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

Breast implant-associated anaplastic large cell lymphoma in Romania: First case series of all documented cases 罗马尼亚与乳房植入物相关的增生性大细胞淋巴瘤：所有记录在案病例的首个病例系列

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.008

Theodor Mareș , Radu Ionescu , Daniel Dima , Michail Sorotos , Fabio Santanelli di Pompeo , Cristian Radu Jecan

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon malignancy, was linked to textured breast implants by moderate evidence in 2021. Documenting Romanian cases provides valuable insights into the epidemiology, management, and outcomes, thereby, enhancing global understanding and informing clinical practices. Our objective was to analyze BIA-ALCL cases in Romania, focusing on patient demographics, implant characteristics, clinical presentation, diagnostic methods, treatment, and outcomes.

We conducted a retrospective review of all known BIA-ALCL cases in Romania by examining patient demographics, implant details, clinical presentation, diagnostic methods, and outcomes. Data sources included medical records, surgical reports, follow-up data, and implant characteristics such as shape, texture, and manufacturer of implants.

The mean age at diagnosis was 44.4 years. All 5 patients had textured implants and no replacements, 4 for aesthetic indication and 1 for reconstruction. The mean time from implantation to diagnosis was 7.2 years. Clinical presentations were primarily late seromas, diagnosed through fine needle aspiration and immunohistochemistry. Treatment involved multidisciplinary teams, with bilateral en-bloc explantation for all patients, and adjuvant therapies in 2 cases. One patient had immediate reconstruction with smooth implants and acellular dermal matrix. Notably, no disease recurrence was observed post-treatment.

The low BIA-ALCL prevalence in Romania estimated at 1:44,500 compared to the mean of 1:13,745 in Europe indicates the need for increased awareness and tracking. Establishing mandatory national implant registries, pathology databases, and enhancing physician and patient education will help identify potential cases. All cases involved textured implants, highlighting the need for ongoing research to identify risk factors and guide surgeons consulting patients with textured implants.

乳房植入物相关性无弹性大细胞淋巴瘤（BIA-ALCL）是一种不常见的恶性肿瘤，2021 年有中等程度的证据表明它与质地的乳房植入物有关。记录罗马尼亚的病例可为流行病学、管理和预后提供宝贵的见解，从而加深全球对该病的了解，并为临床实践提供参考。我们对罗马尼亚所有已知的 BIA-ALCL 病例进行了回顾性审查，研究了患者的人口统计学特征、植入物特征、临床表现、诊断方法、治疗和结果。数据来源包括病历、手术报告、随访数据以及植入物的形状、质地和制造商等植入物特征。5名患者均植入了质地较硬的假体，但没有更换假体，其中4人是为了美观，1人是为了重建。从植入到确诊的平均时间为 7.2 年。临床表现主要是晚期血清瘤，通过细针穿刺和免疫组化确诊。治疗涉及多学科团队，所有患者均接受了双侧整块切除术，2例患者接受了辅助治疗。一名患者使用光滑植入物和非细胞真皮基质进行了即刻重建。值得注意的是，治疗后未发现疾病复发。罗马尼亚的 BIA-ALCL 患病率较低，估计为 1:44500，而欧洲的平均患病率为 1:13745，这表明有必要加强宣传和跟踪。建立强制性国家植入物登记册、病理学数据库以及加强医生和患者教育将有助于识别潜在病例。所有病例都涉及纹理植入物，这突出表明有必要进行持续研究，以确定风险因素，并指导外科医生为使用纹理植入物的患者提供咨询。

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引用次数: 0

Sensor technology and machine learning to guide clinical decision making in plastic surgery 用传感器技术和机器学习指导整形外科临床决策

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.010

Francisco R. Avila , Sahar Borna , Christopher J. McLeod , Charles J. Bruce , Rickey E. Carter , Cesar A. Gomez-Cabello , Sophia M. Pressman , Syed Ali Haider , Antonio Jorge Forte

Subjective clinical evaluations are deeply rooted in medical practice. Recent advances in sensor technology facilitate the acquisition of extensive amounts of objective physiological data that can serve as a surrogate for subjective assessments. Along with sensor technology, a branch of artificial intelligence, known as machine learning, has provided decisive advances in several areas of medicine due to its pattern recognition and outcome prediction abilities. The assimilation of machine learning algorithms into sensor technology can substantially improve our current diagnostic and treatment competencies. This review explores available data on the use of sensor technology and machine learning in areas of interest for plastic surgeons, updates current knowledge on the most recent technological advances, and provides a new perspective on the field.

