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

Incidence of and risk factors for post-operative venous thromboembolism after free flap breast reconstruction in a London teaching hospital: A retrospective cohort study 伦敦一家教学医院的游离皮瓣乳房再造术后静脉血栓栓塞的发生率和风险因素：回顾性队列研究

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.bjps.2024.09.084

Silvia Allikmets , Edelyne Tandanu , Karen Lee Jialin , Victoria Rose

Objective

The objective of this study was to determine the incidence of venous thromboembolism (VTE) following autologous breast reconstruction, assess risk factors that may predict incidence and assess the accuracy of the Caprini risk assessment model.

Background

VTE is a rare, but potentially lethal complication of autologous breast reconstruction. An accurate preoperative risk-stratification strategy is essential to improve patient outcomes by determining the patients who would benefit from extended thromboprophylaxis after surgery.

Methods

Patients who underwent autologous free flap breast reconstruction at a London teaching hospital from 2019–2021 were included. Risk factors for VTE were analysed. VTE incidence was assessed, and the risk factors were identified using multivariate analysis.

Results

Overall, 368 patients were included in the study. Among them, 10 (2.72%) had a confirmed diagnosis of post-operative VTE, at an average of 23 days after surgery (range 3–64 days). All VTEs occurred in deep, inferior epigastric artery perforator flap patients with a history of breast cancer. Multivariate regression analysis revealed a statistically significant correlation between the incidence of VTE and Caprini score (p = 0.030) and length of hospital stay (p = 0.007). Tamoxifen use was individually significant for VTE (p = 0.043) but non-significant (p = 0.106) when confounded for length of hospital stay (LOS) and Caprini score.

Conclusions

Current VTE risk assessment tools do not accurately identify patients who are at risk of developing VTE following free flap breast reconstruction. The Caprini risk assessment model and LOS may be useful in predicting post-operative VTE in this cohort. These patients may benefit from extended chemoprophylaxis. Larger prospective studies are required to optimise risk prediction models in this cohort.

本研究旨在确定自体乳房重建术后静脉血栓栓塞症（VTE）的发病率，评估可能预测发病率的风险因素，并评估 Caprini 风险评估模型的准确性。准确的术前风险分级策略对改善患者预后至关重要，因为它能确定哪些患者在术后将受益于延长的血栓预防措施。方法纳入了2019-2021年在伦敦一家教学医院接受自体游离瓣乳房重建术的患者。分析了VTE的风险因素。评估了 VTE 发生率，并通过多变量分析确定了风险因素。其中，10 例（2.72%）确诊为术后 VTE，平均发生时间为术后 23 天（范围为 3-64 天）。所有 VTE 均发生在有乳腺癌病史的深部上腹下动脉穿孔皮瓣患者身上。多变量回归分析显示，VTE发生率与Caprini评分（p = 0.030）和住院时间（p = 0.007）之间存在统计学意义上的显著相关性。结论目前的 VTE 风险评估工具不能准确识别游离皮瓣乳房再造术后有 VTE 风险的患者。Caprini风险评估模型和LOS可能有助于预测此类患者的术后VTE。这些患者可能会从延长的化学预防中获益。需要进行更大规模的前瞻性研究，以优化该群体的风险预测模型。

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引用次数: 0

Secondary rhinoplasty for unilateral cleft lip nasal deformity using the complex of autologous costal cartilage and fascia grafts 利用自体肋软骨和筋膜移植复合体对单侧唇裂鼻畸形进行二次鼻整形术。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-30 DOI: 10.1016/j.bjps.2024.09.075

Jian-Sheng Diao , Lin He , Xue-Yuan Yu , Xiang-Yu Liu , Yuan Guo , Yu-Yao Lin , Jia Chen , Md Atiqur Rahman , Irfan Ullah , Mao-Guo Shu

Background

Secondary unilateral cleft lip nasal deformity is a prevalent condition in the world, and surgical repair remains a formidable challenge. The objective of the study is to investigate functionally and aesthetically outcomes of a new technique using a complex of autologous costal cartilage and fascia grafts to repair the secondary unilateral cleft lip nasal deformity.

