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

Fragile vessel simulation for microsurgical training: The microwaved chicken-wing model 用于显微外科训练的脆弱血管模拟：微波鸡翼模型

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.bjps.2026.01.016

Akatsuki Kondo, Hiroki Umezawa, Saya Odaka, Kenko Aoki, Rei Ogawa

Background

Microvascular surgeons often encounter fragile vessels; however, simple microsurgical anastomosis training models for such vessels are lacking. We sought to develop such a model by microwave heating chicken wings. We investigated whether this approach reduced the vascular strength of the ulnar artery in the chicken-wing training model.

Methods

Thirty fresh chicken wings were untreated (control) or microwaved at 500 W for 30 or 60 s (n=10/group) and weighed. The ulnar artery was dissected and its external diameter and breaking force were measured. The groups were compared in terms of breaking force using the Kruskal-Wallis test and post-hoc Bonferroni-adjusted pairwise comparisons. The correlation between heating time and breaking force was determined using the Spearman’s rank test. Multiple linear regression was used to examine the influence of heating time, vessel diameter, and tissue weight on breaking force.

Results

Kruskal-Wallis testing and pairwise comparisons showed that 60-s heating significantly reduced vessel-breaking force compared to the control (p=0.000) and 30-s heating (p=0.029). The control and 30-s heating conditions did not differ (p=0.281). Heating time correlated strongly and negatively with breaking force (ρ=−0.793, p<0.001). Multiple linear regression analysis showed that breaking force was associated positively with vessel diameter (β=0.465, p=0.023) and tended to associate negatively with heating time (β=−0.369, p=0.064). Tissue weight had no influence.

Conclusions

Microwave heating for 60 s markedly reduced chicken-wing arterial-vessel strength, creating fragile vessels that may simulate diseased human arteries. This model could be incorporated into the microsurgical training curriculum to promote the acquisition of fine tissue-handling skills.

微血管外科医生经常遇到脆弱的血管；然而，缺乏简单的显微外科吻合训练模型。我们试图通过微波加热鸡翅来开发这样一个模型。我们研究了这种方法是否会降低鸡翼训练模型中尺动脉的血管强度。方法新鲜鸡翅30只（对照）或500 W微波处理30、60 s （n=10/组）称重。解剖尺动脉，测量尺动脉外径和破断力。使用Kruskal-Wallis检验和事后bonferroni调整两两比较比较各组的断裂力。加热时间与断裂力之间的相关性采用斯皮尔曼秩检验。采用多元线性回归研究加热时间、血管直径、组织重量对断裂力的影响。结果skruskal - wallis检验和两两比较显示，与对照组相比，60s加热组的破血管力显著降低（p=0.000）， 30s加热组的破血管力显著降低（p=0.029）。对照组和30 s加热条件无显著差异（p=0.281）。加热时间与断裂力呈显著负相关（ρ= - 0.793, p<0.001）。多元线性回归分析表明，断裂力与血管直径呈正相关（β=0.465, p=0.023），与加热时间呈负相关（β= - 0.369, p=0.064）。组织重量没有影响。结论微波加热60 s可明显降低鸡翼动脉血管强度，形成脆弱血管，可模拟人体病变动脉。该模型可纳入显微外科训练课程，促进精细组织处理技能的习得。

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引用次数: 0

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 : 2026-03-01 Epub 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

Hand-performed minimal fascial incision DIEP flap breast reconstruction: A scoring system and early single-centre experience 手工最小筋膜切口DIEP皮瓣乳房重建：评分系统和早期单中心经验。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.bjps.2026.01.029

Jason C.C. Kwok , Petko Shtarbanov , Mary Dowchan-Kowalska , Nianhe Luo , Thierry Schweizer , Pennylouise Hever , Stephen Hamilton , Shadi Ghali , Dariush Nikkhah

Background

The deep inferior epigastric artery perforator (DIEP) flap remains the gold standard for autologous breast reconstruction. Traditional harvest techniques often require a large fascial incision that increases donor-site morbidity. Minimally-invasive approaches, such as robotic-assisted incisions, reduce this impact but introduce a steep learning curve and higher intra-operative costs. We aimed to detail our early experience in hand-performed minimal fascial incision (MFI) DIEP flap.

Methods

A retrospective review was conducted of DIEP flaps for breast reconstruction performed from June 2024 to December 2024 at a single centre in London, United Kingdom. Patients were grouped by incision types: standard (>6 cm) or MFI (≤6 cm). Baseline characteristics, preoperative imaging results, and postoperative outcomes were recorded for comparison.

