Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第6页

Functional outcomes after supra-pubic phalloplasty 耻骨上阴茎成形术后的功能效果。

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.2024.09.065

Background

A thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty technique has not been reported.

Purpose of the study

To report the outcomes on sexuality, urinary function, satisfaction, and regrets following SPP performed at our centre.

Subjects studied

All consecutive patients who underwent the three-step technique of pre-expanded SPP between 2007 and 2018 and who had at least one year of follow-up.

Methods

Questionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self-Esteem And Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery patient-reported outcome measures (USS-PROM) questionnaire.

Main findings

A total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures, and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3 cm (standard deviation [SD] 2.6), and the mean girth was 11.8 cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item lower urinary tract symptom score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%).

Conclusion

Pre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall, sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position.

背景：对耻骨上阴茎成形术（SPP）的功能结果进行全面评估，并对阴茎成形术技术的不同方面进行评估的报告尚未见报道：研究目的：报告在本中心进行耻骨上阴茎成形术（SPP）后在性生活、排尿功能、满意度和遗憾方面的结果：2007年至2018年期间接受预扩张SPP三步技术的所有连续患者，且随访至少一年：调查问卷用于分析阴茎重建的几个方面：性生活、排尿功能、感知敏感度和满意度。性能力通过自尊与关系（SEAR）问卷进行评估。泌尿功能根据尿道狭窄手术患者报告结果测量（USS-PROM）问卷进行分析：共纳入 77 名患者，其中 92.2% 为跨性别男性，33 人（42.9%）回答了问卷。28名患者（36.4%）接受了尿道延长术（UL），42名患者（54.5%）植入了勃起假体。新阴茎的平均长度为 15.3 厘米（标准差 [SD] 2.6），平均周长为 11.8 厘米（标准差 2.1）。平均 SEAR 总分（/100）为 73.8（标准差 26.7）。下尿路症状六项平均得分（/24）为 8.4（标清 4.6）。11名患者（73.3%）表示站立位是通常的排尿姿势：结论：预扩张 SPP 是一种稳健的技术，可以获得较大的皮瓣尺寸，从而使患者对新阴茎的外观和阴茎整形技术的选择非常满意。总体而言，性功能结果大多良好。就站立位排尿而言，UL 是可行且有效的。

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引用次数: 0

Does prepectoral placement delay adjuvant therapies compared to retropectoral immediate implant-based breast reconstruction? A retrospective analysis 与胸骨后即刻植入假体的乳房重建相比，胸骨前植入假体是否会延迟辅助治疗？回顾性分析。

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.2024.09.064

Background

Prepectoral (PP) immediate implant-based breast reconstruction (IBBR) is becoming increasingly popular compared to retropectoral (RP) reconstruction. This study compares the timing of administration of different adjuvant therapy (ATs) after PP or RP IBBR.

Patients and methods

A monocentric retrospective analysis was conducted on patients undergoing mastectomy and IBBR from January 2018 to December 2023. Preoperative characteristics, mastectomy procedure type, PP or RP implant placement, postoperative outcomes, AT type, and time between surgery and AT administration were collected and analyzed.

Results

167 patients (206 breasts) were included. 123 underwent PP IBBR and 44 RP IBBR. The mean time between surgery and first AT administration was similar in the PP group (45.7 days, SD 39.3) compared to the RP group (37.4 days, SD 33.1) (p-value 0.2100). No significant differences were found in the timing of endocrine therapy (ET), chemotherapy (CT), or radiotherapy (RT) initiation between the PP and RP groups. Patients with seroma had a delayed initiation of CT (83.67 days, SD 123.7) versus those without seroma (42.1 days, SD 29.7) (p-value 0.0298).

Conclusions

The average time between surgery and administration of the first AT following PP IBBR was similar compared to RP IBBR. Postoperative seromas were associated with delayed CT in the overall population.