Methods

First, the autologous costal cartilage and fascia were harvested from a total of 34 patients with secondary unilateral cleft lip nasal deformity, who were undergoing treatments at the First Affiliated Hospital of Xi’an Jiaotong University from April 2020 to June 2023. Then, the cartilage was sub-divided into 6 pieces and placed on the depressed alar base, nasal columella, lower lateral cartilage, and nasal tip. At the same time, the fascia was trimmed to cover the nasal tip cap graft and augment the dorsum of the nose. Patient outcomes were assessed through subjective evaluation and objective anthropometric measurements. In addition, associated complications were also examined.

Results

All were primary healing incisions, and no patients were encountered with any clinical complications. We found that the overall mean score of the Independent Rhinoplasty Outcome Score (IROS) was very good during the subjective assessment. Also, the objective measurements indicated an excellent nasal symmetry. Furthermore, both functionally and aesthetically satisfactory outcomes were obtained in all the patients during long-time follow-up.

Conclusions

Secondary rhinoplasty using the complex of autologous costal cartilage and fascia grafts is a safe and effective approach for unilateral cleft lip nasal deformity repair.

背景：继发性单侧唇裂鼻畸形是世界上的一种常见病，手术修复仍是一项艰巨的挑战。本研究旨在探讨一种使用自体肋软骨和筋膜复合移植修复继发性单侧唇裂鼻畸形的新技术在功能和美学上的效果：首先，从2020年4月至2023年6月在西安交通大学第一附属医院接受治疗的34例继发性单侧唇裂鼻畸形患者身上采集自体肋软骨和筋膜。将软骨细分为 6 块，分别放置在凹陷的耳廓基底、鼻小柱、下外侧软骨和鼻尖上。同时，修剪筋膜以覆盖鼻尖帽移植物并隆起鼻背。通过主观评价和客观人体测量来评估患者的效果。此外，还对相关并发症进行了检查：结果：所有切口均初步愈合，没有患者出现任何临床并发症。我们发现，在主观评估中，独立鼻整形结果评分（IROS）的总体平均得分非常高。同时，客观测量结果表明鼻部对称性极佳。此外，在长期随访中，所有患者在功能和美观方面都获得了令人满意的结果：使用自体肋软骨和筋膜移植复合体进行二次鼻整形是一种安全有效的单侧唇裂鼻畸形修复方法。

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引用次数: 0

Auricular deformity correction with simultaneous reconstruction of the conchal bowl using autologous ear cartilage for “flat ear”: A novel surgical technique 使用自体耳软骨矫正耳廓畸形，同时重建 "扁平耳 "的耳廓：一种新颖的手术技术。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-30 DOI: 10.1016/j.bjps.2024.09.077

Jiajun Zhi, Jingwei Feng, Luping Zhao, Xiaobo Yu, Haiyue Jiang

Backgrounds

“Flat ear” is a subtype of Grade II conchal-type microtia characterized by severely underdeveloped conchal bowl. Traditional surgical techniques often rely on autologous costal cartilage, which poses several risks and complications. This study aimed to introduce a novel surgical technique using autologous ear cartilage in auricular deformity correction surgery with simultaneous conchal bowl reconstruction for “flat ear.”

Methods

A total of 19 patients were involved in this single-center, retrospective cohort study. All patients underwent the described surgical technique. Data were collected preoperatively, immediately after the surgery, and at the last follow-up, including auricular length, width, perimeter, and conchal bowl depth. Patient satisfaction was assessed using the Visual Analog Scale (VAS).

