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

Thighs lift in the post-bariatric patient – A systematic review 减肥后患者的大腿移位术--系统性综述

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.bjps.2024.09.011

Background

Thigh lift, first described by Lewis in 1957, consists of thigh recontouring by various strategies. In post-bariatric thigh lift (PBTL), the technical details become fundamental due to both patient comorbidities and increased risk of complications. Moreover, post-bariatric weight loss affects the thighs, resulting in significant tissue redundancy, inner excess, lower thigh deformity, later excess, and buttocks ptosis. With the present paper, a systematic review of PBTL procedures is reported and a comprehensive classification system is proposed, aiming to improve their medical and surgical management.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was carried out by searching the PubMed (MEDLINE) database from May 2004 to May 2024 using the search string “thighplasty OR thigh lift OR post-bariatric thighplasty OR (thigh lift AND weight loss) OR (thigh lift AND liposuction)”. Original studies discussing PBTL with a minimum of three clinical cases were eligible for inclusion.

Results

The final synthesis included 17 articles and 496 patients. The articles were published in the last 20 years. Several papers discussed significant PBTL surgical strategies and technical measures.

Conclusions

PBTL is challenging because of both technical factors and complex comorbidities of post-bariatric patients. This comprehensive assessment of PBTL may help in choosing the appropriate treatment based on a patient’s individual needs. Liposuction-assisted inner thigh lift with combined horizontal-vertical scars and skin-only excision is effective and versatile for most patients. However, select cases may benefit from alternative and more invasive strategies. Artificial intelligence is a topic of growing interest, and it will probably become increasingly relevant in PBTL.

背景1957年，刘易斯（Lewis）首次描述了大腿移位术，它包括通过各种策略对大腿进行重塑。在减肥后大腿提升术（PBTL）中，由于患者的合并症和并发症风险的增加，技术细节变得至关重要。此外，减肥后体重下降会影响大腿，导致大腿组织明显冗余、内侧赘肉、大腿下部畸形、后期赘肉和臀部下垂。本文报告了对 PBTL 手术的系统性综述，并提出了一个全面的分类系统，旨在改善其医疗和手术管理。方法通过使用搜索字符串 "大腿成形术或大腿提升术或减肥后大腿成形术或（大腿提升术和减肥）或（大腿提升术和吸脂）"搜索 PubMed (MEDLINE) 数据库，对 2004 年 5 月至 2024 年 5 月期间的系统性综述（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）进行了系统性综述。对至少有三个临床病例的 PBTL 进行讨论的原创研究符合纳入条件。这些文章发表于过去 20 年。结论由于技术因素和减肥后患者复杂的合并症，PBTL 具有挑战性。对 PBTL 的全面评估有助于根据患者的个人需求选择合适的治疗方法。吸脂辅助大腿内侧提升术结合水平-垂直疤痕和单纯皮肤切除术，对大多数患者来说都是有效且通用的。然而，一些特定病例可能会受益于其他更具创伤性的策略。人工智能是一个越来越受关注的话题，它在 PBTL 中的作用可能会越来越大。

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引用次数: 0

The curious case of medical advisor: The house of cards in aesthetic medicine 医疗顾问的奇特案例：美容医学中的纸牌屋

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.020

引用次数: 0

Taps, wicks, bridges and LIFTs: Clarification on the origins of lymphatic flaps 水龙头、灯芯、桥梁和 LIFT：澄清淋巴瓣的起源

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.018

引用次数: 0

Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study 使用血管化纤维移植治疗股骨干和胫骨创伤后骨缺损后的长期效果和患者报告结果：回顾性队列和横断面调查研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.08.056

Objectives

Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts.

Methods

A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function.

Results

The median bone defect size was 8 cm (IQR 9–7 cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, p < 0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients.

Conclusion

Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.