Results

The final cohort included 33 flaps (15 MFI and 18 standard incisions). The median length of stay was significantly lower in the MFI group [4 days (IQR 4–5)] vs. [5 days (IQR 4–6.25)], (p=0.036). The median number of perforators on a single row was significantly lower in the MFI group [1(IQR 1–2)] vs. [2(IQR 2–3)], (p=0.049). Mesh use was significantly higher in the standard incision group (p=0.001). There was no significant difference in operative time (p=0.128). The average MFI rectus sheath incision length was 4.59 cm. No donor-site complications occurred in either group.

Conclusions

A hand-performed MFI DIEP flap reduced hospital stay and mesh use, and was not significantly different in terms of operative time or complication rate to a standard DIEP flap. A scoring system was proposed to optimise patient selection for MFI. The hand-performed technique represents a key step in the surgical learning curve towards laparoscopic and robotic approaches. Further multi-centre prospective studies should be carried out to minimise performance bias and test the proposed framework.

背景：腹下深动脉穿支皮瓣（DIEP）仍然是自体乳房重建的金标准。传统的采收技术通常需要一个大的筋膜切口，这增加了供体部位的发病率。微创方法，如机器人辅助切口，减少了这种影响，但引入了陡峭的学习曲线和更高的术中费用。我们的目的是详细介绍我们的早期经验，手操作的最小筋膜切口（MFI） DIEP皮瓣。方法：回顾性分析2024年6月至2024年12月在英国伦敦单一中心进行的乳房重建DIEP皮瓣。患者按切口类型分组：标准（> ~ 6cm）或MFI（≤6cm）。记录基线特征、术前影像学结果和术后结果进行比较。结果：最终队列包括33个皮瓣（15个MFI和18个标准切口）。MFI组的中位住院时间[4天（IQR 4-5）]明显低于[5天（IQR 4-6.25）], （p=0.036）。MFI组单排穿支的中位数[1(IQR 1-2)]明显低于[2(IQR 2-3)], （p=0.049）。标准切口组补片使用率明显高于标准切口组（p=0.001）。两组手术时间差异无统计学意义（p=0.128）。MFI直肌鞘平均切口长度为4.59 cm。两组均未发生供区并发症。结论：手工操作的MFI DIEP皮瓣减少了住院时间和补片的使用，并且在手术时间和并发症发生率方面与标准DIEP皮瓣没有显著差异。提出了一种评分系统来优化MFI患者的选择。手工操作的技术代表了手术学习曲线向腹腔镜和机器人方法的关键一步。进一步的多中心前瞻性研究应该进行，以尽量减少表现偏差和测试所提出的框架。

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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 : 2026-03-01 Epub 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。

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引用次数: 0

Predictors of postoperative complications following staged nipple-sparing mastectomy: A systematic review & meta-analysis 分期保留乳头乳房切除术术后并发症的预测因素：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 : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.bjps.2026.01.022

Osama Darras , Kate Jensen , Diwakar Phuyal , Sarah N. Bishop , Rene Van der Hulst , Raffi Gurunian , Shan Shan Qiu

Introduction

In ptotic breasts, patients can undergo breast reduction or mastopexy before nipple-sparing mastectomy (NSM) to improve the esthetic outcomes. Literature also suggests the benefit of staged nipple-sparing mastectomy (SNSM) on preserving the nipple-areolar complex (NAC). The aim of this study was to identify the predictors of postoperative complications after SNSM and consider whether shorter intervals between the stages are feasible.

Methods

We reviewed MEDLINE and Embase for studies on SNSM outcomes, following the PRISMA guidelines. Key terms included “mastectomy,” “mastopexy,” and “nipple.” Studies detailing surgical timelines and complications were included. Studies utilizing nipple grafting were excluded. Variables of interest included time between surgeries and complications such as NAC necrosis, infection, wound healing problems, seroma, hematoma, fat necrosis, and skin flap necrosis.

Results

Eighteen studies were included for data extraction, encompassing 1085 breasts in 743 patients who received SNMS after breast-reducing mastectomy. The mean age was 46.1 ± 2.3 years, and the mean BMI was 27.8 ± 3.6 kg/m². In studies with fewer than 12 months between surgeries, shorter intervals did not increase the odds of total complications (p = 0.272) or nipple-related complications (p = 0.457). Mastectomy weight positively correlated with complication odds, reaching borderline significant (B = 0.001, p = 0.05). In implant-based reconstructions, implant size significantly positively correlated with the odds of complications (B = 0.002, p = 0.046).

