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

A full-face contouring using micro-autologous fat transplantation (MAFT)-gun technique in Vietnamese population 在越南人群中使用微型自体脂肪移植（MAFT）-枪式技术进行全脸塑形。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-27 DOI: 10.1016/j.bjps.2024.09.074

Introduction

The micro-autologous fat transplantation (MAFT)-gun technique is applied to accurately deliver small fat parcels to multiple fat layers across different sites. Our study presents the surgical and clinical outcomes of using the MAFT-gun technique for full-face contouring.

Methods

From January 2021 to June 2023, 31 healthy participants undergoing full-face volumization using the MAFT-gun technique at our hospital were included in this study. Data on fat volume grafted at different facial sites, complications, and satisfaction rates (%) were collected and analyzed.

Results

The average fat volumes grafted over the left and right cheeks were 10.3 ± 0.31 ml and 10.2 ± 0.30 ml, respectively. The forehead and temples required lower fat volumes of 9.8 ± 0.23 ml and 4.5 ± 0.21 ml, respectively. Small fat volumes were required for the nasolabial fold, the tear trough, and the infraorbital areas, with 2.2 ± 0.11 ml, 1.9 ± 0.10 ml, and 1.4 ± 0.11 ml, respectively. The fat volumes for the nasolabial fold and the tear trough were significantly different between young and old people. No complications, including infection, necrosis, or vascular injury, were noted. At the end of the follow-up, 26 patients (83.9%) expressed their satisfaction after the procedure.

Conclusion

The MAFT-gun technique is safe and effective for full-face autologous fat grafting. Commercial closed-system processors could be an effective alternative to centrifugation for fat processing. The procedure significantly improved facial hollowness and resulted in a more attractive and satisfied appearance to people even after 12 months postoperatively.

简介：微型自体脂肪移植枪（MAFT）技术可将小块脂肪准确地移植到不同部位的多个脂肪层。我们的研究介绍了使用微型自体脂肪移植枪技术进行全脸塑形的手术和临床效果：方法：2021年1月至2023年6月，31名健康参与者在我院接受了使用MAFT-gun技术的全脸塑形手术。收集并分析了面部不同部位的脂肪移植量、并发症和满意率（%）等数据：左脸颊和右脸颊的平均脂肪移植量分别为 10.3 ± 0.31 毫升和 10.2 ± 0.30 毫升。前额和太阳穴需要的脂肪量较少，分别为 9.8 ± 0.23 毫升和 4.5 ± 0.21 毫升。鼻唇沟、泪沟和眶下区域所需的脂肪量较少，分别为 2.2 ± 0.11 毫升、1.9 ± 0.10 毫升和 1.4 ± 0.11 毫升。鼻唇沟和泪沟的脂肪量在年轻人和老年人之间存在显著差异。没有发现感染、坏死或血管损伤等并发症。随访结束时，26 名患者（83.9%）对手术表示满意：结论：MAFT-枪技术对于全脸自体脂肪移植是安全有效的。商用封闭系统处理器可有效替代离心脂肪处理。该手术明显改善了面部凹陷，即使在术后 12 个月后，也能使人看起来更有魅力、更满意。

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引用次数: 0

Does the geographic region of plastic surgery away rotations influence residency match success by region? 整形外科客场轮转的地理区域是否会影响各地区住院医师培训的成功率？

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-27 DOI: 10.1016/j.bjps.2024.08.071

Introduction

Integrated plastic surgery is consistently one of the most competitive residency specialties to successfully match. Students, advisors, and mentors are constantly looking for strategies to increase the odds of successfully matching. Away rotations (AR) give students and residency programs a chance to experience each other and get a gage of program fit and gives the student ability to show interest in a geographic region. The purpose of this study is to determine if completing an away rotation in a specific geographic region increases the chances of matching there.

Methods

U.S. medical student seniors from 2018-2023 applying into integrated plastic surgery were analyzed. The Texas STAR survey was used as a data source. Data was collected on the number of applications, interviews, AR, applicant home region, and match outcome and stratified into 4 regions, central, northeast, south, and west based on AAMC program listings. Applicant statistics such as standardized exam scores were also collected. Linear and logistic regression were conducted assess associations with increased interviews and successfully matching in specific geographic regions. χ² and independent T-tests were used to assess associations between match outcome and applicant statistics.

Results

401 applicants with 28561 applications were included for analysis. Match success was 78.3%. Most applicants completed at least 1 AR (85.9%) with a mean of 2.04 per applicant. Completing more AR in a region resulted in significantly more interview offers in that area, with an average increase of 1.3 interviews for each AR completed (p<.001). Completing more AR and having more interviews in a particular region increased the odds of matching in that region (p<.05). Number of interviews, completing an AR, USMLE Step 2 score, alpha omega alpha membership, and cumulative quartile rank were associated with increased match success.

