Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第3页

Unequal burden: Inguinal sentinel lymph node biopsy and the disproportionate risk of infection in melanoma 不平等的负担：腹股沟前哨淋巴结活检和黑色素瘤感染的不成比例的风险。

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.2025.12.039

Aleksandra Nowak , Jessica Coyle , Abigail Colletta , Veronique Verhoeven , Gino Vissers

Aim

To evaluate surgical site-specific infection rates after sentinel lymph node biopsies (SLNB) for melanoma.

Methods

This single-centre retrospective analysis of prospectively collected data included 422 patients who underwent SLNB between January 2020 and January 2025. Negative post-operative outcomes within 31 days were recorded: infection, seroma, wound dehiscence, haematoma, lymphedema and other complications. Clinical variables included: demographics, SLNB site and result, comorbidity, prophylactic antibiotic use and American Joint Committee on Cancer stage. Multivariable logistic regression was used to identify predictors of infection. This study adheres to the STROBE guidelines (Supplementary Appendix).

Results

Across the 422 patients in the cohort (mean age 59.1 years, range 6–89 years), infection accounted for 55 cases (13%). Rates varied markedly by site: inguinal 23.9%, axilla 7.8%, knee 29.4% and head/neck 3.0%. All infections were managed with antibiotics, and none required re‑operation. Multivariable analysis revealed that inguinal site (OR 5.01, 95% CI 2.50–10.04, p < 0.001) and male gender (OR 2.57, 95% CI 1.30–5.09, p = 0.007) independently predicted postoperative infection. Age and comorbidity were not associated with increased risk in our cohort.

Conclusion

Within this UK cohort, the SLNB anatomical site emerged as the strongest driver of postoperative infection, with inguinal procedures carrying the greatest increase in risk. Male patients were also at a higher risk of infection. These findings highlight the value of targeted prevention strategies and close postoperative surveillance for high-risk groups.

目的：评价黑色素瘤前哨淋巴结活检（SLNB）后手术部位特异性感染率。方法：这项单中心回顾性分析前瞻性收集的数据包括422名在2020年1月至2025年1月期间接受SLNB的患者。术后31天内阴性结果：感染、血肿、创面裂开、血肿、淋巴水肿等并发症。临床变量包括：人口统计学、SLNB部位和结果、合并症、预防性抗生素使用和美国癌症分期联合委员会。使用多变量逻辑回归来确定感染的预测因素。本研究遵循STROBE指南（补充附录）。结果：在队列中的422例患者（平均年龄59.1岁，范围6-89岁）中，感染占55例（13%）。不同部位的发病率差异显著：腹股沟23.9%，腋窝7.8%，膝关节29.4%，头颈部3.0%。所有感染均使用抗生素治疗，无一例需要再次手术。多变量分析显示腹股沟部位（OR 5.01, 95% CI 2.50-10.04, p）。结论：在英国队列中，SLNB解剖部位成为术后感染的最强驱动因素，腹股沟手术风险增加最大。男性患者感染的风险也更高。这些发现强调了有针对性的预防策略和对高危人群术后密切监测的价值。

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引用次数: 0

Explainable AI modeling of postoperative surgical site infection risk in autologous breast reconstruction 自体乳房再造术术后手术部位感染风险的可解释AI模型

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.2025.12.029

Diwakar Phuyal , Berk Ozmen , Ibrahim Berber , Graham Schwarz

Background

Surgical site infections (SSIs) following autologous breast reconstruction, particularly deep inferior epigastric perforator (DIEP) flap procedures, pose a substantial clinical burden and is associated with increased risk of hospital readmission. Existing prediction models lack sufficient accuracy in identifying high-risk patients. We aimed to develop a machine learning model to predict 30-day SSI risk and identify key predictors using a national surgical quality database.