目的创伤后临界大小骨缺损给整形外科医生带来了整形挑战。血管化腓骨移植是一种治疗股骨和胫骨骨缺损的成熟疗法。本研究旨在评估患者报告的长期生活质量、血管化腓骨移植物下肢重建的成功率和并发症发生率。方法回顾性队列纳入了1990年至2021年期间因创伤后胫骨和股骨头缺损而接受腓骨移植物重建治疗的29例临界大小骨缺损患者。为了评估与健康相关的生活质量以及重返工作岗位的情况和满意度，研究人员使用短表-36、下肢功能量表和自制问卷（包括 DN4、满意度和主观踝关节功能）进行了横断面调查。心理成分得分与荷兰人口标准值相当，而身体功能受损得分与疼痛相关（r 0.849，p <0.001）。19 名患者中有 7 名出现了神经病理性症状，19 名患者中有 11 名恢复了正常的日常活动。所有受访者对康复的总体满意度均为正面或中性。29 名患者中有 19 人的骨愈合顺利。29 位患者中有 25 位实现了骨结合。结论血管化腓骨移植术可使胫骨和股骨创伤后节段性骨缺失患者的骨愈合率和肢体挽救率提高。患者对整体恢复情况的满意度很高，但功能结果仍然受损。

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引用次数: 0

Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation 半颌畸形的综合治疗方法：正颌外科手术与按顺序定制的植入手术相结合。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.015

Objective

This study aimed to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult patients with hemifacial microsomia (HFM).

Methods

Six adults with HFM (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial computed tomography scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry.

Results

At T1, no significant differences were observed in skeletal movements compared with planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. After personalized implantation (T3), further significant improvements were observed in skeletal symmetry.

Conclusion

Combining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult patients with HFM, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.

研究目的本研究旨在评估将正颌手术与分期患者特异性植入体（PSI）相结合，对半颜面小畸形（HFM）成人患者的颅面部不对称进行全面重建的临床效果：六名成人半面小畸形患者（1 名 I 型，5 名 IIa 型）接受了正颌手术，以矫正骨骼错位和下巴偏斜。为解决颅面部不对称问题，患者接受了序列 PSI 植入术。在正颌手术前（T0）、正颌手术后三个月内（T1）、正颌手术后一年及个性化植入前（T2）和个性化植入后（T3）四个时间点采集了数字头颅侧位图和头颅计算机断层扫描。评估参数包括骨骼和牙槽骨测量、咬合角度、下巴偏差、骨骼稳定性和面部轮廓对称性：结果：在 T1 阶段，骨骼移动与计划的手术移动相比无明显差异（P > 0.05）。同样，在 T2 阶段，骨骼运动与 T1 阶段观察到的骨骼运动没有明显差异（P > 0.05），这表明手术的精确性和稳定性。对骨骼和牙槽骨参数、咬合角度和下巴偏差的分析表明，与T0相比，T1时的SNB、FH-NPo和ST N vert-Pog显著增加（p 0.05），表明术后稳定性很高。在个性化植入后（T3），骨骼对称性进一步得到显著改善：结论：将正颌手术与分期 PSIs 结合使用，可有效重建高频颌面整形术成年患者的颅面不对称，显著改善骨骼对齐、咬合倾斜和下巴偏斜，且术后效果稳定。

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引用次数: 0

DaxibotulinumtoxinA for injection to treat moderate or severe glabellar lines: A randomized, multicenter, Phase III, double-blind, placebo-controlled trial in China 用于注射治疗中度或重度川字纹的达希布毒毒素 A：中国一项随机、多中心、III期、双盲、安慰剂对照试验

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.012

Background

DaxibotulinumtoxinA for injection (DAXI), a novel botulinum toxin type A formulation, is FDA-approved for glabellar lines treatment. Its clinical efficacy has been demonstrated in two Phase III trials (SAKURA 1 and SAKURA 2).

Objective

To evaluate DAXI efficacy and safety in Chinese adults with moderate/severe glabellar lines.

Methods

In this Phase III, randomized (2:1), double-blind trial, Chinese adults with moderate/severe glabellar lines received 40 U DAXI or placebo into the corrugator muscles bilaterally and the procerus. Glabellar line severity was evaluated by investigators (Investigator Global Assessment-Frown Wrinkle Severity [IGA-FWS] scale) and participants (Patient Frown Wrinkle Severity [PFWS] scale) for ≥24 to 36 weeks. The primary endpoint was the proportion of 2-point composite responders achieving ≥2-point reduction in IGA-FWS and PFWS scores at week 4 post-treatment.

