Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第2页

The utility of ChatGPT in gender-affirming mastectomy education ChatGPT 在性别确认乳房切除术教育中的实用性。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.020

Introduction

The integration of AI such as ChatGPT in medicine has been showing promise in enhancing patient education. Gender-affirming mastectomy (GAM) is a surgical procedure designed to help individuals transition to their self-identified gender, playing a crucial role in mitigating psychological distress for many transmasculine and non-binary (TNB) patients. With increased demand and attention towards GAM, plastic and reconstructive surgeons may rely on AI-driven chatbots as an accessible, accurate, and patient-driven model for relevant details on this procedure.

Specific Aim(s)

This study aimed to assess the quality and readability of information provided by ChatGPT in response to frequently asked questions (FAQs) related to GAM.

Methods

Inspired by online forums and physician websites, 10 frequently asked questions (FAQs) about pre- and postoperative topics were submitted to ChatGPT and assessed using validated readability score measures and expert interpretation.

Results

The average readability score was 16.0 ± 1, indicating a college or graduate reading level. Mean accuracy, comprehensiveness, and danger scores were 8.8 ± 0.5, 7.8 ± 0.7, and 2.2 ± 0.4, respectively. Although physicians appreciated ChatGPT's tone, patient autonomy, and advice to seek professional medical and mental help, they also cited instance of generic information, misinformation, support of debated techniques, and pathologization of gender dysphoria.

Conclusion

Even with its promise in providing accurate and comprehensive information on GAM, ChatGPT’s current limitations suggest caution as a supplementary tool to physician consultation.

导言将人工智能（如 ChatGPT）融入医疗领域，在加强患者教育方面大有可为。性别确认乳房切除术（GAM）是一种外科手术，旨在帮助个人过渡到自我认定的性别，在减轻许多跨性别和非二元（TNB）患者的心理压力方面发挥着至关重要的作用。随着对 GAM 的需求和关注的增加，整形和重建外科医生可能会依赖人工智能驱动的聊天机器人，将其作为一个可访问的、准确的和以患者为导向的模型，以了解该手术的相关细节：本研究旨在评估 ChatGPT 在回答与 GAM 相关的常见问题（FAQs）时所提供信息的质量和可读性：受在线论坛和医生网站的启发，我们向 ChatGPT 提交了 10 个关于术前和术后主题的常见问题（FAQ），并使用经过验证的可读性评分标准和专家解释进行了评估：结果：平均可读性分数为 16.0 ± 1，表明阅读水平为大学或研究生水平。准确性、全面性和危险性的平均得分分别为 8.8 ± 0.5、7.8 ± 0.7 和 2.2 ± 0.4。虽然医生们对 ChatGPT 的语气、患者自主性以及寻求专业医疗和心理帮助的建议表示赞赏，但他们也提到了一些通用信息、错误信息、对有争议的技术的支持以及性别焦虑症病理化的情况：结论：尽管 ChatGPT 有希望提供准确、全面的 GAM 信息，但其目前的局限性表明，将其作为医生咨询的辅助工具还需谨慎。

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引用次数: 0

Pharyngostoma reconstruction after laryngectomy and radiotherapy: A retrospective study and literature review 喉切除术和放疗后的咽喉瘤重建：回顾性研究与文献综述。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.019

Background

The occurrence of pharyngocutaneous fistula or pharyngostoma after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery.

Aim

The purpose of this study is to review the surgical approach and evaluate the results regarding reconstruction methods of pharyngostoma, caused after laryngectomy and radiotherapy.

Patients and methods

The total number of patients is 15. Pharyngostoma caused swallowing difficulties, as well as frequent aspiration pneumonia. The intervention interval from laryngectomy to pharyngeal reconstruction varied between one and three years, depending on the severity of symptoms and after the complete failure of conservative rehabilitation methods. Pharyngostoma reconstruction was performed mainly with pectoralis major myocutaneous flap in 11 cases. The radial forearm free flap and the anterolateral thigh free flap were also used in the remaining four cases.