Results

The study included 12 males and 7 females, with an average age of 10.67 ± 3.86 years. Postoperative results showed significant improvements in auricular measurements, with the affected ear achieving near symmetry with the normal ear. The mean conchal bowl depth was restored from a preoperative 4.33 ± 1.78 mm to 17.32 ± 1.28 mm postoperatively. VAS scores for patient satisfaction increased significantly from 1.44 ± 0.92 preoperatively to 7.72 ± 1.49 postoperatively, with stability observed at the last follow-up.

Conclusion

The novel technique offers a promising alternative to traditional costal cartilage-based auricular deformity correction surgery, providing excellent aesthetic outcomes and high patient satisfaction. This approach may expand treatment options for patients with “flat ear” and related auricular deformities, with reduced invasiveness and potential for future auditory rehabilitation.

背景："扁平耳 "是 II 级海螺型小耳畸形的一种亚型，其特点是海螺碗发育严重不足。传统的手术技术通常依赖于自体肋软骨，这会带来一些风险和并发症。本研究旨在介绍一种使用自体耳软骨进行耳廓畸形矫正手术的新型手术技术，同时对 "扁平耳 "进行耳廓重建：共有19名患者参与了这项单中心回顾性队列研究。所有患者都接受了所述的手术技术。研究人员收集了患者术前、术后和最后一次随访时的数据，包括耳廓长度、宽度、周长和耳廓深度。患者满意度采用视觉模拟量表（VAS）进行评估：研究对象包括 12 名男性和 7 名女性，平均年龄为（10.67 ± 3.86）岁。术后结果显示，耳廓测量结果有明显改善，患耳与正常耳几乎对称。平均耳蜗深度从术前的 4.33 ± 1.78 毫米恢复到术后的 17.32 ± 1.28 毫米。患者满意度的 VAS 评分从术前的 1.44 ± 0.92 显著增加到术后的 7.72 ± 1.49，并在最后一次随访中保持稳定：这项新技术可替代传统的以肋软骨为基础的耳廓畸形矫正手术，具有良好的美学效果和较高的患者满意度。这种方法可为 "扁平耳 "及相关耳廓畸形患者提供更多的治疗选择，同时还能减少创口，为未来的听觉康复提供可能。

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引用次数: 0

Fifty free flaps from the ear 耳部 50 个自由瓣

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-29 DOI: 10.1016/j.bjps.2024.09.082

M. Zena , P. Homsy , E. Romanowski , A. Lindford , P. Lassus

Background

Reconstruction of facial and intraoral defects is often challenging. Local pedicled flaps may not always be available and distant free flaps usually have suboptimal color match and texture for the facial area. The aim of this study was to assess whether auricular free flaps are a valid reconstructive option.

Methods

Clinical data and outcomes of patients who underwent reconstruction with microsurgical flaps from the ear between 2011 and 2021 were analyzed. Patient demographic data, type of flaps, etiology, location and size of the defect, features of the pedicle and recipient vessels, complications, and additional surgeries were reviewed.

Results

Overall, 48 patients with 50 microsurgical flaps were identified. Thirty-one patients (65%) were men and 17 were (35%) women. The median age was 62 years. Among the 50 flaps, 26 (52%) were helix flaps, 20 (40%) were temporal artery posterior auricular skin flaps, and 4 (8%) were extended helix flaps. The nose was the most frequently reconstructed region (n = 32, 64%), followed by the tongue (n = 6, 12%), floor of the mouth (n = 5%), lower eyelid (n = 2%), and in one (2%) patient each, restoration of the upper eyelid, ear, larynx, esophagus, lower lip, and palate. The median follow-up was 74 months. Three flaps (6%) were lost, and the overall rate of complications was 46%. Surgical intervention was required in 7 (14%) cases. All cases healed with acceptable cosmesis.

Conclusions

The ear is a valuable source of tissue for complex reconstructions of the face and intraoral regions. However, this technique is surgically demanding and should be reserved for selected cases.