主观临床评估在医疗实践中根深蒂固。传感器技术的最新进展为获取大量客观生理数据提供了便利，这些数据可以作为主观评估的替代。随着传感器技术的发展，人工智能的一个分支--机器学习，凭借其模式识别和结果预测能力，在多个医学领域取得了决定性的进步。将机器学习算法融入传感器技术可以大大提高我们目前的诊断和治疗能力。本综述探讨了在整形外科医生感兴趣的领域使用传感器技术和机器学习的现有数据，更新了有关最新技术进展的现有知识，并为该领域提供了新的视角。

引用次数: 0

The evolution of a large-scale facial gender affirmation program: A comparative outcomes analysis 大规模面部性别确认计划的演变：成果对比分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.007

Nghiem H. Nguyen , Leandra Doan , Michael W. Chu , Stacey H. Francis , Yuan Liu , James C. Lee

Background

The volume of facial feminization surgery (FFS) performed has increased tremendously over the last decade as new gender affirmation programs have formed. Advancements in surgical planning and treatment protocols have resulted in complex, multiprocedural FFS operations. This study examines the characteristics and outcomes of a large-scale FFS program over a 5-year lifespan.

Methods

A retrospective analysis was performed of all patients who underwent FFS in a high-volume integrated healthcare system from program initiation in 2018–2019 (early cohort) to maturation in 2021–2022 (late cohort). Patient charts were reviewed for demographic factors, operative details, complications, postoperative Emergency Department or Urgent Care (ED/UC) visits, revisions, and readmissions. Patient characteristics and outcomes were compared between early and late cohorts.

Results

A total of 191 patients were included, with 109 in the early cohort and 82 in the late cohort. Patient demographics were similar except mean age (40.3 years early cohort versus 36.3 years late cohort, p = 0.03). Patients in the late cohort had longer operations (5.40 h versus 6.16 h, p = 0.008), with a greater percentage of patients receiving genioplasty, rhinoplasty, fat grafting, or lip lift. Despite this, fewer patients in the late cohort were admitted postoperatively (62.4% versus 13.4%, p < 0.001). There were no differences in total complications, minor complications, revisions, ED/UC visits, or readmissions. However, major complications were significantly more common in the early cohort (4.6% versus 0.0%, p = 0.05).

Conclusion

As a nascent FFS program matures, the number of procedures in a single operation increased along with operative length. Major complications and postoperative admission rates decreased while total complications remained low.

背景：过去十年中，随着新的性别确认计划的形成，面部女性化手术（FFS）的数量大幅增加。手术规划和治疗方案的进步导致了复杂、多程序的面部女性化手术。本研究探讨了一项大型 FFS 项目 5 年间的特点和结果：对一个大容量综合医疗系统从 2018-2019 年项目启动（早期队列）到 2021-2022 年项目成熟（晚期队列）期间所有接受 FFS 的患者进行了回顾性分析。对患者病历中的人口统计学因素、手术细节、并发症、术后急诊科或急诊护理（ED/UC）就诊、复诊和再入院情况进行了审查。对早期和晚期患者的特征和结果进行了比较：共纳入 191 名患者，其中早期队列 109 人，晚期队列 82 人。除平均年龄（早期组为 40.3 岁，晚期组为 36.3 岁，P = 0.03）外，患者的人口统计学特征相似。晚期患者的手术时间更长（5.40 小时对 6.16 小时，P = 0.008），接受基因成形术、鼻成形术、脂肪移植术或唇部提升术的患者比例更高。尽管如此，晚期组群中术后入院的患者人数更少（62.4% 对 13.4%，P 结论：晚期组群中术后入院的患者人数更少（62.4% 对 13.4%，P 结论）：随着新生的全额资助项目日趋成熟，单次手术中的程序数量随手术时间的延长而增加。主要并发症和术后入院率有所下降，而总并发症仍保持在较低水平。

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引用次数: 0

Corrigendum to “A modified Bilhaut-Cloquet procedure for thumb duplication: Reconstruction of functionality and appearance” [J Plast Reconstr Aesthet Surg 75 8 (2022) 2644–2649] 对 "改良 Bilhaut-Cloquet 手术治疗拇指重复：功能和外观的重建" [J Plast Reconstr Aesthet Surg 75 8 (2022) 2644-2649]。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.09.070