Results

The post-operative course was uncomplicated, and in most cases, the feeding with soft food started after a barium meal between 15 and 20 days post-operatively. Complications include wound dehiscence and leak treated conservatively and one case of carotid rupture.

Conclusions

The gold standard for pharyngostoma reconstruction, after laryngectomy and cervical radiotherapy, remains the use of pectoralis major myocutaneous flap. In cases of extensive neck radionecrosis, free flaps are preferable. Reliable and stable cover of the large vessels of the neck, along with the reconstruction of the digestive tract and the restoration of swallowing function are issues that are analysed in correlation with the avoidance of stenosis and swallowing difficulties.

背景：头颈部肿瘤手术后出现咽瘘或咽口瘤是一种严重的并发症。目的：本研究旨在回顾喉切除术和放疗后引起的咽口瘘的手术方法，并评估重建方法的效果：患者和方法：患者总数为 15 人。咽喉瘤导致吞咽困难，并经常引发吸入性肺炎。从喉切除术到咽部重建的干预间隔时间为一到三年不等，这取决于症状的严重程度以及保守康复方法完全失败后的情况。11例患者主要使用胸大肌肌皮瓣进行咽喉重建。其余四例也使用了前臂桡侧游离皮瓣和大腿前外侧游离皮瓣：结果：术后过程并不复杂，大多数病例在术后 15-20 天服用钡餐后开始进食软食。并发症包括保守治疗的伤口裂开和渗漏，以及一例颈动脉破裂：结论：喉切除术和颈部放疗后，咽喉瘤重建的金标准仍然是使用胸大肌皮瓣。在颈部广泛放射性坏死的病例中，游离皮瓣更为可取。颈部大血管的可靠和稳定覆盖、消化道的重建以及吞咽功能的恢复，都是与避免狭窄和吞咽困难相关的问题。

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引用次数: 0

A new perspective: Quantitative description of the Cupid’s peak aesthetics essence 新的视角：丘比特峰美学本质的量化描述。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.022

Objectives

The Cupid’s peak triangle theory was established to reveal the aesthetics essence of the Cupid’s peak through golden ratio deviation to provide quantitative theoretical basis for lip plastic and cosmetic surgery.

Materials and methods

Model the Cupid’s peak line on the lip bow ridge and construct expressions for Cupid’s peak parameters and their associated triangle theory using the angle circle (AC) and radius circle (RC) of the Cupid’s peak line. Calculate and establish functional relationships for Cupid’s peak parameters and the concept of the Cupid’s peak index (CPI) golden ratio deviation (GRD).

Results

In the Cupid’s peak triangle theory, important parameters describing Cupid’s peak morphology include Cupid’s peak angle (ACp), arc (RCp), the smooth connection point (SI) of the Cupid’s peak arc and line, and the CPI. The parameters are interrelated in their functional relationships. ACp determines RCp, the SI point determines the proportion of the Cupid’s peak arc to the line, and CPI determines GRD. Cupid’s peak parameter ranges in the normal population are as follows: ACp is 109°−160°, RCp is 1.24–0.35 rad, CPI is 0.614–0.508, and GRD is 0.62%−17.85%.

Conclusions

The Cupid’s peak triangle theory reveals the functional relationship between the Cupid’s peak parameters and quantifies the aesthetics essence of lip shape.

Clinical relevance

The morphology of the Cupid’s peak serves as a tangible manifestation of lip shape aesthetics. This study aims to elucidate the aesthetic essence and general principles of Cupid’s peak morphology, offering a quantitative theoretical foundation for lip plastic and cosmetic surgery.

