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

Cholesteatoma in concha-type microtia 胆脂瘤见于甲壳型小鼠

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.bjps.2025.12.036

Nobuyuki Mitsuhashi , Takatoshi Yotsuyanagi , Ken Yamashita , Shinji Kato , Ayaka Kitada , Minoru Sakuraba

Background

Concha-type microtia with congenital aural stenosis carries a risk of external auditory canal cholesteatoma, which may cause infection and lead to the loss of costal cartilage grafts during auricular reconstruction. However, awareness of this risk among plastic surgeons remains limited. We aimed to review cases of cholesteatoma in concha-type microtia and discuss optimal management strategies.

Methods

We conducted a single-center retrospective review of patients with concha-type or small concha-type microtia and congenital aural stenosis who underwent auricular reconstruction with costal cartilage grafting between January 2018 and December 2021. We identified patients who developed external auditory canal cholesteatoma and analyzed the timing of occurrence, treatment, postoperative complications, graft preservation or removal, and postoperative course (including recurrence).

Results

Among 278 patients with microtia (90 auricles), 83 had concha-type or small concha-type microtia. The mean age at surgery was 11.8 years (range 10 to 24 years; median 11 years), and the cohort comprised 53 males and 30 females. Congenital aural stenosis (<4 mm) was present in 60 auricles, with cholesteatoma occurring in 4 (6.7%). One cholesteatoma was diagnosed preoperatively, two were diagnosed shortly after reconstruction (one required graft removal), and two were diagnosed after reconstruction. All patients underwent cholesteatoma excision and canalplasty. During ≥2 years of follow-up, mild restenosis but no recurrence were observed.

Conclusion

Concha-type microtia with congenital aural stenosis carries a risk of cholesteatoma. Preoperative screening is essential, and excision should precede auricular reconstruction. Vigilance during and after reconstruction, and close collaboration with otolaryngologists, are essential to prevent complications.

先天性耳廓狭窄的耳甲型小耳症有外耳道胆脂瘤的风险，可能引起感染并导致耳廓重建时肋软骨移植物的丢失。然而，整形外科医生对这种风险的认识仍然有限。我们的目的是回顾胆脂瘤在耳甲型小耳蜗的病例，并讨论最佳的管理策略。方法对2018年1月至2021年12月行肋软骨移植耳廓重建术的耳廓型或小耳廓型小耳廓狭窄患者进行单中心回顾性分析。我们确定了发生外耳道胆脂瘤的患者，并分析了发生时间、治疗、术后并发症、移植物保存或切除以及术后病程（包括复发）。结果278例小耳廓（90耳）中，有83例为甲壳型或小甲壳型小耳廓。手术的平均年龄为11.8岁（范围10 - 24岁，中位数11岁），队列包括53名男性和30名女性。先天性耳廓狭窄（4mm） 60例，胆脂瘤4例（6.7%）。1例术前诊断为胆脂瘤，2例重建后不久诊断为胆脂瘤（1例需要移除移植物），2例重建后诊断为胆脂瘤。所有患者均行胆脂瘤切除术和胆管成形术。随访≥2年，轻度再狭窄，无复发。结论先天性耳廓狭窄伴耳甲型小耳有胆脂瘤的危险。术前筛查是必要的，切除应先于耳廓重建。重建期间和重建后保持警惕，并与耳鼻喉科医生密切合作，对预防并发症至关重要。

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引用次数: 0

Sustainability in hand trauma surgery: An eco-audit of the flexor tendon laceration repair pathway 手部创伤手术的可持续性：屈肌腱撕裂修复途径的生态审计

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.bjps.2025.12.033

Zahra Ahmed , Alexander Zargaran , Olivia Kamoga , Punn Tannirandorn , Sara Sousi , David Zargaran , Norbert Kang , Afshin Mosahebi

Background

Hand trauma accounts for nearly one-third of emergency department (ED) attendances in the United Kingdom (UK). Particularly, repair of flexor tendon injuries is one of the most commonly performed plastic surgery procedures and requires months of repeated contact with hand therapy for optimal outcomes. The environmental impacts of treatment have not previously been evaluated.