Bo He , Guoxin Nan

引用次数: 0

New strategy for shortening the consolidation period in distraction lengthening of phalanges or metacarpal bone 缩短指骨或掌骨牵引延长术巩固期的新策略

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.012

Satoshi Usami , Yoshitaka Hamada , Takeyasu Toyama , Riichiro Kinosita , Masahiro Sawada , Takanori Saito

Distraction lengthening of digits enhances hand function in patients with congenital phalangeal defects or traumatic hand amputations. Although callotasis is a useful distraction lengthening method, it is challenging and often results in various complications and prolonged fixation. Based on our experiences, we attempted to develop innovations to reduce the fixation period. We included 12 digits from nine patients with digital bone defects; lengthening was performed on seven proximal phalanges and five metacarpal bones using an Ilizarov mini-fixator device. In three digits, cancellous bone grafting within the cavity of the distraction callus, concomitant with internal fixation using an intramedullary screw, was performed to shorten the Healing Index. The mean achieved lengthening was 24 mm for proximal phalanges and 22 mm for metacarpal bones, with a Healing Index of 37.9 and 42.6 days/cm, respectively. Additionally, the Healing Index was significantly shorter in the three digits treated with cancellous bone grafting and internal fixation (mean 27.0 days/cm) than in the nine with no bone grafting (mean 44.1 days/cm). Major complications included early bone union, insufficient fingertip skin, and callus fractures during the consolidation period, affecting two, two, and one patient, respectively. Bone grafting within the distraction callus cavity promotes rapid bone formation, while internal fixation enables earlier removal of external fixators, thereby shortening the Healing Index.

对先天性指骨缺损或外伤性手部截肢的患者进行牵引性指骨延长术可增强其手部功能。虽然胼胝体是一种有用的牵引延长方法，但它具有挑战性，往往会导致各种并发症和固定时间延长。根据我们的经验，我们尝试进行创新，以缩短固定时间。我们纳入了 9 位数字骨缺损患者的 12 个手指；使用 Ilizarov 迷你固定器对 7 个近节指骨和 5 个掌骨进行了延长。在三个手指中，在使用髓内螺钉进行内固定的同时，还在牵张胼胝体腔内进行了松质骨移植，以缩短愈合指数。近节指骨和掌骨的平均延长长度分别为 24 毫米和 22 毫米，愈合指数分别为 37.9 天/厘米和 42.6 天/厘米。此外，接受松质骨移植和内固定治疗的三个手指的愈合指数（平均 27.0 天/厘米）明显短于未接受植骨治疗的九个手指的愈合指数（平均 44.1 天/厘米）。主要并发症包括早期骨结合、指尖皮肤不足和巩固期胼胝体骨折，分别有两名、两名和一名患者出现并发症。在牵张胼胝腔内进行植骨可促进骨质快速形成，而内固定可使外固定器尽早移除，从而缩短愈合指数。

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引用次数: 0

Socioeconomic disparities in reception of limb-sparing surgery versus amputation for lower extremity sarcoma 接受下肢肉瘤保肢手术与截肢手术的社会经济差异。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.005

Dylan K. Kim , Kevin Kuonqui , David Dugue , Wakenda K. Tyler , Jarrod T. Bogue

Background

In lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery.

Methods

Patients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (p < 0.05).

Results

A total of 6465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12–2.85, p = 0.015). Nonmetropolitan residence (OR: 1.69, 95% CI: 1.43–2.00, p < 0.001) also conferred higher risk of amputation compared with residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (p < 0.001) even when controlled by sociodemographic and clinical characteristics.

Conclusions

There are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes.

背景：在下肢肉瘤治疗中，由于术后发病率降低、生活质量提高，保肢手术是截肢手术的优选方案。本研究对可能影响接受保肢手术的社会经济差异进行了新颖的分析：方法：从监测、流行病学和最终结果（SEER）数据库中筛选出2007年至2021年间接受保肢手术或截肢手术的下肢骨或软组织肉瘤患者。收集了每位患者的人口统计学、社会经济学和肿瘤学变量。进行了多变量二元逻辑回归，以评估截肢的术前人口学和肿瘤学风险因素（P 结果：最终共确定了 6465 名患者，其中 586 人（9.1%）接受了截肢手术。在控制了肿瘤大小、分期和新辅助治疗后，非西班牙裔美国印第安人/阿拉斯加原住民种族/民族预测截肢的几率最高（OR：1.78，95% CI：1.12-2.85，p = 0.015）。非大都市居住地（OR：1.69，95% CI：1.43-2.00，p 结论：肢体截肢的几率存在显著差异：即使考虑到基线肿瘤学特征的差异，在下肢肉瘤治疗的保肢手术和截肢率方面仍存在明显差异。进一步研究这些趋势的社会经济驱动因素将有助于制定改善重建结果差异的措施。

