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

A single center retrospective observational study on 106 consecutive lipedema surgeries: Defining the ideal surgical approach 一项针对106例连续脂肪水肿手术的单中心回顾性观察研究：确定理想的手术入路。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-23 DOI: 10.1016/j.bjps.2025.12.018

Maëlle Thiry , Luigi Schiraldi , Martino Guiotto , Marco Fresa , Lucia Mazzolai , Pietro G. di Summa

Introduction

Lipedema causes abnormal fat accumulation in the limbs, leading to pain, functional impairment, and body image disturbance. Nowadays, various liposuction techniques are available. The wet technique is increasingly being considered as the gold standard; however, comparative data between the dry and wet methods remain limited. We evaluated the efficacy of liposuction and compared outcomes between dry and wet approaches. Our analysis focused on surgical characteristics, complication rates, and clinical outcomes including pain relief, functional improvement, and esthetic satisfaction, with comparisons made between preoperative and 12-month postoperative results.

Methods

Besides surgical data extraction, patient-reported outcome measures (PROMs) were obtained through three different standardized questionnaires to assess pain relief, function gain, and esthetic satisfaction.

Results

Both techniques were effective, demonstrating overall improvements in pain, function, and body image, when comparing pre and postoperative outcomes. Lipoaspirate volumes were comparable between the groups. Operative time was significantly shorter in the wet technique group. Short-term complication rates did not differ between dry and wet techniques. While both techniques led to a global improvement, the wet technique showed greater potential in pain reduction and better esthetics satisfaction 12 months post-surgery.

Conclusion

Lipedema is a complex disease that is still poorly understood. Liposuction may offer symptomatic relief regardless of the technique used, but the wet technique demonstrates better postoperative results, with improved PROMs and fewer complications. The treatment of lipedema requires a multidisciplinary approach, while conservative therapy remains the first-line option, surgical treatment by wet liposuction should be considered for its significant potential in improving functional outcomes and as an effective therapeutic option.

简介：脂水肿导致肢体脂肪异常堆积，导致疼痛、功能障碍和身体形象障碍。如今，有各种各样的抽脂技术可供选择。湿法技术越来越被认为是黄金标准；然而，干法和湿法之间的比较数据仍然有限。我们评估了吸脂术的疗效，并比较了干法和湿法的结果。我们的分析侧重于手术特点、并发症发生率和临床结果，包括疼痛缓解、功能改善和审美满意度，并对术前和术后12个月的结果进行比较。方法：除手术数据提取外，通过三种不同的标准化问卷评估疼痛缓解、功能获得和审美满意度，获得患者报告的结果测量（PROMs）。结果：两种技术都是有效的，在比较术前和术后结果时，显示出疼痛、功能和身体形象的总体改善。两组间吸脂量具有可比性。湿法组手术时间明显缩短。短期并发症发生率在干法和湿法之间没有差异。虽然这两种技术都带来了全面的改善，但湿法技术在术后12个月的疼痛减轻和美学满意度方面显示出更大的潜力。结论：脂水肿是一种复杂的疾病，目前仍知之甚少。无论采用何种技术，吸脂术都可以缓解症状，但湿法术后效果更好，PROMs得到改善，并发症更少。脂水肿的治疗需要多学科的方法，保守治疗仍然是一线选择，湿吸脂手术治疗应该被考虑，因为它在改善功能结果方面有很大的潜力，也是一种有效的治疗选择。

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引用次数: 0

The balanced aesthetic yielding of alar design (BAYAD) technique: A rulerless, visual landmark guided approach for alar base reduction in rhinoplasty cases 鼻翼设计的平衡美学屈服（BAYAD）技术：一种无尺子、视觉地标引导的鼻整形病例鼻翼基部缩小方法

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-30 DOI: 10.1016/j.bjps.2026.01.031

Bayad Jaza Mahmood

Background

Alar base reduction in rhinoplasty is technically demanding, especially across diverse ethnic anatomies. Traditional ruler-based measurements often fail to accommodate intraoperative variations.

Objective

To assess the outcomes of the balanced aesthetic yielding of alar design (BAYAD) technique, a rulerless method guided by intraoperative visual landmarks.

Methods

A prospective comparative study included 927 rhinoplasty patients who underwent alar base modification between January 2022 and January 2025. Of these, 827 were treated using the BAYAD technique and 100 with traditional ruler-based planning. Primary outcomes were operative time, complication rates, revision rates, and patient satisfaction. Subgroup analysis was performed by ethnicity. Data were analyzed using the t- and Chi-square tests, with significance at p < 0.05.