Methods

A pilot retrospective service evaluation using process mapping and life-cycle assessment of 17 patients undergoing flexor tendon repair was performed using the functional unit of one completed patient pathway cycle, from ED to surgery, to rehabilitation and full recovery. Data were collected retrospectively from electronic patient records, supplier data and emission factor databases. Estimates for carbon dioxide emissions were generated in kgCO₂eq., allowing us to look for specific opportunities for pathway optimisation, in line with the national guidelines.

Results

We estimated the carbon footprint of a patient undergoing flexor tendon repair to be approximately 113.2 kgCO₂eq. The rehabilitation phase made the greatest contribution to emissions (59.9 kgCO₂eq., 52.9%) and patient travel was responsible for 79.4% of total emissions (89.9 kgCO₂eq.), followed by the production and transport of equipment (8.5 kgCO₂eq., 7.5%) needed for treatment.

Conclusions

The results of this pilot eco-audit identified key emission sources and potential interventions to reduce carbon emissions for this pathway. These include reducing the need for patient travel, which can be achieved by greening hand therapy through increased use of virtual consultations and encouraging the use of mobile phone applications. We also recommend the adoption of circular economy principles by using reusable surgical gowns and drapes, creation of procedure-specific equipment packs, and increased use of wide-awake local anaesthesia, no tourniquet.

背景：手部创伤占英国急诊科（ED）就诊人数的近三分之一。特别是，屈肌腱损伤的修复是最常见的整形手术之一，需要数月的反复接触手部治疗才能达到最佳效果。治疗对环境的影响以前没有得到评估。方法对17例接受屈肌腱修复术的患者，采用过程图和生命周期评估的方法，采用一个完整的患者路径周期的功能单元，从急诊科到手术，再到康复和完全恢复，进行回顾性服务评价。数据回顾性收集自电子病历、供应商数据和排放因子数据库。估算的二氧化碳排放量以kgCO2eq为单位。，使我们能够根据国家指导方针寻找途径优化的具体机会。结果我们估计接受屈肌腱修复的患者的碳足迹约为113.2 kgco2。恢复阶段对排放的贡献最大（59.9 kgCO2eq）。占总排放量的79.4% （89.9 kgco2当量），其次是设备的生产和运输（8.5 kgco2当量）。（7.5%）。该试点生态审计的结果确定了该路径的主要排放源和潜在的减少碳排放的干预措施。这些措施包括减少患者的旅行需求，这可以通过增加使用虚拟咨询和鼓励使用移动电话应用程序来实现绿色手部治疗。我们还建议采用循环经济原则，使用可重复使用的手术服和纱布，创建手术专用设备包，并增加使用全清醒局部麻醉，不使用止血带。

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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 : 2026-01-07 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

Optimizing outcomes in pediatric microvascular mandibular reconstruction: A 23-year institutional experience 优化儿童下颌骨微血管重建的结果：23年的机构经验。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-06 DOI: 10.1016/j.bjps.2025.12.030

Theodor B. Lenz, Dominic J. Romeo, Allison C. Hu, Jacob R. Thomas, Patrick Akarapimand, Scott P. Bartlett, Jesse A. Taylor, Eric J. Granquist, Cassandra A. Ligh, Jordan W. Swanson

Background

The vascularized free fibula flap (VFFF) is a well-established technique for addressing critical-sized mandibular defects, including those in pediatric patients. However, surgical risk factors and impact on growth potential are not well understood, particularly in skeletally immature patients, nor are the methods to optimize growth and outcomes.

Methods

We retrospectively reviewed children who underwent mandibular reconstruction using VFFF between 2001 and 2024 at our institution. Complications were classified using the Clavien–Dindo scale. Data were analyzed using Pearson’s r correlation, Fisher’s exact tests, and chi-squared analysis.

Results

Twenty-nine patients underwent 31 mandibular reconstructions using VFFFs at a median age of 14 years old (range: 3.5–18.9 years), most commonly after ameloblastoma resection (n=10, 32%). Twenty-nine (94%) flaps were successful, and 17 complication events transpired among 13 (42%) operations, most commonly hardware exposure (n=4, 24%). Complications decreased with increased institutional experience (after 2016, p=0.011) and with the use of two rather than one venous anastomosis (p=0.002). Recipient site complications were more common in patients under 12 years of age (p=0.026). Although flap viability was high; two flap failures occurred with single venous anastomosis, and none with two venous anastomoses. Hardware removal was planned on an average 15.7 months after nine operations (29%) to maintain growth potential; subsequent corrective orthognathic surgery was performed following four flaps (13%).

