Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第5页

Usage patterns of regional anesthesia for panniculectomy in the United States 区域麻醉在美国胰腺切除术中的使用模式。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-28 DOI: 10.1016/j.bjps.2025.11.054

Angad S. Sidhu , George S. Corpuz , Nikola Vuckovic , Dylan K. Kim , Ivan Hadad

Regional anesthesia (RA) reduces opioid consumption, improves postoperative pain control, and facilitates recovery. Although racial and ethnic disparities in RA use have been documented in various surgical fields, limited data exist on its use in plastic surgery and body contouring procedures. We aimed to evaluate the utilization of RA and potential disparities among patients undergoing panniculectomies. We conducted a retrospective cohort study using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2014 to 2020. Patients who underwent panniculectomies were analyzed, and adjunct peripheral nerve block use was evaluated. Multivariate logistical regression was used to evaluate associations between patient characteristics and RA usage. Among 8779 patients, 594 (6.8%) received RA for panniculectomies. Unadjusted analysis showed Black patients had significantly lower odds of receiving RA compared to White patients (OR 0.77, 95% CI 0.61–0.96, p=0.023), whereas patients classified as “Other” had higher odds (OR 2.64, 95% CI 1.50–4.62, p<0.001). After adjustment for age, sex, race, ethnicity, BMI, smoking status, diabetes, hypertension, chronic steroid use, COPD, CHF, dialysis, cancer, bleeding, and ASA class, no statistically significant differences in RA receipt for panniculectomy were observed by race or ethnicity. In this national cohort of patients undergoing abdominal body contouring surgery, no statistically significant racial or ethnic disparities in RA use were observed after adjustment. The low overall utilization of RA may suggest underuse in panniculectomies and highlights opportunities to optimize prophylactic pain management strategies for patients.

区域麻醉（RA）减少阿片类药物的消耗，改善术后疼痛控制，促进康复。尽管在不同的外科领域中，类风湿关节炎的使用存在种族和民族差异，但在整形外科和身体轮廓手术中，类风湿关节炎的使用数据有限。我们的目的是评估RA的使用情况以及在输卵管切除术患者中的潜在差异。我们使用美国外科医师学会-国家手术质量改进计划（ACS-NSQIP）数据库从2014年至2020年进行了一项回顾性队列研究。我们分析了接受胰腺小管切除术的患者，并评估了辅助周围神经阻滞的使用。多变量逻辑回归用于评估患者特征与RA使用之间的关系。在8779例患者中，594例（6.8%）接受了输卵管切除术。未经调整的分析显示，与白人患者相比，黑人患者接受RA的几率明显较低（OR 0.77, 95% CI 0.61-0.96, p=0.023），而归类为“其他”的患者的几率较高(OR 2.64, 95% CI 1.50-4.62, p

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引用次数: 0

Comparative effectiveness of corticosteroid injections for trigger finger: A systematic review of randomized controlled trials 皮质类固醇注射治疗扳机指的比较有效性：随机对照试验的系统回顾

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-23 DOI: 10.1016/j.bjps.2025.11.047

Gabriel Kuper , Dylan Da Silva , Matthew Carr , Erin Brown

Background

Trigger finger is a common condition marked by painful catching or locking of a digit during motion. Although corticosteroid injections (CSIs) are widely used, there is limited consensus on the optimal corticosteroid type, dose, injection technique, or use of adjunctive therapies. This systematic review examined the effectiveness and safety of methylprednisolone and triamcinolone in achieving symptom remission.

Methods

A systematic search was conducted across PubMed, Embase, and MEDLINE from inception to May 2024. Inclusion criteria focused on randomized controlled trials (RCTs) evaluating methylprednisolone or triamcinolone in adults with trigger finger. The primary outcome was symptom remission, defined as the resolution of triggering and functional impairment. Data extraction and risk-of-bias assessments were performed in duplicate using the Revised Cochrane Risk-of-Bias Tool.

