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

The thenar eminence as a reference standard for muscle flap turgor assessment in free tissue transfer for facial reanimation: A novel clinical assessment framework 鱼际隆起作为面部再生游离组织移植中肌肉瓣肿胀评估的参考标准：一种新的临床评估框架

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-12 DOI: 10.1016/j.bjps.2025.10.043

Jing Qin Tay, Sheng-Lian Lee, Alfonso Orlando, David Chwei-Chin Chuang

引用次数: 0

Algorithmic recipient vessel selection for vessel-depleted lower limbs 下肢血管衰竭的受体血管选择算法

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.bjps.2025.11.011

Alex Sorkin , Chad Chang , Marco Marcasciano , Kai Yuan Cheng , Filippo Di Meglio , Michela Schettino , Hung Chi-Chen

Background

Lower limb reconstruction is a complex challenge that requires careful selection of recipient vessels to achieve optimal outcomes. We aimed to develop an algorithm for selecting recipient vessels based on defect location, size, composition, and lower limb vasculature.

Methods

We retrospectively reviewed 518 consecutive lower limb free flap reconstructions from 1983 to 2022. Using our hospital database, we developed an algorithm to identify suitable recipient vessels and matched them with appropriate reconstructive techniques.

Results

The algorithm classifies patients into four groups based on vascular availability. Group I included 419 patients with intact vessels who underwent direct anastomosis to a suitable flap. Group II comprised 25 patients with no accessible vessels below the medial sural artery. These patients were reconstructed with a free flap using a long vascular pedicle (anterolateral thigh flap, latissimus dorsi, and fibular flap), anastomosed to the medial sural artery. Twenty-one patients in Group III had accessible vessels only in the thigh and underwent reconstruction with a vein loop or two free flaps to reach the defect. A radial forearm flap served as a bridge flap, connecting an additional flap to cover the defect. Fifty-three patients in Group IV had no vessels available in the lower limb, but the foot remained perfused and sensate. This group underwent a two-stage procedure: first, a radial forearm bridge flap was connected to a recipient vessel in the healthy limb; after maturation, a second free flap was anastomosed to the bridge flap to cover the defect.

Conclusions

Our database shows that this algorithm offers a thorough and reproducible method for selecting recipient vessels in microsurgical lower limb reconstruction.

背景：下肢重建是一项复杂的挑战，需要仔细选择受体血管以达到最佳效果。我们的目标是开发一种基于缺陷位置、大小、组成和下肢血管系统选择受体血管的算法。方法回顾性分析1983 ~ 2022年518例连续下肢游离皮瓣重建病例。利用我们的医院数据库，我们开发了一种算法来识别合适的受体血管，并将它们与合适的重建技术相匹配。结果该算法根据血管可用性将患者分为四组。第一组包括419例血管完整的患者，直接吻合到合适的皮瓣。第二组包括25例腓肠内侧动脉下无血管可达的患者。这些患者采用长血管蒂（股前外侧皮瓣、背阔肌和腓骨皮瓣）与腓肠内侧动脉吻合的游离皮瓣重建。第三组21例患者仅在大腿有可达血管，并通过静脉环或两个自由皮瓣重建以达到缺损。前臂桡骨皮瓣作为桥状皮瓣，连接另一个皮瓣覆盖缺损。IV组53例患者下肢无血管可用，但足部仍有灌注和感觉。该组接受了两阶段手术：首先，将前臂桡骨桥皮瓣连接到健康肢体的受体血管；成熟后，将第二游离皮瓣与桥瓣吻合以覆盖缺损。结论sour数据库表明，该算法为显微外科下肢重建中受体血管的选择提供了一种全面、可重复的方法。

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引用次数: 0

Palatal subunits analysis in unilateral cleft lip and palate compared to controls: A comparative cohort study 单侧唇裂和腭裂患者的腭亚单位分析：一项比较队列研究

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-01 DOI: 10.1016/j.bjps.2025.10.049

Prasad Nalabothu , José W.M. Santos , Steven Cook , Francisco W.M.G. Muniz , Yoriko Lill , Benito K. Benitez , Andreas A. Mueller

Background

It is essential to objectively evaluate how a unilateral complete cleft lip and palate (UCLP) alters palatal anatomy. This study defines palatal subunits, to assess tissue changes in distinct anatomical areas of the palate. Additionally, we describe the changes after passive presurgical plate therapy.