背景面部和口腔内缺损的重建通常具有挑战性。局部带蒂皮瓣不一定总是可用，而远处游离皮瓣的颜色匹配和质地通常不适合面部区域。本研究旨在评估耳廓游离皮瓣是否是一种有效的重建选择。方法分析了2011年至2021年间接受耳廓显微外科皮瓣重建的患者的临床数据和结果。回顾了患者的人口统计学数据、皮瓣类型、病因、缺损的位置和大小、基底和受体血管的特征、并发症以及额外的手术。男性患者 31 例（占 65%），女性患者 17 例（占 35%）。中位年龄为 62 岁。在 50 个皮瓣中，26 个（52%）是螺旋皮瓣，20 个（40%）是颞动脉后耳廓皮瓣，4 个（8%）是扩展螺旋皮瓣。重建最多的部位是鼻子（32 例，占 64%），其次是舌头（6 例，占 12%）、口底（5%）、下眼睑（2%），另有 1 例患者（2%）修复了上眼睑、耳朵、喉咙、食道、下唇和上颚。中位随访时间为 74 个月。有 3 个皮瓣（6%）脱落，并发症的总发生率为 46%。7例（14%）需要手术治疗。结论耳部是面部和口腔内区域复杂重建的重要组织来源。然而，这种技术对手术要求较高，应保留给特定病例。

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引用次数: 0

Volumetric evaluation of autologous fat transfer for total breast reconstruction 自体脂肪移植用于全乳房重建的容积评估

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-29 DOI: 10.1016/j.bjps.2024.09.083

Jamilla L.M. Wederfoort , Darius A.X. Trommelen , Mohammad Al Tarah , Juliette E. Hommes , Sander M.J. van Kuijk , René R.W.J. van der Hulst , Andrzej A. Piatkowski , for The BREAST- trial investigators

Background

Reconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although several studies have researched the volumetric aspects of AFT, some outcomes such as volume retention, viability, and possible confounders for graft survival, remain unclear. This study aimed to answer these questions.

Methods

Post-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months post-operative. Volume retention was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis.

Results

A total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Post-operative volumes differed significantly at 12 months in favor of the IBR group (83.8 ml, p < 0.001). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β = 1.107, p = 0.001), comorbidities (β = 28.567, p = 0.002), age (β = −0.514, p = 0.007), and total lipofilling (β = −0.028, p < 0.001).

Conclusion

Plastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, and these breast volumes stabilize at 6 months and VECTRA 3D is reliable for breast volume measurement. Approximately a third of the grafted fat was calculated to survive post-operatively and reconstructive surgeons should be aware not to transfer too much fat in one session.

背景整形外科医生已从使用自体脂肪移植（AFT）矫正不规则轮廓转向重建丰满乳房。虽然已有多项研究对自体脂肪移植的体积方面进行了研究，但一些结果，如体积保持率、存活率以及可能影响移植物存活率的因素仍不清楚。本研究旨在回答这些问题。方法多中心前瞻性 BREAST 试验中的乳房切除术后妇女被随机分配到 AFT 乳房重建或植入物重建 (IBR)。使用 Vectra 3D 成像系统对乳房体积进行评估，并在术后 12 个月进行比较。容积保留的定义是增大的容积除以脂肪填充容积。通过多变量回归分析确定了影响移植物存活率的重要混杂因素。结果共有 148 名患者（75 名 AFT，73 名 IBR）被纳入最终分析。术后 12 个月的容量差异显著，IBR 组更优（83.8 毫升，p < 0.001）。对于 AFT 患者，移植物存活率在 6 至 12 个月之间没有下降，12 个月时的平均移植物存活率为 37.1%。影响移植物存活率的重要混杂因素包括胸围（β = 1.107，p = 0.001）、合并症（β = 28.567，p = 0.002）、年龄（β = -0.514，p = 0.007）和总脂肪填充量（β = -0.结论整形外科医生仅使用 AFT 就能在乳房切除术后重建丰满的乳房，而且这些乳房体积在 6 个月后会趋于稳定，VECTRA 3D 是测量乳房体积的可靠工具。据计算，约有三分之一的移植脂肪在术后存活，因此整形外科医生应注意不要在一次手术中移植过多脂肪。