Results

The BAYAD group comprised 507 females and 320 males (mean age 32.4 ± 6.2 years), with 49.8% Middle Eastern, 34.2% Kurdish, and 16.0% Mediterranean patients. Patient satisfaction was significantly higher with BAYAD (94% vs. 85%), with 61.9% reporting excellent outcomes. Complications were fewer, including minor asymmetry (4.2% vs. 8%) and revision surgeries (3.1% vs. 7%). Operative efficiency improved, with alar base reduction averaging 5.1 ± 1.8 min compared to 12.5 ± 3.9 min, a mean saving of 7.4 min, contributing to a 7.4-min reduction in total rhinoplasty duration. No significant differences were found in gender, age, or ethnicity (p > 0.05).

Conclusion

The BAYAD technique is a reliable, efficient, and anatomy-driven alternative to ruler-based methods, achieving higher satisfaction, fewer complications, and greater adaptability across ethnic nasal types, reinforcing its role in modern rhinoplasty.

背景鼻整形术中鼻基缩小在技术上要求很高，特别是在不同种族的解剖结构中。传统的基于尺子的测量常常不能适应术中变化。目的评价术中视觉标志引导下无尺子的鼻翼设计平衡美学生成技术（BAYAD）的效果。方法一项前瞻性比较研究纳入了2022年1月至2025年1月期间接受鼻翼基部修复的927例鼻整形患者。其中827例采用BAYAD技术，100例采用传统尺子规划。主要结果为手术时间、并发症发生率、翻修率和患者满意度。按种族进行亚组分析。数据分析采用t检验和卡方检验，p <； 0.05为显著性。结果BAYAD组女性507例，男性320例（平均年龄32.4±6.2岁），中东患者占49.8%，库尔德患者占34.2%，地中海患者占16.0%。BAYAD的患者满意度显著提高（94%对85%），61.9%的患者报告了良好的结果。并发症较少，包括轻微不对称（4.2%对8%）和翻修手术（3.1%对7%）。手术效率提高，鼻翼基部减少平均5.1±1.8分钟，而12.5±3.9分钟，平均节省7.4分钟，总鼻整形时间减少7.4分钟。在性别、年龄或种族方面没有发现显著差异（p > 0.05）。结论BAYAD技术是一种可靠、高效、以解剖为导向的方法，可替代基于尺子的方法，具有更高的满意度、更少的并发症和更强的跨民族鼻型适应性，在现代鼻整形中具有重要的应用价值。

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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 : 2026-03-01 Epub 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 impact of closed-incision negative-pressure therapy on donor-site outcomes in drainless abdominal free flap breast reconstruction 闭口负压治疗对无引流腹部自由皮瓣乳房再造术供区预后的影响。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.bjps.2026.01.027

Jina Kim, Chanwoo Park, Kyong-Je Woo, Goo-Hyun Mun

Concerns regarding donor-site healing persist in abdominal-based free flap breast reconstruction. Although closed-incision negative-pressure therapy (CINPT) has demonstrated wound-related benefits, its efficacy without the use of drains remains unexplored. We evaluated the impact of CINPT compared with those of standard dressings on abdominal donor-site outcomes in drainless closure. We retrospectively reviewed patients with breast cancer who underwent abdominal-based free flap breast reconstruction without donor-site drains between January 2023 and April 2025. Patients received either CINPT (using the PICO system, Smith & Nephew) or the standard dressing (using Steri-Strips, 3M). Outcomes included fluid collections requiring aspiration, overall donor-site complications, and BREAST-Q abdomen scores. A total of 172 patients were included (CINPT group: 86 and standard group: 86). There were no significant differences in the incidence of donor-site fluid accumulation (26.7% vs. 22.1%, p = 0.478) or overall complications (4.7% vs. 5.8%, p = 1.000). CINPT showed higher early scar satisfaction at 2.6 months (2.3 ± 0.9 vs. 2.1 ± 0.8, p = 0.048); whereas other BREAST-Q subscales were comparable. In drainless abdominal-based free flap breast reconstruction, CINPT did not reduce fluid collections or other donor-site complications compared with standard dressings. Standard dressing may be a safe and sufficient option, whereas CINPT may offer benefits in early scar satisfaction.