Methods

A total of 13,312 DIEP flap reconstructions from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2016 and 2022 were analyzed. An XGBoost classifier incorporating demographic, comorbidity, operative, and laboratory variables was trained and evaluated using accuracy, recall, precision, F1 score, and area under the curve (AUC). Model explainability was assessed using SHapley Additive exPlanations (SHAP) to identify key predictors and their directional influence.

Results

The overall SSI rate was 8.14%. XGBoost classifier achieved an accuracy of 74.6%, a recall of 74.6%, and an AUC of 0.63 for predicting 30-day SSI. Key predictors of SSI included year of surgery (5.3% in 2016 and 9.3% in 2022), elevated BMI, increased body weight, prolonged operative time, and longer hospital stay.

Conclusion

This model demonstrates the feasibility and interpretability of explainable AI in identifying SSI-related risk patterns using large-scale national data. It provides a framework for retrospective SSI risk analysis and hypothesis generation, thereby establishing a robust foundation for future preoperative-focused and prospectively validated prediction models.

背景自体乳房重建术后的手术部位感染（ssi），特别是腹下深穿支（DIEP）皮瓣手术，造成了巨大的临床负担，并增加了再入院的风险。现有的预测模型在识别高危患者方面缺乏足够的准确性。我们的目标是开发一个机器学习模型来预测30天的SSI风险，并使用国家手术质量数据库确定关键预测因素。方法对2016年至2022年美国外科学会国家手术质量改进计划（NSQIP）中13312例DIEP皮瓣重建进行分析。结合人口统计学、合并症、手术和实验室变量的XGBoost分类器进行了训练，并使用准确性、召回率、精度、F1评分和曲线下面积（AUC）进行了评估。使用SHapley加性解释（SHAP）评估模型的可解释性，以确定关键预测因子及其方向性影响。结果SSI总发生率为8.14%。XGBoost分类器预测30天SSI的准确率为74.6%，召回率为74.6%，AUC为0.63。SSI的主要预测因素包括手术年份（2016年为5.3%，2022年为9.3%）、BMI升高、体重增加、手术时间延长和住院时间延长。该模型证明了可解释人工智能在利用大规模国家数据识别ssi相关风险模式方面的可行性和可解释性。它为回顾性SSI风险分析和假设生成提供了一个框架，从而为未来以术前为重点和前瞻性验证的预测模型奠定了坚实的基础。

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引用次数: 0

The role of negative pressure wound therapy on TGF-β1, MMP-9, α-SMA, and collagen type III in preventing burn contractures in a porcine model 负压创面治疗对TGF-β1、MMP-9、α-SMA和III型胶原预防猪烧伤挛缩的作用

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.2025.12.034

Muhammad Rosadi Seswandhana , Gunadi , Sumadi L. Anwar , Teguh Aryandono , Ishandono Dachlan , Budi Mulyono , Irianiwati Widodo , Yohanes W. Wirohadidjojo , Mokhammad P.L. Sukma , Pramana Adhityo

Introduction

Burns are a leading cause of disability and death, requiring prolonged hospitalization and high costs that impair daily activities. Wound healing involves cytokines and growth factors. Despite various treatments, ideal wound dressing remains unidentified. Negative pressure wound therapy (NPWT) has shown potential as an ideal wound healing environment. We compared saline dressings, silver sulfadiazine, intermittent NPWT, and continuous NPWT on wound contraction, re-epithelialization, and biomarkers (MMP-9, TGF-β1, α-SMA, and COL3) in a porcine deep dermal burn model.

Methods

Six male Yorkshire pigs received 20 burns and were treated with NaCl 0.9% dressings, silver sulfadiazine, intermittent, or continuous NPWT. Wound healing was assessed on days 1, 3, 7, 14, and 21. MMP-9 and TGF-β1 were analyzed using ELISA, α-SMA, and COL3 using immunohistochemistry. Statistical analyses included linear regression, ANOVA, post-hoc tests, and path analyses.