Results

Overall, 307 participants received treatment (DAXI, 205; placebo, 102). A significantly greater proportion of participants in the DAXI arm vs the placebo arm achieved a 2-point composite response at week 4: 125 (61.0%) vs 1 (1.0%); difference, 60.0% [95% CI 49.40–66.46]; 2-sided p < 0.0001). At week 4, 94.1% of the DAXI-treated participants achieved an IGA-FWS score 0/1 (none/mild) and 86.3% achieved PFWS 0/1; median time to loss of none/mild on IGA-FWS and PFWS was 23.9 weeks. The benefits of DAXI over placebo through week 24 occurred regardless of the baseline IGA-FWS score, prior botulinum toxin type A (BoNTA) exposure, sex or age. DAXI was well tolerated with no new safety signals.

Conclusion

DAXI provided durable efficacy and acceptable safety for treating moderate/severe glabellar lines in Chinese participants.

背景注射用A型肉毒杆菌毒素（DAXI）是一种新型A型肉毒杆菌毒素制剂，已被美国食品与药物管理局批准用于治疗眉间纹。方法在这项随机（2:1）、双盲的 III 期试验中，患有中度/重度川字纹的中国成年人接受了 40 U DAXI 或安慰剂注射。在≥24至36周的时间内，由研究人员（研究人员全球评估-皱眉严重程度[IGA-FWS]量表）和参与者（患者皱眉严重程度[PFWS]量表）对睑板纹严重程度进行评估。主要终点是治疗后第4周IGA-FWS和PFWS评分减少≥2分的2分复合应答者的比例。结果共有307名参与者接受了治疗（DAXI，205人；安慰剂，102人）。DAXI治疗组与安慰剂治疗组相比，在第4周达到2分综合反应的人数比例明显更高：125人（61.0%）对1人（1.0%）；差异为60.0% [95% CI 49.40-66.46]；双侧P< 0.0001）。第4周时，94.1%接受DAXI治疗的患者IGA-FWS评分达到0/1（无/轻度），86.3%的患者PFWS评分达到0/1；IGA-FWS和PFWS评分达到无/轻度的中位时间为23.9周。无论基线IGA-FWS评分、之前是否接触过A型肉毒毒素（BoNTA）、性别或年龄如何，DAXI在第24周时的疗效均优于安慰剂。DAXI的耐受性良好，没有出现新的安全信号。结论DAXI对治疗中国参试者的中度/重度川字纹具有持久疗效和可接受的安全性。

{"title":"DaxibotulinumtoxinA for injection to treat moderate or severe glabellar lines: A randomized, multicenter, Phase III, double-blind, placebo-controlled trial in China","authors":"","doi":"10.1016/j.bjps.2024.09.012","DOIUrl":"10.1016/j.bjps.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>DaxibotulinumtoxinA for injection (DAXI), a novel botulinum toxin type A formulation, is FDA-approved for glabellar lines treatment. Its clinical efficacy has been demonstrated in two Phase III trials (SAKURA 1 and SAKURA 2).</div></div><div><h3>Objective</h3><div>To evaluate DAXI efficacy and safety in Chinese adults with moderate/severe glabellar lines.</div></div><div><h3>Methods</h3><div>In this Phase III, randomized (2:1), double-blind trial, Chinese adults with moderate/severe glabellar lines received 40 U DAXI or placebo into the corrugator muscles bilaterally and the procerus. Glabellar line severity was evaluated by investigators (Investigator Global Assessment-Frown Wrinkle Severity [IGA-FWS] scale) and participants (Patient Frown Wrinkle Severity [PFWS] scale) for ≥24 to 36 weeks. The primary endpoint was the proportion of 2-point composite responders achieving ≥2-point reduction in IGA-FWS and PFWS scores at week 4 post-treatment.</div></div><div><h3>Results</h3><div>Overall, 307 participants received treatment (DAXI, 205; placebo, 102). A significantly greater proportion of participants in the DAXI arm vs the placebo arm achieved a 2-point composite response at week 4: 125 (61.0%) vs 1 (1.0%); difference, 60.0% [95% CI 49.40–66.46]; 2-sided p < 0.0001). At week 4, 94.1% of the DAXI-treated participants achieved an IGA-FWS score 0/1 (none/mild) and 86.3% achieved PFWS 0/1; median time to loss of none/mild on IGA-FWS and PFWS was 23.9 weeks. The benefits of DAXI over placebo through week 24 occurred regardless of the baseline IGA-FWS score, prior botulinum toxin type A (BoNTA) exposure, sex or age. DAXI was well tolerated with no new safety signals.</div></div><div><h3>Conclusion</h3><div>DAXI provided durable efficacy and acceptable safety for treating moderate/severe glabellar lines in Chinese participants.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358068","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