Results

Thirteen RCTs, including 1116 patients (1153 digits), were analyzed. Methylprednisolone showed higher overall remission (83.6%) than triamcinolone (44.8%), with consistent efficacy across doses and techniques. Although higher doses of triamcinolone improved outcomes, a statistically significant dose-response relationship was not found. Injection technique (ultrasound-guided vs blind; intra-sheath vs extra-sheath) did not significantly influence outcomes. Secondary injections improved outcomes in partial responders. Adverse events occurred in 2.8% of triamcinolone patients (e.g., skin atrophy, steroid flare) and were not reported for methylprednisolone.

Conclusion

Methylprednisolone appeared more effective and better tolerated than triamcinolone in trigger finger treatment. Injection technique and adjunctive therapies, such as splinting, had a limited impact on outcomes. Further research is needed to tailor treatment to individual patient characteristics.

Systematic review

Level I

扳机指是一种常见的情况，其特征是在运动时手指被抓或锁住时疼痛。尽管皮质类固醇注射（CSIs）被广泛使用，但对于皮质类固醇的最佳类型、剂量、注射技术或辅助治疗的使用，人们的共识有限。本系统综述检查了甲基强的松龙和曲安奈德在实现症状缓解方面的有效性和安全性。方法系统检索PubMed、Embase和MEDLINE自建站至2024年5月的相关文献。纳入标准侧重于随机对照试验（rct）评估甲基强的松龙或曲安奈德治疗成人扳机指。主要结局是症状缓解，定义为触发和功能障碍的解决。数据提取和偏倚风险评估采用经修订的Cochrane偏倚风险评估工具一式两份进行。结果共纳入13项随机对照试验，包括1116例患者（1153指）。甲基强的松龙的总体缓解率（83.6%）高于曲安奈德（44.8%），在不同剂量和技术下均具有一致的疗效。虽然高剂量曲安奈德改善了结果，但没有发现统计学上显著的剂量-反应关系。注射技术（超声引导vs盲注射；鞘内vs鞘外注射）对结果没有显著影响。二次注射改善了部分应答者的预后。不良事件发生在2.8%的曲安奈德患者中（例如，皮肤萎缩，类固醇发作），甲基强的松龙未见报道。结论甲强的松龙治疗扳机指比曲安奈德更有效，耐受性更好。注射技术和辅助治疗，如夹板，对结果的影响有限。需要进一步的研究来根据患者的个体特征定制治疗方案。系统评价

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引用次数: 0

Impact of scroll reconstruction on nasal tip rotation and projection following primary open rhinoplasty 初开鼻成形术后螺旋形重建对鼻尖旋转和突出的影响

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-13 DOI: 10.1016/j.bjps.2025.11.024

Agah Yeniceri, Melih Cayonu

Nasal tip stability is a key determinant of long-term rhinoplasty outcomes, yet the role of scroll reconstruction in supporting this stability remains insufficiently studied. This study investigated the impact of scroll reconstruction on nasal tip stability in patients undergoing primary open rhinoplasty with cephalic resection of the lower lateral cartilage. This retrospective study included 69 patients who underwent primary open approach rhinoplasty between 2021 and 2024. The mean age of the patients was 25.18 ± 5.69 years. Standardized lateral photographs were used to assess nasal tip rotation (nasolabial angle) and projection (Goode ratio) preoperatively and at 1 week and 12 months postoperatively. The results revealed that the scroll reconstruction group exhibited significantly less loss of nasal tip rotation (6 degrees) compared with the control group (10 degrees) during long-term follow-up (p < 0.0001). Additionally, the scroll reconstruction group showed significantly less loss of nasal tip projection (0.029) compared with the control group (0.042) during the same period (p = 0.007). Correlation analysis indicated a weak but significant relationship between early postoperative changes and long-term outcomes (r = 0.302, p = 0.012). Our study suggested that scroll reconstruction may contribute to maintaining nasal tip stability by reducing postoperative changes in rotation and projection.