Patients and methods

The palates of 21 newborns with non-syndromic UCLP were analyzed using 3D scans at two time points: post-birth (T1) and before primary surgery (T2). Subunits were defined as the premaxilla, alveolar crests, palatal segments, vomer, and true cleft. A control group of 17 age-matched infants with intact palates at T2 was included for comparison. Landmarks and coordinate systems were employed for linear and surface measurements.

Results

At T2, patients with cleft showed a total palatal surface area that was 8.04% smaller compared to those in the control group (p=0.015). The premaxilla was 15.94% larger in the study group than in the control group at T2 (p=0.024). Tuberosity and canine width were 12.95% (p<0.001) and 7.16% (p=0.012) larger, respectively, in patients with cleft at T2 compared to the controls. The true cleft area decreased by 43.18% (p<0.001) from T1 to T2. Anterior cleft width decreased by 35.48% (p=0.002).

Conclusions

This anatomical subunit analysis provided a distinct understanding of UCLP morphology and how it responds to treatment. It revealed important regional differences, such as the larger, variable premaxilla and primary deficiency in the palatal-maxillary fibromucosa of the cleft side. These findings support subunit-based assessments as valuable tools for diagnostic, personalized treatment and future 3D research in cleft care.

客观评价单侧完全性唇腭裂（UCLP）对腭解剖结构的影响是非常必要的。本研究定义腭亚单位，以评估腭不同解剖区域的组织变化。此外，我们描述了被动术前钢板治疗后的变化。患者和方法对21例新生儿无综合征性UCLP在出生后（T1）和手术前（T2）两个时间点的腭部进行三维扫描分析。亚单位定义为上颌骨前、牙槽嵴、腭节、牙槽嵴和真裂。对照组包括17名年龄匹配的T2时完整腭的婴儿进行比较。直线和表面测量采用地标和坐标系统。结果腭裂患者的T2总腭表面积比对照组小8.04% （p=0.015）。研究组在T2时的前颌比对照组大15.94% （p=0.024）。与对照组相比，T2腭裂患者的结节和犬齿宽度分别增大12.95% （p= 0.001）和7.16% （p=0.012）。从T1到T2，真裂面积减少43.18% （p<0.001）。前裂宽度减少35.48% （p=0.002）。该解剖亚基分析提供了对UCLP形态及其对治疗的反应的清晰理解。它揭示了重要的区域差异，如较大的，多变的前颌骨和腭裂侧上颌纤维粘膜的原发性缺乏。这些发现支持基于亚单位的评估作为诊断、个性化治疗和未来唇裂护理3D研究的宝贵工具。

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引用次数: 0

Identifying transfusion criteria and risk factors after deep inferior epigastric artery perforator flap breast reconstruction 腹下深动脉穿支皮瓣乳房重建术后输血标准及危险因素的探讨。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-26 DOI: 10.1016/j.bjps.2025.11.049

Brian Chen , Rocio Castillo-Larios , Sean K. Park , Erin R. Suydam , Martin I. Newman

Background

Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction depends on perfusion and outflow through microvascular anastomoses. Preoperative anemia is predictive of transfusion and increased complications; however, transfusion is also linked to thrombosis. Moreover, guidelines for transfusion after DIEP flaps are not established. We aimed to identify a safe hemoglobin level after DIEP flaps and identify risk factors and complications associated with transfusion.

Methods

A retrospective study was performed for DIEP flap breast reconstruction patients over 5 years. Patient characteristics and postoperative variables were gathered. Outcomes included 30-day complications, surgical takebacks, microvascular thrombosis, and flap loss. Descriptive statistics and receiver operating characteristic curve were used to determine the lowest hemoglobin (Hb) cutoff where complications increased.

Results

Overall, 156 patients (239 flaps) underwent DIEP flap reconstruction. Transfused patients were younger, had lower preoperative Hb, longer surgery, higher blood loss, immediate reconstruction, bilateral reconstruction, and lower postoperative Hb. They had increased 30-day complications and more surgical takebacks, and higher rates of microvascular thromboses, though no increased flap loss. Receiver operating characteristic curve identified an Hb of 8.3, below which more complications were seen.

