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

Trends in opioid prescribing by plastic surgeons for medicare part D patients 整形外科医生为医疗保险D部分患者开具阿片类药物处方的趋势

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-15 DOI: 10.1016/j.bjps.2026.01.014

Jason Zhang, Hannah Soltani, Puja Jagasia, Kristian Nenchev, Sophia G. Allison, Jason H. Ko, Michael A. Howard, Chad M. Teven

Purpose

Previous analyses of Medicare part D opioid prescribing by plastic surgeons demonstrated decreasing prescription rates, but data in past 2017 have not been well-described. This study aims to elucidate more recent patterns in plastic surgery opioid prescribing.

Methods

Opioid prescriptions by plastic surgeons from 2013 to 2022 were retrospectively extracted from the CMS Medicare part D Prescribers database. Analyses were normalized to per million Medicare part D beneficiaries.

Results

From 2013 to 2022, 997,765 opioid prescriptions were extracted from the database. The top 2 opioids prescribed were hydrocodone (520,893; 52.2%) and oxycodone (307,206; 30.8%). The top 2 states by volume of opioid prescriptions were Mississippi (50,992 claims per million beneficiaries) and Georgia (48,911). The Southern region had the most opioid prescriptions (590,086 claims per million beneficiaries), while the Northeast had the least (120,671). The opioid prescribing rate decreased across the study period, from 3360 to 1554 prescriptions per million beneficiaries (53.8% decrease). The number of patients with an opioid prescription also decreased from 2211 per million beneficiaries in 2013 to 1272 in 2022 (42.5% decrease). Similarly, the total days supplied decreased from 24,608 days per million beneficiaries (2013) to 6824 (2022), a 72.3% decrease.

Conclusion

Opioid prescribing for plastic surgery has declined from 2013 to 2022. Despite these promising trends, it is important to continue efforts to monitor and control opioid prescribing.

先前对医疗保险D部分阿片类药物处方整形外科医生的分析表明处方率下降，但过去2017年的数据并未得到很好的描述。本研究旨在阐明整形手术中阿片类药物处方的最新模式。方法从CMS医疗保险D部分处方者数据库中回顾性提取2013 - 2022年整形外科医生开具的类药物处方。分析标准化到每百万医疗保险D部分受益人。结果2013 - 2022年，从数据库中提取阿片类药物处方997,765张。处方前2位的阿片类药物分别为氢可酮（520,893例，52.2%）和羟考酮（307,206例，30.8%）。阿片类药物处方数量最多的两个州是密西西比州（每百万受益人索赔50,992人）和佐治亚州（48,911人）。南部地区的阿片类药物处方最多（每百万受益人索赔590,086份），而东北部最少（120,671份）。在整个研究期间，阿片类药物处方率下降，从每百万受益人3360张处方降至1554张处方（下降53.8%）。阿片类药物处方患者的数量也从2013年的每百万受益人2211人减少到2022年的1272人（减少42.5%）。同样，总供应天数从每百万受益人24608天（2013年）减少到6824天（2022年），减少了72.3%。结论2013 - 2022年整形外科阿片类药物处方呈下降趋势。尽管有这些有希望的趋势，重要的是继续努力监测和控制阿片类药物处方。

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引用次数: 0

Recipient site selection in vascularized lymph node transfer for secondary lymphedema: A systematic review and meta-analysis 继发性淋巴水肿的血管化淋巴结转移的受体部位选择：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 : 2026-01-14 DOI: 10.1016/j.bjps.2026.01.005

Mohamad Rachadian Ramadan , Patricia Angelin , Parintosa Atmodiwirjo

Vascularized lymph node transfer (VLNT) is an established microsurgical approach for secondary lymphedema; however, the optimal recipient site remains uncertain. This systematic review and meta-analysis aimed to compare outcomes between different recipient sites in upper and lower extremity VLNT. Following the PRISMA guidelines, PubMed, Scopus, and ScienceDirect were searched to October 2024. Outcomes assessed included circumferential reduction rate (CRR), volume-based reduction, cellulitis incidence, and quality of life. Meta-analysis was performed using the generic inverse-variance method with random effects. Heterogeneity was assessed using I², and sensitivity and meta-regression analysis explored potential sources of variability. Fifteen studies met the inclusion criteria. Meta-analysis was feasible only for distal inset data due to substantial heterogeneity among proximal and middle sites. Distal inset demonstrated the highest pooled CRR (42.2% for upper extremity and 42.5% for lower extremity), though heterogeneity remained high (I² = 84–91%). Distal placement also showed reduced cellulitis incidence and improved quality of life scores. While distal inset placement yielded the greatest circumferential reduction, outcomes varied widely across studies. No single recipient site was universally superior, optimal selection should be tailored to disease stage, edema distribution, and tissue condition.