Conclusion

Completing AR in specific geographic regions increased the number of interviews and chances of matching in the same region.

简介：综合整形外科一直是竞争最激烈的住院医师培训专业之一。学生、顾问和导师都在不断寻找策略，以提高成功匹配的几率。客场轮转（AR）给学生和住院医师培训项目提供了一个相互体验的机会，让学生有机会了解项目是否适合自己，同时也让学生有能力展示自己对某一地区的兴趣。本研究的目的是确定在特定地区完成一次客场轮转是否会增加与该地区匹配的机会：分析了 2018-2023 年申请综合整形外科的美国医学生大四学生。数据来源为德克萨斯州 STAR 调查。收集了申请数量、面试、AR、申请者家乡地区和匹配结果等数据，并根据AAMC项目列表将申请者分层为中部、东北部、南部和西部4个地区。此外，还收集了申请人的统计数据，如标准化考试成绩。线性回归和逻辑回归评估了特定地理区域面试增加和成功匹配的相关性。使用 χ² 和独立 T 检验来评估匹配结果与申请人统计数据之间的关联：共有 401 名申请者提交了 28561 份申请，纳入分析。匹配成功率为 78.3%。大多数申请人至少完成了 1 次 AR（85.9%），平均每位申请人完成 2.04 次。在某一地区完成更多的 AR 可明显增加该地区的面试机会，平均每完成一次 AR 可增加 1.3 个面试机会（p 结论：在特定地理区域完成 AR 可增加同一区域的面试次数和匹配机会。

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引用次数: 0

Patient-reported outcomes and comprehensive assessment of wrist function after scaphoid reconstruction: A single-center retrospective study on 162 patients 肩胛骨重建术后的患者报告结果和腕关节功能综合评估：对162名患者进行的单中心回顾性研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-27 DOI: 10.1016/j.bjps.2024.09.071

A vast body of literature emphasizes the use of radiological data for assessing outcomes in scaphoid reconstruction. The goal of this single-center study was to examine patient-reported outcomes and wrist function after scaphoid reconstruction.

A total of 162 of 370 patients who underwent scaphoid reconstruction between January 2007 and December 2020 were included in the study. Analyses were conducted using R version 4.0.2 with a significance level at p ≤ 0.05.

The clinical follow-up averaged 7.44 years (range 1.03–14.65), with 87% of patients achieving union. The average Disability of the Arm, Shoulder, and Hand (DASH) score was 7.54 (±10.08). The range of motion (ROM) for extension/flexion (E/F) averaged 115.97° (±21.77°) and the grip strength averaged 42.49 kg (±10.78). No statistically significant differences in the parameters studied were observed regarding the occurrence of union. Subgroups of patients without avascular necrosis (AVN), and those with preoperative carpal misalignment and without carpal instability, achieved better functional outcomes with nonvascularized bone grafts compared to vascularized grafts. K-wire fixation resulted in poorer functional outcomes in cases of carpal instability, including ROM in E/F (p = 0.02) and total ROM (p = 0.03), compared to stabilization with compression screw. In patients with AVN (N = 27), neither the type of bone graft nor the osteosynthesis method had any significant effect on functional or patient-reported outcomes. Female patients had higher DASH score (p = 0.03), ROM in E/F (p = 0.04), ROM in ulnar/radial deviation (p = 0.04), ROM in pronation/supination (p = 0.02), and cROM (p = 0.01) than the male patients.

More complex reconstruction methods may lead to inferior outcomes and should be reserved for specific indications. The better functional but worse patient-reported outcomes in female patients warrant further analysis.

大量文献强调使用放射学数据评估肩胛骨重建的效果。这项单中心研究的目的是检查患者报告的结果和肩胛骨重建后的腕关节功能。研究共纳入了2007年1月至2020年12月期间接受肩胛骨重建的370名患者中的162名。临床随访时间平均为7.44年（范围为1.03-14.65年），87%的患者实现了骨结合。手臂、肩部和手部残疾（DASH）平均评分为7.54（±10.08）分。伸展/屈曲活动范围（ROM）平均为115.97°（±21.77°），握力平均为42.49公斤（±10.78）。所研究的参数在发生骨结合方面没有发现明显的统计学差异。与血管移植相比，无血管坏死（AVN）、术前腕关节错位但无腕关节不稳定的亚组患者使用无血管骨移植的功能效果更好。在腕关节不稳定的病例中，与使用加压螺钉固定相比，K线固定的功能效果较差，包括E/F ROM（p = 0.02）和总ROM（p = 0.03）。在AVN患者中（N = 27），骨移植类型和骨合成方法对功能或患者报告结果均无显著影响。与男性患者相比，女性患者的DASH评分（p = 0.03）、E/F ROM（p = 0.04）、尺侧/桡侧偏离ROM（p = 0.04）、前伸/上举ROM（p = 0.02）和cROM（p = 0.01）都更高。女性患者的功能较好，但患者报告的结果较差，这值得进一步分析。