{"title":"Volumetric evaluation of autologous fat transfer for total breast reconstruction","authors":"Jamilla L.M. Wederfoort , Darius A.X. Trommelen , Mohammad Al Tarah , Juliette E. Hommes , Sander M.J. van Kuijk , René R.W.J. van der Hulst , Andrzej A. Piatkowski , for The BREAST- trial investigators","doi":"10.1016/j.bjps.2024.09.083","DOIUrl":"10.1016/j.bjps.2024.09.083","url":null,"abstract":"<div><h3>Background</h3><div>Reconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although several studies have researched the volumetric aspects of AFT, some outcomes such as volume retention, viability, and possible confounders for graft survival, remain unclear. This study aimed to answer these questions.</div></div><div><h3>Methods</h3><div>Post-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months post-operative. Volume retention was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis.</div></div><div><h3>Results</h3><div>A total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Post-operative volumes differed significantly at 12 months in favor of the IBR group (83.8 ml, <em>p < 0.001</em>). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β = 1.107, <em>p = 0.001</em>), comorbidities (β = 28.567, <em>p = 0.002</em>), age (β = −0.514, <em>p = 0.007</em>), and total lipofilling (β = −0.028, <em>p < 0.001</em>).</div></div><div><h3>Conclusion</h3><div>Plastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, and these breast volumes stabilize at 6 months and VECTRA 3D is reliable for breast volume measurement. Approximately a third of the grafted fat was calculated to survive post-operatively and reconstructive surgeons should be aware not to transfer too much fat in one session.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"99 ","pages":"Pages 317-328"},"PeriodicalIF":2.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441868","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

Upper eyelid lymphatic anatomy is associated with blepharoplasty recovery 上眼睑淋巴解剖与眼睑成形术的恢复有关。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-29 DOI: 10.1016/j.bjps.2024.09.079

Hiroshi Nishioka , Ikkei Takashimizu , Shunsuke Yuzuriha

Background

Lymphatic vessels support wound recovery and absorb excess fluid. Blepharoplasty involves excess tissue excision, and this study investigated the relationship between lymph vessel density in excised tissue and the postoperative course.

Methods

Forty eyelids from 21 patients with blepharoptosis who underwent blepharoplasty were included. Each resected excess tissue sample was divided into 4 parts by 3 parasagittal cuts—medial, central, and lateral. The area percentages occupied by lymphatic vessels and elastic fibers in the inner tissue between skin and muscle, exposed by these cuts, were determined histologically. The wound-healing process was assessed at 2 weeks and 1, 3, and 6 months postoperatively, using a visual analog scale (VAS) to estimate edema and the Vancouver Scar Scale (VSS) for scar assessment.

Results

With increasing age, the area percentage of lymphatic vessels declined significantly (r = −0.581, p < 0.001), while an increase in solar elastosis was observed. The percentage of lymphatic vessels was highest on the medial side of the eyelid (p < 0.05), where their relative distribution to the “shallow layer” close to the skin was also the highest (p < 0.01). Independent of age, the VSS values at 2 weeks and 1 month postoperatively were significantly lower in patients with a higher area percentage of lymphatic vessels (2 weeks: p < 0.05; 1 month: p < 0.01).

Conclusions

In patients undergoing blepharoplasty, the percentage of lymphatic vessels in the upper eyelid tissue decreased with advancing age. Higher proportions of lymphatic vessels were associated with improved wound-healing outcomes.