血管化淋巴结转移（VLNT）是继发性淋巴水肿的显微外科治疗方法；然而，最佳的受体位置仍然不确定。本系统综述和荟萃分析旨在比较上肢和下肢VLNT不同受者部位的结果。按照PRISMA指南，检索PubMed、Scopus和ScienceDirect至2024年10月。评估的结果包括圆周缩小率（CRR）、体积缩小、蜂窝织炎发生率和生活质量。采用随机效应的通用反方差法进行meta分析。使用I2评估异质性，敏感性和meta回归分析探索变异性的潜在来源。15项研究符合纳入标准。由于近端和中端位置的异质性，荟萃分析仅适用于远端插入数据。远端插入显示最高的总CRR（上肢42.2%，下肢42.5%），尽管异质性仍然很高（I2 = 84-91%）。远端放置也显示蜂窝织炎发生率降低，生活质量评分提高。虽然远端置入获得了最大的周向复位，但不同研究的结果差异很大。没有单一的受体部位是普遍优越的，最佳选择应根据疾病分期、水肿分布和组织状况量身定制。

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引用次数: 0

Immediate versus delayed symmetrisation of the contralateral breast after oncoplastic procedures: A systematic review and meta-analysis 肿瘤整形手术后对侧乳房的即时对称与延迟对称：一项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 : 2026-01-14 DOI: 10.1016/j.bjps.2026.01.004

Hussain A. Abdulla , Mohamed A. Abdulla , Raja Eid , Sameh Hashem , Ahmed Alhaddad

Background

The optimal timing of contralateral symmetrisation in oncoplastic breast surgery remains controversial. The aim was to compare outcomes between patients who underwent immediate versus delayed symmetrising procedures.

Methods

A systematic review was performed in accordance with the PRIMSA guidelines. PubMed, Embase and Scopus databases were searched for studies reporting outcomes of oncoplastic procedures with immediate and delayed contralateral symmetrisation. Meta-analyses were conducted for surgical, oncological and patient-reported outcomes between the two groups.

Results

Twelve studies comprising 2339 (immediate, n = 1227 and delayed, n = 1112) patients were included. There were no significant differences in overall complications, all reoperations, reoperations for complications, aesthetic revisions, recurrence rates, delays in adjuvant therapy or patient-reported outcomes between the two groups. In the subgroup of patients who underwent breast conserving surgery, immediate symmetrisation was associated with lower rates of overall reoperations (19.3% vs 25%, p = 0.03), reoperations for complications (5.2% vs 10.9%, p = 0.01) and aesthetic revisions (6.6% v 15.2%, p = 0.0003). Delayed symmetrisation trended towards lower rates of aesthetic revisions in the mastectomy cohort (18% vs 28%, p = 0.002).

Conclusion

Immediate contralateral symmetrisation does not appear to increase oncologic risk and provides comparable overall outcomes to delayed procedures. In the setting of therapeutic mammaplasty, immediate symmetrisation may reduce the need for secondary procedures, thereby supporting its use in appropriately selected patients. These findings can help guide multidisciplinary decision-making and inform patient counselling regarding the timing of contralateral procedures in oncoplastic breast surgery, but it should be interpreted in the context of predominantly retrospective data and moderate heterogeneity.

背景：在乳腺肿瘤整形手术中对侧对称的最佳时机仍然存在争议。目的是比较接受即时和延迟对称手术的患者之间的结果。方法按照PRIMSA指南进行系统评价。检索PubMed、Embase和Scopus数据库，查找报告立即和延迟对侧对称的肿瘤整形手术结果的研究。对两组之间的手术、肿瘤和患者报告的结果进行meta分析。结果纳入12项研究，包括2339例患者（即刻，n = 1227，延迟，n = 1112）。两组患者在总并发症、所有再手术、并发症再手术、美学修复、复发率、辅助治疗延迟或患者报告的结果方面无显著差异。在接受保乳手术的患者亚组中，立即对称与总体再手术率（19.3% vs 25%, p = 0.03）、并发症再手术率（5.2% vs 10.9%, p = 0.01）和美学修复率（6.6% vs 15.2%, p = 0.0003）相关。在乳房切除术队列中，延迟对称倾向于较低的美学修复率（18% vs 28%, p = 0.002）。结论：即刻对侧对称手术不会增加肿瘤风险，并且与延迟手术的总体结果相当。在治疗性乳房成形术中，立即对称可以减少二次手术的需要，从而支持在适当选择的患者中使用。这些发现可以帮助指导多学科决策，并告知患者关于肿瘤乳房手术对侧手术时机的咨询，但它应该在主要回顾性数据和中等异质性的背景下进行解释。

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引用次数: 0

Patient recruitment strategies of the Belgian plastic surgeon: A national anonymous survey 比利时整形外科医生的患者招募策略：一项全国匿名调查

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-13 DOI: 10.1016/j.bjps.2026.01.001

Renee De Busser , Amélie Bouteille , Stefaan Callens , Margot Den Hondt , Moustapha Hamdi

Background

Patient recruitment strategies in plastic surgery are diverse, and no overview exists for Belgium. Internationally, word of mouth is the most common method, while social media usage grows.

Purpose

This study aimed to map recruitment methods among Belgian plastic surgeons and explore differences by age and professional location.

Methods

Plastic surgeons practicing in Belgium were included in a prospective survey. An anonymous online questionnaire (LimeSurvey) was distributed and data analysed using SPSS.

