Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第4页

A 4-core intra-osseous flexor tendon repair for trauma and distal 2nd stage tendon reconstruction 4核骨内屈肌腱修复创伤和远端第二阶段肌腱重建

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-17 DOI: 10.1016/j.bjps.2026.01.015

Jessica Lynch , Henry Lonsdale , Anna Helene Katrin Riemen , Paul McArthur

引用次数: 0

Audit and technical modifications of scout vein graft technique 童军静脉移植技术的审核与技术改进。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-16 DOI: 10.1016/j.bjps.2026.01.013

Madhu Periasamy, Vamseedharan Muthukumar, Hari Venkatramani, S. Raja Sabapathy

引用次数: 0

Costal cartilage tissue regeneration after the modified first-stage autologous ear reconstruction for microtia: A retrospective study 改良一期自体耳廓重建术后肋软骨组织再生的回顾性研究

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.2026.01.008

Jiachao Xiong , Yingshen Shi , Zhe Liu, Ni Zhuang, Hua Jiang, Yuxin Qian, Rong Guo

Background

The modified first-stage autologous ear reconstruction for patients with microtia has been part of our regular practice since 2020, with long-term follow-up revealing no thoracic complications in the patients. Our previous clinical studies systematically investigated and advocated for the critical role of preserving the intact costal cartilage membrane and its precise suturing.

Methods

This retrospective cohort study focused on primary reconstruction for congenital microtia. Patients were screened based on exclusion and inclusion criteria. Data on patient demographics and three-dimensional CT reconstructions of the costal cartilage were collected. Additionally, in vivo animal experiments were conducted to assess the characteristics of the regenerated tissue within the perichondrium.

Results

A total of 161 ear reconstructions performed for patients with microtia were included, comprising 54 cases on the left side, 102 cases on the right side, and 5 cases on both sides. We found that suturing the preserved costal cartilage membrane in place maintained its native contour and trajectory. A direct relationship was found between advancing age, higher physical quality, and superior costal cartilage regeneration among patients undergoing the modified first-stage autologous ear reconstruction. Patients older than 10 years demonstrated a high proportion of tissue regeneration and good postoperative thoracic stability at an early stage. Furthermore, animal models revealed regenerated costal cartilage at the perichondrial suture sites in rabbits 6 months postoperatively.

Conclusions

We conducted long-term follow-up on patients who underwent the modified first-stage ear reconstruction and they showed no thoracic complications. It emphasized the critical importance of obtaining costal cartilage, preferably in patients 10 years of age and older, and preserving and suturing the intact costal cartilage membrane during the modified two-flap method. These findings provide theoretical support for clinically adopting this technique.

自2020年以来，微创患者改良的一期自体耳廓重建已成为我们常规实践的一部分，长期随访显示患者无胸部并发症。我们以前的临床研究系统地研究并提倡保留完整的肋软骨膜及其精确缝合的关键作用。方法采用回顾性队列研究方法，对先天性小体畸形进行初步重建。根据排除和纳入标准对患者进行筛选。收集了患者的人口统计学数据和肋软骨的三维CT重建。此外，还进行了体内动物实验，以评估软骨膜内再生组织的特性。结果共纳入161例小耳症患者的耳廓再造术，其中左侧54例，右侧102例，双侧5例。我们发现将保留的肋软骨膜缝合在适当的位置可以保持其原有的轮廓和轨迹。在接受改良一期自体耳廓重建术的患者中，年龄的增长、身体素质的提高与肋软骨再生能力的提高有直接关系。年龄大于10岁的患者在早期表现出高比例的组织再生和良好的术后胸部稳定性。此外，动物模型显示，术后6个月，家兔在软骨周围缝合部位出现了再生的肋软骨。结论我们对接受改良一期耳廓再造术的患者进行了长期随访，无胸部并发症。它强调了在改良的双瓣方法中获得肋软骨的重要性，最好是10岁及以上的患者，并保留和缝合完整的肋软骨膜。本研究结果为临床应用该技术提供了理论支持。

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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 : 2026-01-15 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。

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引用次数: 0

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。

{"title":"Immediate versus delayed symmetrisation of the contralateral breast after oncoplastic procedures: A systematic review and meta-analysis","authors":"Hussain A. Abdulla , Mohamed A. Abdulla , Raja Eid , Sameh Hashem , Ahmed Alhaddad","doi":"10.1016/j.bjps.2026.01.004","DOIUrl":"10.1016/j.bjps.2026.01.004","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 89-99"},"PeriodicalIF":2.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039490","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

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。

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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。

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引用次数: 0