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引用次数: 0

Case series of genital lymphaticovenous anastomosis for genital lymphatic vesicles 生殖器淋巴管-静脉吻合术治疗生殖器淋巴囊肿的病例系列

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-27 DOI: 10.1016/j.bjps.2024.09.072

Background

The management of lymphatic vesicles is challenging. This study aimed to clarify the lymphatic flow around the genitals and assess the effect of genital lymphaticovenous anastomosis (LVA) on lymphatic vesicles.

Methods

We conducted a retrospective study of 34 patients who underwent lymphatic vesicle resection and LVA. In patients with genital lymphedema, 2 types of lymphatic inflow existed around the genital area; from the lower extremities (type 1) and from the buttocks (type 2). Lymphoscintigraphy was performed to detect type 1 lymphatics injecting isotope into the first interdigital area. Indocyanine green (ICG) lymphography was performed to detect type 2 lymphatics injecting ICG into the ischial tuberosity. Lymphatic vesicles were resected, and LVA was performed on the legs and/or genitals. Postoperative recurrence rate of lymphatic vesicles and the frequency of cellulitis were evaluated.

Results

Type 1 lymphatics were observed in 38.2% of the patients. ICG lymphography showed a linear inflow to the genitals in 40.9% and dermal backflow inflow in 24.2%. Both type 1 and 2 lymphatic vessels were observed in 10 patients (29.4%). Genital LVA was performed in 31 patients and lower extremity LVA was performed in 15 patients. The average follow-up period was 332 days, and recurrence was observed in 8 (25.8%) of 31 patients who underwent total resection. The average number of cellulitis episodes decreased significantly from 2.8 times before surgery to 0.31 times after surgery (p < 0.01).

Conclusion

LVA in the genital area and lower limbs was effective in preventing postoperative recurrence of lymphatic vesicles after resection.

背景淋巴囊的治疗具有挑战性。本研究旨在明确生殖器周围的淋巴流，并评估生殖器淋巴-静脉吻合术（LVA）对淋巴囊的影响。方法我们对 34 名接受淋巴囊切除术和 LVA 的患者进行了回顾性研究。在生殖器淋巴水肿患者中，生殖器周围存在两种类型的淋巴流入：来自下肢（1型）和来自臀部（2型）。淋巴管造影是为了检测第一类淋巴管，将同位素注射到生殖器第一间区域。吲哚菁绿（ICG）淋巴造影术用于检测将 ICG 注入跗骨结节的 2 型淋巴管。切除淋巴囊，并在腿部和/或生殖器上进行淋巴管切除术（LVA）。结果38.2%的患者发现了1型淋巴管。ICG淋巴造影显示，40.9%的淋巴管呈线状流入生殖器，24.2%的淋巴管呈真皮回流。在 10 名患者（29.4%）中同时观察到 1 型和 2 型淋巴管。31名患者进行了生殖器淋巴管切除术，15名患者进行了下肢淋巴管切除术。平均随访时间为 332 天，31 名接受全切除术的患者中有 8 人（25.8%）复发。蜂窝织炎的平均发作次数从术前的 2.8 次明显降低到术后的 0.31 次（p < 0.01）。

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引用次数: 0

Exploring the use, outcomes, barriers, and facilitators of prehabilitation and rehabilitation in abdominoplasty surgeries: A scoping review 探索腹部整形手术中预康复和康复的使用、结果、障碍和促进因素：范围界定综述。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-26 DOI: 10.1016/j.bjps.2024.09.039

Objective

This review aimed to map the literature on prehabilitation and rehabilitation in adults undergoing abdominoplasty, identifying gaps and areas for future research.

Methods

The review followed the PRISMA guidelines for Scoping Reviews and was registered on the Open Science Framework platform (https://osf.io/m4k5s). The search for studies was conducted in the following electronic databases: PubMed, Scopus, EMBASE, Web of Science, PEDro, LILACS, The Cochrane Library, and CINAHL. The search strategy used the PCC approach: P: abdominoplasty surgery; C: prehabilitation or rehabilitation interventions; C: patient-related outcomes, hospital outcomes, safety outcomes, mortality, intervention description, feasibility of intervention selection and delivery, reported barriers and facilitators, and various study designs.