Conclusion

Pediatric mandibular reconstruction using VFFF is safe and effective, with the majority maintaining functional occlusion with growth. Complication rates are comparable to those in the adult population and may be mitigated via multiple vein anastomoses and institutional experience.

背景：带血管的游离腓骨瓣（VFFF）是一种成熟的技术，用于解决临界大小的下颌骨缺损，包括那些儿童患者。然而，手术风险因素和对生长潜力的影响还不清楚，特别是在骨骼不成熟的患者中，也没有优化生长和结果的方法。方法：我们回顾性分析了2001年至2024年间在我院使用VFFF进行下颌骨重建的儿童。采用Clavien-Dindo量表对并发症进行分类。数据分析采用Pearson’s r相关、Fisher’s精确检验和卡方分析。结果：29例患者使用VFFFs进行了31次下颌重建，中位年龄为14岁（范围：3.5-18.9岁），最常见的是成釉细胞瘤切除术（n= 10.32%）。29例（94%）皮瓣成功，13例（42%）手术中发生17例并发症，最常见的是硬体暴露（n= 4,24%）。随着机构经验的增加（2016年以后，p=0.011）和使用两次静脉吻合术而不是一次静脉吻合术（p=0.002），并发症减少。受体部位并发症在12岁以下患者中更为常见（p=0.026）。虽然皮瓣活力高；单静脉吻合术有2例皮瓣失败，双静脉吻合术无皮瓣失败。为保持增长潜力，9次手术后平均需要15.7个月（29%）进行硬体移除；随后的矫正正颌手术在4个皮瓣后进行（13%）。结论：使用VFFF重建儿童下颌骨是安全有效的，大多数人在生长过程中保持了功能咬合。并发症发生率与成人相当，可以通过多静脉吻合术和机构经验来减轻。

{"title":"Optimizing outcomes in pediatric microvascular mandibular reconstruction: A 23-year institutional experience","authors":"Theodor B. Lenz, Dominic J. Romeo, Allison C. Hu, Jacob R. Thomas, Patrick Akarapimand, Scott P. Bartlett, Jesse A. Taylor, Eric J. Granquist, Cassandra A. Ligh, Jordan W. Swanson","doi":"10.1016/j.bjps.2025.12.030","DOIUrl":"10.1016/j.bjps.2025.12.030","url":null,"abstract":"<div><h3>Background</h3><div>The vascularized free fibula flap (VFFF) is a well-established technique for addressing critical-sized mandibular defects, including those in pediatric patients. However, surgical risk factors and impact on growth potential are not well understood, particularly in skeletally immature patients, nor are the methods to optimize growth and outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed children who underwent mandibular reconstruction using VFFF between 2001 and 2024 at our institution. Complications were classified using the Clavien–Dindo scale. Data were analyzed using Pearson’s r correlation, Fisher’s exact tests, and chi-squared analysis.</div></div><div><h3>Results</h3><div>Twenty-nine patients underwent 31 mandibular reconstructions using VFFFs at a median age of 14 years old (range: 3.5–18.9 years), most commonly after ameloblastoma resection (n=10, 32%). Twenty-nine (94%) flaps were successful, and 17 complication events transpired among 13 (42%) operations, most commonly hardware exposure (n=4, 24%). Complications decreased with increased institutional experience (after 2016, p=0.011) and with the use of two rather than one venous anastomosis (p=0.002). Recipient site complications were more common in patients under 12 years of age (p=0.026). Although flap viability was high; two flap failures occurred with single venous anastomosis, and none with two venous anastomoses. Hardware removal was planned on an average 15.7 months after nine operations (29%) to maintain growth potential; subsequent corrective orthognathic surgery was performed following four flaps (13%).</div></div><div><h3>Conclusion</h3><div>Pediatric mandibular reconstruction using VFFF is safe and effective, with the majority maintaining functional occlusion with growth. Complication rates are comparable to those in the adult population and may be mitigated via multiple vein anastomoses and institutional experience.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 32-42"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013975","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

Unequal burden: Inguinal sentinel lymph node biopsy and the disproportionate risk of infection in melanoma 不平等的负担：腹股沟前哨淋巴结活检和黑色素瘤感染的不成比例的风险。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-06 DOI: 10.1016/j.bjps.2025.12.039

Aleksandra Nowak , Jessica Coyle , Abigail Colletta , Veronique Verhoeven , Gino Vissers

Aim

To evaluate surgical site-specific infection rates after sentinel lymph node biopsies (SLNB) for melanoma.