Conclusion

Among patients with high-risk characteristics undergoing DIEP flap reconstruction, there is the possibility for transfusion and associated complications. Withholding transfusion for hemodynamically stable patients with Hb >8.3 appears to be safe. Lower Hb is associated with increased transfusion and complications; however, when managed appropriately, it does not increase flap loss.

背景：腹下深动脉穿支（DIEP）皮瓣乳房重建依赖于微血管吻合口灌注和流出。术前贫血预示输血和并发症增加；然而，输血也与血栓形成有关。此外，DIEP皮瓣后的输血指南尚未建立。我们的目的是确定DIEP皮瓣后的安全血红蛋白水平，并确定输血相关的危险因素和并发症。方法：对5年以上DIEP皮瓣乳房重建术患者进行回顾性研究。收集患者特征和术后变量。结果包括30天并发症、手术撤回、微血管血栓形成和皮瓣丢失。描述性统计和受试者工作特征曲线用于确定并发症增加时的最低血红蛋白（Hb）临界值。结果：156例患者（239个皮瓣）接受了DIEP皮瓣重建。输血患者较年轻，术前Hb较低，手术时间较长，出血量较高，立即重建，双侧重建，术后Hb较低。他们的30天并发症增加，手术回复率更高，微血管血栓发生率更高，但皮瓣损失没有增加。受试者工作特征曲线显示Hb为8.3，低于此值可出现更多并发症。结论：具有高危特征的患者行DIEP皮瓣重建术，存在输血及相关并发症的可能性。对于血流动力学稳定的Hb b> 8.3患者，停止输血似乎是安全的。较低的Hb与输血和并发症增加有关；然而，如果处理得当，它不会增加皮瓣损失。

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引用次数: 0

Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma – A systematic review of literature 乳房植入物相关间变性大细胞淋巴瘤的流行病学-文献系统综述。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-20 DOI: 10.1016/j.bjps.2025.11.038

Michail Sorotos , Guido Firmani , Theodor Mareş , Alessandra Ceccaroni , Fabio Santanelli di Pompeo

Introduction

Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL) cases are steadily increasing worldwide. When considering only the patients with textured implant as the active population, prevalence appears higher than previously reported, and uncertainty regarding incidence rate (IR) trends. We aimed to provide comprehensive estimates by identifying epidemiologic studies reporting prevalence, risk, and IR.

Methods

A systematic review was conducted up to November 2024 across PubMed, Google Scholar, and Web of Science. Epidemiological data were extracted from the “Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology” (PROFILE) registry (US-specific), Food and Drug Administration (FDA)-Medical Device Reporting (MDR) (US/global), and BIA-ALCL Global Network (worldwide), providing granular data for 2019–2024, enabling yearly IR analysis. All findings were normalized using textured implants patients as the denominator. Interrupted time-series analysis was used to determine the impact of the COVID-19 pandemic on BIA-ALCL reporting.

Results

Among the 1949 studies, 23 were analyzed. Prevalence: 1.0–397.9/100,000 persons; risk: 1:250–1:99,992; and IR 0.021–124/100.000 persons/year. Nationally (US), PROFILE and FDA-MDR data showed IR peaking in 2020 (16.4 and 25.7/100,000) and then declining. Globally, FDA-MDR estimates peaked in 2021 (0.95/100,000) and plummeted in 2022 (0.14/100,000). Global Network data peaked in 2018 (0.68/100,000), dropped in 2020 (0.18/100,000), but rose again in 2024 (0.73/100,000). Significant IR declines (p = 0.02), were identified during the COVID-19 pandemic (2020–2022). Global data suggest transient underreporting and diagnostic delays.

Conclusion

BIA-ALCL IR decreased in 2022, then rose globally in 2023–2024, but not in the US, where it continued declining. IR trends were increasing but were influenced by COVID-19, with differences in absolute values likely reflecting smooth vs. textured implant market share variations. Contextualizing epidemiology by surface type and geography remains fundamental.