目的：建立丘比特峰三角理论，通过黄金比例偏差揭示丘比特峰的美学本质，为唇部整形美容提供定量理论依据：建立丘比特峰三角理论，通过黄金比例偏差揭示丘比特峰的美学本质，为唇部整形美容提供定量理论依据：在唇弓脊上建立丘比特峰线模型，并利用丘比特峰线的角度圆（AC）和半径圆（RC）构建丘比特峰参数及其相关三角形理论的表达式。计算并建立丘比特峰参数的函数关系和丘比特峰指数（CPI）黄金比例偏差（GRD）的概念：在丘比特峰三角形理论中，描述丘比特峰形态的重要参数包括丘比特峰角度（ACp）、弧度（RCp）、丘比特峰弧线和直线的平滑连接点（SI）以及 CPI。这些参数在功能关系上相互关联。ACp 决定 RCp，SI 点决定丘比特峰弧线与直线的比例，CPI 决定 GRD。正常人群的丘比特峰参数范围如下：ACp为109°-160°，RCp为1.24-0.35 rad，CPI为0.614-0.508，GRD为0.62%-17.85%：丘比特峰三角理论揭示了丘比特峰参数之间的功能关系，并量化了唇形的美学本质：丘比特峰的形态是唇形美学的具体体现。本研究旨在阐明丘比特峰形态的美学本质和一般原理，为唇部整形和美容手术提供定量理论基础。

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引用次数: 0

Quality of Life after Open Extremity Trauma (QUINTET) study: An international, multicentric, observational, cohort study of quality of life following lower extremity open fractures 开放性四肢创伤后生活质量（QUINTET）研究：一项关于下肢开放性骨折后生活质量的国际性、多中心、观察性、队列研究。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.025

Introduction

Open lower limb fractures are severe injuries with long-lasting consequences. Limited research has been conducted on the impact of these injuries on quality of life (QoL), internationally.

Methods

The Quality of Life after Open Extremity Trauma (QUINTET) study was designed as an international, multicentric, observational, cohort study of patients presented with open lower limb fractures. Demographic and clinical information was collected, along with repeated validated QoL measures. Primary outcomes were SF-12 and EQ-5D-3L, and secondary outcomes were soft tissue infection, deep infection, non-union and amputation.

Results

A total of 92 patients were enrolled in 8 centres, based in the UK, Spain, Chile and Sudan. The mean age at presentation was 54 years, 47 years for males and 64 years for females. Males presented a higher proportion of road traffic accidents as the underlying mechanism, whereas for females, this was the case of low-energy falls. Participant retention was 71.7% and 73.9% for the 3- and 12-month assessments, respectively. There was a substantial reduction in QoL after open fracture, which only partially recovered at 12 months. Participants recruited in the UK presented lower QoL scores compared with patients treated in Spain and Chile.

Discussion

For this study, international patient recruitment proved challenging, leading to most patients being recruited in the UK. Despite this limitation, we found a statistically significant detriment in self-reported QoL, which did not recover after a year. This study highlights differences in quality-of-life outcomes from a gender and international perspective.

简介开放性下肢骨折是一种严重的损伤，会造成长期的后果。目前，国际上关于这些损伤对生活质量（QoL）影响的研究十分有限：开放性四肢创伤后生活质量（QUINTET）研究是一项国际性、多中心、观察性、队列研究，研究对象为开放性下肢骨折患者。该研究收集了患者的人口统计学和临床信息，并反复采用了经过验证的 QoL 测量方法。主要结果为 SF-12 和 EQ-5D-3L，次要结果为软组织感染、深部感染、不愈合和截肢：英国、西班牙、智利和苏丹的 8 个中心共招募了 92 名患者。患者的平均年龄为 54 岁，其中男性 47 岁，女性 64 岁。男性以道路交通事故为根本原因的比例较高，而女性则以低能量跌倒为根本原因。在 3 个月和 12 个月的评估中，参与者的保留率分别为 71.7% 和 73.9%。开放性骨折后，患者的生活质量大幅下降，12个月后才部分恢复。与在西班牙和智利接受治疗的患者相比，在英国招募的参与者的 QoL 分数较低：讨论：在这项研究中，国际患者招募具有挑战性，导致大多数患者在英国招募。尽管存在这一局限性，但我们发现自我报告的 QoL 在统计学上有显著下降，一年后仍未恢复。这项研究从性别和国际角度强调了生活质量结果的差异。