鼻尖的稳定性是长期鼻整形效果的关键决定因素，然而，在支持这种稳定性方面，滚动重建的作用仍然没有得到充分的研究。本研究探讨了涡旋重建对初次开放性鼻成形术伴有头侧切除下外侧软骨患者鼻尖稳定性的影响。这项回顾性研究包括了69名在2021年至2024年间接受了首次开放式鼻整形手术的患者。患者平均年龄25.18±5.69岁。术前、术后1周和12个月采用标准化侧位照片评估鼻尖旋转（鼻唇角）和突出（古德比）。结果显示，在长期随访中，卷轴重建组鼻尖旋转损失（6度）明显少于对照组（10度）（p < 0.0001）。与对照组（0.042）相比，滚动重建组在同一时期鼻尖突出损失（0.029）显著减少（p = 0.007）。相关分析显示，术后早期变化与远期预后之间存在较弱但显著的相关性（r = 0.302, p = 0.012）。我们的研究表明，通过减少术后旋转和突出的变化，滚动重建可能有助于维持鼻尖的稳定性。

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引用次数: 0

Nine factors influencing breast ptosis following reduction mammoplasty 影响缩乳术后乳房下垂的九个因素

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-06 DOI: 10.1016/j.bjps.2025.11.003

Marco Gratteri , Giovanni Francesco Marangi , Fara Desiree Romano , Felicia Geanina Grosu , Daniela Porso , Andrea Tarantino , Luigi Abate , Riccardo De Bernardis , Annalisa Cogliandro , Paolo Persichetti

Introduction

Ptosis is a common complication after reduction mammoplasty, but its main influencing factors remain unclear. We aimed to evaluate the roles of age, smoking, pregnancies, hypertension, diabetes, preoperative glandular composition, stretch marks, Fitzpatrick skin type, weight change, Ribeiro flap usage, resected tissue weight, and preoperative and postoperative breast volume on breast droop within the first year after surgery.

Materials and methods

Overall, 127 women who consecutively underwent reduction mammoplasty within 3 years took part in this study. Previously cited recorded data were noted and exported in Prism10 for correlation analysis with two indexes of breast ptosis: sternal notch-nipple and nipple-inframammary fold T12-T1 deltas.

Results

For breast ptosis, the major influencing positive factors were age, postsurgery breast volume, stretch mark score, estimated preoperative major glandular composition of the breast, and delta weight. Smoking history and diabetes mellitus correlate in a moderate manner. Pregnancy weakly positively correlated with breast ptosis, whereas preoperative breast volume, resected breast weight, and Fitzpatrick skin type did not correlate with the investigated indexes. The only factor that negatively correlated with breast ptosis indexes was the usage of Ribeiro flap.

Conclusion

Breast ptosis after reduction mammoplasty is strongly correlated with age, postsurgery breast volume, stretch mark score, estimated preoperative major glandular composition of the breast, and delta weight in the first year after surgery. Other influencing factors were smoking history, diabetes mellitus, and history of pregnancy. The Ribeiro flap proved to have a protective role.

上睑下垂是缩乳术后常见的并发症，其主要影响因素尚不清楚。我们的目的是评估年龄、吸烟、怀孕、高血压、糖尿病、术前腺体组成、妊娠纹、Fitzpatrick皮肤类型、体重变化、Ribeiro皮瓣使用、切除组织重量、术前和术后乳房体积对术后一年内乳房下垂的影响。材料和方法总共有127名在3年内连续接受乳房缩小术的女性参与了本研究。在Prism10中记录之前引用的记录数据并导出，与胸骨缺口-乳头和乳头-乳下褶T12-T1 delta两个乳房下垂指标进行相关性分析。结果乳房下垂的主要影响因素为年龄、术后乳房体积、妊娠纹评分、术前乳房主要腺体组成和体重。吸烟史与糖尿病有中度相关性。妊娠与乳房下垂呈弱正相关，而术前乳房体积、切除乳房重量和Fitzpatrick皮肤类型与所调查的指标无关。唯一与乳房下垂指数呈负相关的因素是Ribeiro皮瓣的使用。结论缩乳术后乳房下垂与年龄、术后乳房体积、妊娠纹评分、术前乳房主要腺体组成及术后1年体重密切相关。其他影响因素包括吸烟史、糖尿病和妊娠史。里贝罗皮瓣被证明具有保护作用。

