusion criteria and risk factors after deep inferior epigastric artery perforator flap breast reconstruction 腹下深动脉穿支皮瓣乳房重建术后输血标准及危险因素的探讨。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-26 DOI: 10.1016/j.bjps.2025.11.049

Brian Chen , Rocio Castillo-Larios , Sean K. Park , Erin R. Suydam , Martin I. Newman

Background

Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction depends on perfusion and outflow through microvascular anastomoses. Preoperative anemia is predictive of transfusion and increased complications; however, transfusion is also linked to thrombosis. Moreover, guidelines for transfusion after DIEP flaps are not established. We aimed to identify a safe hemoglobin level after DIEP flaps and identify risk factors and complications associated with transfusion.

Methods

A retrospective study was performed for DIEP flap breast reconstruction patients over 5 years. Patient characteristics and postoperative variables were gathered. Outcomes included 30-day complications, surgical takebacks, microvascular thrombosis, and flap loss. Descriptive statistics and receiver operating characteristic curve were used to determine the lowest hemoglobin (Hb) cutoff where complications increased.

Results

Overall, 156 patients (239 flaps) underwent DIEP flap reconstruction. Transfused patients were younger, had lower preoperative Hb, longer surgery, higher blood loss, immediate reconstruction, bilateral reconstruction, and lower postoperative Hb. They had increased 30-day complications and more surgical takebacks, and higher rates of microvascular thromboses, though no increased flap loss. Receiver operating characteristic curve identified an Hb of 8.3, below which more complications were seen.

Conclusion

Among patients with high-risk characteristics undergoing DIEP flap reconstruction, there is the possibility for transfusion and associated complications. Withholding transfusion for hemodynamically stable patients with Hb >8.3 appears to be safe. Lower Hb is associated with increased transfusion and complications; however, when managed appropriately, it does not increase flap loss.

背景：腹下深动脉穿支（DIEP）皮瓣乳房重建依赖于微血管吻合口灌注和流出。术前贫血预示输血和并发症增加；然而，输血也与血栓形成有关。此外，DIEP皮瓣后的输血指南尚未建立。我们的目的是确定DIEP皮瓣后的安全血红蛋白水平，并确定输血相关的危险因素和并发症。方法：对5年以上DIEP皮瓣乳房重建术患者进行回顾性研究。收集患者特征和术后变量。结果包括30天并发症、手术撤回、微血管血栓形成和皮瓣丢失。描述性统计和受试者工作特征曲线用于确定并发症增加时的最低血红蛋白（Hb）临界值。结果：156例患者（239个皮瓣）接受了DIEP皮瓣重建。输血患者较年轻，术前Hb较低，手术时间较长，出血量较高，立即重建，双侧重建，术后Hb较低。他们的30天并发症增加，手术回复率更高，微血管血栓发生率更高，但皮瓣损失没有增加。受试者工作特征曲线显示Hb为8.3，低于此值可出现更多并发症。结论：具有高危特征的患者行DIEP皮瓣重建术，存在输血及相关并发症的可能性。对于血流动力学稳定的Hb b> 8.3患者，停止输血似乎是安全的。较低的Hb与输血和并发症增加有关；然而，如果处理得当，它不会增加皮瓣损失。