在以腹部为基础的自由皮瓣乳房重建中，对供体部位愈合的担忧仍然存在。虽然闭合切口负压疗法（CINPT）已经证明了与伤口相关的益处，但其在不使用引流管的情况下的疗效仍未得到探索。我们评估了CINPT与标准敷料在无引流闭合中对腹部供区结果的影响。我们回顾性分析了2023年1月至2025年4月期间接受无供区引流的腹部游离皮瓣乳房重建术的乳腺癌患者。患者接受CINPT（使用PICO系统，Smith & Nephew）或标准敷料（使用Steri-Strips， 3M）。结果包括需要抽吸的液体收集、供体部位的总体并发症和BREAST-Q腹部评分。共纳入172例患者（CINPT组86例，标准组86例）。供体部位积液发生率（26.7%比22.1%,p = 0.478）和总并发症发生率（4.7%比5.8%,p = 1.000）差异无统计学意义。CINPT在2.6个月时显示更高的早期疤痕满意度（2.3±0.9比2.1±0.8,p = 0.048）；而其他BREAST-Q量表具有可比性。在无排水腹部自由皮瓣乳房重建中，与标准敷料相比，CINPT并没有减少液体收集或其他供体部位并发症。标准敷料可能是安全和充分的选择，而CINPT可能在早期疤痕满意方面有好处。

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引用次数: 0

Recent preoperative opioid prescription is associated with increased complications after microsurgical breast reconstruction 近期术前阿片类药物处方与显微外科乳房重建术后并发症增加有关。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-15 DOI: 10.1016/j.bjps.2026.01.010

Patricia M. Fuentes , Matthew Q. Dao , Emma Lascar , Sheuli Chowdhury , Bernice Yu , Jasmin Wilson , Arjun Nanda , Jeffery Russell , Peter J. Taub , Peter W. Henderson

Background

Opioids are frequently prescribed during breast cancer treatment, resulting in patients presenting with recent opioid exposure for microsurgical breast reconstruction (MBR). However, the effect of preoperative opioid use on postoperative outcomes following MBR remains poorly defined. We evaluated whether recent opioid exposure is associated with increased postoperative complications and healthcare utilization after MBR.

Methods

In this retrospective cohort analysis using the TriNetX national database, adult female patients who underwent MBR (2010–2025) were identified and 1:1 propensity score matching was performed. These patients were then divided into two groups: matched opioid use and matched non-opioid use groups. Primary outcomes were 30-day complications (wound dehiscence, surgical site infection [SSI], sepsis, urinary tract infection [UTI], and pulmonary embolism [PE]). Secondary outcomes were 30-day hospital readmission and emergency department (ED) visits, and reoperation within 1 year. The Pearson chi-squared test or Fisher’s exact test and t-test were used to compare the cohorts, and multivariable regression analysis was conducted for each outcome to calculate risk ratios (RRs). Statistical significance was set at p<0.05.

Results

Among the 23,471 patients, 3780 in the opioid use group were matched to 3780 non-opioid use controls. The opioid use group had higher 30-day complication rates: wound dehiscence (RR 1.37, p=0.006), SSI (RR 1.35, p=0.008), sepsis (RR 1.59, p=0.040), UTI (RR 2.04, p=0.040), and PE (RR 2.24, p=0.013). Healthcare utilization was greater among the opioid users, with increased readmissions (RR 1.25, p=0.036), ED visits (RR 1.57, p<0.001), and reoperations (RR 1.29, p<0.001).

Conclusion

Recent preoperative use of opioids is a significant risk factor for early and late complications following MBR.

背景：阿片类药物在乳腺癌治疗中经常被开处方，导致近期出现阿片类药物暴露的患者进行显微外科乳房重建（MBR）。然而，术前阿片类药物使用对MBR术后结果的影响仍然不明确。我们评估了近期阿片类药物暴露是否与MBR术后并发症和医疗保健利用增加有关。方法：使用TriNetX国家数据库进行回顾性队列分析，确定2010-2025年接受MBR的成年女性患者，并进行1:1倾向评分匹配。然后将这些患者分为两组：匹配阿片类药物使用组和匹配非阿片类药物使用组。主要结局是30天的并发症（伤口裂开、手术部位感染（SSI）、败血症、尿路感染（UTI）和肺栓塞（PE））。次要结局是30天的再入院和急诊（ED）就诊，以及1年内的再手术。采用Pearson卡方检验或Fisher精确检验和t检验对队列进行比较，并对各结局进行多变量回归分析，计算风险比（rr）。结果：在23,471例患者中，阿片类药物使用组中有3780例与非阿片类药物使用对照组相匹配。阿片类药物使用组30天并发症发生率较高：伤口裂开（RR 1.37, p=0.006）、SSI （RR 1.35, p=0.008）、脓毒症（RR 1.59, p=0.040）、UTI （RR 2.04, p=0.040）、PE （RR 2.24, p=0.013）。阿片类药物使用者的医疗保健利用率更高，再入院率增加（RR 1.25, p=0.036），急诊科就诊率增加（RR 1.57, p）。结论：近期术前使用阿片类药物是MBR术后早期和晚期并发症的重要危险因素。