Methods

This single-centre retrospective analysis of prospectively collected data included 422 patients who underwent SLNB between January 2020 and January 2025. Negative post-operative outcomes within 31 days were recorded: infection, seroma, wound dehiscence, haematoma, lymphedema and other complications. Clinical variables included: demographics, SLNB site and result, comorbidity, prophylactic antibiotic use and American Joint Committee on Cancer stage. Multivariable logistic regression was used to identify predictors of infection. This study adheres to the STROBE guidelines (Supplementary Appendix).

Results

Across the 422 patients in the cohort (mean age 59.1 years, range 6–89 years), infection accounted for 55 cases (13%). Rates varied markedly by site: inguinal 23.9%, axilla 7.8%, knee 29.4% and head/neck 3.0%. All infections were managed with antibiotics, and none required re‑operation. Multivariable analysis revealed that inguinal site (OR 5.01, 95% CI 2.50–10.04, p < 0.001) and male gender (OR 2.57, 95% CI 1.30–5.09, p = 0.007) independently predicted postoperative infection. Age and comorbidity were not associated with increased risk in our cohort.

Conclusion

Within this UK cohort, the SLNB anatomical site emerged as the strongest driver of postoperative infection, with inguinal procedures carrying the greatest increase in risk. Male patients were also at a higher risk of infection. These findings highlight the value of targeted prevention strategies and close postoperative surveillance for high-risk groups.

目的：评价黑色素瘤前哨淋巴结活检（SLNB）后手术部位特异性感染率。方法：这项单中心回顾性分析前瞻性收集的数据包括422名在2020年1月至2025年1月期间接受SLNB的患者。术后31天内阴性结果：感染、血肿、创面裂开、血肿、淋巴水肿等并发症。临床变量包括：人口统计学、SLNB部位和结果、合并症、预防性抗生素使用和美国癌症分期联合委员会。使用多变量逻辑回归来确定感染的预测因素。本研究遵循STROBE指南（补充附录）。结果：在队列中的422例患者（平均年龄59.1岁，范围6-89岁）中，感染占55例（13%）。不同部位的发病率差异显著：腹股沟23.9%，腋窝7.8%，膝关节29.4%，头颈部3.0%。所有感染均使用抗生素治疗，无一例需要再次手术。多变量分析显示腹股沟部位（OR 5.01, 95% CI 2.50-10.04, p）。结论：在英国队列中，SLNB解剖部位成为术后感染的最强驱动因素，腹股沟手术风险增加最大。男性患者感染的风险也更高。这些发现强调了有针对性的预防策略和对高危人群术后密切监测的价值。

{"title":"Unequal burden: Inguinal sentinel lymph node biopsy and the disproportionate risk of infection in melanoma","authors":"Aleksandra Nowak , Jessica Coyle , Abigail Colletta , Veronique Verhoeven , Gino Vissers","doi":"10.1016/j.bjps.2025.12.039","DOIUrl":"10.1016/j.bjps.2025.12.039","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate surgical site-specific infection rates after sentinel lymph node biopsies (SLNB) for melanoma.</div></div><div><h3>Methods</h3><div>This single-centre retrospective analysis of prospectively collected data included 422 patients who underwent SLNB between January 2020 and January 2025. Negative post-operative outcomes within 31 days were recorded: infection, seroma, wound dehiscence, haematoma, lymphedema and other complications. Clinical variables included: demographics, SLNB site and result, comorbidity, prophylactic antibiotic use and American Joint Committee on Cancer stage. Multivariable logistic regression was used to identify predictors of infection. This study adheres to the STROBE guidelines (Supplementary Appendix).</div></div><div><h3>Results</h3><div>Across the 422 patients in the cohort (mean age 59.1 years, range 6–89 years), infection accounted for 55 cases (13%). Rates varied markedly by site: inguinal 23.9%, axilla 7.8%, knee 29.4% and head/neck 3.0%. All infections were managed with antibiotics, and none required re‑operation. Multivariable analysis revealed that inguinal site (OR 5.01, 95% CI 2.50–10.04, p < 0.001) and male gender (OR 2.57, 95% CI 1.30–5.09, p = 0.007) independently predicted postoperative infection. Age and comorbidity were not associated with increased risk in our cohort.</div></div><div><h3>Conclusion</h3><div>Within this UK cohort, the SLNB anatomical site emerged as the strongest driver of postoperative infection, with inguinal procedures carrying the greatest increase in risk. Male patients were also at a higher risk of infection. These findings highlight the value of targeted prevention strategies and close postoperative surveillance for high-risk groups.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"114 ","pages":"Pages 14-22"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014055","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