Contralateral submental artery island flap for oral tongue reconstruction — a retrospective study in patients with oral tongue squamous cell carcinoma 用于口腔舌重建的对侧下颌动脉岛状皮瓣--对口腔舌鳞癌患者的回顾性研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.005

Background

Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related deaths in developing countries. The oral tongue is the most common site involved by OSCC. About one-third of the patients have neck nodal metastasis at presentation. Oral tongue reconstruction after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is an extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, submental flap harvesting based on contralateral facial vessels is possible without compromising oncological safety. This study discusses the feasibility and outcomes of contralateral submental artery island flap (SMIF) for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months.

Results

Of the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy before surgery. Thirty-three underwent bilateral neck dissection. Two patients had partial flap loss, which was managed conservatively. Five patients had either locoregional or distant recurrence, but none in the flap site. Three had pathological positive nodes at ipsilateral level 1b, and one had pathologically positive nodes at contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up.

Conclusion

In the properly selected patient, contralateral SMIF offers an oncologically safe and technically simpler alternative for free flap reconstruction.

背景口腔鳞状细胞癌（OSCC）是发展中国家癌症相关死亡的主要原因。口腔舌部是 OSCC 最常累及的部位。约三分之一的患者在发病时有颈部结节转移。癌症切除术后的口腔舌重建是适当康复的必要条件。对于不适合进行游离组织转移等长时间手术的患者，可采用局部皮瓣进行舌重建。下颌骨皮瓣是一种常用的选择。然而，当口腔底部广泛受累或同侧 1 级有大块结节病时，可以在不影响肿瘤安全性的情况下，根据对侧面部血管采集下额皮瓣。本研究通过对中位随访 8.5 个月的 34 例口腔舌癌患者进行回顾性系列研究，探讨了对侧门下动脉岛状皮瓣（SMIF）用于口腔舌癌切除术后重建的可行性和结果。33名患者接受了双侧颈部切除术。两名患者有部分皮瓣脱落，但采取了保守治疗。五名患者出现局部或远处复发，但均未在皮瓣部位复发。三名患者的同侧 1b 水平结节呈病理阳性，一名患者的对侧 1b 水平结节呈病理阳性。结论在经过适当选择的患者中，对侧 SMIF 为游离皮瓣重建提供了一种肿瘤学上安全、技术上简单的替代方法。

{"title":"Contralateral submental artery island flap for oral tongue reconstruction — a retrospective study in patients with oral tongue squamous cell carcinoma","authors":"","doi":"10.1016/j.bjps.2024.09.005","DOIUrl":"10.1016/j.bjps.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related deaths in developing countries. The oral tongue is the most common site involved by OSCC. About one-third of the patients have neck nodal metastasis at presentation. Oral tongue reconstruction after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is an extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, submental flap harvesting based on contralateral facial vessels is possible without compromising oncological safety. This study discusses the feasibility and outcomes of contralateral submental artery island flap (SMIF) for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months.</div></div><div><h3>Results</h3><div>Of the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy before surgery. Thirty-three underwent bilateral neck dissection. Two patients had partial flap loss, which was managed conservatively. Five patients had either locoregional or distant recurrence, but none in the flap site. Three had pathological positive nodes at ipsilateral level 1b, and one had pathologically positive nodes at contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up.</div></div><div><h3>Conclusion</h3><div>In the properly selected patient, contralateral SMIF offers an oncologically safe and technically simpler alternative for free flap reconstruction.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323401","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

Noninvasive visualization of the midline-crossing arterial variation in the deep inferior epigastric artery perforator flap using photoacoustic tomography for application in patients with abdominal scars 利用光声学断层扫描对腹部疤痕患者应用的下腹深动脉穿孔皮瓣中线交叉动脉变异进行无创观察

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.010

Background

The importance of the subcutaneous arterial network crossing the midline in transverse abdominal flaps has been reported. Photoacoustic tomography can be used to noninvasively visualize subcutaneous vascular networks. We applied this novel technology preoperatively in patients undergoing breast reconstruction to detect individual variations in the midline-crossing arteries.