Results

Eighteen percent of all Belgian plastic surgeons participated. Referrals and word of mouth were the primary recruitment methods, followed by websites and social media. Referrals were mainly by gynaecologists, dermatologists and GPs. Intra-centre collaboration was most frequent in university and general hospitals (both 74%). Non-surgical and aesthetic procedures were proportionally more common in private clinics, while reconstructive procedures dominated university and general hospitals. Fifty-two percent treated international patients, an average of 15% of practice volume, predominantly aesthetic cases (68%). All surgeons used a website, and 54% were active on social media, primarily Instagram (60%) and Facebook (26%). Social media reached mainly 20- to 40-year-old patients (66%) with aesthetic concerns (62%).

Conclusion

Referrals and word of mouth are the most important recruitment strategies among Belgian plastic surgeons. Social media is increasingly relevant, particularly for younger, international patients and aesthetic surgery. Its growing use raises professional, legal, and ethical challenges, highlighting the need for clearer legislation, awareness, and enforcement strategies with patient safety as central priority.

背景：整形外科的患者招募策略是多种多样的，没有比利时的概述。在国际上，口口相传是最常见的方法，而社交媒体的使用也在增长。目的研究比利时整形外科医生的招募方法，探讨年龄和职业地区的差异。方法对在比利时执业的整形外科医生进行前瞻性调查。采用匿名在线问卷（limessurvey）进行调查，并使用SPSS软件对数据进行分析。结果18%的比利时整形外科医生参与了调查。推荐和口口相传是主要的招聘方式，其次是网站和社交媒体。转介者主要是妇科医生、皮肤科医生和全科医生。中心内合作在大学医院和综合医院最为常见（均为74%）。非手术和美容手术在私人诊所中更为常见，而重建手术在大学和综合医院中占主导地位。52%的人治疗国际患者，平均占业务量的15%，主要是美容病例（68%）。所有的外科医生都使用一个网站，54%的人活跃在社交媒体上，主要是Instagram（60%）和Facebook（26%）。社交媒体接触的主要是20- 40岁的患者（66%），他们关注审美（62%）。结论推荐和口碑是比利时整形外科医生最重要的招聘策略。社交媒体越来越重要，尤其是对年轻的国际患者和美容手术。它的使用日益增加，带来了专业、法律和道德方面的挑战，突出表明需要更明确的立法、意识和执法策略，以患者安全为中心优先事项。

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引用次数: 0

Masculinizing chest surgery outcomes by body mass index and American Society of Anesthesiologists class in ambulatory care 男性化胸部手术结果与身体质量指数和美国麻醉医师协会门诊护理等级的关系

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-13 DOI: 10.1016/j.bjps.2026.01.002

Neha Shah , Emily MacLeod , Kyle Kirkham , Kathleen Armstrong

Background

Masculinizing chest surgery improves quality of life, though access is often restricted based on body mass index. Centers of excellence in gender-affirming surgery have begun developing perioperative practices to increase safety among high-risk patients. We aimed to compare postoperative complications among patients receiving masculinizing chest surgery based on body mass index (BMI) and American Society of Anesthesiologists (ASA) class, and to suggest a perioperative protocol to manage these patients in ambulatory facilities.

Methods

We conducted a retrospective chart review of patients receiving masculinizing chest surgeries (full mastectomies and breast reductions) between August 2021 and October 2024 from one surgeon at an ambulatory facility with a center of excellence in gender-affirming surgery. Patients without postoperative follow-up or height/weight data (2/532) were excluded. Perioperative management and postoperative complications occurring by one-year postoperatively were compared based on body mass index, per the World Health Organization categories, and American Society of Anesthesiologists classes via the Chi-squared test and a multivariable logistic regression.

Results

In total, 530 individuals aged 15–66 years with body mass index ranging 16.1–58.7 kg/m² were included. Notably, 22% of participants experienced a complication ranging from Grades I to IIIb on the Clavien–Dindo scale. There were no significant differences in Grades I, II, IIIa, or IIIb complications between the BMI or ASA groups. After adjusting for age and smoking, compared to participants with BMI <25.0 kg/m², no BMI group had higher odds of experiencing postoperative complications. Compared to patients in ASA Class I, controlling for age, participants in ASA II and III/IV did not have higher odds of experiencing postoperative complications.

Conclusions

There was no difference in the rate or odds of postoperative complications after masculinizing chest surgery based on body mass index or American Society of Anesthesiologists class, suggesting appropriate perioperative protocols may allow patients at higher-risk to access this procedure in ambulatory facilities.