背景：与胸骨后（RP）乳房重建相比，胸骨前（PP）即刻植入假体乳房重建（IBBR）越来越受欢迎。本研究比较了PP或RP IBBR术后不同辅助治疗（AT）的用药时机：对2018年1月至2023年12月期间接受乳房切除术和IBBR的患者进行了单中心回顾性分析。收集并分析了术前特征、乳房切除手术类型、PP或RP植入物放置、术后结果、AT类型以及手术与AT用药之间的时间：结果：共纳入 167 名患者（206 个乳房）。结果：共纳入 167 例患者（206 个乳房），其中 123 例接受了 PP IBBR，44 例接受了 RP IBBR。PP组（45.7天，SD 39.3）与RP组（37.4天，SD 33.1）相比，手术与首次给药之间的平均时间相似（P值为0.2100）。内分泌治疗（ET）、化疗（CT）或放疗（RT）的开始时间在 PP 组和 RP 组之间没有发现明显差异。有血清肿的患者开始 CT 的时间（83.67 天，SD 123.7）晚于无血清肿的患者（42.1 天，SD 29.7）（P 值 0.0298）：与RP IBBR相比，PP IBBR从手术到首次使用AT的平均时间相似。在所有人群中，术后血清肿与 CT 延误有关。

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引用次数: 0

The therapeutic effect of dressing of exposed reconstructed auricle on patients after reconstruction of auricle 外露再造耳廓敷料对耳廓再造术后患者的治疗效果。

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.2024.09.049

The dressing of the reconstructed auricle after total auricle reconstruction surgery is an important measure of postoperative nursing. However, a uniform dressing of the reconstructed auricle after total auricle reconstruction surgery has not been formed. We carried out this clinical study to provide a new idea and method for the postoperative dressing of reconstructed auricle by comparing the therapeutic effect of the completely covered dressing method and the dressing method of exposed reconstructed auricle. Clinical data and postoperative data of patients with microtia treated by total auricle reconstruction in Plastic Surgery Hospital from January 2023 to January 2024 were retrospectively collected. Patients treated with the completely covered dressing method after surgery were included in the control group, and patients treated with the dressing method of exposed reconstructed auricles after surgery were included in the experimental group. A total of 45 patients were in the experimental group and 48 patients in the control group. In terms of postoperative complications, the incidence of complications was 8.89% in the experimental group and 37.5% in the control group (P < 0.05). In terms of the satisfaction rate of patients and their families, the satisfaction rate of the experimental group was 97.78%, and that of the control group was 83.3% (P < 0.05). Compared with the traditional method of the completely covered dressing method after total auricle reconstruction surgery, the dressing method of exposed reconstructed auricle has a lower complication rate, a higher satisfaction rate of patients and their families, and a better therapeutic effect for patients after total auricle reconstruction surgery.

全耳廓再造手术后对再造耳廓的包扎是术后护理的一项重要措施。然而，目前尚未形成全耳廓再造术后再造耳廓的统一包扎方法。我们开展了这项临床研究，通过比较完全覆盖敷料法和暴露再造耳廓敷料法的治疗效果，为再造耳廓的术后敷料提供一种新的思路和方法。该研究回顾性收集了整形外科医院自2023年1月至2024年1月采用全耳廓再造术治疗的小耳症患者的临床资料和术后资料。将术后采用完全覆盖包扎法治疗的患者列为对照组，将术后采用外露再造耳廓包扎法治疗的患者列为实验组。实验组共有 45 名患者，对照组共有 48 名患者。在术后并发症方面，实验组的并发症发生率为 8.89%，对照组为 37.5%（P < 0.05）。在患者及其家属的满意度方面，实验组的满意度为 97.78%，对照组的满意度为 83.3%（P < 0.05）。与传统的全耳廓再造术后完全覆盖包扎法相比，外露再造耳廓包扎法的并发症发生率更低，患者及家属的满意度更高，对全耳廓再造术后患者的治疗效果更好。

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引用次数: 0

The diagnostic utility of CT attenuation values in detecting calcification within costal cartilage CT 衰减值在检测肋软骨钙化方面的诊断效用。

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.2024.09.066

Background

To establish and verify diagnostic criteria for the identification of costal cartilage calcification based on computed tomography (CT) attenuation value.