Methods

Six patients scheduled to undergo breast reconstruction using free deep inferior epigastric artery perforator flaps were examined. Each scan of the 12 × 8-cm region took approximately 8 min. The accuracy of the tentative artery evaluation defined by photoacoustic tomography was compared with the arterial phase detected by intraoperative indocyanine green angiography. The number of perforator vessels used for the flap, surgical time for flap elevation, and perfusion area ratio were compared with those of the control group.

Results

The average match rate between tentative artery prediction by photoacoustic tomography and arterial-phase assessment by intraoperative angiography in five patients was 79.8%. Each midline-crossing artery showed individual variations. The photoacoustic tomography group (PAT-1 to 5) showed 1.8 perforators per flap, 163 min for flap elevation, and 93% perfusion area, with no significant differences from the control group (N = 5). A 63-year-old woman (PAT-6) with abdominal scars, including a midline abdominal incision, showed a preserved midline-crossing artery. The planned single perforator deep inferior epigastric perforator flap was successfully applied to the contralateral perfusion area.

Conclusions

Photoacoustic tomography noninvasively visualizes the subcutaneous midline-crossing arterial networks. Understanding individual vascular variations can support preoperative planning and surgical indication of abdominal flaps, especially in patients with postsurgical scars.

背景据报道，横向腹部皮瓣中穿越中线的皮下动脉网络非常重要。光声断层扫描可用于无创观察皮下血管网络。我们将这项新技术应用于乳房重建患者的术前检查，以检测中线交叉动脉的个体差异。每次扫描 12 × 8 厘米区域的时间约为 8 分钟。将光声断层扫描确定的暂定动脉评估的准确性与术中吲哚菁绿血管造影检测的动脉相位进行了比较。结果5例患者中，光声断层扫描的暂定动脉预测与术中血管造影的动脉相位评估的平均匹配率为79.8%。每条中线交叉动脉都有个体差异。光声断层组（PAT-1 至 5）显示每个皮瓣有 1.8 条穿孔动脉，皮瓣提升时间为 163 分钟，灌注面积为 93%，与对照组（N = 5）无明显差异。一名 63 岁的妇女（PAT-6）腹部有疤痕，包括腹部中线切口，但保留了一条中线交叉动脉。结论照片声学断层扫描可无创地观察皮下中线交叉动脉网络。了解个体血管变化有助于腹部皮瓣的术前规划和手术指征，尤其是对术后有疤痕的患者。

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引用次数: 0

Evolving role of staging CT scans during CT-angiography for DIEP flap reconstruction planning CT 血管造影术中分期 CT 扫描在 DIEP 皮瓣重建规划中不断发展的作用

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.bjps.2024.09.009

Background

Preoperative planning with CT-angiography (CTA) in deep inferior epigastric perforator (DIEP) flap reconstruction is an essential preoperative tool. The aim of this study was to describe the management of the incidental findings following the introduction and further modification of a combined CTA and CT-staging preoperative protocol which includes chest, abdomen, pelvis, and musculoskeletal system.

Material and methods

A retrospective case series of 292 patients (Group 1) with breast cancer who underwent DIEP flap between 2015 and 2019. This was followed by a re-assessment between 2019 and 2021 of 101 patients (Group 2) following modification of the staging-CT protocol to include only those patients who received chemotherapy. Group 1 included immediate and delayed reconstruction; whereas Group 2 included only the high-risk delayed reconstruction cases. Both groups had CT staging.

Result

Overall, 30% of Group 1, most likely those who had the delayed reconstruction, had findings which were recommended for further follow-up. This led to a change in staging of the high-risk patients only at the end of 2019 to those who underwent chemotherapy and had delayed reconstruction.

Briefly, 56.4% of Group 2 demonstrated incidental findings, 42.1% of them required repeat scanning, 7% were referred to other specialties, and 47.4% did not require further action. There were no cases of occult metastatic breast cancer in either series; however, 1% were diagnosed with de novo primary cancers at non breast sites only in the first series.

Conclusion

The screening of patients with asymptomatic breast cancer as part of CTA scanning prior to autologous reconstruction is not universally practiced and not supported by the NICE guidelines. This unit changed the practice to stop preoperative staging for low-risk patients by the end of 2019, and reserved it for the high-risk patient groups to reduce cost.