Results

Among the 2444 references examined, 12 studies met the inclusion criteria, predominantly consisting of small clinical trials. The most frequent surgical approach was combined abdominoplasty, present in 58.3% of the studies. Physiotherapists integrated with the prehabilitation and/or rehabilitation team in 33.3% of cases. Notably, 75% of the studies focused on postoperative rehabilitation, with lymphatic drainage techniques being the most common intervention, appearing in 41.7% of the studies. 33.3% of the studies mentioned respiratory complications such as atelectasis, pneumonia, and respiratory failure as postoperative occurrences. Some gaps were identified, including insufficiently detailed reports of interventions and diversity in the type and timing of outcome measurements.

Conclusions

This review highlights the lack of data on the effects of prehabilitation and rehabilitation in patients undergoing abdominoplasty, due to the diversity of measures and variable assessment times, emphasizing the need for standardization and multicenter studies to determine optimal interventions and their impacts.

目的本综述旨在梳理有关成人腹部整形术前康复和康复的文献，找出差距和未来研究领域：本综述遵循《范围界定综述 PRISMA 指南》，并在开放科学框架平台 (https://osf.io/m4k5s) 上注册。研究检索在以下电子数据库中进行：PubMed、Scopus、EMBASE、Web of Science、PEDro、LILACS、The Cochrane Library 和 CINAHL。搜索策略采用 PCC 方法：P：腹部整形手术；C：康复前或康复干预；C：患者相关结果、医院结果、安全结果、死亡率、干预描述、干预选择和实施的可行性、报告的障碍和促进因素以及各种研究设计：在2444篇参考文献中，有12篇符合纳入标准，主要是小型临床试验。最常见的手术方法是腹部联合整形术，占研究总数的 58.3%。物理治疗师与康复前和/或康复团队相结合的案例占 33.3%。值得注意的是，75%的研究侧重于术后康复，其中淋巴引流技术是最常见的干预措施，出现在41.7%的研究中。33.3%的研究提到术后会出现呼吸系统并发症，如肺不张、肺炎和呼吸衰竭。研究还发现了一些不足之处，包括干预措施的报告不够详细以及结果测量的类型和时间的多样性：本综述强调，由于测量方法的多样性和评估时间的不确定性，腹部整形术患者术前康复和康复效果方面缺乏数据，因此需要进行标准化和多中心研究，以确定最佳干预措施及其影响。

{"title":"Exploring the use, outcomes, barriers, and facilitators of prehabilitation and rehabilitation in abdominoplasty surgeries: A scoping review","authors":"","doi":"10.1016/j.bjps.2024.09.039","DOIUrl":"10.1016/j.bjps.2024.09.039","url":null,"abstract":"<div><h3>Objective</h3><div>This review aimed to map the literature on prehabilitation and rehabilitation in adults undergoing abdominoplasty, identifying gaps and areas for future research.</div></div><div><h3>Methods</h3><div>The review followed the PRISMA guidelines for Scoping Reviews and was registered on the Open Science Framework platform (<span><span>https://osf.io/m4k5s</span><svg><path></path></svg></span>). The search for studies was conducted in the following electronic databases: PubMed, Scopus, EMBASE, Web of Science, PEDro, LILACS, The Cochrane Library, and CINAHL. The search strategy used the PCC approach: P: abdominoplasty surgery; C: prehabilitation or rehabilitation interventions; C: patient-related outcomes, hospital outcomes, safety outcomes, mortality, intervention description, feasibility of intervention selection and delivery, reported barriers and facilitators, and various study designs.</div></div><div><h3>Results</h3><div>Among the 2444 references examined, 12 studies met the inclusion criteria, predominantly consisting of small clinical trials. The most frequent surgical approach was combined abdominoplasty, present in 58.3% of the studies. Physiotherapists integrated with the prehabilitation and/or rehabilitation team in 33.3% of cases. Notably, 75% of the studies focused on postoperative rehabilitation, with lymphatic drainage techniques being the most common intervention, appearing in 41.7% of the studies. 33.3% of the studies mentioned respiratory complications such as atelectasis, pneumonia, and respiratory failure as postoperative occurrences. Some gaps were identified, including insufficiently detailed reports of interventions and diversity in the type and timing of outcome measurements.</div></div><div><h3>Conclusions</h3><div>This review highlights the lack of data on the effects of prehabilitation and rehabilitation in patients undergoing abdominoplasty, due to the diversity of measures and variable assessment times, emphasizing the need for standardization and multicenter studies to determine optimal interventions and their impacts.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569603","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

Evaluating two decades of traumatic amputations treated in US emergency departments: A multicenter epidemiological analysis from NEISS 评估二十年来美国急诊科治疗的外伤性截肢病例：来自 NEISS 的多中心流行病学分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-25 DOI: 10.1016/j.bjps.2024.09.068

引用次数: 0

Outcomes of free flap breast reconstruction in patients aged 70 years and over: A single-centre experience 70 岁及以上患者的游离皮瓣乳房重建效果：单中心经验

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-24 DOI: 10.1016/j.bjps.2024.09.059

Background

Chronological age is an important factor in determining whether a patient can be offered reconstruction following breast cancer surgery. Free flap breast reconstruction is considered the gold standard but is seldom offered to older patients, as the risks are considered too high. This study aimed to examine the outcomes of free flap breast reconstruction in patients aged ≥70 years treated in our unit.