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引用次数: 0

From science fair to TIME cover: The hype surrounding a teen’s skin cancer treating soap 从科学展到《时代》周刊封面：青少年皮肤癌治疗肥皂的炒作

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.006

引用次数: 0

A comparative analysis of free fibula flap donor leg and recipient vessel selection in composite oromandibular defect reconstructions 复合下颌缺损重建中游离腓骨瓣供体腿和受体血管选择的比较分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.023

Background

The free fibula flap (FFF) is acknowledged as the primary choice for reconstructing composite oromandibular defects (COMDs), yet the impact of donor leg selection remains inadequately explored. This study aims to investigate the correlation between flap failure and the choice of donor leg and recipient vessel side.

Materials and methods

In a retrospective analysis spanning 2011 to 2020, FFFs for COMD were examined using electronic records. Patient data, comorbidities, radiation history, FFF details, and intraoperative variables were considered. Laterality was categorized into “Cis” and “Trans” groups, further subclassified based on blood supply. Analyses involved logistic regression, bivariate analysis, and propensity score matching.

Results

A total of 155 subjects with intraoral mucosal defects repaired only by the skin paddle of FFF were included. Cases were categorized into “Cis” (n = 65; 42%) and “Trans” (n = 90; 58%) groups based on COMD side and donor leg selection. No significant baseline differences emerged. Logistic regression found no laterality impact on total FFF failure. Initially, gender correlated with flap failure, but adjustment diminished the association. Partial skin paddle necrosis correlated with diabetes, not laterality. Propensity score matching revealed no significant differences between right and left legs in laterality or total flap failure risk. Subgroup analysis found no differences in parameters or flap failure rates within “Cis” and “Trans” groups.

Conclusion

Donor leg selection in COMD reconstruction with FFFs does not exhibit specificity. Furthermore, despite potential limitations in vessel anastomosis due to pedicle length or trauma history, recipient vessel side selection does not evidently affect flap failure.

背景游离腓骨瓣（FFF）被认为是重建复合下颌缺损（COMD）的首选，但供体腿选择的影响仍未得到充分探讨。本研究旨在探讨皮瓣失败与供体腿和受体血管侧的选择之间的相关性。材料和方法在2011年至2020年的回顾性分析中，我们使用电子记录检查了用于COMD的FFF。研究考虑了患者数据、合并症、放射史、FFF细节和术中变量。侧位分为 "顺式 "和 "反式 "两组，并根据供血情况进一步细分。分析包括逻辑回归、双变量分析和倾向评分匹配。结果共纳入 155 例仅通过 FFF 皮瓣修复口内粘膜缺损的受试者。根据 COMD 侧和供体腿的选择，病例被分为 "顺式 "组（n = 65；42%）和 "反式 "组（n = 90；58%）。没有出现明显的基线差异。逻辑回归发现，侧位对 FFF 的总失败率没有影响。最初，性别与皮瓣失败有关联，但调整后关联性减弱。部分皮瓣坏死与糖尿病有关，与侧位无关。倾向评分匹配显示，左右腿在侧位或皮瓣总失败风险方面没有明显差异。亚组分析发现，"顺式 "组和 "反式 "组在参数或皮瓣失败率方面没有差异。此外，尽管血管吻合可能会因血管蒂长度或创伤史而受到限制，但受体血管侧的选择显然不会影响皮瓣失败。