Results

Intermittent NPWT showed the lowest wound contraction on days 14 and 21 (p<0.001) and highest re-epithelialization on day-21 (p=0.0027). MMP-9 and TGF-β1 levels were significantly elevated in both NPWT groups across most time points (days 1, 3, 7, and 14), with TGF-β1 peaking in the NaCl group on day-21. Significant α-SMA histoscores differences appeared on day 3, while COL3 differences were significant on day-14.

Conclusions

NPWT may reduce wound contraction and accelerates re-epithelialization without impairing wound healing, confirmed by modulation of MMP-9, TGFβ1, α-SMA, and COL3, suggesting the potential to minimize contracture scar formation.

导读：烧伤是致残和死亡的主要原因，需要长期住院治疗，费用高，影响日常活动。伤口愈合涉及细胞因子和生长因子。尽管有各种治疗方法，理想的伤口敷料仍未确定。负压创面治疗是一种理想的创面愈合环境。我们比较了生理盐水敷料、磺胺嘧啶银、间歇NPWT和连续NPWT对猪深部皮肤烧伤模型伤口收缩、再上皮化和生物标志物（MMP-9、TGF-β1、α-SMA和COL3）的影响。方法：公约克猪6头，烧伤20次，用0.9% NaCl敷料、磺胺嘧啶银、间歇或连续NPWT治疗。分别于第1、3、7、14、21天评估伤口愈合情况。ELISA法分析MMP-9、TGF-β1，免疫组化法分析α-SMA、COL3。统计分析包括线性回归、方差分析、事后检验和通径分析。结果：间歇性NPWT在第14天和第21天创面收缩最小(p结论：NPWT可减少创面收缩，加速创面再上皮化，但不损害创面愈合，通过调节MMP-9、TGFβ1、α-SMA和COL3证实，提示可能减少挛缩性瘢痕形成。

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引用次数: 0

Harnessing population genetics and animal models to uncover the genetics of skin scarring 利用群体遗传学和动物模型来揭示皮肤疤痕的遗传学。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.11.010

Oscar A. Peña , Marisa Cañadas-Garre , Iona Collins , Nicholas J. Timpson , Paul Martin

Skin wound healing is a complex process that requires the orchestrated response of several different cell types to repair the damaged tissue and restore function. Superficial skin wounds tend to heal within days. However, larger and deeper wounds such as those caused by trauma or surgery generally heal by leaving a scar, which can impact tissue function. Scars can be debilitating, painful, and can significantly impair function. New developments to prevent and treat scarring require a deeper understanding of the cellular and molecular mechanisms associated with wound healing and scarring. Most of our current understanding of the genetics of wound healing comes from studies in animal models. However, population health approaches combined with experimental validation in animal models offer new opportunities to harness natural variability in wound repair outcomes in the population and identify new relevant biology controlling different aspects of repair and scarring in a different way. These approaches have the potential to reveal association between genetic loci and wound phenotypes in humans. Complementary experimental studies in animal models can help to validate these candidate genes and our understanding of the underlying mechanisms. In this non-systematic review, we propose the application of strategies using population health/genetics together with zebrafish models of wounding to specifically study skin scarring. We discuss potential pitfalls and strengths of the combined and complementary use of population health approaches and animal models for the identification and validation of new genes involved in skin repair, and in particular, scarring.

皮肤创面愈合是一个复杂的过程，需要多种不同类型细胞的协调反应来修复受损组织和恢复功能。皮肤表面的伤口往往会在几天内愈合。然而，更大和更深的伤口，如创伤或手术造成的伤口，通常会留下疤痕来愈合，这会影响组织功能。疤痕会使人虚弱、痛苦，并会严重损害身体机能。预防和治疗瘢痕形成的新进展需要对与伤口愈合和瘢痕形成相关的细胞和分子机制有更深入的了解。我们目前对伤口愈合的遗传学的了解大多来自动物模型的研究。然而，人群健康方法与动物模型实验验证相结合，为利用人群中伤口修复结果的自然变异性提供了新的机会，并确定了以不同方式控制修复和瘢痕形成不同方面的新的相关生物学。这些方法有可能揭示遗传位点与人类伤口表型之间的关系。动物模型的补充实验研究可以帮助验证这些候选基因和我们对潜在机制的理解。在这篇非系统综述中，我们建议将群体健康/遗传学策略与斑马鱼损伤模型结合起来专门研究皮肤疤痕。我们讨论了潜在的缺陷和优势，结合和补充使用人群健康方法和动物模型来识别和验证参与皮肤修复的新基因，特别是疤痕。