Methods

360 chest CT slices of 120 patients were reviewed and annotated retrospectively and receiver operating characteristic curve was used to evaluate the diagnostic ability of CT attenuation value. Another 20 slices containing calcification were randomly selected and annotated by 4 doctors for further validation. hematoxylin and eosin and collagen type X (COLX) staining was performed on the residual costal cartilage.

Results

In total 355,129 voxels were detected and 187.5 was confirmed as the optimal CT attenuation value threshold, with a sensitivity of 98.6% and a specificity of 99.7%, for costal cartilage calcification diagnosis. Threshold-based identification of calcification demonstrated a similarity of nearly 80% with specialists’ assessments, and exhibited advantages in the identification of subtle calcifications in the further validation. We also observed that CT attenuation values among males demonstrated a centralized distribution, whereas those among females exhibited a bimodal distribution. Threshold-based identified calcification showed a positivity of COLX.

Conclusions

CT attenuation value could validly and reliably diagnose calcification within costal cartilage. Further investigations involving larger cohorts of patients are required to elucidate the risk factors and underlying mechanisms of costal cartilage calcification.

背景：建立并验证基于计算机断层扫描（CT）衰减值的肋软骨钙化诊断标准：方法：对 120 例患者的 360 张胸部 CT 切片进行回顾性审查和标注，并使用接收器操作特征曲线评估 CT 衰减值的诊断能力。对残留的肋软骨进行苏木精、伊红和 X 型胶原（COLX）染色：结果：共检测出 355 129 个体素，187.5 被确认为诊断肋软骨钙化的最佳 CT 衰减值阈值，灵敏度为 98.6%，特异度为 99.7%。基于阈值的钙化鉴定与专家评估的相似度接近 80%，并在进一步验证中显示出鉴定细微钙化的优势。我们还观察到，男性的 CT 衰减值呈集中分布，而女性则呈双峰分布。基于阈值识别的钙化显示出 COLX 的阳性：CT衰减值可有效、可靠地诊断肋软骨内的钙化。要阐明肋软骨钙化的风险因素和潜在机制，还需要对更多患者进行进一步研究。

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引用次数: 0

Racial disparity in peripheral nerve block usage in breast reconstruction: A nationwide analysis 乳房再造术中使用周围神经阻滞的种族差异：全国性分析

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.bjps.2024.09.054

Peripheral nerve block (PNB) usage in plastic surgery is associated with reduction in post-operative opioid consumption and pain demonstrating benefits in breast reconstruction (BR). This retrospective study explored whether racial-ethnic disparities exist with PNB use for postoperative analgesia in patients undergoing BR.

Using the American College of Surgeons National Surgical Quality Improvement Program database, women who underwent BR from 2012–2021 and received “regional” in addition to general anesthesia were included in the study. Patients without race and ethnicity data and who received other additional anesthesia were excluded. Unweighted rates of PNB use were compared between racial-ethnic groups and BR modality. Multivariate logistic regression assessed whether race and ethnicity were independently associated with receiving PNBs.

A total of 25,188 patients underwent BR and 9429 patients (37.4%) received PNB for postoperative analgesia. Patient demographics reached statistical, but not clinical, significance in age and BMI. Comorbidities were not significantly different between groups. Black patients were less likely to receive PNBs (p < 0.001), while Asian and Other patients were more likely to receive PNBs compared to White patients (p < 0.001). Black patients were less likely to receive PNB in immediate implant-based and autologous BR, as well as delayed autologous (p < 0.05). Asian patients were more likely to receive PNB for all implant-based BR compared to White patients (p < 0.001). Ethnicity had no significant impact on receipt of PNB. As a conclusion, racial disparity exists in use of PNBs for postoperative analgesia in BR. Equitable access to PNBs should be championed to not augment baseline racial disparity in BR.