{"title":"Socioeconomic disparities in reception of limb-sparing surgery versus amputation for lower extremity sarcoma","authors":"Dylan K. Kim , Kevin Kuonqui , David Dugue , Wakenda K. Tyler , Jarrod T. Bogue","doi":"10.1016/j.bjps.2024.10.005","DOIUrl":"10.1016/j.bjps.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>In lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery.</div></div><div><h3>Methods</h3><div>Patients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (<em>p</em> < 0.05).</div></div><div><h3>Results</h3><div>A total of 6465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12–2.85, <em>p</em> = 0.015). Nonmetropolitan residence (OR: 1.69, 95% CI: 1.43–2.00, <em>p</em> < 0.001) also conferred higher risk of amputation compared with residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (<em>p</em> < 0.001) even when controlled by sociodemographic and clinical characteristics.</div></div><div><h3>Conclusions</h3><div>There are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"99 ","pages":"Pages 436-444"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515424","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

Total umbilical reconstruction using a tri-radiate incision technique 采用三辐切口技术的全脐带重建术

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.004

V. Naraynsingh , M. Maharaj , S. Maharajh , D. Harnanan , Y. Singh , S. Hassranah , M. Ragbir

Background

Neo-umbilicus aesthetics, often previously ignored or considered an afterthought, is now a major concern in abdominal surgical planning for abdominoplasty in morbid obesity and ventral hernia repairs. Umbilical loss or deformation is immediately recognised owing to its central position causing psychological discomfort, stress and low self-esteem in patients.

Several umbilical surgical techniques are described, but there is no universally accepted “standard” technique for umbilical reconstruction.

Our purpose was to describe a new method, the tri-radiate incision (TRI) which leads to the creation of an aesthetically pleasing navel, significantly improving the patient’s satisfaction and surgeon’s cosmetic standards.

Methods and materials

This study consisted of 21 consecutive cases of umbilical reconstruction of obese (18) and non-obese (3) patients during abdominoplasty (10) or ventral hernia repair (11) as the main indicators and patient satisfaction was rated post-operatively.

Results

No major post-operative complications such as flap necrosis, umbilical stenosis, flattening or misplacement, cicatricial hypertrophic scarring, infection or haematoma, as recorded in various techniques requiring revision surgeries, were encountered. Serosanguineous discharge observed during the first week was very common.

Patient satisfaction with the umbilicus was rated 10/10 by 17 patients and 9/10 by 4 patients from the obese and non-obese categories.

Conclusion

The minimally scarring TRI neo-umbilicus technique offers a new option regardless of age, gender or body mass index in creating a neo-umbilicus that is safe, reliable and reproducible using a single-staged procedure. It achieves all the permanently desired aesthetic standards, with relatively little or no post-operative complications but high patient satisfaction in abdominoplasty and hernia repair.

背景以前，脐部美学往往被忽视或被认为是事后才考虑的问题，而现在，脐部美学已成为病态肥胖腹部整形术和腹股沟疝修补术腹部手术规划中的一个主要问题。我们的目的是描述一种新的方法，即三辐射切口（TRI），它能创造出美观的肚脐，显著提高患者的满意度和外科医生的美容标准。方法和材料本研究以腹部整形术（10）或腹股沟疝修补术（11）为主要指标，对肥胖（18）和非肥胖（3）患者的 21 例连续脐部重建术进行了研究，并对患者的术后满意度进行了评分。结果在各种需要进行翻修手术的技术中，未发现皮瓣坏死、脐部狭窄、扁平或错位、卡他性增生性瘢痕、感染或血肿等重大术后并发症。17 名患者对脐部的满意度为 10/10，4 名肥胖和非肥胖患者对脐部的满意度为 9/10。结论：微瘢痕 TRI 新脐部技术提供了一种新的选择，无论年龄、性别或体重指数如何，都能通过单阶段手术安全、可靠、可重复地创建新脐部。在腹部整形和疝修补术中，它能达到所有永久性的预期美学标准，术后并发症相对较少或没有，但患者满意度很高。