{"title":"A comparative analysis of free fibula flap donor leg and recipient vessel selection in composite oromandibular defect reconstructions","authors":"","doi":"10.1016/j.bjps.2024.10.023","DOIUrl":"10.1016/j.bjps.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>The free fibula flap (FFF) is acknowledged as the primary choice for reconstructing composite oromandibular defects (COMDs), yet the impact of donor leg selection remains inadequately explored. This study aims to investigate the correlation between flap failure and the choice of donor leg and recipient vessel side.</div></div><div><h3>Materials and methods</h3><div>In a retrospective analysis spanning 2011 to 2020, FFFs for COMD were examined using electronic records. Patient data, comorbidities, radiation history, FFF details, and intraoperative variables were considered. Laterality was categorized into “Cis” and “Trans” groups, further subclassified based on blood supply. Analyses involved logistic regression, bivariate analysis, and propensity score matching.</div></div><div><h3>Results</h3><div>A total of 155 subjects with intraoral mucosal defects repaired only by the skin paddle of FFF were included. Cases were categorized into “Cis” (n = 65; 42%) and “Trans” (n = 90; 58%) groups based on COMD side and donor leg selection. No significant baseline differences emerged. Logistic regression found no laterality impact on total FFF failure. Initially, gender correlated with flap failure, but adjustment diminished the association. Partial skin paddle necrosis correlated with diabetes, not laterality. Propensity score matching revealed no significant differences between right and left legs in laterality or total flap failure risk. Subgroup analysis found no differences in parameters or flap failure rates within “Cis” and “Trans” groups.</div></div><div><h3>Conclusion</h3><div>Donor leg selection in COMD reconstruction with FFFs does not exhibit specificity. Furthermore, despite potential limitations in vessel anastomosis due to pedicle length or trauma history, recipient vessel side selection does not evidently affect flap failure.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593107","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

Dynamic three-dimensional facial topography in pediatric facial palsy: Understanding asymmetrical facial contours 小儿面瘫的动态三维面部地形图：了解不对称的面部轮廓。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.bjps.2024.10.024

Background

Objective assessment of facial movements remains pivotal for diagnosis, treatment, and long-term monitoring of patients with facial palsy (FP). This study aims to utilize curvature analysis in pediatric patients with and without FP to define facial contours and to quantify three-dimensional (3D) excursion during smile.

Methods

Pediatric patients with and without FP had 3D motion capture acquired from rest to maximum smile positions. 3D curvature analysis was performed with a custom MATLAB algorithm. A 40-vertex “smile curve” along the nasolabial fold-cheek-orbit contour was extracted from each patient-specific 3D mesh hemiface. This allowed the quantification of excursion and asymmetry for affected vs. unaffected sides in FP patients, and comparison with controls.

Results

Twelve FP (mean 12.5 yr, range 5–18) and 12 control (mean 12.1 yr, range 5–18) patients were analyzed. Differences in facial contour are intensified during animation, especially in the nasolabial fold, cheek, and periorbital regions of interest and the smile curve that links them. Mean excursion differed significantly between the FP and control groups in all regions of interest (p < 0.0001).

Conclusions

Curvature analysis provides insight into the unexplored relationship of the 3D morphological dynamics of the concavity and convexity of the face, to add to the understanding of this complex condition. The magnitude of asymmetry between an FP patient’s affected vs. unaffected smile curve excursion, and comparison to the control group, could allow surgical treatment to be tailored to an individual patient’s dynamic anatomy by identifying and quantifying facial region-specific asymmetry.

背景：面部运动的客观评估对于面瘫（FP）患者的诊断、治疗和长期监测至关重要。本研究旨在对患有和未患有面瘫的儿科患者进行曲率分析，以确定面部轮廓并量化微笑时的三维（3D）偏移：方法：对患有和未患有 FP 的儿科患者从静止到最大微笑位置进行三维运动捕捉。采用定制的 MATLAB 算法进行三维曲率分析。从每个患者特定的三维网格半面提取了沿鼻唇沟-颊-眶轮廓的 40 个矢量的 "微笑曲线"。这样就可以量化 FP 患者患侧与非患侧的偏移和不对称情况，并与对照组进行比较：分析了 12 名 FP 患者（平均 12.5 岁，5-18 岁不等）和 12 名对照组患者（平均 12.1 岁，5-18 岁不等）。在动画过程中，面部轮廓的差异会加剧，尤其是在鼻唇沟、脸颊和眶周等相关区域以及连接这些区域的微笑曲线上。FP 组和对照组在所有相关区域的平均偏移量都有显著差异（p 结论：FP 组和对照组在所有相关区域的平均偏移量都有显著差异（p）：曲率分析有助于深入了解面部凹凸的三维形态动态关系，从而加深对这一复杂情况的理解。FP 患者受影响与未受影响的微笑曲线偏移之间的不对称程度，以及与对照组的比较，可以通过识别和量化面部特定区域的不对称，使手术治疗符合患者的动态解剖结构。