背景：淋巴管支持伤口恢复并吸收多余液体。眼睑成形术需要切除多余的组织，本研究调查了切除组织中淋巴管密度与术后过程之间的关系：方法：研究对象包括 21 名接受眼睑成形术的眼睑下垂患者的 40 个眼睑。每个切除的多余组织样本都被分成 4 部分，分别由 3 个副矢状切口--内侧、中央和外侧。对这些切口暴露的淋巴管和皮肤与肌肉之间内部组织的弹性纤维所占的面积百分比进行组织学测定。在术后 2 周、1、3 和 6 个月，使用视觉模拟量表（VAS）评估水肿情况，并使用温哥华疤痕量表（VSS）评估疤痕情况：结果：随着年龄的增长，淋巴管的面积百分比显著下降（r = -0.581，p 结论：淋巴管的面积百分比与疤痕的面积百分比之间存在着显著的相关性：在接受眼睑成形术的患者中，上眼睑组织中淋巴管的比例随着年龄的增长而下降。淋巴管比例越高，伤口愈合效果越好。

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引用次数: 0

The waist-to-hip ratio is a superior predictor of complications in breast reconstruction: A prospective pilot study 腰臀比是预测乳房再造并发症的最佳指标：前瞻性试验研究。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-28 DOI: 10.1016/j.bjps.2024.09.076

Nirbhay S. Jain, Kasra Rahmati, Michael Delong, Jaco Festekjian

Introduction

Breast reconstruction remains common. Identifying the key risk factors for preoperative counseling is key to improving surgical outcomes. The body mass index is a commonly used measure of preoperative risk but remains controversial. We propose that the waist-to-hip ratio, a measure of central adiposity, is superior to the body mass index in predicting complications.

Methods

A single surgeon’s breast reconstruction patients were prospectively analyzed from 2022–2023. Demographic data, medical comorbidities, and surgical variables were recorded, as were complications including infection, wound breakdown, and loss of reconstruction. Height, weight, waist circumference, and hip circumference were collected to calculate the waist-to-hip ratio, waist-to-height ratio, and body surface area. Statistical analysis and multivariate analysis were performed.

Results

One hundred patients were evaluated, 50 for alloplastic and 50 for autologous, abdominally based reconstruction. For alloplastic patients, 26% had complications, with a higher waist-to-hip ratio (0.96 v 0.88). On multivariate regression, the waist-to-hip was the only significant independent predictor of complications. For autologous reconstruction, again 26% had complications, with a higher waist-to-hip ratio (0.96 v 0.88). On multivariate regression, the waist-to-hip was the only significant predictor of complications. For both groups, waist-to-hip did not strongly correlate with other morphometric measures. Age and other morphometric measures were not predictive of complications for either set.

Conclusion

The waist-to-hip ratio is a superior predictor of surgical risk to the body mass index in our cohort and could be integrated in plastic surgery practices to improve outcomes.

Level of evidence

IV

导言：乳房再造仍然很常见。确定术前咨询的关键风险因素是改善手术效果的关键。体重指数是衡量术前风险的常用指标，但仍存在争议。我们认为，腰臀比作为中心脂肪含量的衡量标准，在预测并发症方面优于体重指数：方法：我们对一位外科医生在 2022-2023 年期间的乳房重建患者进行了前瞻性分析。记录了人口统计学数据、合并症、手术变量以及并发症，包括感染、伤口破裂和重建损失。收集了身高、体重、腰围和臀围，以计算腰臀比、腰高比和体表面积。进行了统计分析和多变量分析：结果：对 100 名患者进行了评估，其中 50 人进行了异体重建，50 人进行了自体腹部重建。异体患者中有 26% 出现并发症，腰臀比（0.96 对 0.88）较高。在多变量回归中，腰臀比是唯一能显著预测并发症的独立因素。对于自体重建，同样有 26% 的患者出现并发症，腰臀比更高（0.96 对 0.88）。在多变量回归中，腰臀比是唯一能显著预测并发症的因素。在两组患者中，腰臀比与其他形态测量指标的相关性并不强。年龄和其他形态测量指标对两组患者的并发症均无预测作用：结论：在我们的队列中，腰臀比是优于体重指数的手术风险预测指标，可纳入整形外科实践以改善手术效果：证据等级：IV。