Explainable AI modeling of postoperative surgical site infection risk in autologous breast reconstruction 自体乳房再造术术后手术部位感染风险的可解释AI模型

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-06 DOI: 10.1016/j.bjps.2025.12.029

Diwakar Phuyal , Berk Ozmen , Ibrahim Berber , Graham Schwarz

Background

Surgical site infections (SSIs) following autologous breast reconstruction, particularly deep inferior epigastric perforator (DIEP) flap procedures, pose a substantial clinical burden and is associated with increased risk of hospital readmission. Existing prediction models lack sufficient accuracy in identifying high-risk patients. We aimed to develop a machine learning model to predict 30-day SSI risk and identify key predictors using a national surgical quality database.

Methods

A total of 13,312 DIEP flap reconstructions from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2016 and 2022 were analyzed. An XGBoost classifier incorporating demographic, comorbidity, operative, and laboratory variables was trained and evaluated using accuracy, recall, precision, F1 score, and area under the curve (AUC). Model explainability was assessed using SHapley Additive exPlanations (SHAP) to identify key predictors and their directional influence.

Results

The overall SSI rate was 8.14%. XGBoost classifier achieved an accuracy of 74.6%, a recall of 74.6%, and an AUC of 0.63 for predicting 30-day SSI. Key predictors of SSI included year of surgery (5.3% in 2016 and 9.3% in 2022), elevated BMI, increased body weight, prolonged operative time, and longer hospital stay.

Conclusion

This model demonstrates the feasibility and interpretability of explainable AI in identifying SSI-related risk patterns using large-scale national data. It provides a framework for retrospective SSI risk analysis and hypothesis generation, thereby establishing a robust foundation for future preoperative-focused and prospectively validated prediction models.

背景自体乳房重建术后的手术部位感染（ssi），特别是腹下深穿支（DIEP）皮瓣手术，造成了巨大的临床负担，并增加了再入院的风险。现有的预测模型在识别高危患者方面缺乏足够的准确性。我们的目标是开发一个机器学习模型来预测30天的SSI风险，并使用国家手术质量数据库确定关键预测因素。方法对2016年至2022年美国外科学会国家手术质量改进计划（NSQIP）中13312例DIEP皮瓣重建进行分析。结合人口统计学、合并症、手术和实验室变量的XGBoost分类器进行了训练，并使用准确性、召回率、精度、F1评分和曲线下面积（AUC）进行了评估。使用SHapley加性解释（SHAP）评估模型的可解释性，以确定关键预测因子及其方向性影响。结果SSI总发生率为8.14%。XGBoost分类器预测30天SSI的准确率为74.6%，召回率为74.6%，AUC为0.63。SSI的主要预测因素包括手术年份（2016年为5.3%，2022年为9.3%）、BMI升高、体重增加、手术时间延长和住院时间延长。该模型证明了可解释人工智能在利用大规模国家数据识别ssi相关风险模式方面的可行性和可解释性。它为回顾性SSI风险分析和假设生成提供了一个框架，从而为未来以术前为重点和前瞻性验证的预测模型奠定了坚实的基础。

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引用次数: 0

The role of negative pressure wound therapy on TGF-β1, MMP-9, α-SMA, and collagen type III in preventing burn contractures in a porcine model 负压创面治疗对TGF-β1、MMP-9、α-SMA和III型胶原预防猪烧伤挛缩的作用

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-06 DOI: 10.1016/j.bjps.2025.12.034