{"title":"Identifying transfusion criteria and risk factors after deep inferior epigastric artery perforator flap breast reconstruction","authors":"Brian Chen , Rocio Castillo-Larios , Sean K. Park , Erin R. Suydam , Martin I. Newman","doi":"10.1016/j.bjps.2025.11.049","DOIUrl":"10.1016/j.bjps.2025.11.049","url":null,"abstract":"<div><h3>Background</h3><div>Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction depends on perfusion and outflow through microvascular anastomoses. Preoperative anemia is predictive of transfusion and increased complications; however, transfusion is also linked to thrombosis. Moreover, guidelines for transfusion after DIEP flaps are not established. We aimed to identify a safe hemoglobin level after DIEP flaps and identify risk factors and complications associated with transfusion.</div></div><div><h3>Methods</h3><div>A retrospective study was performed for DIEP flap breast reconstruction patients over 5 years. Patient characteristics and postoperative variables were gathered. Outcomes included 30-day complications, surgical takebacks, microvascular thrombosis, and flap loss. Descriptive statistics and receiver operating characteristic curve were used to determine the lowest hemoglobin (Hb) cutoff where complications increased.</div></div><div><h3>Results</h3><div>Overall, 156 patients (239 flaps) underwent DIEP flap reconstruction. Transfused patients were younger, had lower preoperative Hb, longer surgery, higher blood loss, immediate reconstruction, bilateral reconstruction, and lower postoperative Hb. They had increased 30-day complications and more surgical takebacks, and higher rates of microvascular thromboses, though no increased flap loss. Receiver operating characteristic curve identified an Hb of 8.3, below which more complications were seen.</div></div><div><h3>Conclusion</h3><div>Among patients with high-risk characteristics undergoing DIEP flap reconstruction, there is the possibility for transfusion and associated complications. Withholding transfusion for hemodynamically stable patients with Hb >8.3 appears to be safe. Lower Hb is associated with increased transfusion and complications; however, when managed appropriately, it does not increase flap loss.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 382-388"},"PeriodicalIF":2.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Physician perspectives on breast implant illness: A survey of members of the American Society of Plastic Surgeons 医生对乳房植入疾病的看法：美国整形外科学会成员的调查。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-24 DOI: 10.1016/j.bjps.2025.11.050

Kimberly H. Khoo, Lorreen Agandi, Arya A. Akhavan, Rafael Felix P. Tiongco, Joseph Puthumana, Leen El Eter, Alexander H. Sun, Michele A. Manahan , Carisa M. Cooney

Purpose

Increasing patient reports of breast implant illness (BII), a broad constellation of symptoms noted by certain patients with breast implants, has prompted the plastic surgery community to explore this clinical entity. Although current research has investigated patient perspectives, few studies have examined physician opinions. We aimed to understand plastic surgeons’ perspectives on BII and management patterns for patients presenting with these concerns.

Methods

We distributed an IRB-approved survey to a pilot cohort comprising two American Society of Plastic Surgeons (ASPS) subcommittees and, subsequently, to a cohort of ASPS general members. Surveys were distributed via Survey Monkey from September to October 2021 (pilot), then from December 2021 to January 2022. Survey responses were analyzed using descriptive statistics and qualitative coding by one reviewer using thematic analysis.

Results

A total of 62 (60.7%) and 589 responses (11.9%) were received from the pilot and member cohorts, respectively. In both cohorts, the largest portion of respondents identified as men who worked in large metropolitan areas. Respondents disagreed that current data suggest BII as a distinct clinical entity (pilot: 40.4%, n=25; final: 40.8%, n=213) and personally disagreed that BII exists (pilot: 37.1%, n=23; final: 50.9%, n=266). Most respondents had previously seen a patient who believed themselves to have BII (pilot: 88.7%, n=55; final: 94.1%, n=492).

Conclusion

Although no consensus defining BII as a distinct disease exists, plastic surgeons are encountering patients seeking relief from its symptoms. Understanding surgeons’ opinions on BII at the member leadership levels can guide future research and efforts for patient counseling.

目的：越来越多的患者报告乳房植入物疾病（BII），某些乳房植入物患者注意到的广泛症状，促使整形外科社区探索这一临床实体。虽然目前的研究调查了患者的观点，但很少有研究调查了医生的观点。我们的目的是了解整形外科医生对BII的看法以及对出现这些问题的患者的管理模式。方法：我们向由两个美国整形外科学会（ASPS）小组委员会组成的试点队列分发了一份irb批准的调查，随后分发给ASPS普通成员队列。2021年9月至10月（试点），2021年12月至2022年1月，通过Survey Monkey进行调查。调查结果分析使用描述性统计和定性编码由一个审稿人使用专题分析。结果：从试点队列和成员队列中分别收到62份（60.7%）和589份（11.9%）回复。在这两个群体中，大部分受访者都是在大城市工作的男性。受访者不同意目前的数据表明BII是一个独特的临床实体（试点：40.4%,n=25；最终：40.8%,n=213），个人不同意BII的存在（试点：37.1%,n=23；最终：50.9%,n=266）。大多数应答者以前曾见过认为自己患有BII的患者（试点：88.7%,n=55；最终：94.1%,n=492）。结论：尽管没有将BII定义为一种独特的疾病的共识，但整形外科医生遇到了寻求缓解其症状的患者。在成员领导层面了解外科医生对BII的意见可以指导未来的研究和患者咨询工作。