Methods

We conducted a retrospective review examining the outcomes of consecutive patients aged ≥70 years undergoing free flap breast reconstruction at a single centre between January 2015 and December 2023. Logistic regression was used to determine the relationship between increasing age and comorbidities, and four primary outcome variables— all complications, readmission, return to theatre and length of stay.

Results

We identified 71 patients with a mean age of 72.3 years (70–78 years). 63.4% had one or more comorbidities, with the most common being hypertension and hypercholesterolaemia. Most patients (90.1%) were American Society of Anesthesiologists (ASA) grade 1 or 2. The overall complication rate was 36.6%, most of which were minor wound healing complications (22.5%). There were no episodes of flap loss, either partial or complete. The rates of severe complications (14.1%), readmission (8.4%) and return to theatre (7.0%) were low and comparable to those previously published for our general patient cohort. There was no relationship between increasing age beyond 70 years and any of the four primary adverse outcome measures.

Conclusions

Free flap breast reconstruction in patients aged ≥70 years can be successful and safe. Therefore, it should be considered as an option for fit, surgically optimised patients, independent of age.

研究背景年龄是决定乳腺癌术后能否进行乳房再造的一个重要因素。游离皮瓣乳房再造被认为是金标准，但由于风险太高，很少为老年患者提供。本研究旨在探讨在我院接受治疗的年龄≥70岁患者的游离皮瓣乳房重建结果。方法我们进行了一项回顾性研究，探讨了2015年1月至2023年12月期间在一个中心接受游离皮瓣乳房重建的年龄≥70岁的连续患者的结果。我们使用逻辑回归来确定年龄增加、合并症和四个主要结果变量（所有并发症、再入院、重返手术室和住院时间）之间的关系。结果我们确定了71名平均年龄为72.3岁（70-78岁）的患者。63.4%的患者患有一种或多种并发症，其中最常见的是高血压和高胆固醇血症。大多数患者（90.1%）为美国麻醉医师协会（ASA）1级或2级。总体并发症发生率为36.6%，其中大部分是轻微的伤口愈合并发症（22.5%）。没有出现皮瓣部分或完全脱落的情况。严重并发症发生率（14.1%）、再入院率（8.4%）和重返手术室率（7.0%）都很低，与之前公布的普通患者群体的发生率相当。结论年龄超过70岁的患者进行游离皮瓣乳房重建手术是成功和安全的。因此，对于身体健康、手术优化的患者，无论年龄大小，都应将其视为一种选择。

{"title":"Outcomes of free flap breast reconstruction in patients aged 70 years and over: A single-centre experience","authors":"","doi":"10.1016/j.bjps.2024.09.059","DOIUrl":"10.1016/j.bjps.2024.09.059","url":null,"abstract":"<div><h3>Background</h3><div>Chronological age is an important factor in determining whether a patient can be offered reconstruction following breast cancer surgery. Free flap breast reconstruction is considered the gold standard but is seldom offered to older patients, as the risks are considered too high. This study aimed to examine the outcomes of free flap breast reconstruction in patients aged ≥70 years treated in our unit.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review examining the outcomes of consecutive patients aged ≥70 years undergoing free flap breast reconstruction at a single centre between January 2015 and December 2023. Logistic regression was used to determine the relationship between increasing age and comorbidities, and four primary outcome variables— all complications, readmission, return to theatre and length of stay.</div></div><div><h3>Results</h3><div>We identified 71 patients with a mean age of 72.3 years (70–78 years). 63.4% had one or more comorbidities, with the most common being hypertension and hypercholesterolaemia. Most patients (90.1%) were American Society of Anesthesiologists (ASA) grade 1 or 2. The overall complication rate was 36.6%, most of which were minor wound healing complications (22.5%). There were no episodes of flap loss, either partial or complete. The rates of severe complications (14.1%), readmission (8.4%) and return to theatre (7.0%) were low and comparable to those previously published for our general patient cohort. There was no relationship between increasing age beyond 70 years and any of the four primary adverse outcome measures.</div></div><div><h3>Conclusions</h3><div>Free flap breast reconstruction in patients aged ≥70 years can be successful and safe. Therefore, it should be considered as an option for fit, surgically optimised patients, independent of age.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441872","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

Impact of connective tissue diseases on complications following aesthetic surgery: A matched cohort study 结缔组织疾病对美容手术并发症的影响：匹配队列研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-21 DOI: 10.1016/j.bjps.2024.09.048

Background

The association between connective tissue diseases (CTDs), including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma, and complications following aesthetic surgery is under-investigated. We hypothesized that the risk of complications following aesthetic surgery was higher in patients with these connective tissue disorders compared to matched non-CTD patients.