男性化胸部手术可以提高生活质量，但通常会受到身体质量指数的限制。性别确认手术的优秀中心已经开始开发围手术期实践，以提高高风险患者的安全性。我们的目的是比较基于身体质量指数（BMI）和美国麻醉医师协会（ASA）分级的男性化胸部手术患者的术后并发症，并建议在门诊设施管理这些患者的围手术期方案。方法：我们对2021年8月至2024年10月期间接受男性化胸部手术（全乳切除和缩胸）的患者进行回顾性图表回顾，这些患者由一名外科医生在一家性别肯定手术卓越中心的门诊机构接受手术。排除无术后随访或身高/体重资料（2/532）的患者。通过卡方检验和多变量logistic回归，根据世界卫生组织分类和美国麻醉医师学会分类的体重指数，比较围手术期管理和术后一年发生的术后并发症。结果共纳入530人，年龄15 ~ 66岁，体重指数16.1 ~ 58.7 kg/m2。值得注意的是，22%的参与者经历了Clavien-Dindo量表中I级至IIIb级的并发症。BMI组和ASA组之间I、II、IIIa或IIIb级并发症无显著差异。在调整年龄和吸烟因素后，与BMI为25.0 kg/m2的参与者相比，没有BMI组出现术后并发症的几率更高。与ASA I级患者相比，在控制年龄的情况下，ASA II和III/IV级患者出现术后并发症的几率并不高。结论：基于体重指数或美国麻醉医师学会分级，男性化胸部手术术后并发症的发生率或几率没有差异，提示适当的围手术期方案可允许高危患者在门诊设施进行该手术。

{"title":"Masculinizing chest surgery outcomes by body mass index and American Society of Anesthesiologists class in ambulatory care","authors":"Neha Shah , Emily MacLeod , Kyle Kirkham , Kathleen Armstrong","doi":"10.1016/j.bjps.2026.01.002","DOIUrl":"10.1016/j.bjps.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Masculinizing chest surgery improves quality of life, though access is often restricted based on body mass index. Centers of excellence in gender-affirming surgery have begun developing perioperative practices to increase safety among high-risk patients. We aimed to compare postoperative complications among patients receiving masculinizing chest surgery based on body mass index (BMI) and American Society of Anesthesiologists (ASA) class, and to suggest a perioperative protocol to manage these patients in ambulatory facilities.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of patients receiving masculinizing chest surgeries (full mastectomies and breast reductions) between August 2021 and October 2024 from one surgeon at an ambulatory facility with a center of excellence in gender-affirming surgery. Patients without postoperative follow-up or height/weight data (2/532) were excluded. Perioperative management and postoperative complications occurring by one-year postoperatively were compared based on body mass index, per the World Health Organization categories, and American Society of Anesthesiologists classes via the Chi-squared test and a multivariable logistic regression.</div></div><div><h3>Results</h3><div>In total, 530 individuals aged 15–66 years with body mass index ranging 16.1–58.7 kg/m<sup>2</sup> were included. Notably, 22% of participants experienced a complication ranging from Grades I to IIIb on the Clavien–Dindo scale. There were no significant differences in Grades I, II, IIIa, or IIIb complications between the BMI or ASA groups. After adjusting for age and smoking, compared to participants with BMI <25.0 kg/m<sup>2</sup>, no BMI group had higher odds of experiencing postoperative complications. Compared to patients in ASA Class I, controlling for age, participants in ASA II and III/IV did not have higher odds of experiencing postoperative complications.</div></div><div><h3>Conclusions</h3><div>There was no difference in the rate or odds of postoperative complications after masculinizing chest surgery based on body mass index or American Society of Anesthesiologists class, suggesting appropriate perioperative protocols may allow patients at higher-risk to access this procedure in ambulatory facilities.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 172-179"},"PeriodicalIF":2.4,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080549","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

Aesthetic outcomes and surgical complications of acellular dermal matrix in immediate direct-to-implant breast reconstruction: A meta-analysis of comparative studies 脱细胞真皮基质在直接植入乳房重建中的美学效果和手术并发症：比较研究的荟萃分析

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-12 DOI: 10.1016/j.bjps.2025.12.040

Omar ElSewify , Rawan ElAbd , Leen ElEter , Natasha Barone , Brea Willey , Samuel J. Lin , Joshua Vorstenbosch

Acellular dermal matrix (ADM) is frequently used in implant-based breast reconstruction due to its perceived aesthetic superiority and reduction in postoperative complications. This meta-analysis aims to investigate the aesthetic outcomes and surgical complications of ADM in immediate direct-to-implant (DTI) breast reconstruction. A systematic literature review was conducted using Medline, EMBASE, and Cochrane databases up to November 25, 2024. Comparative studies analyzing aesthetic outcomes and surgical complications of DTI reconstruction with and without ADM were included. Ten articles were eligible, with 416 patients undergoing ADM DTI reconstruction and 339 undergoing immediate reconstruction without ADM. The mean follow-up duration was 25 months. The mean age for cases was 47 ± 6 years, comparable with controls (48 ± 6; p > 0.1). The mean body mass index was similar (23.5 ± 2.7 kg/m²; p > 0.1). Implant volume was comparable at 280 ± 65 versus 265 ± 79 cc; p > 0.1. Drain removal timing (15 vs 13 days) and hospital stay (5 vs 6 days) were similar (p > 0.1). Meta-analysis showed comparable rates of haematoma, capsular contraction, skin necrosis, and wound dehiscence. However, ADM was associated with a higher risk of infection (odds ratio, 3.15, p = 0.0005, I² = 0%). Results for seroma and implant loss should be interpreted with caution. Aesthetic outcomes, although variably measured, were mostly comparable. ADM use in DTI reconstruction offers more comfort with pocket coverage but appears to carry higher risks of infection, implant loss, and possibly seroma. This meta-analysis offers guidance regarding risks, benefits, and costs associated with ADM use in clinical practice.