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引用次数: 0

A retrospective cohort study: Waterjet-assisted liposuction reduces inflammation but increases the risk of hypokalemia in patients with lipoedema 一项回顾性队列研究：水刀辅助吸脂术减轻了脂肪性水肿患者的炎症反应，但增加了低钾血症的风险。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-13 DOI: 10.1016/j.bjps.2024.10.013

Introduction

Lipoedema is a congenital fat distribution disorder. It leads to a pathological increase in adipose tissue due to a hypertrophy and hyperplasia of the adipocytes. Currently, the disease affects approximately 10% of women. A common treatment of the disease is liposuction to remove the pathologic fat cells.

Patients and Methods

A total of 47 patients (mean age: 62.00 ± 12.96 years) were treated with the conventional tumescent liposuction and 25 patients (mean age of 45.16 ± 12.87 years) with waterjet-assisted liposuction (WAL), a gentle, tissue-conserving method that washes out fat cells. WAL is thought to cause less damage to surrounding tissue than tumescent liposuction and thus, less trauma.

Results

At the postoperative level, the C-reactive protein was significantly (p* = 0.0195) lower after WAL treatment, implying a lower inflammation level than after tumescent liposuction. Also, a decrease of electrolytes such as potassium in the blood serum was observed in some cases. The postoperative potassium level dropped by 0.30 ± 0.24 mmol/l, a value that was significantly lower in WAL-treated patients where the level dropped by 0.47 ± 0.31 mmol/l. The mean fat aspirate using the conventional tumescent method was 3302.13 ± 1345.89 ml and 3727.08 ± 151.96 ml with the WAL treatment.

Conclusions

WAL is a tissue-conserving method that washes out fat cells with less trauma to surrounding tissue as observed with conventional tumescent liposuction. WAL causes a lower inflammation level but higher loss of potassium ions. This latter aspect needs attention after the liposuction treatment.

Trial registration

Waterjet-assisted liposuction reduces inflammation but increases the risk of hypokalemia when compared to conventional tumescent liposuction in patients with lipoedema, DRKS00034711. Registered July 17, 2024 - Retrospectively registered. Trial registration number DRKS00034711.

简介脂肪性水肿是一种先天性脂肪分布障碍。由于脂肪细胞肥大和增生，导致脂肪组织病理性增加。目前，约有 10% 的女性患有此病。该病的常见治疗方法是通过吸脂术去除病理性脂肪细胞：共有 47 名患者（平均年龄：62.00 ± 12.96 岁）接受了传统的膨胀吸脂术治疗，25 名患者（平均年龄 45.16 ± 12.87 岁）接受了水刀辅助吸脂术（WAL）治疗。与抽脂术相比，水刀辅助抽脂术对周围组织的损伤较小，因此创伤也较小：结果：术后 C 反应蛋白在 WAL 治疗后明显降低（p* = 0.0195），这意味着炎症水平低于抽脂术。此外，在一些病例中还观察到血清中钾等电解质的下降。术后血钾水平下降了 0.30 ± 0.24 mmol/l，而 WAL 治疗患者的血钾水平明显降低了 0.47 ± 0.31 mmol/l。使用传统抽吸法抽吸的脂肪平均为 3302.13 ± 1345.89 毫升，而使用 WAL 治疗抽吸的脂肪平均为 3727.08 ± 151.96 毫升：WAL是一种保护组织的方法，与传统的膨胀吸脂法相比，WAL在洗出脂肪细胞时对周围组织的创伤更小。WAL 造成的炎症水平较低，但钾离子流失较多。吸脂治疗后需要注意后一个方面：水刀辅助吸脂术与传统的抽脂术相比，可减少脂肪性水肿患者的炎症反应，但会增加低钾血症的风险，DRKS00034711。2024年7月17日注册 - 追溯注册。试验注册号 DRKS00034711。