在整形外科手术中使用周围神经阻滞（PNB）可减少术后阿片类药物的用量，并对乳房再造（BR）术后疼痛有好处。这项回顾性研究探讨了接受乳房再造术的患者在使用周围神经阻滞术进行术后镇痛时是否存在种族和族裔差异。研究利用美国外科学院国家外科质量改进计划数据库，纳入了在 2012-2021 年期间接受乳房再造术且除全身麻醉外还接受了 "区域 "麻醉的女性患者。没有种族和民族数据以及接受了其他额外麻醉的患者被排除在外。比较了不同种族-民族群体和麻醉方式之间的非加权 PNB 使用率。多变量逻辑回归评估了种族和民族是否与接受 PNBs 有独立关联。共有 25188 名患者接受了 BR，9429 名患者（37.4%）接受了 PNB 术后镇痛。患者的人口统计学特征在年龄和体重指数方面有统计学意义，但无临床意义。各组间的合并症无明显差异。与白人患者相比，黑人患者接受 PNB 的可能性较低（p < 0.001），而亚裔和其他族裔患者接受 PNB 的可能性较高（p < 0.001）。黑人患者在即刻种植型和自体 BR 以及延迟自体 BR 中接受 PNB 的可能性较低（p < 0.05）。与白人患者相比，亚裔患者更有可能在所有植入式乳房造口术中接受 PNB（p < 0.001）。种族对接受 PNB 没有明显影响。综上所述，在使用 PNB 用于 BR 术后镇痛方面存在种族差异。应提倡公平使用 PNB，以免扩大 BR 中的种族差异基线。

{"title":"Racial disparity in peripheral nerve block usage in breast reconstruction: A nationwide analysis","authors":"","doi":"10.1016/j.bjps.2024.09.054","DOIUrl":"10.1016/j.bjps.2024.09.054","url":null,"abstract":"<div><div>Peripheral nerve block (PNB) usage in plastic surgery is associated with reduction in post-operative opioid consumption and pain demonstrating benefits in breast reconstruction (BR). This retrospective study explored whether racial-ethnic disparities exist with PNB use for postoperative analgesia in patients undergoing BR.</div><div>Using the American College of Surgeons National Surgical Quality Improvement Program database, women who underwent BR from 2012–2021 and received “regional” in addition to general anesthesia were included in the study. Patients without race and ethnicity data and who received other additional anesthesia were excluded. Unweighted rates of PNB use were compared between racial-ethnic groups and BR modality. Multivariate logistic regression assessed whether race and ethnicity were independently associated with receiving PNBs.</div><div>A total of 25,188 patients underwent BR and 9429 patients (37.4%) received PNB for postoperative analgesia. Patient demographics reached statistical, but not clinical, significance in age and BMI. Comorbidities were not significantly different between groups. Black patients were less likely to receive PNBs (<em>p</em> < 0.001), while Asian and Other patients were more likely to receive PNBs compared to White patients (<em>p</em> < 0.001). Black patients were less likely to receive PNB in immediate implant-based and autologous BR, as well as delayed autologous (<em>p</em> < 0.05). Asian patients were more likely to receive PNB for all implant-based BR compared to White patients (<em>p</em> < 0.001). Ethnicity had no significant impact on receipt of PNB. As a conclusion, racial disparity exists in use of PNBs for postoperative analgesia in BR. Equitable access to PNBs should be championed to not augment baseline racial disparity in BR.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312690","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

Autologous fat grafting auxiliary methods in craniofacial deformities: A systematic review and network meta-analysis 颅面畸形的自体脂肪移植辅助方法：系统综述和网络荟萃分析。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.bjps.2024.09.060

Background

To increase autologous fat grafting (AFG) volume retention, current advancements focus on adding an auxiliary method to the process. This review aimed to address which auxiliary methods prove to be the best in terms of volume retention outcome.