{"title":"Recent preoperative opioid prescription is associated with increased complications after microsurgical breast reconstruction","authors":"Patricia M. Fuentes , Matthew Q. Dao , Emma Lascar , Sheuli Chowdhury , Bernice Yu , Jasmin Wilson , Arjun Nanda , Jeffery Russell , Peter J. Taub , Peter W. Henderson","doi":"10.1016/j.bjps.2026.01.010","DOIUrl":"10.1016/j.bjps.2026.01.010","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are frequently prescribed during breast cancer treatment, resulting in patients presenting with recent opioid exposure for microsurgical breast reconstruction (MBR). However, the effect of preoperative opioid use on postoperative outcomes following MBR remains poorly defined. We evaluated whether recent opioid exposure is associated with increased postoperative complications and healthcare utilization after MBR.</div></div><div><h3>Methods</h3><div>In this retrospective cohort analysis using the TriNetX national database, adult female patients who underwent MBR (2010–2025) were identified and 1:1 propensity score matching was performed. These patients were then divided into two groups: matched opioid use and matched non-opioid use groups. Primary outcomes were 30-day complications (wound dehiscence, surgical site infection [SSI], sepsis, urinary tract infection [UTI], and pulmonary embolism [PE]). Secondary outcomes were 30-day hospital readmission and emergency department (ED) visits, and reoperation within 1 year. The Pearson chi-squared test or Fisher’s exact test and <em>t</em>-test were used to compare the cohorts, and multivariable regression analysis was conducted for each outcome to calculate risk ratios (RRs). Statistical significance was set at p<0.05.</div></div><div><h3>Results</h3><div>Among the 23,471 patients, 3780 in the opioid use group were matched to 3780 non-opioid use controls. The opioid use group had higher 30-day complication rates: wound dehiscence (RR 1.37, p=0.006), SSI (RR 1.35, p=0.008), sepsis (RR 1.59, p=0.040), UTI (RR 2.04, p=0.040), and PE (RR 2.24, p=0.013). Healthcare utilization was greater among the opioid users, with increased readmissions (RR 1.25, p=0.036), ED visits (RR 1.57, p<0.001), and reoperations (RR 1.29, p<0.001).</div></div><div><h3>Conclusion</h3><div>Recent preoperative use of opioids is a significant risk factor for early and late complications following MBR.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 186-195"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115320","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

Outbound cosmetic tourism from the United Kingdom: Patient experiences following a decade of complication management at a tertiary plastic surgery unit 来自英国的出境美容旅游：在三级整形外科单位十年并发症管理后的患者经验。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-30 DOI: 10.1016/j.bjps.2026.01.035

Theodore Pezas , Paul Oregi , Sultan Hussein , Zsaki Sidhu , Nora Nugent , Maleeha Mughal , Paul Roblin , Marlene See , Victoria Rose , Pari-Naz Mohanna

Introduction

Cosmetic tourism is a rising global phenomenon whereby patients seeking aesthetic surgical and non-surgical treatments choose to have these performed outside their country of residence. According to the British Association of Aesthetic Plastic Surgeons, the number of people requiring hospital care in the United Kingdom (UK) after undergoing cosmetic surgery abroad has increased by 94% from 2020 to 2023. Whilst numerous publications have focused on potential safety and financial implications associated with managing the complications of cosmetic tourism, little is known of patient experience associated with this process.

Aims

To understand the UK patient-reported experience of outbound cosmetic surgery tourists following a decade of complication management at our tertiary plastic surgery unit.

Methods

Retrospective data were collected from 103 patients referred to our tertiary plastic surgery unit with complications following cosmetic surgery performed outside the UK over a ten-year period. A subset of these patients (n=48) completed a telephone survey designed to better understand the patient experience (motivations, perioperative experience and retrospective decision-making). All questions were independently assessed by the Clinical Outcomes and Audit Manager at our hospital, and the study was registered with our hospital’s Clinical Audit Department (registration number 15585). Patients were informed of the purpose of the study and that participation was voluntary. Verbal consent was obtained from all respondents.