Methods

All patients diagnosed with RA, SLE, and scleroderma who underwent aesthetic surgery at our institution from 2003–2022 were reviewed. Demographic data, comorbidities, medications, procedures, and postoperative complications were collected. Non-CTD controls were identified for each procedure and matched 1:1 based on propensity scores derived from race, sex, body mass index, smoking status, and comorbidities.

Results

Six hundred 38 patients were included, comprising 319 (50%) patients diagnosed with CTD and 319 (50%) controls. The average age at surgery was 56.3 years. There were 129 complications. There were no differences between the CTD and non-CTD patients in number of total complications (69 versus 60, p = 0.38), major complications (23 versus 16, p = 0.25), or minor complications (46 versus 44, p = 0.73). Complications were not significantly different between CTD patients and controls who underwent blepharoplasty (p = 0.38), breast reduction (p = 0.91), abdominoplasty (p = 0.46), or rhytidectomy (p = 0.50). CTD patients who underwent breast augmentation had significantly more complications than matched non-CTD patients in bivariate analysis (7 versus 0, p = 0.018*) and multivariable logistic regression (OR: 10.2, 95% CI: 1.21 to 93.3, p = 0.039*).

Conclusions

Most aesthetic surgeries can safely be performed in patients with CTDs. Patients seeking breast augmentation should be counseled on a potentially increased risk of postoperative complications.

背景结缔组织疾病（CTD），包括类风湿性关节炎（RA）、系统性红斑狼疮（SLE）和硬皮病，与美容手术后并发症之间的关系尚未得到充分研究。我们假设，与匹配的非结缔组织疾病患者相比，这些结缔组织疾病患者在美容手术后出现并发症的风险更高。方法回顾了 2003-2022 年期间在本院接受美容手术的所有确诊为 RA、系统性红斑狼疮和硬皮病的患者。收集了人口统计学数据、合并症、药物、手术和术后并发症。根据种族、性别、体重指数、吸烟状况和合并症得出的倾向分数，为每项手术确定了非 CTD 对照组，并进行了 1:1 匹配。手术时的平均年龄为 56.3 岁。共有 129 例并发症。CTD 和非 CTD 患者在总并发症数量（69 对 60，P = 0.38）、主要并发症（23 对 16，P = 0.25）或轻微并发症（46 对 44，P = 0.73）方面没有差异。接受眼睑成形术（p = 0.38）、乳房缩小术（p = 0.91）、腹部成形术（p = 0.46）或韵律切除术（p = 0.50）的 CTD 患者与对照组的并发症无明显差异。在双变量分析（7 对 0，p = 0.018*）和多变量逻辑回归（OR：10.2，95% CI：1.21 至 93.3，p = 0.039*）中，接受隆胸手术的 CTD 患者的并发症明显多于匹配的非 CTD 患者。结论大多数美容手术都可以安全地在 CTD 患者中进行，但应告知寻求隆胸的患者术后并发症的风险可能会增加。

{"title":"Impact of connective tissue diseases on complications following aesthetic surgery: A matched cohort study","authors":"","doi":"10.1016/j.bjps.2024.09.048","DOIUrl":"10.1016/j.bjps.2024.09.048","url":null,"abstract":"<div><h3>Background</h3><div>The association between connective tissue diseases (CTDs), including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma, and complications following aesthetic surgery is under-investigated. We hypothesized that the risk of complications following aesthetic surgery was higher in patients with these connective tissue disorders compared to matched non-CTD patients.</div></div><div><h3>Methods</h3><div>All patients diagnosed with RA, SLE, and scleroderma who underwent aesthetic surgery at our institution from 2003–2022 were reviewed. Demographic data, comorbidities, medications, procedures, and postoperative complications were collected. Non-CTD controls were identified for each procedure and matched 1:1 based on propensity scores derived from race, sex, body mass index, smoking status, and comorbidities.</div></div><div><h3>Results</h3><div>Six hundred 38 patients were included, comprising 319 (50%) patients diagnosed with CTD and 319 (50%) controls. The average age at surgery was 56.3 years. There were 129 complications. There were no differences between the CTD and non-CTD patients in number of total complications (69 versus 60, p = 0.38), major complications (23 versus 16, p = 0.25), or minor complications (46 versus 44, p = 0.73). Complications were not significantly different between CTD patients and controls who underwent blepharoplasty (p = 0.38), breast reduction (p = 0.91), abdominoplasty (p = 0.46), or rhytidectomy (p = 0.50). CTD patients who underwent breast augmentation had significantly more complications than matched non-CTD patients in bivariate analysis (7 versus 0, <strong>p = 0.018</strong>*) and multivariable logistic regression (<strong>OR: 10.2, 95% CI: 1.21 to 93.3, p = 0.039</strong>*).</div></div><div><h3>Conclusions</h3><div>Most aesthetic surgeries can safely be performed in patients with CTDs. Patients seeking breast augmentation should be counseled on a potentially increased risk of postoperative complications.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358067","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