Muhammad Rosadi Seswandhana , Gunadi , Sumadi L. Anwar , Teguh Aryandono , Ishandono Dachlan , Budi Mulyono , Irianiwati Widodo , Yohanes W. Wirohadidjojo , Mokhammad P.L. Sukma , Pramana Adhityo

Introduction

Burns are a leading cause of disability and death, requiring prolonged hospitalization and high costs that impair daily activities. Wound healing involves cytokines and growth factors. Despite various treatments, ideal wound dressing remains unidentified. Negative pressure wound therapy (NPWT) has shown potential as an ideal wound healing environment. We compared saline dressings, silver sulfadiazine, intermittent NPWT, and continuous NPWT on wound contraction, re-epithelialization, and biomarkers (MMP-9, TGF-β1, α-SMA, and COL3) in a porcine deep dermal burn model.

Methods

Six male Yorkshire pigs received 20 burns and were treated with NaCl 0.9% dressings, silver sulfadiazine, intermittent, or continuous NPWT. Wound healing was assessed on days 1, 3, 7, 14, and 21. MMP-9 and TGF-β1 were analyzed using ELISA, α-SMA, and COL3 using immunohistochemistry. Statistical analyses included linear regression, ANOVA, post-hoc tests, and path analyses.

Results

Intermittent NPWT showed the lowest wound contraction on days 14 and 21 (p<0.001) and highest re-epithelialization on day-21 (p=0.0027). MMP-9 and TGF-β1 levels were significantly elevated in both NPWT groups across most time points (days 1, 3, 7, and 14), with TGF-β1 peaking in the NaCl group on day-21. Significant α-SMA histoscores differences appeared on day 3, while COL3 differences were significant on day-14.

Conclusions

NPWT may reduce wound contraction and accelerates re-epithelialization without impairing wound healing, confirmed by modulation of MMP-9, TGFβ1, α-SMA, and COL3, suggesting the potential to minimize contracture scar formation.

导读：烧伤是致残和死亡的主要原因，需要长期住院治疗，费用高，影响日常活动。伤口愈合涉及细胞因子和生长因子。尽管有各种治疗方法，理想的伤口敷料仍未确定。负压创面治疗是一种理想的创面愈合环境。我们比较了生理盐水敷料、磺胺嘧啶银、间歇NPWT和连续NPWT对猪深部皮肤烧伤模型伤口收缩、再上皮化和生物标志物（MMP-9、TGF-β1、α-SMA和COL3）的影响。方法：公约克猪6头，烧伤20次，用0.9% NaCl敷料、磺胺嘧啶银、间歇或连续NPWT治疗。分别于第1、3、7、14、21天评估伤口愈合情况。ELISA法分析MMP-9、TGF-β1，免疫组化法分析α-SMA、COL3。统计分析包括线性回归、方差分析、事后检验和通径分析。结果：间歇性NPWT在第14天和第21天创面收缩最小(p结论：NPWT可减少创面收缩，加速创面再上皮化，但不损害创面愈合，通过调节MMP-9、TGFβ1、α-SMA和COL3证实，提示可能减少挛缩性瘢痕形成。

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引用次数: 0

Harnessing population genetics and animal models to uncover the genetics of skin scarring 利用群体遗传学和动物模型来揭示皮肤疤痕的遗传学。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.11.010

Oscar A. Peña , Marisa Cañadas-Garre , Iona Collins , Nicholas J. Timpson , Paul Martin

Skin wound healing is a complex process that requires the orchestrated response of several different cell types to repair the damaged tissue and restore function. Superficial skin wounds tend to heal within days. However, larger and deeper wounds such as those caused by trauma or surgery generally heal by leaving a scar, which can impact tissue function. Scars can be debilitating, painful, and can significantly impair function. New developments to prevent and treat scarring require a deeper understanding of the cellular and molecular mechanisms associated with wound healing and scarring. Most of our current understanding of the genetics of wound healing comes from studies in animal models. However, population health approaches combined with experimental validation in animal models offer new opportunities to harness natural variability in wound repair outcomes in the population and identify new relevant biology controlling different aspects of repair and scarring in a different way. These approaches have the potential to reveal association between genetic loci and wound phenotypes in humans. Complementary experimental studies in animal models can help to validate these candidate genes and our understanding of the underlying mechanisms. In this non-systematic review, we propose the application of strategies using population health/genetics together with zebrafish models of wounding to specifically study skin scarring. We discuss potential pitfalls and strengths of the combined and complementary use of population health approaches and animal models for the identification and validation of new genes involved in skin repair, and in particular, scarring.