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引用次数: 0

What to expect following targeted muscle reinnervation/regenerative peripheral nerve interface: Pain outcomes in an amputee population 定向肌肉神经再支配/再生外周神经接口后的预期效果：截肢者的疼痛结果。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-13 DOI: 10.1016/j.bjps.2024.10.017

Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have shown promise in improving and/or preventing neuropathic pain and reducing narcotic use in amputees. However, anecdotally, some patients experience an increase in pain in the first few months post-operatively. This study explored the pain trajectory of 22 upper and lower extremity amputees following their TMR and/or RPNI procedure in their first post-operative year, with a focus on the patterns of recovery in the first few months. Our study found an overall decrease in the amount of pain and pain medication use at various time points post-operatively. Of note, several individuals had an increase in pain or required an increase in pain medications in the first three months. Different outcomes for patients who underwent primary versus secondary surgery were seen, which has been observed in other studies. Further prospective studies are warranted to evaluate these trends in pain after TMR or RPNI surgery in individuals with major limb amputations.

靶向肌肉神经再支配（TMR）和再生周围神经接口（RPNI）在改善和/或预防截肢者的神经性疼痛和减少麻醉剂使用方面已显示出前景。然而，据传闻，一些患者在术后头几个月疼痛加剧。本研究探讨了 22 名上肢和下肢截肢者在接受 TMR 和/或 RPNI 术后第一年的疼痛轨迹，重点关注术后最初几个月的恢复模式。我们的研究发现，在术后的不同时间点，疼痛和止痛药物的使用量总体上有所减少。值得注意的是，有几个人在头三个月疼痛加剧或需要增加止痛药物。接受初次手术和二次手术的患者结果不同，这在其他研究中也有观察到。有必要进一步开展前瞻性研究，以评估大肢截肢患者在接受 TMR 或 RPNI 手术后疼痛的趋势。

引用次数: 0

Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies 分析外伤性视神经病变患者的风险因素，比较治疗策略的视觉效果。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.015

Background

Traumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study aimed to identify predictive risk factors for TON and evaluate the effectiveness of current treatments with respect to visual outcomes in patients with TON.

Methods

This study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity.

Results

This study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, megadose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression.

Conclusion

Clinicians can achieve early prediction of TON in patients with an initial unconscious state and the identified risk factors. The results indicated that the conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.

背景：创伤性视神经病变（TON）是一种罕见的面部创伤并发症，可导致视力丧失。TON的临床诊断基于头部外伤史和眼科检查；然而，TON的风险因素和理想的治疗策略仍未确定。本研究旨在确定TON的预测性风险因素，并评估当前治疗方法对TON患者视觉效果的影响：本研究回顾性地纳入了2008年至2019年期间眶周面部骨骼骨折的患者。记录初始面骨计算机断层扫描、眼科检查结果、初始格拉斯哥昏迷量表和损伤严重程度评分。该研究将患者分为4个干预组（即药物治疗组、手术治疗组、综合治疗组和观察组），以比较视力结果：本研究共招募了1168名面部骨折患者，其中93人（7.96%）被诊断为TON。TON的独立风险因素包括视管骨折、内侧眶壁骨折、球后血肿和头部简易损伤量表≥4。最初没有光感的TON患者最终视力（VA）往往较差。结果表明，接受观察、大剂量皮质类固醇治疗、手术减压或类固醇治疗和减压联合治疗的患者在视力改善方面没有明显差异：结论：临床医生可以对最初处于昏迷状态并存在已识别风险因素的患者进行 TON 早期预测。结果表明，与接受药物治疗或手术治疗的患者相比，保守观察对 TON 患者的 VA 效果并不差。

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引用次数: 0