脱细胞真皮基质（ADM）因其美学优势和减少术后并发症而被广泛应用于假体乳房重建。本荟萃分析旨在探讨ADM在直接植入乳房重建术（DTI）中的美学效果和手术并发症。使用Medline、EMBASE和Cochrane数据库进行系统文献综述，截止到2024年11月25日。对比研究分析了有和没有ADM的DTI重建的美学结果和手术并发症。10篇文章符合条件，其中416例患者接受了ADM DTI重建，339例患者接受了不进行ADM的立即重建。平均随访时间为25个月。病例的平均年龄为47±6岁，与对照组（48±6;p > 0.1）相当。平均体重指数相似（23.5±2.7 kg/m2; p > 0.1）。种植体体积为280±65和265±79 cc；P >；引流时间（15天vs 13天）和住院时间（5天vs 6天）相似（p > 0.1）。荟萃分析显示血肿、包膜收缩、皮肤坏死和伤口裂开的发生率相当。然而，ADM与较高的感染风险相关（优势比为3.15,p = 0.0005, I2 = 0%）。血肿和植入物丢失的结果应谨慎解释。审美结果，虽然测量变量不同，但大多具有可比性。ADM用于DTI重建提供了更舒适的口袋覆盖，但似乎有更高的感染、种植体丢失和可能的血清肿的风险。本荟萃分析为临床实践中使用ADM的风险、收益和成本提供了指导。

{"title":"Aesthetic outcomes and surgical complications of acellular dermal matrix in immediate direct-to-implant breast reconstruction: A meta-analysis of comparative studies","authors":"Omar ElSewify , Rawan ElAbd , Leen ElEter , Natasha Barone , Brea Willey , Samuel J. Lin , Joshua Vorstenbosch","doi":"10.1016/j.bjps.2025.12.040","DOIUrl":"10.1016/j.bjps.2025.12.040","url":null,"abstract":"<div><div>Acellular dermal matrix (ADM) is frequently used in implant-based breast reconstruction due to its perceived aesthetic superiority and reduction in postoperative complications. This meta-analysis aims to investigate the aesthetic outcomes and surgical complications of ADM in immediate direct-to-implant (DTI) breast reconstruction. A systematic literature review was conducted using Medline, EMBASE, and Cochrane databases up to November 25, 2024. Comparative studies analyzing aesthetic outcomes and surgical complications of DTI reconstruction with and without ADM were included. Ten articles were eligible, with 416 patients undergoing ADM DTI reconstruction and 339 undergoing immediate reconstruction without ADM. The mean follow-up duration was 25 months. The mean age for cases was 47 ± 6 years, comparable with controls (48 ± 6; <em>p</em> > 0.1). The mean body mass index was similar (23.5 ± 2.7 kg/m<sup>2</sup>; <em>p</em> > 0.1). Implant volume was comparable at 280 ± 65 versus 265 ± 79 cc; <em>p</em> > 0.1. Drain removal timing (15 vs 13 days) and hospital stay (5 vs 6 days) were similar (<em>p</em> > 0.1). Meta-analysis showed comparable rates of haematoma, capsular contraction, skin necrosis, and wound dehiscence. However, ADM was associated with a higher risk of infection (odds ratio, 3.15, <em>p</em> = 0.0005, <em>I</em><sup>2</sup> = 0%). Results for seroma and implant loss should be interpreted with caution. Aesthetic outcomes, although variably measured, were mostly comparable. ADM use in DTI reconstruction offers more comfort with pocket coverage but appears to carry higher risks of infection, implant loss, and possibly seroma. This meta-analysis offers guidance regarding risks, benefits, and costs associated with ADM use in clinical practice.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 100-116"},"PeriodicalIF":2.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080627","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

Cholesteatoma in concha-type microtia 胆脂瘤见于甲壳型小鼠

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.bjps.2025.12.036

Nobuyuki Mitsuhashi , Takatoshi Yotsuyanagi , Ken Yamashita , Shinji Kato , Ayaka Kitada , Minoru Sakuraba

Background

Concha-type microtia with congenital aural stenosis carries a risk of external auditory canal cholesteatoma, which may cause infection and lead to the loss of costal cartilage grafts during auricular reconstruction. However, awareness of this risk among plastic surgeons remains limited. We aimed to review cases of cholesteatoma in concha-type microtia and discuss optimal management strategies.

Methods

We conducted a single-center retrospective review of patients with concha-type or small concha-type microtia and congenital aural stenosis who underwent auricular reconstruction with costal cartilage grafting between January 2018 and December 2021. We identified patients who developed external auditory canal cholesteatoma and analyzed the timing of occurrence, treatment, postoperative complications, graft preservation or removal, and postoperative course (including recurrence).

Results

Among 278 patients with microtia (90 auricles), 83 had concha-type or small concha-type microtia. The mean age at surgery was 11.8 years (range 10 to 24 years; median 11 years), and the cohort comprised 53 males and 30 females. Congenital aural stenosis (<4 mm) was present in 60 auricles, with cholesteatoma occurring in 4 (6.7%). One cholesteatoma was diagnosed preoperatively, two were diagnosed shortly after reconstruction (one required graft removal), and two were diagnosed after reconstruction. All patients underwent cholesteatoma excision and canalplasty. During ≥2 years of follow-up, mild restenosis but no recurrence were observed.