皮肤创面愈合是一个复杂的过程，需要多种不同类型细胞的协调反应来修复受损组织和恢复功能。皮肤表面的伤口往往会在几天内愈合。然而，更大和更深的伤口，如创伤或手术造成的伤口，通常会留下疤痕来愈合，这会影响组织功能。疤痕会使人虚弱、痛苦，并会严重损害身体机能。预防和治疗瘢痕形成的新进展需要对与伤口愈合和瘢痕形成相关的细胞和分子机制有更深入的了解。我们目前对伤口愈合的遗传学的了解大多来自动物模型的研究。然而，人群健康方法与动物模型实验验证相结合，为利用人群中伤口修复结果的自然变异性提供了新的机会，并确定了以不同方式控制修复和瘢痕形成不同方面的新的相关生物学。这些方法有可能揭示遗传位点与人类伤口表型之间的关系。动物模型的补充实验研究可以帮助验证这些候选基因和我们对潜在机制的理解。在这篇非系统综述中，我们建议将群体健康/遗传学策略与斑马鱼损伤模型结合起来专门研究皮肤疤痕。我们讨论了潜在的缺陷和优势，结合和补充使用人群健康方法和动物模型来识别和验证参与皮肤修复的新基因，特别是疤痕。

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引用次数: 0

A better understanding and outcomes for wounds and scars: 25 Years of the Scar Free Foundation 对伤口和疤痕更好的理解和结果：无疤痕基金会25年

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.12.027

Jason Wong (JPRAS Deputy Editor), Richard Nugee (Lt. Gen., Chief Executive)

引用次数: 0

Orofacial cleft repair: A clinical model for studying genetic contribution to scar severity 口面裂修复：研究疤痕严重程度遗传贡献的临床模型。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.bjps.2025.10.044

Rebecca J. Richardson , Kevin Thiessen , Nigel Mercer , Bruce Richard , Yvonne Wren , Jonathan Sandy

Scars resulting from surgical repair of cleft lip and palate provide a unique model in humans for studying factors that affect the severity of scarring. Anatomically, clefts of the lip and palate are consistent in location and are treated surgically with similar methods and timing. This contrasts with the considerably greater variability observed in traumatic injuries, burns or emergency surgical procedures and the scars resulting from these cause tissue damage. Clinical audit protocols for cleft lip and palate ensure that data on outcomes for appearance, function and wellbeing are collected at standard points in a child’s development and are followed-up over time, permitting cross sectional and longitudinal analysis of scarring. Therefore, enhancing our understanding of the impact of genetics and environmental factors on scar severity following surgical repair of clefts can provide information on factors that may be associated with scarring from other insults, where uniform data are not available. Animal models offer opportunities to investigate factors that could influence scar severity and overall repair quality. In this review, we will discuss the possibilities for scarring research in cohorts of children born with cleft defects and the advantages of using different animal models for studying the mechanistic drivers of variation in scar severity.

唇腭裂手术修复后的瘢痕为研究影响瘢痕严重程度的因素提供了一个独特的人体模型。解剖上，唇裂和腭裂在位置上是一致的，用相似的手术方法和时间来治疗。这与在创伤性损伤、烧伤或紧急外科手术中观察到的更大的可变性形成对比，这些造成的疤痕会导致组织损伤。唇腭裂的临床审计方案确保在儿童发育的标准点收集外观，功能和健康结果的数据，并随着时间的推移进行随访，允许对疤痕进行横断面和纵向分析。因此，加强我们对遗传和环境因素对唇腭裂手术修复后瘢痕严重程度的影响的理解，可以提供可能与其他损伤引起的瘢痕相关的因素的信息，在这些方面没有统一的数据。动物模型为研究可能影响疤痕严重程度和整体修复质量的因素提供了机会。在这篇综述中，我们将讨论在先天性腭裂缺陷儿童群体中进行疤痕研究的可能性，以及使用不同动物模型研究疤痕严重程度变化的机制驱动因素的优势。

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