简介：乳房植入物相关的间变性大细胞淋巴瘤（BIA-ALCL）病例在世界范围内稳步增加。当仅考虑有纹理植入物的患者作为活动人群时，患病率似乎高于先前报道，并且发病率（IR）趋势不确定。我们的目的是通过确定报告患病率、风险和IR的流行病学研究来提供全面的估计。方法：到2024年11月，通过PubMed、b谷歌Scholar和Web of Science进行系统评价。流行病学数据提取自“乳房植入物和间变性大细胞淋巴瘤病因学和流行病学的患者登记和结果”（PROFILE）登记（美国特定），食品和药物管理局(FDA)-医疗器械报告（MDR）（美国/全球）和BIA-ALCL全球网络（全球），提供2019-2024年的颗粒数据，实现年度IR分析。所有结果均以有纹理植入物患者为分母进行归一化。采用中断时间序列分析确定COVID-19大流行对BIA-ALCL报告的影响。结果：在1949项研究中，分析了23项。患病率：1.0-397.9/10万人；风险:1:250-1:99,992;IR为0.021-124/ 100000人/年。在全国范围内（美国），PROFILE和FDA-MDR数据显示IR在2020年达到峰值（16.4和25.7/100,000），然后下降。在全球范围内，FDA-MDR估计在2021年达到峰值（0.95/10万），并在2022年暴跌（0.14/10万）。全球网络数据在2018年达到峰值（0.68/10万），在2020年下降（0.18/10万），但在2024年再次上升（0.73/10万）。在2019冠状病毒病大流行期间（2020-2022年），IR显著下降（p = 0.02）。全球数据显示短暂的少报和诊断延误。结论：BIA-ALCL IR在2022年下降，然后在2023-2024年全球上升，但在美国没有继续下降。IR趋势正在增加，但受COVID-19的影响，绝对值的差异可能反映了光滑与纹理植入物市场份额的变化。根据地表类型和地理将流行病学背景化仍然是基本的。

{"title":"Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma – A systematic review of literature","authors":"Michail Sorotos , Guido Firmani , Theodor Mareş , Alessandra Ceccaroni , Fabio Santanelli di Pompeo","doi":"10.1016/j.bjps.2025.11.038","DOIUrl":"10.1016/j.bjps.2025.11.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL) cases are steadily increasing worldwide. When considering only the patients with textured implant as the active population, prevalence appears higher than previously reported, and uncertainty regarding incidence rate (IR) trends. We aimed to provide comprehensive estimates by identifying epidemiologic studies reporting prevalence, risk, and IR.</div></div><div><h3>Methods</h3><div>A systematic review was conducted up to November 2024 across PubMed, Google Scholar, and Web of Science. Epidemiological data were extracted from the “Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology” (PROFILE) registry (US-specific), Food and Drug Administration (FDA)-Medical Device Reporting (MDR) (US/global), and BIA-ALCL Global Network (worldwide), providing granular data for 2019–2024, enabling yearly IR analysis. All findings were normalized using textured implants patients as the denominator. Interrupted time-series analysis was used to determine the impact of the COVID-19 pandemic on BIA-ALCL reporting.</div></div><div><h3>Results</h3><div>Among the 1949 studies, 23 were analyzed. Prevalence: 1.0–397.9/100,000 persons; risk: 1:250–1:99,992; and IR 0.021–124/100.000 persons/year. Nationally (US), PROFILE and FDA-MDR data showed IR peaking in 2020 (16.4 and 25.7/100,000) and then declining. Globally, FDA-MDR estimates peaked in 2021 (0.95/100,000) and plummeted in 2022 (0.14/100,000). Global Network data peaked in 2018 (0.68/100,000), dropped in 2020 (0.18/100,000), but rose again in 2024 (0.73/100,000). Significant IR declines (p = 0.02), were identified during the COVID-19 pandemic (2020–2022). Global data suggest transient underreporting and diagnostic delays.</div></div><div><h3>Conclusion</h3><div>BIA-ALCL IR decreased in 2022, then rose globally in 2023–2024, but not in the US, where it continued declining. IR trends were increasing but were influenced by COVID-19, with differences in absolute values likely reflecting smooth vs. textured implant market share variations. Contextualizing epidemiology by surface type and geography remains fundamental.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 399-410"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746458","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

Machine learning and computer vision for detection and classification of pain in lower extremity amputees 机器学习和计算机视觉在下肢截肢者疼痛检测和分类中的应用。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-28 DOI: 10.1016/j.bjps.2025.11.052

Arya S. Rao , Floris V. Raasveld , Omar Moussa , Benjamin R. Johnston , Anna Luan , Zihe Zhang , Clifford J. Woolf , Krystle R. Tuaño , Ian L. Valerio , Kyle R. Eberlin

Objective

Pain sketches help visualize neuropathic pain patterns in amputees and may predict surgical outcomes following targeted muscle reinnervation (TMR). Current manual interpretation introduces subjectivity and potential bias. Machine learning offers potential for automated, objective classification of these sketches. Therefore, we aimed to develop and evaluate a machine learning approach for automated classification of pain sketches from lower extremity amputees who underwent targeted muscle reinnervation (TMR).