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引用次数: 0

The PROMise of patient-reported outcome measures: An ethical minefield? 患者报告结果测量的前景：伦理雷区？

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-12-18 DOI: 10.1016/j.bjps.2025.12.016

Samantha S.Y. Leong, Michael J. Rice, Rachel M. Clancy, Giulia Colavitti

引用次数: 0

Surgical management and outcomes of recurrent palatal fistulae: Insights from CLAPP’s institutional experience 复发性腭瘘的外科治疗和结果：来自CLAPP机构经验的见解。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-12-17 DOI: 10.1016/j.bjps.2025.12.022

Muhammad Daiem , Ghulam Qadir Fayyaz , Sohaib Irfan , Muhammad Mustehsan Bashir , Muneeb Nasir , Marvee Turk , Larry H. Hollier , Marshall G. Miles , Subodh Kumar Singh , Jitske Nolte , Corstiaan Breugem

Background

Recurrent palatal fistulae pose a considerable challenge owing to prior failed repair, substantial scarring, and limited local tissue availability. These defects are particularly challenging to manage in low- and middle-income countries, where expertise and resources for cleft care may be limited. Furthermore, there remains a paucity of data focused specifically on patients presenting with recurrent palatal fistulae.

Methods

A retrospective cohort study was conducted at CLAPP Hospital, Lahore (January 2022-December 2024), by including patients with at least one prior failed palatal fistula repair and ≥9 months of follow-up. Fistulae were classified using the Pakistan Fistula Classification Scheme. Surgical techniques were reviewed, and logistic regression analysis was performed to identify predictors of recurrence.

Results

A total of 282 patients were included (mean age: 16.4 years). Fistula recurrence occurred in 63 patients (22.3%). Larger defects (>10 mm) and older age at the time of surgery were independently associated with increased recurrence risk (adjusted odds ratio [aOR] = 3.28, p = 0.043; aOR = 1.05, p = 0.004). The Bardach re-do palatoplasty was the most commonly used technique (56.0%), but it was associated with higher recurrence, reflecting its frequent use in more complex defects.

Conclusion

Recurrent palatal fistulae demand individualized, patient-centric surgical strategies. Older age and larger defect size significantly increase recurrence risk, underscoring the need for meticulous planning and selection of techniques that address scarring, vascularity, and local tissue limitations. These findings may inform management strategies, particularly in high-volume cleft centers within resource-constrained environments.

背景：由于先前的修复失败，大量疤痕和局部组织可用性有限，复发性腭瘘提出了相当大的挑战。这些缺陷在低收入和中等收入国家尤其具有挑战性，在这些国家，唇裂护理的专业知识和资源可能有限。此外，仍然缺乏专门针对复发性腭瘘患者的数据。方法：在拉合尔CLAPP医院（2022年1月- 2024年12月）进行回顾性队列研究，纳入至少一次腭裂修复失败且随访≥9个月的患者。采用巴基斯坦瘘分类方案对瘘管进行分类。回顾手术技术，并进行逻辑回归分析以确定复发的预测因素。结果：共纳入282例患者，平均年龄16.4岁。瘘管复发63例（22.3%）。缺损较大（bbb10 mm）和手术时年龄较大与复发风险增加独立相关（校正优势比[aOR] = 3.28, p = 0.043; aOR = 1.05, p = 0.004）。Bardach再做腭成形术是最常用的技术（56.0%），但其复发率较高，反映了其经常用于更复杂的缺陷。结论：复发性腭瘘需要个性化的、以患者为中心的手术策略。年龄越大和缺损尺寸越大会显著增加复发风险，强调需要细致的计划和选择解决疤痕、血管和局部组织限制的技术。这些发现可以为管理策略提供信息，特别是在资源受限环境下的高容量裂缝中心。