Conclusions

Patient factors such as mastectomy weight and implant size were associated with higher complication rates. In studies of patients who underwent a second surgery within 12 months, no correlation was found between the interval between surgeries and complication likelihood, suggesting that a shorter interval may be safely considered.

简介：对于上睑下垂的乳房，患者可以在保留乳头的乳房切除术（NSM）前进行乳房缩小或乳房固定术，以改善美观效果。文献还表明，分阶段乳头保留乳房切除术（SNSM）对保留乳头-乳晕复合体（NAC）的好处。本研究的目的是确定SNSM术后并发症的预测因素，并考虑缩短两期之间的时间间隔是否可行。方法：我们根据PRISMA指南，回顾MEDLINE和Embase对SNSM结果的研究。关键词包括“乳房切除术”、“乳房切除术”和“乳头”。包括详细的手术时间表和并发症的研究。排除了乳头移植的研究。感兴趣的变量包括手术间隔时间和并发症，如NAC坏死、感染、伤口愈合问题、血肿、血肿、脂肪坏死和皮瓣坏死。结果：18项研究纳入数据提取，包括743例缩乳术后接受SNMS的1085个乳房。平均年龄46.1±2.3岁，平均BMI为27.8±3.6 kg/m2。在手术间隔少于12个月的研究中，较短的间隔并没有增加总并发症（p = 0.272）或乳头相关并发症（p = 0.457）的几率。乳房切除重量与并发症发生率呈正相关，达到临界显著（B = 0.001, p = 0.05）。在种植体重建中，种植体大小与并发症发生率显著正相关（B = 0.002, p = 0.046）。结论：患者因素如乳房切除术重量和种植体大小与较高的并发症发生率相关。在对12个月内接受第二次手术的患者的研究中，没有发现手术间隔与并发症可能性之间的相关性，这表明可以考虑较短的手术间隔。

{"title":"Predictors of postoperative complications following staged nipple-sparing mastectomy: A systematic review & meta-analysis","authors":"Osama Darras , Kate Jensen , Diwakar Phuyal , Sarah N. Bishop , Rene Van der Hulst , Raffi Gurunian , Shan Shan Qiu","doi":"10.1016/j.bjps.2026.01.022","DOIUrl":"10.1016/j.bjps.2026.01.022","url":null,"abstract":"<div><h3>Introduction</h3><div>In ptotic breasts, patients can undergo breast reduction or mastopexy before nipple-sparing mastectomy (NSM) to improve the esthetic outcomes. Literature also suggests the benefit of staged nipple-sparing mastectomy (SNSM) on preserving the nipple-areolar complex (NAC). The aim of this study was to identify the predictors of postoperative complications after SNSM and consider whether shorter intervals between the stages are feasible.</div></div><div><h3>Methods</h3><div>We reviewed MEDLINE and Embase for studies on SNSM outcomes, following the PRISMA guidelines. Key terms included “mastectomy,” “mastopexy,” and “nipple.” Studies detailing surgical timelines and complications were included. Studies utilizing nipple grafting were excluded. Variables of interest included time between surgeries and complications such as NAC necrosis, infection, wound healing problems, seroma, hematoma, fat necrosis, and skin flap necrosis.</div></div><div><h3>Results</h3><div>Eighteen studies were included for data extraction, encompassing 1085 breasts in 743 patients who received SNMS after breast-reducing mastectomy. The mean age was 46.1 ± 2.3 years, and the mean BMI was 27.8 ± 3.6 kg/m<sup>2</sup>. In studies with fewer than 12 months between surgeries, shorter intervals did not increase the odds of total complications (p = 0.272) or nipple-related complications (p = 0.457). Mastectomy weight positively correlated with complication odds, reaching borderline significant (B = 0.001, p = 0.05). In implant-based reconstructions, implant size significantly positively correlated with the odds of complications (B = 0.002, p = 0.046).</div></div><div><h3>Conclusions</h3><div>Patient factors such as mastectomy weight and implant size were associated with higher complication rates. In studies of patients who underwent a second surgery within 12 months, no correlation was found between the interval between surgeries and complication likelihood, suggesting that a shorter interval may be safely considered.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 225-235"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146128087","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

Functional and psychological benefits of postpartum restoration surgery: A systematic review 产后修复手术的功能和心理益处：系统综述

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.bjps.2025.12.010

I.S. Whitaker , P. Swarnkar , S.R. Ali , E. Thomson , N. Nugent , M.D. Pacifico

Background

There has been a rise in women seeking surgical help to aesthetically correct postpartum deformities of the breast and abdomen, known as the ’mummy makeover’. The aim of this systematic review was to evaluate the literature and provide a contemporary evidence base for the positive physical and psychological effects of surgical restoration/rejuvenation of the postpartum body.