Conclusion

Concha-type microtia with congenital aural stenosis carries a risk of cholesteatoma. Preoperative screening is essential, and excision should precede auricular reconstruction. Vigilance during and after reconstruction, and close collaboration with otolaryngologists, are essential to prevent complications.

先天性耳廓狭窄的耳甲型小耳症有外耳道胆脂瘤的风险，可能引起感染并导致耳廓重建时肋软骨移植物的丢失。然而，整形外科医生对这种风险的认识仍然有限。我们的目的是回顾胆脂瘤在耳甲型小耳蜗的病例，并讨论最佳的管理策略。方法对2018年1月至2021年12月行肋软骨移植耳廓重建术的耳廓型或小耳廓型小耳廓狭窄患者进行单中心回顾性分析。我们确定了发生外耳道胆脂瘤的患者，并分析了发生时间、治疗、术后并发症、移植物保存或切除以及术后病程（包括复发）。结果278例小耳廓（90耳）中，有83例为甲壳型或小甲壳型小耳廓。手术的平均年龄为11.8岁（范围10 - 24岁，中位数11岁），队列包括53名男性和30名女性。先天性耳廓狭窄（4mm） 60例，胆脂瘤4例（6.7%）。1例术前诊断为胆脂瘤，2例重建后不久诊断为胆脂瘤（1例需要移除移植物），2例重建后诊断为胆脂瘤。所有患者均行胆脂瘤切除术和胆管成形术。随访≥2年，轻度再狭窄，无复发。结论先天性耳廓狭窄伴耳甲型小耳有胆脂瘤的危险。术前筛查是必要的，切除应先于耳廓重建。重建期间和重建后保持警惕，并与耳鼻喉科医生密切合作，对预防并发症至关重要。

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引用次数: 0

Sustainability in hand trauma surgery: An eco-audit of the flexor tendon laceration repair pathway 手部创伤手术的可持续性：屈肌腱撕裂修复途径的生态审计

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.bjps.2025.12.033

Zahra Ahmed , Alexander Zargaran , Olivia Kamoga , Punn Tannirandorn , Sara Sousi , David Zargaran , Norbert Kang , Afshin Mosahebi

Background

Hand trauma accounts for nearly one-third of emergency department (ED) attendances in the United Kingdom (UK). Particularly, repair of flexor tendon injuries is one of the most commonly performed plastic surgery procedures and requires months of repeated contact with hand therapy for optimal outcomes. The environmental impacts of treatment have not previously been evaluated.

Methods

A pilot retrospective service evaluation using process mapping and life-cycle assessment of 17 patients undergoing flexor tendon repair was performed using the functional unit of one completed patient pathway cycle, from ED to surgery, to rehabilitation and full recovery. Data were collected retrospectively from electronic patient records, supplier data and emission factor databases. Estimates for carbon dioxide emissions were generated in kgCO₂eq., allowing us to look for specific opportunities for pathway optimisation, in line with the national guidelines.

Results

We estimated the carbon footprint of a patient undergoing flexor tendon repair to be approximately 113.2 kgCO₂eq. The rehabilitation phase made the greatest contribution to emissions (59.9 kgCO₂eq., 52.9%) and patient travel was responsible for 79.4% of total emissions (89.9 kgCO₂eq.), followed by the production and transport of equipment (8.5 kgCO₂eq., 7.5%) needed for treatment.

Conclusions

The results of this pilot eco-audit identified key emission sources and potential interventions to reduce carbon emissions for this pathway. These include reducing the need for patient travel, which can be achieved by greening hand therapy through increased use of virtual consultations and encouraging the use of mobile phone applications. We also recommend the adoption of circular economy principles by using reusable surgical gowns and drapes, creation of procedure-specific equipment packs, and increased use of wide-awake local anaesthesia, no tourniquet.

背景：手部创伤占英国急诊科（ED）就诊人数的近三分之一。特别是，屈肌腱损伤的修复是最常见的整形手术之一，需要数月的反复接触手部治疗才能达到最佳效果。治疗对环境的影响以前没有得到评估。方法对17例接受屈肌腱修复术的患者，采用过程图和生命周期评估的方法，采用一个完整的患者路径周期的功能单元，从急诊科到手术，再到康复和完全恢复，进行回顾性服务评价。数据回顾性收集自电子病历、供应商数据和排放因子数据库。估算的二氧化碳排放量以kgCO2eq为单位。，使我们能够根据国家指导方针寻找途径优化的具体机会。结果我们估计接受屈肌腱修复的患者的碳足迹约为113.2 kgco2。恢复阶段对排放的贡献最大（59.9 kgCO2eq）。占总排放量的79.4% （89.9 kgco2当量），其次是设备的生产和运输（8.5 kgco2当量）。（7.5%）。该试点生态审计的结果确定了该路径的主要排放源和潜在的减少碳排放的干预措施。这些措施包括减少患者的旅行需求，这可以通过增加使用虚拟咨询和鼓励使用移动电话应用程序来实现绿色手部治疗。我们还建议采用循环经济原则，使用可重复使用的手术服和纱布，创建手术专用设备包，并增加使用全清醒局部麻醉，不使用止血带。