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引用次数: 0

Modified blepharoplasty combined with autologous fat transplantation into the orbital septum for the correction of dermatochalasis and sunken eyelids 改良眼睑成形术结合眶隔自体脂肪移植矫正真皮皲裂和眼睑凹陷

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.2024.09.073

Zhen Liang , Jiaxi Liu , Lei Guo , Yan Jiang , Linghan Qu , Xianhui Zeng , Hui Li , Juan Zhang , Baoqiang Song

Background

Periorbital aging typically manifests with dermatochalasis and depression of the upper eyelid. While blepharoplasty is a popular choice for addressing upper eyelid skin laxity, it is not effective for treating sunken eyelids. This study introduces an innovative approach for periorbital rejuvenation by simultaneously addressing dermatochalasis and sunken upper eyelids in aging Asian women.

Method

This study involved 45 patients with upper eyelid dermatochalasis accompanied by moderate to severe depression. Sub-brow blepharoplasty was performed in conjunction with upper eyelid granular fat grafting in the orbital septum for these patients. Preoperative measurements of the depth and volume of the upper eyelid depressions were taken, and surgical outcomes were assessed at 3 and 6 months postoperatively using the Global Aesthetic Improvement Scale (GAIS) score and the Antera 3D camera.

Result

The average depth of the upper eyelid depression before surgery was 6.501 ± 1.473 mm, and the average volume was 0.579 ± 0.144 cm³. Significant improvements in both the depth and volume of the depressions were observed at 3 and 6 months after surgery compared to preoperative measurements. The GAIS scores were also improved and postoperative outcomes were deemed satisfactory.

Conclusion

For patients with dermatochalasis accompanied by moderate to severe upper eyelid depression, standard blepharoplasty alone is insufficient to correct the sunken eyelid. This novel technique, which combines autologous granular fat injection into the orbital septum with blepharoplasty, effectively addresses periorbital aging, enhancing facial rejuvenation.

背景眶上部老化通常表现为上眼睑皮肤松弛和凹陷。虽然重睑成形术是解决上眼睑皮肤松弛问题的常用方法，但对治疗眼睑凹陷效果不佳。本研究介绍了一种创新的眶周年轻化方法，可同时解决亚洲老年女性的真皮皲裂和上眼睑凹陷问题。在对这些患者进行眉下睑成形术的同时，还在眶隔进行了上眼睑颗粒脂肪移植手术。术前测量了上眼睑凹陷的深度和体积，术后3个月和6个月使用全球美学改善量表（GAIS）评分和Antera三维照相机评估了手术效果。结果术前上眼睑凹陷的平均深度为（6.501 ± 1.473）毫米，平均体积为（0.579 ± 0.144）立方厘米。与术前测量结果相比，术后 3 个月和 6 个月的凹陷深度和体积均有明显改善。结论对于伴有中度至重度上眼睑凹陷的真皮皲裂症患者，单纯的标准眼睑成形术不足以矫正眼睑凹陷。这项新技术将自体颗粒脂肪注射到眶隔和眼睑成形术相结合，有效解决了眶周老化问题，增强了面部年轻化效果。

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引用次数: 0

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

Hoang Thanh Tuan , Luu Dang Ai , Nguyen Anh Ngoc , Nguyen Lan Huong , Vu Quang Vinh , Tran Van Anh

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。

{"title":"A full-face contouring using micro-autologous fat transplantation (MAFT)-gun technique in Vietnamese population","authors":"Hoang Thanh Tuan , Luu Dang Ai , Nguyen Anh Ngoc , Nguyen Lan Huong , Vu Quang Vinh , Tran Van Anh","doi":"10.1016/j.bjps.2024.09.074","DOIUrl":"10.1016/j.bjps.2024.09.074","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"98 ","pages":"Pages 388-395"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396421","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

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

Mason J. Horne , Ethan D. Paliwoda , Ishan Patel , Dzifa S. Kpodzo , Angela P. Mihalic , Stephanie M.C. Bray

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