Methods

A comprehensive literature search was performed in five medical databases, including PubMed, Proquest, Scopus, CENTRAL, and ScienceDirect, until March 2024, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

Results

Twenty-six studies were included in this review, and seven studies were included in the network meta-analysis. Reported auxiliary methods include stromal vascular fractions (SVFs) [12.20, 95% confidence intervals (CI) 0.04 to 24.35], adipose tissue-derived stem cells (ADSCs) (24.20, 95% CI 4.14 to 44.26), and platelet-rich plasma (PRP) [24.10, 95% CI −2.68 to 50.88]. When compared with the standard AFG approach, SVFs (p = 0.049) and ADSCs (p = 0.018) were more successful in retaining volume. However, PRP (p = 0.077) was not as effective. The comparison between auxiliary approaches, ADSCs vs PRP (p = 0.994), ADSCs vs SVFs (p = 0.271), and PRP vs SVF (p = 0.383), did not show any significant differences. Subgroup analysis revealed that the use of volumetric measuring methods has a substantial impact on the reported volume retention (p < 0.0001).

Conclusion

Enhanced volume retention can be attained with the utilization of SVF and ADSCs auxiliary methods in comparison to AFG, with or without PRP. Given the insignificant differences between SVF and ADSC, along with the greater complexity of the ADSC process, we recommend for the preferable use of SVF.

背景：为了提高自体脂肪移植（AFG）的容积保持率，目前的进展主要集中在为这一过程添加辅助方法。本综述旨在探讨哪种辅助方法在容积保持效果方面被证明是最好的：根据系统综述和元分析首选报告项目（PRISMA）指南，在五大医学数据库（包括 PubMed、Proquest、Scopus、CENTRAL 和 ScienceDirect）中进行了全面的文献检索，检索期至 2024 年 3 月：本综述纳入了 26 项研究，网络荟萃分析纳入了 7 项研究。报告的辅助方法包括基质血管碎片（SVFs）[12.20，95%置信区间（CI）0.04至24.35]、脂肪组织衍生干细胞（ADSCs）（24.20，95% CI 4.14至44.26）和富血小板血浆（PRP）[24.10，95% CI -2.68至50.88]。与标准 AFG 方法相比，SVFs（p = 0.049）和 ADSCs（p = 0.018）在保留容积方面更为成功。然而，PRP（p = 0.077）的效果不佳。ADSCs vs PRP (p = 0.994)、ADSCs vs SVFs (p = 0.271)和 PRP vs SVF (p = 0.383)等辅助方法之间的比较没有显示出任何显著差异。分组分析表明，使用容积测量方法对报告的容积保持率有很大影响（p < 0.0001）：结论：使用 SVF 和 ADSCs 辅助方法与使用或不使用 PRP 的 AFG 相比，可以提高容积保持率。鉴于 SVF 和 ADSC 之间的差异并不明显，而且 ADSC 过程更为复杂，我们建议优先使用 SVF。

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引用次数: 0

Two-step cluster analysis based on three-dimensional CT measurements of craniofacial structures in severe craniofacial microsomia 基于颅面结构三维 CT 测量的重度颅面微畸形两步聚类分析。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.bjps.2024.09.052

Background

The Pruzansky-Kaban and OMENS classifications do not provide additional details on temporomandibular joint deformities. The aim of this study was to classify and quantitatively define severe forms of craniofacial microsomia based on three-dimensional maxillofacial measurements, focusing on deformities in the zygomatic, temporal, and mandibular bones.

Methods

Maxillofacial computed tomography (CT) scans of children with severe types of craniofacial microsomia (CFM) from 2010 to 2020 were collected. Three-dimensional measurements of zygomatic arch length, height of mandibular ramus, height of maxilla, and occlusal cant were performed. A two-step cluster analysis was conducted based on zygomatic arch continuity, occlusal cant, and the ratio of the affected side to the unaffected side (A/U ratio) for zygomatic arch length, mandibular ramus height, and maxillary height.