{"title":"Physician perspectives on breast implant illness: A survey of members of the American Society of Plastic Surgeons","authors":"Kimberly H. Khoo, Lorreen Agandi, Arya A. Akhavan, Rafael Felix P. Tiongco, Joseph Puthumana, Leen El Eter, Alexander H. Sun, Michele A. Manahan , Carisa M. Cooney","doi":"10.1016/j.bjps.2025.11.050","DOIUrl":"10.1016/j.bjps.2025.11.050","url":null,"abstract":"<div><h3>Purpose</h3><div>Increasing patient reports of breast implant illness (BII), a broad constellation of symptoms noted by certain patients with breast implants, has prompted the plastic surgery community to explore this clinical entity. Although current research has investigated patient perspectives, few studies have examined physician opinions. We aimed to understand plastic surgeons’ perspectives on BII and management patterns for patients presenting with these concerns.</div></div><div><h3>Methods</h3><div>We distributed an IRB-approved survey to a pilot cohort comprising two American Society of Plastic Surgeons (ASPS) subcommittees and, subsequently, to a cohort of ASPS general members. Surveys were distributed via Survey Monkey from September to October 2021 (pilot), then from December 2021 to January 2022. Survey responses were analyzed using descriptive statistics and qualitative coding by one reviewer using thematic analysis.</div></div><div><h3>Results</h3><div>A total of 62 (60.7%) and 589 responses (11.9%) were received from the pilot and member cohorts, respectively. In both cohorts, the largest portion of respondents identified as men who worked in large metropolitan areas. Respondents disagreed that current data suggest BII as a distinct clinical entity (pilot: 40.4%, n=25; final: 40.8%, n=213) and personally disagreed that BII exists (pilot: 37.1%, n=23; final: 50.9%, n=266). Most respondents had previously seen a patient who believed themselves to have BII (pilot: 88.7%, n=55; final: 94.1%, n=492).</div></div><div><h3>Conclusion</h3><div>Although no consensus defining BII as a distinct disease exists, plastic surgeons are encountering patients seeking relief from its symptoms. Understanding surgeons’ opinions on BII at the member leadership levels can guide future research and efforts for patient counseling.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 342-352"},"PeriodicalIF":2.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative effectiveness of corticosteroid injections for trigger finger: A systematic review of randomized controlled trials 皮质类固醇注射治疗扳机指的比较有效性：随机对照试验的系统回顾

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-23 DOI: 10.1016/j.bjps.2025.11.047

Gabriel Kuper , Dylan Da Silva , Matthew Carr , Erin Brown

Background

Trigger finger is a common condition marked by painful catching or locking of a digit during motion. Although corticosteroid injections (CSIs) are widely used, there is limited consensus on the optimal corticosteroid type, dose, injection technique, or use of adjunctive therapies. This systematic review examined the effectiveness and safety of methylprednisolone and triamcinolone in achieving symptom remission.

Methods

A systematic search was conducted across PubMed, Embase, and MEDLINE from inception to May 2024. Inclusion criteria focused on randomized controlled trials (RCTs) evaluating methylprednisolone or triamcinolone in adults with trigger finger. The primary outcome was symptom remission, defined as the resolution of triggering and functional impairment. Data extraction and risk-of-bias assessments were performed in duplicate using the Revised Cochrane Risk-of-Bias Tool.

Results

Thirteen RCTs, including 1116 patients (1153 digits), were analyzed. Methylprednisolone showed higher overall remission (83.6%) than triamcinolone (44.8%), with consistent efficacy across doses and techniques. Although higher doses of triamcinolone improved outcomes, a statistically significant dose-response relationship was not found. Injection technique (ultrasound-guided vs blind; intra-sheath vs extra-sheath) did not significantly influence outcomes. Secondary injections improved outcomes in partial responders. Adverse events occurred in 2.8% of triamcinolone patients (e.g., skin atrophy, steroid flare) and were not reported for methylprednisolone.