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引用次数: 0

A better understanding and outcomes for wounds and scars: 25 Years of the Scar Free Foundation 对伤口和疤痕更好的理解和结果：无疤痕基金会25年

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.12.027

Jason Wong (JPRAS Deputy Editor), Richard Nugee (Lt. Gen., Chief Executive)

引用次数: 0

Orofacial cleft repair: A clinical model for studying genetic contribution to scar severity 口面裂修复：研究疤痕严重程度遗传贡献的临床模型。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.10.044

Rebecca J. Richardson , Kevin Thiessen , Nigel Mercer , Bruce Richard , Yvonne Wren , Jonathan Sandy

Scars resulting from surgical repair of cleft lip and palate provide a unique model in humans for studying factors that affect the severity of scarring. Anatomically, clefts of the lip and palate are consistent in location and are treated surgically with similar methods and timing. This contrasts with the considerably greater variability observed in traumatic injuries, burns or emergency surgical procedures and the scars resulting from these cause tissue damage. Clinical audit protocols for cleft lip and palate ensure that data on outcomes for appearance, function and wellbeing are collected at standard points in a child’s development and are followed-up over time, permitting cross sectional and longitudinal analysis of scarring. Therefore, enhancing our understanding of the impact of genetics and environmental factors on scar severity following surgical repair of clefts can provide information on factors that may be associated with scarring from other insults, where uniform data are not available. Animal models offer opportunities to investigate factors that could influence scar severity and overall repair quality. In this review, we will discuss the possibilities for scarring research in cohorts of children born with cleft defects and the advantages of using different animal models for studying the mechanistic drivers of variation in scar severity.

唇腭裂手术修复后的瘢痕为研究影响瘢痕严重程度的因素提供了一个独特的人体模型。解剖上，唇裂和腭裂在位置上是一致的，用相似的手术方法和时间来治疗。这与在创伤性损伤、烧伤或紧急外科手术中观察到的更大的可变性形成对比，这些造成的疤痕会导致组织损伤。唇腭裂的临床审计方案确保在儿童发育的标准点收集外观，功能和健康结果的数据，并随着时间的推移进行随访，允许对疤痕进行横断面和纵向分析。因此，加强我们对遗传和环境因素对唇腭裂手术修复后瘢痕严重程度的影响的理解，可以提供可能与其他损伤引起的瘢痕相关的因素的信息，在这些方面没有统一的数据。动物模型为研究可能影响疤痕严重程度和整体修复质量的因素提供了机会。在这篇综述中，我们将讨论在先天性腭裂缺陷儿童群体中进行疤痕研究的可能性，以及使用不同动物模型研究疤痕严重程度变化的机制驱动因素的优势。

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引用次数: 0

Evaluating the role of the ‘Accessible Novel Solutions for Widespread Emergency Reconstructive Surgery’ (ANSWERS) 3D-printed perineal training model for conflict-related sexual violence injuries 评估“广泛紧急重建手术的无障碍新解决方案”（ANSWERS） 3d打印会阴培训模型对与冲突有关的性暴力伤害的作用。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.11.051

Stephen R. Ali , HRH The Duchess of Edinburgh , Gloire Byabene , Carys Edwards , Beth Norman , Octavian Parkes , Hari Arora , Denis Mukwege , Iain S. Whitaker

Introduction

Conflict-related sexual violence (CRSV) causes considerable physical and psychological harm, often leading to complex urogenital injuries that require specialised reconstructive surgery. Despite the growing global demand for specialised surgical care, access to niche specialities and training resources remain limited, particularly in high-conflict and resource-constrained areas. This study evaluates the effectiveness of the Accessible Novel Solutions for Widespread Emergency Reconstructive Surgery (ANSWERS) 3D-printed model, developed in collaboration with the Panzi Foundation, as a training tool for urogenital fistula repair associated with CRSV.