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引用次数: 0

National survey of thromboprophylaxis management and tranexamic acid utilization in patients undergoing non-free flap breast surgery 非游离皮瓣乳房手术患者血栓预防管理和氨甲环酸使用的全国调查。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.bjps.2025.12.031

Justin Haas , Ted Zhou , Kimberley Yuen , Helene Retrouvey , James Douketis , Ammara Ghumman

Introduction

Patients undergoing breast surgery are at risk of venous thromboembolism (VTE), but most literature examining thromboprophylaxis management in breast surgery focuses on free flap reconstruction. We evaluated thromboprophylaxis and tranexamic acid (TXA) practices among Canadian plastic surgeons for non-free flap breast surgeries.

Materials/methods

An anonymous online survey was distributed to Canadian plastic surgeons in 2025. Data collected included demographics, VTE prophylaxis strategies, and TXA use across nine commonly-performed non-free flap breast procedures. Predictors of thromboprophylaxis and TXA use were identified.

Results

Sixty-five surgeons nationwide (34% response rate) completed the survey; 43% had completed a breast fellowship. Although 79% reported regular use of VTE risk tools, prophylaxis practices varied widely. The most common threshold for initiating prophylaxis was 2–3 h of operative duration (35%). Mechanical prophylaxis was the least common in breast augmentation (38%), and chemical prophylaxis was the most common in pedicled flap reconstruction (46%). Fellowship-trained surgeons initiated thromboprophylaxis at earlier operative times (OR 5.8, 95% CI 1.8–19.1), whereas those with more than 10 years of experience delayed initiation (OR 8.2, 95% CI 1.8–38.0). Self-reported “guideline-adherent” surgeons were more likely to use mechanical prophylaxis than surgeons who did not report guideline usage. TXA use correlated with chemical thromboprophylaxis usage (OR 8.0, 95% CI 1.8–86.0) and earlier prophylaxis initiation (OR 27.2, 95% CI 2.7–273.1).

Conclusion

Thromboprophylaxis management is inconsistent in non-free flap breast surgery. Fellowship training, TXA utilization, and guideline usage predicted proactive prophylaxis approaches, whereas more clinical experience predicted conservative behaviors. Prophylaxis consensus is needed to support consistent, evidence-based care.

导论：接受乳房手术的患者存在静脉血栓栓塞（VTE）的风险，但大多数关于乳房手术中血栓预防管理的文献都集中在自由皮瓣重建上。我们评估了加拿大整形外科医生在非游离皮瓣乳房手术中的血栓预防和氨甲环酸（TXA）做法。材料/方法：一份匿名在线调查于2025年分发给加拿大整形外科医生。收集的数据包括人口统计学、静脉血栓栓塞预防策略和TXA在9种常用的非游离皮瓣乳房手术中的使用。确定血栓预防和TXA使用的预测因素。结果：全国65名外科医生完成调查，回复率34%；43%的人完成了乳房奖学金。尽管79%的人报告经常使用静脉血栓栓塞风险工具，但预防措施差异很大。开始预防的最常见阈值是手术持续时间2-3小时（35%）。机械预防在隆胸中最不常见（38%），化学预防在带蒂皮瓣重建中最常见（46%）。接受过奖学金培训的外科医生在更早的手术时间开始血栓预防（OR 5.8, 95% CI 1.8-19.1），而那些有10年以上经验的外科医生延迟了开始（OR 8.2, 95% CI 1.8-38.0）。自我报告的“遵循指南”的外科医生比未报告指南使用的外科医生更有可能使用机械预防。TXA的使用与化学血栓预防使用（OR 8.0, 95% CI 1.8-86.0）和早期预防开始（OR 27.2, 95% CI 2.7-273.1）相关。结论：非游离皮瓣乳房手术的血栓预防管理不一致。研究员培训、TXA的使用和指南的使用预测了积极的预防方法，而更多的临床经验预测了保守的行为。需要达成预防共识，以支持一致的循证护理。