Results

Fifty patients (32 male, 18 female) were included in the study. They were classified into 2 clusters through cluster analysis. Cluster 1 comprised subjects (44% of patients) with continuous zygomatic arches. Cluster 2 comprised subjects (39% of patients) with discontinuous zygomatic arches. The zygomatic arch A/U ratio in cluster 1 was greater than that in cluster 2, with statistical significance observed. Additionally, the maxilla height A/U ratio in cluster 1 was lower than in cluster 2, also with statistical significance. There was no statistically significant difference observed in the ramus height A/U ratio and occlusal cant between clusters 1 and 2.

Conclusions

Based on craniofacial measurements, severe CFM can be categorized into two types: continuous zygomatic arch and discontinuous zygomatic arch. This cluster analysis complemented the OMENS classification and could assist in the selection and design of prosthetic joints for patients with CFM.

背景：普鲁赞斯基-卡班（Pruzansky-Kaban）和奥曼斯（OMENS）分类法没有提供有关颞下颌关节畸形的更多详细信息。本研究的目的是根据颌面部三维测量结果，对严重颅面小畸形进行分类和定量定义，重点是颧骨、颞骨和下颌骨的畸形：方法：收集 2010 年至 2020 年严重颅面小畸形（CFM）儿童的颌面部计算机断层扫描（CT）结果。对颧弓长度、下颌横突高度、上颌骨高度和咬合面进行了三维测量。根据颧弓长度、下颌横突高度和上颌高度的颧弓连续性、咬合斜度以及患侧与非患侧的比率（A/U比率）进行了两步聚类分析：研究共纳入 50 名患者（32 名男性，18 名女性）。通过聚类分析将他们分为两组。聚类 1 包括颧弓连续的受试者（44% 的患者）。第 2 组包括颧弓不连续的受试者（39% 的患者）。第 1 组的颧弓 A/U 比值大于第 2 组，具有统计学意义。此外，第 1 组的上颌骨高度 A/U 比值低于第 2 组，也有统计学意义。第 1 组和第 2 组的颌骨高度 A/U 比和咬合面形在统计学上没有明显差异：根据颅颌面测量结果，严重 CFM 可分为两种类型：连续颧弓和不连续颧弓。该聚类分析是对OMENS分类的补充，有助于为CFM患者选择和设计修复关节。

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引用次数: 0

The use of SCIP-based vascularized lymphnode and lymphatic vessels transfer in perforator-to-perforator fashion: A standard approach to potentially reduce morbidity and increase efficacy in lymphedema surgery 以穿孔器对穿孔器的方式使用基于 SCIP 的血管化淋巴结和淋巴管转移：淋巴水肿手术中降低发病率和提高疗效的标准方法

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.bjps.2024.09.063

引用次数: 0

Sleep quality after autologous breast reconstruction 自体乳房重建后的睡眠质量

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.bjps.2024.09.035

Background

Sleep is a fundamental aspect of human health and well-being, but is often interrupted in a hospital setting. Especially after surgery, poor sleep quality can negatively affect postoperative recovery and quality of life. Therefore, the aim of this study was to gain insights into the quality of sleep in patients after autologous breast reconstruction and evaluate factors associated with the quality of sleep.

Materials and methods

In this single-center observational cohort study, participants completed a sleep diary, including the Pittsburgh sleep quality index (PSQI) and EQ-5D-5L quality of life questionnaire, before surgery, during hospital admission, and two weeks and three months postoperative. Additional variables such as pain and anesthesia duration were collected.

Results

Twenty-nine patients were included. Before the surgery, 58% of them experienced poor quality of sleep, with a median PSQI score of 5.0. During hospital admission, 83% of the patients had poor quality of sleep, with a PSQI score of 6.0. The PSQI score two weeks postoperative increased to 7.0 and decreased three months postoperative to 5.0. Patients with pain scores >4 (“pain” group), had higher median PSQI scores than patients with pain scores ≤4 (“no pain” group) at all postoperative time points previously mentioned. No correlation was observed between anesthesia duration or quality of life.