Methods

Here, 588 pain sketches from 206 lower extremity amputees (2021–2024) were analyzed. Convolutional neural networks were trained to perform binary classifications between pain categories (focal, radiating, diffuse, and no pain). Unsupervised hierarchical clustering was used to identify novel pain distribution patterns.

Results

Binary classification models achieved the highest performance distinguishing no pain versus diffuse pain (AUROC: 0.799). Other models showed AUROCs between 0.587–0.760. Hierarchical clustering revealed distinct pain distribution patterns based on anatomical location and extent, providing insights beyond traditional classification schemes.

Conclusions

Machine learning can effectively automate pain sketch classification in lower extremity amputees, offering potential clinical utility for preoperative planning. This approach may help standardize interpretation and improve surgical decision-making for TMR procedures.

Level of Evidence

IV—Therapeutic

目的：疼痛草图有助于可视化截肢者的神经性疼痛模式，并可预测靶向肌肉神经移植（TMR）后的手术结果。目前的人工口译引入了主观性和潜在的偏见。机器学习为这些草图的自动、客观分类提供了潜力。因此，我们旨在开发和评估一种机器学习方法，用于对接受靶向肌肉神经移植（TMR）的下肢截肢者的疼痛草图进行自动分类。方法：对206例下肢截肢患者（2021-2024）588张疼痛草图进行分析。卷积神经网络被训练成在疼痛类别（局灶性、辐射性、弥漫性和无痛）之间进行二元分类。采用无监督分层聚类来识别新的疼痛分布模式。结果：二元分类模型在区分无疼痛和弥漫性疼痛方面表现最佳（AUROC: 0.799）。其他模型的auroc在0.587-0.760之间。分层聚类揭示了基于解剖位置和程度的不同疼痛分布模式，提供了超越传统分类方案的见解。结论：机器学习可以有效地自动化下肢截肢患者的疼痛草图分类，为术前规划提供潜在的临床应用价值。这种方法有助于规范TMR手术的解释和改进手术决策。证据等级：iv -治疗性。

{"title":"Machine learning and computer vision for detection and classification of pain in lower extremity amputees","authors":"Arya S. Rao , Floris V. Raasveld , Omar Moussa , Benjamin R. Johnston , Anna Luan , Zihe Zhang , Clifford J. Woolf , Krystle R. Tuaño , Ian L. Valerio , Kyle R. Eberlin","doi":"10.1016/j.bjps.2025.11.052","DOIUrl":"10.1016/j.bjps.2025.11.052","url":null,"abstract":"<div><h3>Objective</h3><div>Pain sketches help visualize neuropathic pain patterns in amputees and may predict surgical outcomes following targeted muscle reinnervation (TMR). Current manual interpretation introduces subjectivity and potential bias. Machine learning offers potential for automated, objective classification of these sketches. Therefore, we aimed to develop and evaluate a machine learning approach for automated classification of pain sketches from lower extremity amputees who underwent targeted muscle reinnervation (TMR).</div></div><div><h3>Methods</h3><div>Here, 588 pain sketches from 206 lower extremity amputees (2021–2024) were analyzed. Convolutional neural networks were trained to perform binary classifications between pain categories (focal, radiating, diffuse, and no pain). Unsupervised hierarchical clustering was used to identify novel pain distribution patterns.</div></div><div><h3>Results</h3><div>Binary classification models achieved the highest performance distinguishing no pain versus diffuse pain (AUROC: 0.799). Other models showed AUROCs between 0.587–0.760. Hierarchical clustering revealed distinct pain distribution patterns based on anatomical location and extent, providing insights beyond traditional classification schemes.</div></div><div><h3>Conclusions</h3><div>Machine learning can effectively automate pain sketch classification in lower extremity amputees, offering potential clinical utility for preoperative planning. This approach may help standardize interpretation and improve surgical decision-making for TMR procedures.</div></div><div><h3>Level of Evidence</h3><div>IV—Therapeutic</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 713-720"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013948","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