{"title":"Surgical management and outcomes of recurrent palatal fistulae: Insights from CLAPP’s institutional experience","authors":"Muhammad Daiem , Ghulam Qadir Fayyaz , Sohaib Irfan , Muhammad Mustehsan Bashir , Muneeb Nasir , Marvee Turk , Larry H. Hollier , Marshall G. Miles , Subodh Kumar Singh , Jitske Nolte , Corstiaan Breugem","doi":"10.1016/j.bjps.2025.12.022","DOIUrl":"10.1016/j.bjps.2025.12.022","url":null,"abstract":"<div><h3>Background</h3><div>Recurrent palatal fistulae pose a considerable challenge owing to prior failed repair, substantial scarring, and limited local tissue availability. These defects are particularly challenging to manage in low- and middle-income countries, where expertise and resources for cleft care may be limited. Furthermore, there remains a paucity of data focused specifically on patients presenting with recurrent palatal fistulae.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at CLAPP Hospital, Lahore (January 2022-December 2024), by including patients with at least one prior failed palatal fistula repair and ≥9 months of follow-up. Fistulae were classified using the Pakistan Fistula Classification Scheme. Surgical techniques were reviewed, and logistic regression analysis was performed to identify predictors of recurrence.</div></div><div><h3>Results</h3><div>A total of 282 patients were included (mean age: 16.4 years). Fistula recurrence occurred in 63 patients (22.3%). Larger defects (>10 mm) and older age at the time of surgery were independently associated with increased recurrence risk (adjusted odds ratio [aOR] = 3.28, p = 0.043; aOR = 1.05, p = 0.004). The Bardach re-do palatoplasty was the most commonly used technique (56.0%), but it was associated with higher recurrence, reflecting its frequent use in more complex defects.</div></div><div><h3>Conclusion</h3><div>Recurrent palatal fistulae demand individualized, patient-centric surgical strategies. Older age and larger defect size significantly increase recurrence risk, underscoring the need for meticulous planning and selection of techniques that address scarring, vascularity, and local tissue limitations. These findings may inform management strategies, particularly in high-volume cleft centers within resource-constrained environments.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 629-637"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914536","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

Absorbable antibiotic bead prophylaxis for implant-based breast reconstruction 可吸收抗生素预防假体乳房重建术。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-12-06 DOI: 10.1016/j.bjps.2025.12.002

Casey Zhang, Hilary Liu, Shirley X. Liu, James D. Fisher, Elizabeth Bailey, Carolyn De La Cruz, Francesco Egro, Michael L. Gimbel, Vu T. Nguyen, Brodie Parent

Introduction

Periprosthetic infection is a serious complication in implant-based breast reconstruction (IBR). Local antibiotic delivery using biodegradable beads is a potential strategy to reduce infection risk. This study describes a single institution’s preliminary experience with absorbable antibiotic beads for preventing infection in IBR.

Methods

A retrospective cohort study was performed of patients who underwent IBR between January 2021 and October 2023. Patients who met high-risk criteria for infection (BMI >30 kg/m², prior smoking history, diabetes, and history of radiation) received antibiotic-infused beads along with the standard of care. Outcomes included periprosthetic infection, infection requiring re-operation, and wound-healing complications. Multivariate logistic regression was performed to control for known risk factors for infection.

Results

Two-hundred eighty-seven patients were included, with 27 (9.4%) receiving antibiotic beads and 260 (90.6%) receiving standard of care alone. No significant difference was observed in infection requiring re-operation between the antibiotic bead group compared to controls (11.1% vs. 16.5%, p=0.46), and no difference in explantation rate (7.4% vs. 10.8%, p=0.59). After controlling for confounders, BMI was significantly associated with increased odds of infection (OR 1.1 CI 1.04 – 1.14, p=.001). In patients who underwent salvage procedures for infection with the application of antibiotics beads (n=15), the overall salvage success rate was 86.7% (n=13).