Conclusion

Poor sleep quality was experienced by most women after autologous breast reconstruction, especially in those with higher postoperative pain scores. This knowledge offers an opportunity to improve the postoperative care for such patients.

背景睡眠是人类健康和幸福的一个基本方面，但在医院环境中却经常被打断。尤其是在手术后，睡眠质量差会对术后恢复和生活质量产生负面影响。因此，本研究旨在深入了解自体乳房再造术后患者的睡眠质量，并评估与睡眠质量相关的因素。材料与方法在这项单中心观察性队列研究中，参与者在手术前、入院期间、术后两周和三个月完成了睡眠日记，包括匹兹堡睡眠质量指数（PSQI）和EQ-5D-5L生活质量问卷。此外，还收集了疼痛和麻醉持续时间等其他变量。手术前，58%的患者睡眠质量不佳，PSQI 中位数为 5.0 分。入院期间，83%的患者睡眠质量差，PSQI 得分为 6.0。术后两周的 PSQI 分数上升到 7.0，术后三个月下降到 5.0。在前面提到的所有术后时间点上，疼痛评分为 >4（"疼痛 "组）的患者的 PSQI 中位数均高于疼痛评分≤4（"无痛 "组）的患者。结论大多数女性在自体乳房再造术后睡眠质量不佳，尤其是术后疼痛评分较高的女性。这些知识为改善此类患者的术后护理提供了机会。

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引用次数: 0

Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome 头痛和神经痛患者的手术治疗延迟与术后效果不佳有关。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.bjps.2024.09.058

Introduction

Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity. This study evaluated the clinical impact of treatment delays on surgical outcomes.

Methods

Overall, 282 patients who underwent nerve decompression surgery at Weill Cornell Medicine and Massachusetts General Hospital between September 2012 and January 2024 were enrolled. Information regarding demographics, onset of symptoms, and headache characteristics was collected using patient surveys. The treatment outcome was evaluated by the percentage of symptom reduction in terms of frequency, duration, and pain intensity. An area under the receiver operating characteristic analysis was performed to determine the optimal timepoint to undergo surgery.

Results

Postoperative symptom reduction and time between the onset of symptoms and surgery were negatively correlated (r = −0.22; p < 0.001). The most significant difference in outcome was found at 2.9 years from symptom onset; patients who underwent surgery before this timepoint reported an average improvement of 79 ± 23% versus 67 ± 35% in those who were treated after the timepoint (p = 0.021).

Conclusion

Our results indicate that delays in undergoing nerve decompression surgery beyond 2.9 years from symptom onset leads to less favorable postoperative outcomes, underscoring the need for timely referral to peripheral nerve surgeons when conservative management fails. Nonetheless, even with delays in surgical intervention, patients continued to experience significant symptom reduction.

简介：尽管神经减压手术已被证明能有效减轻头颈部神经痛和头痛疾病患者的症状，但目前它还不是头痛疾病治疗方案的一部分。因此，患者从出现症状到接受手术治疗平均需要等待 20 年，这导致了高昂的保守治疗费用（每位患者 989,275.65 美元）和患者发病率。本研究评估了治疗延迟对手术结果的临床影响：2012年9月至2024年1月期间在威尔康奈尔医学院和麻省总医院接受神经减压手术的282名患者被纳入研究。通过患者调查收集了有关人口统计学、发病症状和头痛特征的信息。治疗效果根据症状减轻的频率、持续时间和疼痛强度的百分比进行评估。为了确定接受手术的最佳时间点，还进行了受体操作特征下面积分析：结果：术后症状减轻率与症状出现和手术之间的时间呈负相关（r = -0.22；p 结论：我们的结果表明，延迟接受神经外科手术可能会导致患者疼痛加剧：我们的研究结果表明，从症状出现起超过 2.9 年才接受神经减压手术会导致术后效果不佳，这也强调了在保守治疗无效时及时转诊给周围神经外科医生的必要性。尽管如此，即使延迟手术治疗，患者的症状仍能明显减轻。

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