Methods

A PRISMA compliant systematic review (PROSPERO CRD42023399659) was conducted by searching the PubMed, EMBASE, and Central databases in October 2022 and updated in January 2025. The search was complemented by bibliographic secondary linkage and a narrative synthesis of the literature.

Results

Overall, 1365 articles were screened, and 5 met the inclusion criteria. All studies focused on surgical repair of diastasis recti abdominis and/or abdominoplasty and none of the breast. Overall, 498 women were assessed for physical and 314 for psychological effects of surgical interventions. Analysis reflected a minimum of 85% reduction in back pain and urinary incontinence and statistically significant reduction in trunk dysfunction. Quality of life significantly increased across all the assessed fields, with a 99.5% positive change in self-esteem and 95.2% improvement in sexual life observed post-operatively.

Conclusion

This is the first systematic review to ascertain the functional and psychological value of body contouring surgical procedures specifically in postpartum women. The true extent is likely underestimated, owing to publication titles often being generic and heterogenous in nature. These findings support postpartum surgery being classified as reconstructive and not merely cosmetic. Further studies, with an emphasis on patient-reported outcome measures in the postpartum group, would help facilitate holistic psycho-physical rehabilitation to augment surgery provision.

背景越来越多的女性通过外科手术来矫正产后乳房和腹部的畸形，这被称为“妈咪美容”。本系统综述的目的是评估文献，并为手术修复/产后身体年轻化的积极生理和心理影响提供当代证据基础。方法于2022年10月检索PubMed、EMBASE和Central数据库进行符合PRISMA标准的系统评价（PROSPERO CRD42023399659），并于2025年1月更新。搜索是补充书目二级链接和文献的叙述综合。结果共筛选文献1365篇，其中5篇符合纳入标准。所有的研究都集中在手术修复腹直肌移位和/或腹部成形术，而不是乳房。总的来说，498名女性接受了手术干预的生理影响评估，314名接受了心理影响评估。分析表明，背部疼痛和尿失禁至少减少85%，躯干功能障碍的减少具有统计学意义。所有评估领域的生活质量都显著提高，术后观察到自尊有99.5%的积极变化，性生活有95.2%的改善。结论本文首次系统探讨了塑形手术对产后妇女的功能和心理价值。真正的程度可能被低估了，因为出版物的标题往往是通用的和异质的性质。这些发现支持将产后手术归类为重建手术，而不仅仅是美容手术。进一步的研究，重点是产后组患者报告的结果测量，将有助于促进整体心理-身体康复，以增加手术提供。

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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 : 2026-03-01 Epub 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

Flap reconstruction of extremity arteriovenous malformations (AVMs): Strategies and outcomes of a retrospective case series 四肢动静脉畸形（AVMs）的皮瓣重建：回顾性病例系列的策略和结果。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-05 DOI: 10.1016/j.bjps.2025.10.047

Chiara Camilloni , Beniamino Brunetti , Mirco Pozzi , Davide Di Seclì , Alexandros Zeimpekis , Konstantinos S. Papadopoulos , Valeria Petrucci , Emanuele Cigna , Alberto Bolletta , Paolo Persichetti , Shih-Heng Chen , Yueh-Bih Tang , Hung-Chi Chen

Background

Arteriovenous malformations (AVMs) are rare vascular anomalies associated with considerable morbidity and high recurrence rates. Their management remains challenging, with no universally accepted protocol. This study presents a standardized surgical approach developed at our institution, emphasizing early intervention, reconstruction with pedicled flaps or hybrid free flaps with venous bridging, and multidisciplinary care.

Patients and methods

A retrospective analysis of 16 patients (5 men and 11 women; aged 15–59 years) treated for extremity AVMs between 2010 and 2024 was conducted. Inclusion criteria encompassed AVMs in the limbs requiring surgical intervention with flap reconstruction. The key innovations in our treatment protocol were surgical excision using the “pineapple technique” and reconstruction with pedicled or hybrid free flaps with venous bridging to mitigate thrombotic risks.

Results

Indications for surgery included pain, numbness, bleeding, and chronic ulceration. Flap reconstruction had a 100% success rate, with complications occurring in 30% of cases. The recurrence rate was also 30% and recurrences were successfully managed through re-excision.