Conclusion

These data suggest that prophylactic antibiotic beads may reduce infections in high risk patients undergoing IBR. In addition, antibiotic beads may be particularly useful in the case of implant salvage for infection. Additional prospective studies are currently ongoing, and are needed to elucidate safety and efficacy.

假体周围感染是假体乳房重建术（IBR）的一个严重并发症。使用可生物降解的微球局部给药是一种降低感染风险的潜在策略。本研究描述了一个机构的初步经验，可吸收的抗生素珠预防感染的IBR。方法：对2021年1月至2023年10月期间接受IBR的患者进行回顾性队列研究。符合感染高危标准的患者（体重指数>30 kg/m2，既往吸烟史，糖尿病和放疗史）在标准护理的同时接受抗生素输注珠药。结果包括假体周围感染、需要再次手术的感染和伤口愈合并发症。采用多因素logistic回归控制已知感染危险因素。结果：纳入2887例患者，其中27例（9.4%）接受抗生素微珠治疗，260例（90.6%）单独接受标准治疗。与对照组相比，抗生素头组再次手术感染发生率无显著差异（11.1% vs. 16.5%, p=0.46），外植率无显著差异（7.4% vs. 10.8%, p=0.59）。在控制混杂因素后，BMI与感染几率增加显著相关（OR 1.1 CI 1.04 - 1.14, p=.001）。在应用抗生素珠粒进行感染抢救手术的患者中（n=15），总体抢救成功率为86.7% （n=13）。结论：这些数据提示预防性抗生素微球可以减少IBR高危患者的感染。此外，抗生素珠可能是特别有用的情况下种植体抢救感染。目前正在进行更多的前瞻性研究，需要阐明安全性和有效性。

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引用次数: 0

Impact of socioeconomic status on postoperative complications and revision rates in free flap breast reconstruction 社会经济状况对游离皮瓣乳房再造术术后并发症及翻修率的影响

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-10-29 DOI: 10.1016/j.bjps.2025.10.030

Stephanie E. Shin , Joseph A. Lewcun , Annabel E. Baek , Megan R. Newsom , Rendell M. Bernabe , Aaron M. Foglio , Venkat Abbaraju , Jatin P. Vermuri , Megan E. Daniels , Kealani R. Unkel , Paschalia M. Mountziaris

Background

Socioeconomic status (SES) can predict postoperative outcomes in some specialties, but its influence on autologous breast reconstruction is yet to be defined. We examined the impact of SES on postoperative complications and esthetic revisions in free flap breast reconstruction.

Methods

This was a retrospective single-center review of consecutive patients who underwent free flap breast reconstruction between 2013 and 2023. Surgical outcomes, time from mastectomy to reconstruction, and rates of esthetic revision were analyzed while considering race, insurance status, and SES variables, including United States Census data and the Neighborhood Atlas Area Deprivation Index (ADI).

Results

Overall, 244 patients underwent 375 free flap (113 unilateral, 30%) procedures. Significant racial differences included higher body mass index, higher prevalence of diabetes and tobacco use (p < 0.05), and disadvantaged SES, including higher ADI, food insecurity, and limited vehicle access (p < 0.05). Non-White patients waited longer for free flap reconstruction and had fewer flap revisions (p < 0.05). Medicaid insurance predicted complete flap loss (odds ratio (OR) 6.981, 95% confidence interval (CI) 1.244–39.168, p < 0.05). On multivariate analysis, non-White race (OR 0.417, 95% CI 0.189–0.644, p < 0.05), ADI (OR 0.983, 95% CI 0.969–0.998, p < 0.05), and higher number of comorbidities (OR 0.704, 95% CI 0.565–0.859, p < 0.05) negatively predicted esthetic revisions (p < 0.05).

Conclusions

Our results suggest disadvantaged SES does not impact free flap complication rates but may influence surgical timing and whether patients undergo elective flap revisions. Identifying these obstacles is an important step toward improving access to free flap breast reconstruction.