Abdominal muscles infiltration analgesia for donor-site pain in autologous ear reconstruction: A randomized controlled clinical trial 腹部肌肉浸润镇痛治疗自体耳再造术中的供体部位疼痛：随机对照临床试验。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-20 DOI: 10.1016/j.bjps.2024.09.019

Background

Costal cartilage donor-site pain is an adverse effect of autologous ear reconstruction. This study aimed to introduce rectus abdominis and external oblique muscle infiltration analgesia (RAM+EOM-IA) for costal cartilage donor-site pain and evaluate its efficacy and safety.

Methods

The study was a randomized controlled clinical trial. Patients were randomized between intermittent RAM+EOM-IA combined with intravenous patient-controlled anesthesia (IPCA) and IPCA alone. Thirty patients were followed in the RAM+EOM-IA combined with the IPCA group and 30 patients in the IPCA alone group. The primary outcome was the numerical rating score (NRS) of pain recorded during 48 h postoperatively. Secondary outcomes included the Barthel index (BI) and rescue analgesic consumption. Sensory block areas were tested using a cold stimulus.

Results

NRS was significantly lower with RAM+EOM-IA combined with IPCA than with IPCA alone at 28 h (P < 0.01), 32 h (P < 0.01), 36 h (P < 0.01), 44 h (P < 0.001), and 48 h (P < 0.01) postoperatively. The number of patients who received rescue analgesics (P < 0.01) and consumption (P < 0.01) was significantly higher for IPCA alone. RAM+EOM-IA improved the BI at 24 h postoperatively (P < 0.001), especially for mobility (P < 0.001), using the stairs (P < 0.001) and toilet use domains (P < 0.001). At 10 and 60 min after RAM+EOM-IA, the total sensory block area in the abdomen had not extended proximally beyond the xiphoid, distally beyond the navel, and beyond midaxillary and midsternal lines on either side.

Conclusion

RAM+EOM-IA effectively and safely prevented costal cartilage donor-site pain by blocking anterior and lateral cutaneous branches of intercostal nerves from T6 to T10 in microtia patients.

背景：肋软骨供体部位疼痛是自体耳再造术的一种不良反应。本研究旨在引入腹直肌和外斜肌浸润镇痛（RAM+EOM-IA）治疗肋软骨供体部位疼痛，并评估其疗效和安全性：该研究是一项随机对照临床试验。患者被随机分为间歇性RAM+EOM-IA联合静脉患者控制麻醉（IPCA）和单纯IPCA两种。RAM+EOM-IA联合IPCA组和单独IPCA组分别随访了30名和30名患者。主要结果是术后 48 小时内记录的疼痛数字评分（NRS）。次要结果包括巴特尔指数（BI）和抢救镇痛药消耗量。使用冷刺激测试感觉阻滞区域：结果：28 小时后，RAM+EOM-IA 联合 IPCA 的 NRS 明显低于单用 IPCA 的 NRS（P 结论：RAM+EOM-IA 与 IPCA 联合使用能有效减轻术后疼痛：RAM+EOM-IA通过阻断小耳畸形患者T6至T10肋间神经的前侧和外侧皮支，有效、安全地预防了肋软骨供体部位疼痛。