背景在下腹穿孔器（DIEP）皮瓣重建术中，使用 CT 血管造影术（CTA）制定术前计划是一项重要的术前工具。本研究旨在描述在引入并进一步修改包括胸部、腹部、骨盆和肌肉骨骼系统在内的联合 CTA 和 CT 分期术前方案后，对偶然发现的处理情况。材料和方法对 2015 年至 2019 年期间接受 DIEP 皮瓣手术的 292 例乳腺癌患者（第 1 组）进行回顾性病例系列研究。之后在 2019 年至 2021 年期间对 101 名患者（第 2 组）进行了重新评估，并修改了分期-CT 方案，仅纳入接受化疗的患者。第一组包括即刻重建和延迟重建，而第二组只包括高风险的延迟重建病例。结果总体而言，第一组中有 30% 的患者（很可能是那些接受了延迟重建的患者）的检查结果建议进一步随访。简而言之，第2组中56.4%的患者有偶然发现，其中42.1%的患者需要重复扫描，7%的患者被转诊到其他专科，47.4%的患者不需要采取进一步行动。两个系列中均无隐匿性转移性乳腺癌病例；但在第一个系列中，仅有1%的患者被诊断为非乳腺部位的新发原发性癌症。本单位改变了做法，在2019年底前停止对低风险患者进行术前分期，将其保留给高风险患者群体，以降低成本。

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引用次数: 0

Understanding the role of intraoperative hypothermia in perioperative opioid requirements in immediate implant-based breast reconstruction 了解术中低体温在假体乳房即刻重建围手术期阿片类药物需求中的作用

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-06 DOI: 10.1016/j.bjps.2024.08.074

Background

The relationship between perioperative temperatures and postoperative pain is unknown. The present study investigated the relationship of intraoperative hypothermia and perioperative opioid requirements after immediate implant-based breast reconstruction.

Methods

A retrospective chart review was conducted on patients undergoing immediate implant-based breast reconstruction from 2019–2023. Patients were classified into the hypothermic group (majority of procedure <36.0 °C) or normothermic group (majority of procedure ≥36.0 °C). Cumulative inpatient opioid requirements (morphine milli-equivalents [MMEs]) and frequency of patients requiring “high-dose opioids” (≥100 MMEs) were collected and compared between the groups.

Results

In total, 536 patients (835 breasts) were included, among whom 135 (25.1%) were hypothermic. The hypothermic group had lower mean intraoperative (88.4 vs. 99.1 MMEs, P = 0.007) and postoperative (45.6 vs. 56.8 MMEs, P = 0.006) than the normothermic group. Mean (B = 14.6, P = 0.004) and nadir (B = 10.4, P = 0.038) intraoperative temperatures directly predicted higher opioid requirements while higher percentages of the procedure time spent under 36 °C (B = −27.6, P = 0.004) predicted lower opioid requirements. The hypothermic group was associated with 66% decreased odds of requiring high-dose opioids after adjusting for differences in patient and operative characteristics (P = 0.007).

Conclusion

Hypothermia is associated with decreased perioperative opioid requirements. Future studies should further investigate ideal temperature thresholds for warming protocols to minimize postoperative pain.

背景围手术期温度与术后疼痛之间的关系尚不清楚。本研究调查了术中低体温与基于植入物的即刻乳房重建术后围手术期阿片类药物需求的关系。患者被分为低体温组（大部分手术<36.0 °C）或常温组（大部分手术≥36.0 °C）。收集住院患者的阿片类药物累积需求量（吗啡毫当量[MMEs]）和需要 "大剂量阿片类药物"（≥100 MMEs）的患者频率，并在两组间进行比较。结果共纳入536名患者（835个乳房），其中135名（25.1%）体温过低。低体温组的术中平均值（88.4 对 99.1 MMEs，P = 0.007）和术后平均值（45.6 对 56.8 MMEs，P = 0.006）均低于体温正常组。术中平均温度（B = 14.6，P = 0.004）和最低温度（B = 10.4，P = 0.038）直接预示着更高的阿片类药物需求量，而手术时间在 36 °C 以下的百分比越高（B = -27.6，P = 0.004），预示着阿片类药物需求量越低。在调整了患者和手术特征的差异后，低体温组需要大剂量阿片类药物的几率降低了66%（P = 0.007）。未来的研究应进一步探讨理想的体温阈值，以最大限度地减少术后疼痛。

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