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引用次数: 0

Association between cervical lymph node dissection and dementia: a retrospective analysis 宫颈淋巴结清扫术与痴呆症的关系：回顾性分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-11 DOI: 10.1016/j.bjps.2024.10.002

Sungchuan Chao , Chenhisang Kuan , Chiehhuei Huang , Yingsheng Lin , Huifu Huang , Junghsieh Hsieh , Shyueyih Horng , Haochih Tai , Naichen Cheng

Background

Dementia, characterized by memory loss and cognitive impairment, considerably impacts individuals and society. Our research focused on cervical lymph nodes, crucial for CNS lymphatic drainage, in the context of dementia. We hypothesized that the patients with head and neck cancer (HNC) undergoing cervical lymph node dissection (CLND) may have increased dementia risk due to obstructed lymphatic pathways.

Methods

We conducted a retrospective analysis of the electronic medical records from patients over 60 years diagnosed with HNC who underwent CLND between March 2007 and April 2023. We collected demographic data, calculated dementia incidence rates, and compared parameters between patients with and without dementia.

Results

Among the 251 patients with HNC who underwent CLND, 234 were men and 17 were women. Nine male patients developed dementia within an average of 50.1 ± 35.3 months post-surgery. The dementia incidence rate was 0.7 per 100 patient-years, with a cumulative incidence of 10.34% over 8.6 years. The CLND patterns were associated with dementia (p = 0.028), with bilateral supraomohyoid neck dissection (SOHND)/modified radical neck dissection (MRND) and unilateral MRND combined with any neck dissection type on the other side presenting higher risks than unilateral MRND/SOHND (p = 0.016).

Conclusion

Patients with HNC undergoing bilateral and comprehensive lymph node dissection showed higher dementia risk, highlighting the importance of the neck’s lymphatic role in brain health. These findings may guide future surgical practices.

背景以记忆力减退和认知功能障碍为特征的痴呆症对个人和社会造成了严重影响。我们的研究重点是痴呆症中对中枢神经系统淋巴引流至关重要的颈淋巴结。我们假设，接受颈淋巴结清扫术（CLND）的头颈癌（HNC）患者可能会因淋巴通路受阻而增加痴呆风险。我们收集了人口统计学数据，计算了痴呆症发病率，并比较了痴呆症患者与非痴呆症患者的参数。结果在接受CLND的251例HNC患者中，234例为男性，17例为女性。9 名男性患者在术后平均 50.1 ± 35.3 个月内患上了痴呆症。痴呆症发病率为每 100 例患者年 0.7 例，8.6 年的累计发病率为 10.34%。CLND模式与痴呆相关（p = 0.028），双侧颈上淋巴结清扫术（SOHND）/改良根治性颈部清扫术（MRND）和单侧MRND合并另一侧任何类型颈部清扫术的风险高于单侧MRND/SOHND（p = 0.016）。这些发现可为今后的手术实践提供指导。

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引用次数: 0

The free style “Twin V/Y Nasal Perforator Flaps”. An alternative to the forehead flap for nasal tip reconstruction. A case control study 自由式 "双 V/Y 鼻孔皮瓣"。鼻尖重建中前额皮瓣的替代方案。病例对照研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-05 DOI: 10.1016/j.bjps.2024.09.086

Dominik L. Feinendegen , Sandra Y. Feinendegen

Introduction

Replacing the skin along the nasal tip remains a challenge. Depending on the extent of the skin loss, various local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully. However, it requires a multistage procedure and can leave considerable scarring on the patient’s forehead. As an alternative, the authors present the free style “Twin V/Y Nasal Perforator Flaps” (TVYNPF), which can be used as a one-stage procedure for nasal tip reconstruction.

Material and methods

A series of five patients aged between 69 and 89 years with extensive basal cell carcinomas at the nasal tip is presented. The surgical procedure is explained in detail. The follow-up period ranged from 8 to 12 months.

Results

Healing was uneventful for all five patients, and the shape, symmetry, and aesthetical unity of the nasal tip and the alae of the nose were preserved in all patients, without any functional impairment. All scars presented inconspicuously.

Conclusion

In the selected patients, the free style TVYNPF proved to be a good alternative to the forehead flap for one-stage reconstruction of significant skin loss along the nasal tip, while preserving the esthetics and function of the nose.