{"title":"Abdominal muscles infiltration analgesia for donor-site pain in autologous ear reconstruction: A randomized controlled clinical trial","authors":"","doi":"10.1016/j.bjps.2024.09.019","DOIUrl":"10.1016/j.bjps.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Costal cartilage donor-site pain is an adverse effect of autologous ear reconstruction. This study aimed to introduce rectus abdominis and external oblique muscle infiltration analgesia (RAM+EOM-IA) for costal cartilage donor-site pain and evaluate its efficacy and safety.</div></div><div><h3>Methods</h3><div>The study was a randomized controlled clinical trial. Patients were randomized between intermittent RAM+EOM-IA combined with intravenous patient-controlled anesthesia (IPCA) and IPCA alone. Thirty patients were followed in the RAM+EOM-IA combined with the IPCA group and 30 patients in the IPCA alone group. The primary outcome was the numerical rating score (NRS) of pain recorded during 48 h postoperatively. Secondary outcomes included the Barthel index (BI) and rescue analgesic consumption. Sensory block areas were tested using a cold stimulus.</div></div><div><h3>Results</h3><div>NRS was significantly lower with RAM+EOM-IA combined with IPCA than with IPCA alone at 28 h (P < 0.01), 32 h (P < 0.01), 36 h (P < 0.01), 44 h (P < 0.001), and 48 h (P < 0.01) postoperatively. The number of patients who received rescue analgesics (P < 0.01) and consumption (P < 0.01) was significantly higher for IPCA alone. RAM+EOM-IA improved the BI at 24 h postoperatively (P < 0.001), especially for mobility (P < 0.001), using the stairs (P < 0.001) and toilet use domains (P < 0.001). At 10 and 60 min after RAM+EOM-IA, the total sensory block area in the abdomen had not extended proximally beyond the xiphoid, distally beyond the navel, and beyond midaxillary and midsternal lines on either side.</div></div><div><h3>Conclusion</h3><div>RAM+EOM-IA effectively and safely prevented costal cartilage donor-site pain by blocking anterior and lateral cutaneous branches of intercostal nerves from T6 to T10 in microtia patients.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335351","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

Late-onset periorbital edema in patients with a history of facial hyaluronic acid injection: A review on diagnosis and management 有面部透明质酸注射史的晚期眶周水肿患者：诊断和处理综述

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-20 DOI: 10.1016/j.bjps.2024.09.061

Background

Hyaluronic acid (HA) injections for soft tissue augmentation, particularly in the facial area, have become increasingly popular. Nevertheless, a growing number of reports indicate complications associated with this procedure, posing challenges for practitioners. One commonly encountered complication is periorbital edema.

Objective

To review the existing literature on late-onset periorbital edema following HA injections, focusing on clinical presentation, proposed mechanisms, risk factors, diagnostics, and management strategies.

Methods

A literature search was conducted to find articles describing findings on malar edema and eyelid edema following HA injections. The gathered data were categorized and juxtaposed to provide a clearer understanding of this phenomenon.

Results

Incidence rates of periorbital edema post-HA injection vary, with delayed onset occurring weeks to years later. The manifestation involves diffuse edema in the eyelids and malar area, sometimes worsened by trigger factors like infections. Pathophysiology discussions distinguish between inflammatory and non-inflammatory causes, highlighting lymphatic and venous flow disturbances. Risk factors include filler characteristics, injection depth, and patient predispositions. Proper patient evaluation using ultrasonography aids in treatment planning, which could involve corticosteroids, hyaluronidase for HA removal, and subsequent cosmetic procedures like radiofrequency (RF) microneedling. Surgical interventions should be considered after HA dissolution, especially in cases requiring lower blepharoplasty.

Conclusion

Late periorbital edema post-facial HA injections, once rare, is now frequently seen. Understanding and addressing this complication is essential for optimizing patient care and outcomes in clinical practice. Treatment typically involves adjusting hyaluronidase dosage for HA removal. Additional procedures like blepharoplasty, RF needling, or filler reinjection may enhance post-treatment appearance.

背景透明质酸（HA）注射用于软组织增量，尤其是面部软组织增量，已变得越来越流行。然而，越来越多的报告显示这种手术存在并发症，这给医生带来了挑战。方法通过文献检索，找到描述 HA 注射后睑板水肿和眼睑水肿的文章。结果HA注射后眼眶周围水肿的发病率各不相同，延迟发病发生在数周至数年后。表现为眼睑和颊部弥漫性水肿，有时因感染等诱发因素而加重。病理生理学讨论区分了炎症和非炎症原因，强调了淋巴和静脉流动障碍。风险因素包括填充物特性、注射深度和患者体质。使用超声波检查对患者进行适当的评估有助于制定治疗计划，其中可能涉及皮质类固醇、用于去除HA的透明质酸酶以及后续的美容程序，如射频（RF）微针。HA溶解后应考虑手术干预，尤其是需要进行下眼睑整形手术的病例。结论面部HA注射后的晚期眶周水肿曾经很少见，但现在却经常出现。在临床实践中，了解并解决这一并发症对于优化患者护理和治疗效果至关重要。治疗方法通常包括调整透明质酸酶的剂量以去除 HA。眼睑成形术、射频针刺或填充物再注射等附加程序可改善治疗后的外观。

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