Conclusion

Methylprednisolone appeared more effective and better tolerated than triamcinolone in trigger finger treatment. Injection technique and adjunctive therapies, such as splinting, had a limited impact on outcomes. Further research is needed to tailor treatment to individual patient characteristics.

Systematic review

Level I

扳机指是一种常见的情况，其特征是在运动时手指被抓或锁住时疼痛。尽管皮质类固醇注射（CSIs）被广泛使用，但对于皮质类固醇的最佳类型、剂量、注射技术或辅助治疗的使用，人们的共识有限。本系统综述检查了甲基强的松龙和曲安奈德在实现症状缓解方面的有效性和安全性。方法系统检索PubMed、Embase和MEDLINE自建站至2024年5月的相关文献。纳入标准侧重于随机对照试验（rct）评估甲基强的松龙或曲安奈德治疗成人扳机指。主要结局是症状缓解，定义为触发和功能障碍的解决。数据提取和偏倚风险评估采用经修订的Cochrane偏倚风险评估工具一式两份进行。结果共纳入13项随机对照试验，包括1116例患者（1153指）。甲基强的松龙的总体缓解率（83.6%）高于曲安奈德（44.8%），在不同剂量和技术下均具有一致的疗效。虽然高剂量曲安奈德改善了结果，但没有发现统计学上显著的剂量-反应关系。注射技术（超声引导vs盲注射；鞘内vs鞘外注射）对结果没有显著影响。二次注射改善了部分应答者的预后。不良事件发生在2.8%的曲安奈德患者中（例如，皮肤萎缩，类固醇发作），甲基强的松龙未见报道。结论甲强的松龙治疗扳机指比曲安奈德更有效，耐受性更好。注射技术和辅助治疗，如夹板，对结果的影响有限。需要进一步的研究来根据患者的个体特征定制治疗方案。系统评价

{"title":"Comparative effectiveness of corticosteroid injections for trigger finger: A systematic review of randomized controlled trials","authors":"Gabriel Kuper , Dylan Da Silva , Matthew Carr , Erin Brown","doi":"10.1016/j.bjps.2025.11.047","DOIUrl":"10.1016/j.bjps.2025.11.047","url":null,"abstract":"<div><h3>Background</h3><div>Trigger finger is a common condition marked by painful catching or locking of a digit during motion. Although corticosteroid injections (CSIs) are widely used, there is limited consensus on the optimal corticosteroid type, dose, injection technique, or use of adjunctive therapies. This systematic review examined the effectiveness and safety of methylprednisolone and triamcinolone in achieving symptom remission.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across PubMed, Embase, and MEDLINE from inception to May 2024. Inclusion criteria focused on randomized controlled trials (RCTs) evaluating methylprednisolone or triamcinolone in adults with trigger finger. The primary outcome was symptom remission, defined as the resolution of triggering and functional impairment. Data extraction and risk-of-bias assessments were performed in duplicate using the Revised Cochrane Risk-of-Bias Tool.</div></div><div><h3>Results</h3><div>Thirteen RCTs, including 1116 patients (1153 digits), were analyzed. Methylprednisolone showed higher overall remission (83.6%) than triamcinolone (44.8%), with consistent efficacy across doses and techniques. Although higher doses of triamcinolone improved outcomes, a statistically significant dose-response relationship was not found. Injection technique (ultrasound-guided vs blind; intra-sheath vs extra-sheath) did not significantly influence outcomes. Secondary injections improved outcomes in partial responders. Adverse events occurred in 2.8% of triamcinolone patients (e.g., skin atrophy, steroid flare) and were not reported for methylprednisolone.</div></div><div><h3>Conclusion</h3><div>Methylprednisolone appeared more effective and better tolerated than triamcinolone in trigger finger treatment. Injection technique and adjunctive therapies, such as splinting, had a limited impact on outcomes. Further research is needed to tailor treatment to individual patient characteristics.</div><div>Systematic review</div><div>Level I</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 332-341"},"PeriodicalIF":2.4,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0