导言沿鼻尖重建皮肤仍然是一项挑战。根据皮肤缺损的程度，有多种局部或区域皮瓣可用于重建。如果皮肤替代涉及鼻尖，前额皮瓣可以成功使用。然而，这需要一个多阶段的手术，而且会在患者前额留下相当大的疤痕。作为替代方案，作者提出了游离式 "双 V/Y 鼻孔皮瓣"（TVYNPF），可作为鼻尖重建的一个阶段手术。详细解释了手术过程。结果所有五名患者的愈合过程都很顺利，所有患者的鼻尖和鼻翼的形状、对称性和美观统一性都得到了保留，没有出现任何功能障碍。结论在选定的患者中，事实证明游离式 TVYNPF 是前额皮瓣的良好替代品，可用于鼻尖皮肤严重缺损的一期重建，同时保留了鼻子的美观和功能。

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引用次数: 0

Meta analysis of 2059 patients assessing early discharge after DIEP flap breast reconstruction: Comprehensive outcomes before post-operative day 5 对 2059 例 DIEP 乳瓣乳房再造术后早期出院患者进行评估的 Meta 分析：术后第 5 天前的综合疗效。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-03 DOI: 10.1016/j.bjps.2024.09.081

Puja Jagasia, Ricardo A. Torres-Guzman, Eliana Dash, Matthew Sigel, Andrew James, Elizabeth D. Slater, Megan Vucovich, Carrie Kubiak, Stephane Braun, Galen Perdikis, Lauren Connor

Autologous reconstruction with DIEP flap has illustrated greater patient satisfaction with both aesthetic satisfaction and reconstructive treatment process when compared to implant-based reconstruction longitudinally. However, DIEP flap breast reconstruction is associated with longer in-patient hospitalizations to monitor flap status. This systematic review and meta-analysis aims to report outcomes regarding the use of enhanced recovery after surgery (ERAS) protocols, particularly looking at the impact on complication rates in patients who undergo DIEP flap procedures and are discharged within 5 days after surgery. A computerized search was conducted on September 29th, 2023 using the MeSH terms “Free Tissue Flaps” OR “Myocutaneous Flap” OR “Surgical Flaps” AND “Patient Discharge”. Twenty-four papers reporting on 2059 patients were included in the study, and four study groups were created by length of stay as follows: LOS 1–1.99 days = Group 1, LOS 2–2.99 days = Group 2, LOS 3–3.99 = Group 3, and LOS 4–5 days = Group 4 (control). An independent samples t-test was performed to compare the mean rates of each complication between Groups 1 and 4, Groups 2 and 4, and Groups 3 and 4. This meta-analysis showed no significant differences between rates of hematoma, seroma, infection and reoperation between groups. There was a significantly lower rate of total flap loss in all 3 groups with LOS less than 4 days when compared to the group with LOS between 4 and 5 days. This meta-analysis shows that appropriate patients may be discharged safely as early as POD1 following DIEP flap.

与假体重建相比，DIEP皮瓣自体重建在美学满意度和重建治疗过程方面都更令患者满意。然而，DIEP皮瓣乳房重建术需要较长的住院时间来监测皮瓣状态。本系统综述和荟萃分析旨在报告术后恢复强化方案（ERAS）的使用效果，尤其是对接受DIEP皮瓣手术并在术后5天内出院的患者并发症发生率的影响。2023 年 9 月 29 日，我们使用 MeSH 术语 "游离组织皮瓣 "或 "肌皮瓣 "或 "外科皮瓣 "和 "患者出院 "进行了计算机检索。研究共纳入了 24 篇论文，报告了 2059 名患者的情况，并按住院时间长短分为以下四个研究组：LOS 1-1.99 天 = 第 1 组，LOS 2-2.99 天 = 第 2 组，LOS 3-3.99 = 第 3 组，LOS 4-5 天 = 第 4 组（对照组）。对第 1 组和第 4 组、第 2 组和第 4 组以及第 3 组和第 4 组之间每种并发症的平均发生率进行了独立样本 t 检验。这项荟萃分析表明，各组之间的血肿、血清肿、感染和再次手术率没有明显差异。与住院时间在 4 至 5 天之间的组别相比，住院时间少于 4 天的 3 个组别中皮瓣全部脱落的比率明显较低。这项荟萃分析表明，DIEP皮瓣术后适当的患者最早可在POD1安全出院。

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