{"title":"National survey of thromboprophylaxis management and tranexamic acid utilization in patients undergoing non-free flap breast surgery","authors":"Justin Haas , Ted Zhou , Kimberley Yuen , Helene Retrouvey , James Douketis , Ammara Ghumman","doi":"10.1016/j.bjps.2025.12.031","DOIUrl":"10.1016/j.bjps.2025.12.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients undergoing breast surgery are at risk of venous thromboembolism (VTE), but most literature examining thromboprophylaxis management in breast surgery focuses on free flap reconstruction. We evaluated thromboprophylaxis and tranexamic acid (TXA) practices among Canadian plastic surgeons for non-free flap breast surgeries.</div></div><div><h3>Materials/methods</h3><div>An anonymous online survey was distributed to Canadian plastic surgeons in 2025. Data collected included demographics, VTE prophylaxis strategies, and TXA use across nine commonly-performed non-free flap breast procedures. Predictors of thromboprophylaxis and TXA use were identified.</div></div><div><h3>Results</h3><div>Sixty-five surgeons nationwide (34% response rate) completed the survey; 43% had completed a breast fellowship. Although 79% reported regular use of VTE risk tools, prophylaxis practices varied widely. The most common threshold for initiating prophylaxis was 2–3 h of operative duration (35%). Mechanical prophylaxis was the least common in breast augmentation (38%), and chemical prophylaxis was the most common in pedicled flap reconstruction (46%). Fellowship-trained surgeons initiated thromboprophylaxis at earlier operative times (OR 5.8, 95% CI 1.8–19.1), whereas those with more than 10 years of experience delayed initiation (OR 8.2, 95% CI 1.8–38.0). Self-reported “guideline-adherent” surgeons were more likely to use mechanical prophylaxis than surgeons who did not report guideline usage. TXA use correlated with chemical thromboprophylaxis usage (OR 8.0, 95% CI 1.8–86.0) and earlier prophylaxis initiation (OR 27.2, 95% CI 2.7–273.1).</div></div><div><h3>Conclusion</h3><div>Thromboprophylaxis management is inconsistent in non-free flap breast surgery. Fellowship training, TXA utilization, and guideline usage predicted proactive prophylaxis approaches, whereas more clinical experience predicted conservative behaviors. Prophylaxis consensus is needed to support consistent, evidence-based care.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 23-31"},"PeriodicalIF":2.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013978","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

Optimizing outcomes in pediatric microvascular mandibular reconstruction: A 23-year institutional experience 优化儿童下颌骨微血管重建的结果：23年的机构经验。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-06 DOI: 10.1016/j.bjps.2025.12.030

Theodor B. Lenz, Dominic J. Romeo, Allison C. Hu, Jacob R. Thomas, Patrick Akarapimand, Scott P. Bartlett, Jesse A. Taylor, Eric J. Granquist, Cassandra A. Ligh, Jordan W. Swanson

Background

The vascularized free fibula flap (VFFF) is a well-established technique for addressing critical-sized mandibular defects, including those in pediatric patients. However, surgical risk factors and impact on growth potential are not well understood, particularly in skeletally immature patients, nor are the methods to optimize growth and outcomes.

Methods

We retrospectively reviewed children who underwent mandibular reconstruction using VFFF between 2001 and 2024 at our institution. Complications were classified using the Clavien–Dindo scale. Data were analyzed using Pearson’s r correlation, Fisher’s exact tests, and chi-squared analysis.

Results

Twenty-nine patients underwent 31 mandibular reconstructions using VFFFs at a median age of 14 years old (range: 3.5–18.9 years), most commonly after ameloblastoma resection (n=10, 32%). Twenty-nine (94%) flaps were successful, and 17 complication events transpired among 13 (42%) operations, most commonly hardware exposure (n=4, 24%). Complications decreased with increased institutional experience (after 2016, p=0.011) and with the use of two rather than one venous anastomosis (p=0.002). Recipient site complications were more common in patients under 12 years of age (p=0.026). Although flap viability was high; two flap failures occurred with single venous anastomosis, and none with two venous anastomoses. Hardware removal was planned on an average 15.7 months after nine operations (29%) to maintain growth potential; subsequent corrective orthognathic surgery was performed following four flaps (13%).

Conclusion

Pediatric mandibular reconstruction using VFFF is safe and effective, with the majority maintaining functional occlusion with growth. Complication rates are comparable to those in the adult population and may be mitigated via multiple vein anastomoses and institutional experience.

背景：带血管的游离腓骨瓣（VFFF）是一种成熟的技术，用于解决临界大小的下颌骨缺损，包括那些儿童患者。然而，手术风险因素和对生长潜力的影响还不清楚，特别是在骨骼不成熟的患者中，也没有优化生长和结果的方法。方法：我们回顾性分析了2001年至2024年间在我院使用VFFF进行下颌骨重建的儿童。采用Clavien-Dindo量表对并发症进行分类。数据分析采用Pearson’s r相关、Fisher’s精确检验和卡方分析。结果：29例患者使用VFFFs进行了31次下颌重建，中位年龄为14岁（范围：3.5-18.9岁），最常见的是成釉细胞瘤切除术（n= 10.32%）。29例（94%）皮瓣成功，13例（42%）手术中发生17例并发症，最常见的是硬体暴露（n= 4,24%）。随着机构经验的增加（2016年以后，p=0.011）和使用两次静脉吻合术而不是一次静脉吻合术（p=0.002），并发症减少。受体部位并发症在12岁以下患者中更为常见（p=0.026）。虽然皮瓣活力高；单静脉吻合术有2例皮瓣失败，双静脉吻合术无皮瓣失败。为保持增长潜力，9次手术后平均需要15.7个月（29%）进行硬体移除；随后的矫正正颌手术在4个皮瓣后进行（13%）。结论：使用VFFF重建儿童下颌骨是安全有效的，大多数人在生长过程中保持了功能咬合。并发症发生率与成人相当，可以通过多静脉吻合术和机构经验来减轻。

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引用次数: 0