Plastic surgery training in the United Kingdom and Ireland in 2025: Results of the National Training Survey 2025年英国和爱尔兰的整形外科培训：全国培训调查结果。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-10-04 DOI: 10.1016/j.bjps.2025.09.031

Richard Clough , Maria Ioanna Gavala , Arash Rafie , Jia Xin Wen , Anna Rose , Aaliya Uddin , Dujan Bhatti , Susan McCrossan , Rajan Chaudhary , Ciaran Durand , Jonathan Herron , Sara Jasionowska , Jamal Khudr , Kiron Koshy , Edward Muscat , Donal Murphy , Ter-er Kusu Orkar , Dhanuja Senn , Jade Zhao

Introduction

Plastic surgery training in the UK and Ireland is continuously evolving in response to changing healthcare priorities and workforce demands. The UK and Ireland Plastic Surgery Trainees Association conducted a survey among plastic surgery trainees holding national training numbers to elucidate current attitudes towards training.

Methods

A cross-sectional survey of all plastic surgery trainees was developed using a web-based application and distributed via email newsletters, social media and messaging apps.

Results

A total of 142 trainees completed the survey, representing all training years and regions. The most popular career aspirations were hand surgery (31%), breast surgery (20%) and head and neck surgery (9%). A few trainees reported receiving 2 h of local teaching per week (15%) or dedicated time for audit, research or personal study (25%). The majority (81.6%) would recommend their training region to others. The median number of hours worked per week was 56 (48 paid and 8 unpaid). More trainees rated the quality of their aesthetic training negatively than positively (42% vs 32%). Those with dedicated aesthetic rotations were significantly more likely to rate their training positively (p <0.0001). Key factors affecting training were service provision (30%), operative exposure (18%) and consultant willingness to teach (12%). Trainees unanimously supported the opportunity to undertake fellowships during ST8 (96%) and firm-based structures (96%).

Conclusions

Overall, plastic surgery trainees reported high levels of training satisfaction. Recommendations include expanding and standardising access to aesthetic rotations and fellowships during training across the training regions.

简介：整形外科培训在英国和爱尔兰不断发展，以应对不断变化的医疗保健优先事项和劳动力需求。英国和爱尔兰整形外科培训生协会对持有国家培训号的整形外科培训生进行了一项调查，以阐明目前对培训的态度。方法：使用基于网络的应用程序对所有整形手术学员进行横断面调查，并通过电子邮件通讯、社交媒体和消息应用程序分发。结果：共有142名学员完成了调查，代表了所有培训年份和地区。最受欢迎的职业抱负是手部手术（31%）、乳房手术（20%）和头颈部手术（9%）。少数学员报告每周接受2小时的当地教学（15%），或专门用于审计、研究或个人学习（25%）。大多数人（81.6%）会向他人推荐自己的培训地区。每周工作时间的中位数是56小时（48小时带薪，8小时无薪）。更多的受训者对他们的审美训练质量评价消极而不是积极（42%对32%）。那些有专门的美容轮转的人更有可能对他们的培训给予积极的评价(p)结论：总体而言，整形手术学员报告了高水平的培训满意度。建议包括在整个培训区域的培训期间扩大和标准化获得美学轮岗和研究金的机会。

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引用次数: 0

Invited Commentary: “Free functional gracilis muscle opponensplasty for thenar reconstruction: Indications, technique, and long-term outcomes” and reflections on Prof Ninkovic’s career and contributions to plastic surgery 特邀评论：“自由功能性股薄肌对手成形术用于足底重建：适应症、技术和长期结果”，并反思Ninkovic教授的职业生涯和对整形外科的贡献。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-12-15 DOI: 10.1016/j.bjps.2025.12.004

Damir Kosutic , Haris Mesic

引用次数: 0

Reverse expansion-assisted high-quality autologous fat grafting in breast reconstruction: A retrospective comparative study 反向扩张辅助高质量自体脂肪移植术在乳房重建中的回顾性比较研究

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-07-26 DOI: 10.1016/j.bjps.2025.04.057

Haojing Tang , Yao Yao , Feng Lu, Bin Li, Ziqing Dong , Yunjun Liao

Background

Reverse expansion (RE) combined with fat grafting (FG) is a relatively innovative method used for breast reconstruction following mastectomy for breast cancer. Using an expanded subcutaneous adipose tissue layer as the recipient area seems to promote the retention of subsequent grafts. To further validate, the study retrospectively compared clinical outcomes in patients who underwent FG with and without RE for breast reconstruction.