Results

Ninety-six patients were women. Among survey respondents, cost was the primary motivator for travel (n=40); 26 regretted their decision to undergo surgery outside the UK, and 32 stated they would not make the same decision again. Twenty-six respondents found their surgeon by word of mouth, 27 paid less than £5000 in total for their surgery, travel and accommodation and 18 rated their overall experience as below average.

Conclusion

This study provides new insight into UK patients who experienced complications after outbound cosmetic surgery. Although the findings reflect only respondents with complications, they highlight the impact on patient satisfaction, regret and willingness to undergo further surgery, offering valuable perspectives for clinicians and prospective patients.

导语：美容旅游是一种日益增长的全球现象，寻求美容手术和非手术治疗的患者选择在他们居住的国家以外进行这些手术。根据英国美容整形外科医生协会的数据，从2020年到2023年，在国外接受整容手术后需要在英国住院治疗的人数增加了94%。虽然许多出版物都关注与管理美容旅游并发症相关的潜在安全和财务影响，但很少有人知道与此过程相关的患者体验。目的：了解英国患者报告的出境整容游客的经验后，十年的并发症管理在我们的第三整形外科单位。方法：回顾性收集了103例在英国境外进行整容手术后出现并发症的三级整形外科患者的资料。这些患者中的一部分（n=48）完成了一项电话调查，旨在更好地了解患者的经历（动机、围手术期经历和回顾性决策）。所有问题均由我院临床结果和审核经理独立评估，研究在我院临床审核部注册（注册号15585）。患者被告知研究的目的，并且参与是自愿的。所有被调查者口头同意。结果：女性96例。在受访者中，成本是旅游的主要动机（n=40）；26人后悔在英国以外接受手术的决定，32人表示不会再做同样的决定。26名受访者是通过口碑找到他们的外科医生的，27名受访者支付的手术、旅行和住宿费用总计不到5000英镑，18名受访者认为他们的整体体验低于平均水平。结论：这项研究提供了新的见解，英国患者谁经历的并发症后，出境整容手术。虽然调查结果只反映了有并发症的受访者，但他们强调了对患者满意度、后悔和接受进一步手术意愿的影响，为临床医生和潜在患者提供了有价值的观点。

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引用次数: 0

Optimizing the choice between single- and bipedicled DIEP flaps: A strategy guided by 3D volumetrics and indocyanine green angiography 优化单蒂和双蒂DIEP皮瓣的选择：一种由三维体积和吲哚菁绿血管造影指导的策略。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.bjps.2026.01.018

Boyang Xu, Wenyue Liu, Shangshan Li, Zhaohan Chen, Hao Dong, Siyu Hou, Jie Luan, Chunjun Liu

Background

Determining the need for a bipedicled deep inferior epigastric perforator (DIEP) flap is a critical challenge in delayed breast reconstruction. The traditional, experience-based approach is often subjective and inaccurate. We aimed to evaluate a novel quantitative strategy to optimize this decision-making process.

Methods

Patients undergoing delayed DIEP flap reconstruction managed with a new strategy were prospectively enrolled from January 2022 to December 2024, a historical conventional cohort served as the control. The quantitative strategy combines preoperative three-dimensional measurement to define the breast volume deficit with intraoperative indocyanine green angiography to assess real-time flap perfusion. Primary endpoints were the final volume restoration ratio (VRR), rate of bipedicled flap use, and flap-related complications. Follow-up was a minimum of six months. Multivariable logistic regression was performed to control for confounders and identify independent predictors of optimal volumetric symmetry (VRR 90–110%).

Results

A total of 183 patients were included (Strategy: n = 82; Conventional: n = 101). The Strategy group demonstrated a significantly higher rate of bipedicled flaps (58.5% vs. 40.6%, p = 0.016) and optimal symmetry (45.1% vs. 25.7%, p = 0.010). Multivariable analysis confirmed the quantitative strategy as a significant independent predictor for achieving optimal symmetry (odds ratio 2.53; p = 0.005), after adjusting for demographics and defect size. The incidence of flap-related complications was significantly lower in the Strategy group (2.4% vs. 10.9%, p = 0.040).

Conclusion

This strategy provides objective guidance for selecting single-pedicle versus bipedicled DIEP flaps in delayed breast reconstruction and is associated with significantly improved postoperative symmetry while reducing flap-related complications.