Methods

Conducted at Panzi Hospital in the Democratic Republic of Congo, this study employed a cross-sectional survey design involving 13 healthcare professionals. Participants engaged in hands-on practice with the 3D-printed model, creating and repairing simulated defects to closely replicate CRSV injuries. The survey assessed the model’s anatomical fidelity, usability and impact on surgical preparedness, incorporating quantitative ratings and qualitative feedback.

Results

Our findings revealed strong support for the model's training value, with most participants reporting increased confidence in their technical skills. Areas for improvement due to limitations of anatomical detail and material durability were noted. Qualitative insights indicated that integrating the Panzi score—a classification system for fistula severity—and augmented reality or extended reality technology could enhance the model's relevance and interactivity.

Conclusion

The study highlights the use of the ANSWERS 3D-printed model in building competency-based training protocols in CRSV care. Future refinements in the multilayered materials, novel bioengineering approaches to enhance biomimicry, anatomical accuracy based on CT scans and Panzi score classifications hold great potential. Ultimately, digital integrations could lead to the development of a standardised, immersive training curriculum that aligns with Panzi Hospital’s holistic approach, improving surgical outcomes for CRSV survivors globally.

与冲突有关的性暴力（CRSV）造成相当大的身体和心理伤害，往往导致复杂的泌尿生殖系统损伤，需要专门的重建手术。尽管全球对专业外科护理的需求不断增长，但获得利基专业和培训资源的机会仍然有限，特别是在高冲突和资源有限的地区。本研究评估了与Panzi基金会合作开发的广泛紧急重建手术无障碍新解决方案（ANSWERS） 3d打印模型的有效性，该模型作为与CRSV相关的泌尿生殖瘘修复的培训工具。方法：本研究在刚果民主共和国Panzi医院进行，采用横断面调查设计，涉及13名卫生保健专业人员。参与者参与了3d打印模型的动手实践，创建和修复模拟缺陷，以紧密复制CRSV损伤。该调查评估了模型的解剖保真度、可用性和对手术准备的影响，包括定量评分和定性反馈。结果：我们的研究结果显示了对模型训练价值的强有力支持，大多数参与者报告说他们对自己的技术技能增加了信心。指出了由于解剖细节和材料耐久性的限制而需要改进的领域。定性分析表明，将Panzi评分（瘘管严重程度的分类系统）与增强现实或扩展现实技术相结合，可以增强模型的相关性和交互性。结论：该研究强调了在CRSV护理中使用ANSWERS 3d打印模型构建基于能力的培训协议。未来多层材料的改进、增强仿生学的新型生物工程方法、基于CT扫描和Panzi评分分类的解剖准确性都具有巨大的潜力。最终，数字整合可能导致标准化、沉浸式培训课程的开发，该课程与Panzi医院的整体方法相一致，从而改善全球CRSV幸存者的手术结果。

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引用次数: 0

From patient to partner: Crowdsourcing and digital innovations reshaping scar research and scar care management 从患者到合作伙伴：众包和数字创新重塑疤痕研究和疤痕护理管理。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.10.024

K.J.P. Maertens , T. Demarbaix , J. Meirte , U. Van Daele , P. Moortgat

Traditional scar research has historically prioritized clinician-driven outcomes, often neglecting patient-identified needs and real-world experiences. This narrative review synthesizes developments in patient-powered innovation across scar research, drawing from the last decade of literature on patient-reported outcome measures (PROMs), real-world data, digital health tools, and participatory models. Increased adoption of PROMs (e.g., Patient and Observer Scar Assessment Scale 3.0 and SCAR-Q), crowdsourced initiatives, and digital tools (e.g., ScarPath, smartphone apps, and AI-based assessments) are transforming scar research and management by centering patient priorities. Patient-powered approaches—through digital tools, crowdsourcing, and participatory research—are reshaping scar care by promoting real-world engagement and more meaningful, personalized outcomes.