社会经济地位（SES）可以预测某些专科的术后结果，但其对自体乳房重建的影响尚不明确。我们研究了SES对游离皮瓣乳房重建术后并发症和美学修正的影响。方法回顾性分析2013 - 2023年间连续行游离皮瓣乳房重建术的患者。在考虑种族、保险状况和社会经济状况变量（包括美国人口普查数据和邻里地图集区域剥夺指数（ADI））的情况下，分析手术结果、乳房切除术到重建的时间以及美容修复率。结果244例患者共行游离皮瓣375例（单侧113例，占30%）。显著的种族差异包括较高的体重指数、较高的糖尿病患病率和烟草使用（p < 0.05），以及不利的社会经济地位，包括较高的每日摄入量、食品不安全和交通不便（p < 0.05）。非白种人患者等待自由皮瓣重建时间更长，皮瓣修复次数较少（p < 0.05）。医疗补助保险预测皮瓣完全丧失（优势比（OR） 6.981, 95%可信区间（CI） 1.244-39.168, p < 0.05）。在多变量分析中，非白种人（OR 0.417, 95% CI 0.189-0.644, p < 0.05）、ADI （OR 0.983, 95% CI 0.969-0.998, p < 0.05）和较高数量的合共病（OR 0.704, 95% CI 0.565-0.859, p < 0.05）负向预测美学修复（p < 0.05）。结论不利的SES不影响游离皮瓣并发症的发生率，但可能影响手术时机和患者是否进行择期皮瓣修复。确定这些障碍是改善自由皮瓣乳房重建的重要一步。

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引用次数: 0

Haemodynamic assessment of the superficial inferior epigastric artery to demonstrate the vascularisation of a new lower transverse abdominal flap 腹壁下浅动脉的血流动力学评估，以证明一个新的下腹横皮瓣的血管化

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-03 DOI: 10.1016/j.bjps.2025.10.040

Carlos Lacerda A. Almeida , Luiz Felipe Vieira , Laura Vieira Correia , Adriano Sousa Costa , Amanda C.A. Almeida , Daniel C.A. Souza , João Paulo S. Siqueira , Sílvio S. Caldas Neto

Haemodynamics examines the mechanics of blood circulation to define anatomy, support diagnosis, and guide treatment of tissue and organ alterations. The superficial inferior epigastric arteries (SIEAs) were studied in surgical specimens discarded from abdominoplasties to evaluate the most perfused regions for creating the lower transverse abdominal flap. In this observational, descriptive, and analytical study (2021–2024), SIEAs from 78 abdominoplasty specimens were catheterised, divided into four regions, and subjected to haemodynamic analysis. Two groups were studied: G1 (post-bariatric surgery) and G2 (without prior surgery). Numerical variables were summarised using measures of central tendency and dispersion. Associations between categorical variables were tested with Fisher’s exact test. The Shapiro–Wilk test assessed the normality of quantitative variables. Comparisons between two independent groups used Student’s t-test for normally distributed data and the Mann–Whitney U test for non-normal distributions. For paired groups, the paired Student’s t-test was applied for normal data, and the Wilcoxon and Spearman tests for non-normal data. Women comprised 71 participants (91.0%). G1 included 22 (28.2%), and G2 included 56 (71.8%). Statistically significant differences were observed between G1 and G2 in SIEA diameters. Haemodynamic analysis showed satisfactory perfusion in areas I and II (100% contrast filling of the vascular territory), whereas areas III (33.3%) and IV (6.7%) demonstrated unsatisfactory perfusion. This study demonstrated the anatomy and flow of the SIEAs and identified the safest regions of the flap for surgical use. Areas I and II were safe, whereas areas III and IV were not.