背景：确定是否需要双蒂腹下深穿支皮瓣（DIEP）是延迟乳房重建的关键挑战。传统的、基于经验的方法往往是主观的和不准确的。我们旨在评估一种新的定量策略来优化这一决策过程。方法：前瞻性纳入2022年1月至2024年12月接受新策略延迟DIEP皮瓣重建的患者，以历史常规队列为对照。定量策略将术前三维测量确定乳腺体积缺损与术中吲哚菁绿血管造影评估皮瓣实时灌注相结合。主要终点是最终体积恢复率（VRR）、双蒂皮瓣使用率和皮瓣相关并发症。随访至少为6个月。采用多变量逻辑回归控制混杂因素，并确定最佳体积对称性的独立预测因子（VRR 90-110%）。结果：共纳入183例患者（策略：n = 82；常规：n = 101）。策略组显示出更高的双蒂皮瓣率（58.5%比40.6%,p = 0.016）和最佳对称性（45.1%比25.7%,p = 0.010）。在调整了人口统计和缺陷大小之后，多变量分析证实了定量策略是实现最佳对称性的重要独立预测器（优势比2.53;p = 0.005）。策略组皮瓣相关并发症的发生率明显较低（2.4% vs. 10.9%, p = 0.040）。结论：该策略为延迟乳房重建中选择单蒂或双蒂DIEP皮瓣提供了客观指导，并显著改善了术后对称性，减少了皮瓣相关并发症。

{"title":"Optimizing the choice between single- and bipedicled DIEP flaps: A strategy guided by 3D volumetrics and indocyanine green angiography","authors":"Boyang Xu, Wenyue Liu, Shangshan Li, Zhaohan Chen, Hao Dong, Siyu Hou, Jie Luan, Chunjun Liu","doi":"10.1016/j.bjps.2026.01.018","DOIUrl":"10.1016/j.bjps.2026.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Determining the need for a bipedicled deep inferior epigastric perforator (DIEP) flap is a critical challenge in delayed breast reconstruction. The traditional, experience-based approach is often subjective and inaccurate. We aimed to evaluate a novel quantitative strategy to optimize this decision-making process.</div></div><div><h3>Methods</h3><div>Patients undergoing delayed DIEP flap reconstruction managed with a new strategy were prospectively enrolled from January 2022 to December 2024, a historical conventional cohort served as the control. The quantitative strategy combines preoperative three-dimensional measurement to define the breast volume deficit with intraoperative indocyanine green angiography to assess real-time flap perfusion. Primary endpoints were the final volume restoration ratio (VRR), rate of bipedicled flap use, and flap-related complications. Follow-up was a minimum of six months. Multivariable logistic regression was performed to control for confounders and identify independent predictors of optimal volumetric symmetry (VRR 90–110%).</div></div><div><h3>Results</h3><div>A total of 183 patients were included (Strategy: n = 82; Conventional: n = 101). The Strategy group demonstrated a significantly higher rate of bipedicled flaps (58.5% vs. 40.6%, <em>p</em> = 0.016) and optimal symmetry (45.1% vs. 25.7%, <em>p</em> = 0.010). Multivariable analysis confirmed the quantitative strategy as a significant independent predictor for achieving optimal symmetry (odds ratio 2.53; <em>p</em> = 0.005), after adjusting for demographics and defect size. The incidence of flap-related complications was significantly lower in the Strategy group (2.4% vs. 10.9%, <em>p</em> = 0.040).</div></div><div><h3>Conclusion</h3><div>This strategy provides objective guidance for selecting single-pedicle versus bipedicled DIEP flaps in delayed breast reconstruction and is associated with significantly improved postoperative symmetry while reducing flap-related complications.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 196-204"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121333","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

Corrigendum to “Correspondence on: Racial disparities in research productivity among integrated plastic surgery applicants” [J Plast Reconstr Aesthet Surg 113 (2025) 273–274] “通信：种族差异在综合整形手术申请人的研究生产力”的勘误表[J]整形重建美学外科113 (2025)273-274]

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.bjps.2026.01.017

Lawrence O. Lin , Allyson L. Huttinger , Jeffrey E. Janis

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 : 2026-03-01 Epub 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。

{"title":"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","authors":"Muhammad Rosadi Seswandhana , Gunadi , Sumadi L. Anwar , Teguh Aryandono , Ishandono Dachlan , Budi Mulyono , Irianiwati Widodo , Yohanes W. Wirohadidjojo , Mokhammad P.L. Sukma , Pramana Adhityo","doi":"10.1016/j.bjps.2025.12.034","DOIUrl":"10.1016/j.bjps.2025.12.034","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 58-70"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032337","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

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 : 2026-03-01 Epub 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。

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引用次数: 0