Discussion and conclusion

Our findings support a multidisciplinary approach combining embolization and surgical excision with optimized reconstruction to minimize complications. Our protocol demonstrated the effectiveness of early, aggressive intervention and suggested its broader applicability, particularly in using pedicled flaps or hybrid free flaps with venous bridging over conventional free flaps to improve outcomes.

背景：动静脉畸形（AVMs）是一种罕见的血管异常，发病率高，复发率高。他们的管理仍然具有挑战性，没有普遍接受的协议。本研究提出了一种标准化的外科手术方法，强调早期干预，带蒂皮瓣重建或混合自由皮瓣静脉桥接，以及多学科护理。患者与方法：回顾性分析2010 - 2024年间16例（男5例，女11例，年龄15-59岁）四肢动静脉畸形的治疗。纳入标准包括需要手术介入皮瓣重建的肢体动静脉畸形。我们治疗方案的关键创新是手术切除使用“菠萝技术”和重建带蒂或混合自由皮瓣与静脉桥接，以减轻血栓形成的风险。结果：手术指征包括疼痛、麻木、出血和慢性溃疡。皮瓣重建成功率为100%，并发症发生率为30%。复发率为30%，通过再次切除成功地控制了复发。讨论和结论：我们的研究结果支持多学科方法结合栓塞和手术切除，优化重建，以减少并发症。我们的方案证明了早期积极干预的有效性，并建议其更广泛的适用性，特别是在使用带蒂皮瓣或混合自由皮瓣与静脉桥接优于传统自由皮瓣以改善预后。

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引用次数: 0

Machine learning-assisted prediction of speech outcomes at age 5 in patients with nonsyndromic cleft palate after double-opposing Z-plasty 机器学习辅助预测5岁非综合征性腭裂患者双对立z形成形术后的语言结果。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-20 DOI: 10.1016/j.bjps.2025.11.043

Sehoon Yoon , Jee Hyeok Chung , Chae-Yeon Jang , Young-Hye Hong , Sukwha Kim , Seung-Hak Baek , Sungmi Jeon

Various risk factors have been identified for persistent speech impairment after cleft palate repair; however, early risk stratification tools are lacking. This retrospective cohort comprised 1117 patients with nonsyndromic cleft palate (NSCP) who underwent double-opposing Z-plasty (DOZ) by a single surgeon between 1988 and 2017. Perioperative variables included sex, age at surgery, Veau classification, cleft width measured intraoperatively at the bilateral maxillary tuberosities, average palatal length (mean of right and left side measurements), and presence of early palatal fistulae (<1 cm² within 1 month). Outcomes were assessed at age 5 years using standardized speech evaluations conducted by certified speech-language pathologists, focusing on 2 endpoints: the probability of hypernasality and need for speech therapy. A random forest classifier was trained on 80% of the dataset and tested on 20%, incorporating multiple imputation by chained equations, the Synthetic Minority Oversampling Technique, and five-fold cross-validation. The model achieved an area under the receiver operating characteristic (AUROC) of 0.747, area under the precision–recall curve (AUPRC) of 0.352, and F1-score of 0.435 for predicting hypernasality and an AUROC of 0.645, AUPRC of 0.545, and F1-score of 0.611 for predicting the need for therapy. Feature importance analysis identified sex, Veau classification, and cleft width as the most influential predictors. Early small fistulae contributed moderately to hypernasality prediction but were negligible for therapy prediction. This machine learning model, implemented as a web-based calculator (https://cp-speech.mdbcdss.com/), provides an accessible decision-support tool for early risk stratification of speech outcomes at age 5 after DOZ in patients with NSCP.

腭裂修复后持续性语言障碍的各种危险因素已被确定；然而，缺乏早期风险分层工具。该回顾性队列包括1117例非综合征性腭裂（NSCP）患者，他们在1988年至2017年期间由一名外科医生接受了双对立z形成形术（DOZ）。围手术期变量包括性别、手术年龄、Veau分类、术中在双侧上颌结节处测量的裂隙宽度、平均腭长（左右两侧测量的平均值）和早期腭瘘的存在(

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引用次数: 0

Invited commentary on: “A decade later: Geographic access to plastic surgery in the U.S. using the 2022 Area Health Resource File” 特邀评论：“十年后：使用2022年地区健康资源文件在美国进行整形手术的地理通道”。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-29 DOI: 10.1016/j.bjps.2025.11.060

Michael J. Brenner

引用次数: 0