传统的疤痕研究历来优先考虑临床驱动的结果，往往忽略了患者确定的需求和现实世界的经验。这篇叙述性综述综合了疤痕研究中患者驱动创新的发展，借鉴了过去十年关于患者报告结果测量（PROMs）、现实世界数据、数字健康工具和参与式模型的文献。越来越多地采用PROMs（例如，患者和观察者疤痕评估量表3.0和Scar - q）、众包计划和数字工具（例如，ScarPath、智能手机应用程序和基于人工智能的评估），通过集中患者的优先事项，正在改变疤痕研究和管理。通过数字工具、众包和参与式研究，以患者为动力的方法正在通过促进现实世界的参与和更有意义的个性化结果来重塑疤痕护理。

引用次数: 0

Commentary to accompany: Surgical reconstruction of severe pressure ulcers in England from 01/04/2011 to 30/09/2018: Retrospective cohort study using routinely collected data 附评论：2011年4月1日至2018年9月30日英国严重压疮手术重建：使用常规收集数据的回顾性队列研究。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.06.023

James Chan

引用次数: 0

Hair follicle-inspired therapies for wound healing and scar remodelling 毛囊启发治疗伤口愈合和疤痕重塑。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.07.023

Min Waye Chew , Summik Limbu , Paul Kemp , Claire A. Higgins

Human skin does not regenerate after severe injuries. Instead, the wound healing process repairs the skin as quickly as possible, which can lead to the formation of scar tissue. Scar tissue has reduced function compared to healthy skin; contractures limit movement, sensation is altered, the skin is itchy, and there are no functional appendages, such as sweat glands and hair follicles. As the cellular and molecular mechanisms of scarring are becoming better understood, most therapeutic strategies focus on preventing scar formation by targeting the wound healing process. One avenue of research takes inspiration from the hair follicle, as hairy skin heals with faster wound closure and reduced scar formation compared to non-hairy skin. It is thought that the hair follicle has a contributing role in this process and hair follicles transplanted into chronic (non-closing) wounds have been shown to kick-start wound closure. In the context of scarring, hair follicles transplanted into longstanding scar tissue also lead to scar remodelling. In this review, we discuss the role of hair follicles and cells or biomaterials derived from the hair follicle in both wound healing and scar remodelling.

人的皮肤在受到严重伤害后不会再生。相反，伤口愈合过程会尽可能快地修复皮肤，这可能导致疤痕组织的形成。与健康皮肤相比，疤痕组织的功能有所降低；挛缩限制运动，感觉改变，皮肤发痒，没有功能附属物，如汗腺和毛囊。随着瘢痕形成的细胞和分子机制越来越被人们所了解，大多数治疗策略都集中在通过靶向伤口愈合过程来防止瘢痕形成。一项研究从毛囊中获得灵感，因为与无毛皮肤相比，有毛的皮肤愈合速度更快，疤痕形成也更少。人们认为毛囊在这一过程中起着重要作用，将毛囊移植到慢性（非闭合）伤口中已被证明可以启动伤口愈合。在形成疤痕的情况下，将毛囊移植到长期存在的疤痕组织中也会导致疤痕重塑。在这篇综述中，我们讨论了毛囊和毛囊细胞或来源于毛囊的生物材料在伤口愈合和疤痕重塑中的作用。

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引用次数: 0