血液动力学检查血液循环的机制，以定义解剖学，支持诊断，并指导治疗组织和器官的改变。研究了腹部整形手术标本中腹部下浅动脉（siea），以评估形成下腹部横向皮瓣的最灌注区域。在这项观察性、描述性和分析性研究（2021-2024）中，78例腹部成形术标本的siea被置管，分为四个区域，并进行血流动力学分析。研究分为两组：G1组（减肥手术后）和G2组（未手术前）。数值变量用集中趋势和离散度来总结。分类变量间的相关性采用Fisher精确检验。夏皮罗-威尔克检验评估定量变量的正态性。两个独立组之间的比较对正态分布数据使用Student 's t检验，对非正态分布使用Mann-Whitney U检验。对于配对组，正态数据采用配对Student’s t检验，非正态数据采用Wilcoxon和Spearman检验。女性71人（91.0%）。G1 22例（28.2%），G2 56例（71.8%）。G1组与G2组SIEA直径差异有统计学意义。血流动力学分析显示I区和II区灌注满意（血管区域造影剂填充100%），而III区（33.3%）和IV区（6.7%）灌注不满意。本研究展示了siea的解剖结构和血流，并确定了手术使用皮瓣的最安全区域。第一和第二区是安全的，而第三和第四区则不安全。

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引用次数: 0

Retrospective cohort study on pedicled flap reconstruction after trunk soft tissue sarcoma resection: Surgical outcomes and survival analysis 躯干软组织肉瘤切除术后带蒂皮瓣重建的回顾性队列研究：手术效果及生存分析

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-12 DOI: 10.1016/j.bjps.2025.11.012

Fu Laihua , Xiao Wanyi , Liu Yuanxin , Huang Jingyang , Zhou Yang , Xu Songfeng , Qiu Jin , Zhao Zhigang , Yang Jilong

Background and objective

Although pedicled flaps are widely used in trunk reconstruction, evidence remains limited regarding their efficacy in patients with soft tissue sarcoma (STS) requiring wide resection with skeletal involvement.

Methods

This retrospective cohort study analyzed 42 consecutive patients who underwent pedicled flap reconstruction after trunk sarcoma resection at our institution (2019–2024). Flap types included 30 fasciocutaneous and 12 myocutaneous flaps. Outcomes included flap survival (photographic/Doppler assessment) and complications (Clavien-Dindo). Statistical analysis was performed using the Fisher's exact test and Kaplan-Meier methods (SPSS v26).

Results

The cohort demonstrated favorable outcomes with pedicled flap reconstruction (92.86% primary healing rate). Among skeletal defect cases, reconstructions used soft prostheses (n = 6), rigid prostheses (n = 2), or mesh reinforcement (n = 2). During the 11–59 month follow-up period, distant metastases developed in 14.29% of cases (3 pulmonary, 2 hepatic, and 1 peritoneal) (5 pulmonary, 2 pulmonary and hepatic, and 1 peritoneal).

Conclusion

Our findings suggest that pedicled flap reconstruction following wide resection of trunk soft tissue sarcomas is associated with satisfactory outcomes (92.9% primary healing rate) and low major complication rates (7.1% Grade I–II complications). These results indicate that pedicled tissue flaps represent a viable reconstructive option when tumor clearance can be achieved.

背景与目的尽管带蒂皮瓣被广泛应用于躯干重建，但其在需要广泛切除并累及骨骼的软组织肉瘤（STS）患者中的疗效证据仍然有限。方法回顾性队列研究分析了我院（2019-2024）连续42例躯干肉瘤切除术后行带蒂皮瓣重建的患者。皮瓣类型包括30个筋膜皮瓣和12个肌皮瓣。结果包括皮瓣存活（摄影/多普勒评估）和并发症（Clavien-Dindo）。采用Fisher精确检验和Kaplan-Meier方法（SPSS v26）进行统计分析。结果带蒂皮瓣重建效果良好，一期愈合率为92.86%。在骨骼缺损病例中，重建采用软性假体（n = 6）、刚性假体（n = 2）或网状补强（n = 2）。在11-59个月的随访期间，14.29%的病例发生远处转移（3例肺，2例肝，1例腹膜）（5例肺，2例肺和肝，1例腹膜）。结论躯干软组织肉瘤大范围切除后带蒂皮瓣重建效果满意（一期愈合率92.9%），主要并发症发生率低（I-II级并发症7.1%）。这些结果表明，当肿瘤清除可以实现时，带蒂组织皮瓣是一种可行的重建选择。

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