Methods

This study included patients diagnosed with breast cancer who underwent unilateral mastectomy followed by breast reconstruction with high-quality autologous FG at our department between January 2019 and December 2023. The patients were divided into two groups, those who underwent FG plus RE group and those who underwent FG alone. Demographic and clinical characteristics, FG retention rates, BREAST-Q scores, and complications were compared in the two groups.

Results

The present study included 55 patients, 27 in the FG+RE group and 28 in the FG group. Preoperative scores and fat retention rates of the first FG did not differ significantly between these two groups (P>0.05 each). The retention rate of the second FG (i.e., the first FG after RE) was significantly higher in the FG+RE group than in the FG group (P<0.001). A comparison of BREAST-Q postoperative scores in the two groups showed that scores on two subscales, psychosocial well-being and satisfaction with breasts, were significantly superior in the FG+RE than in the FG group (P<0.05 each)

Conclusions

Expander-assisted FG based on the RE strategy can improve graft retention and reduce the number of rounds of FG. Moreover, reverse expansion can result in sufficient skin and improve breast contouring without relying on patient compliance.

背景反向扩张（RE）联合脂肪移植（FG）是一种相对创新的用于乳腺癌切除术后乳房重建的方法。使用扩大的皮下脂肪组织层作为受体区域似乎可以促进后续移植物的保留。为了进一步验证，该研究回顾性比较了在乳房重建术中接受FG和不接受RE的患者的临床结果。方法本研究纳入2019年1月至2023年12月在我科接受单侧乳房切除术后高质量自体FG乳房重建的乳腺癌患者。将患者分为两组，FG + RE组和单独FG组。比较两组患者的人口学和临床特征、FG潴留率、BREAST-Q评分及并发症。结果本研究共纳入55例患者，FG+RE组27例，FG组28例。两组术前评分和第一次FG脂肪潴留率差异无统计学意义（P>均为0.05）。FG+RE组第二次FG（即RE后第一次FG）的保留率显著高于FG组（P<0.001）。两组术后BREAST-Q评分比较显示，FG+RE组在心理社会健康和乳房满意度两个亚量表上的评分均显著优于FG组（p < 0.05）。结论基于RE策略的助推器FG可改善移植物潴留，减少FG轮次。此外，反向扩张可以产生足够的皮肤和改善乳房轮廓，而不依赖于患者的依从性。

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引用次数: 0

Surgical management of pediatric facial Congenital Melanocytic Naevi and use of the novel Patient-Reported Outcome Measure: SCAR-Q to assess outcomes 儿童面部先天性黑素细胞痣的手术治疗和使用新的患者报告的结果测量：SCAR-Q来评估结果。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-20 DOI: 10.1016/j.bjps.2025.11.036

Theodore Howard , Arwa Sindi , Whitney Quong , Gaynor Osman , Brigitte Harrison , Debra Lomas , Veronica Kinsler , Neil Bulstrode

Congenital Melanocytic Naevi (CMN) are benign proliferations of melanocytes present at birth or shortly thereafter. Surgical management is primarily driven by cosmetic and psychosocial considerations, particularly for facial lesions. This study represents the first application of the SCAR-Q Patient-Reported Outcome Measure (PROMs) to assess the outcomes of excision and reconstruction in patients with facial CMN. Over a 10-year period, 71 patients were included, with 28 (39%) completing the SCAR-Q and Patient & Observer Scar Assessment Scale (POSAS) questionnaires. The mean age at surgery was 6.25 years and mean age at data collection was 15 years. Surgical procedures varied and included excision with primary closure, serial excision, skin grafting, and tissue expansion. Overall, patients expressed high satisfaction with the cosmetic outcomes and minimal psychological impact from scarring. However, no statistically significant correlations were found between gender, lesion location, or surgical technique and PROMs scores. The SCAR-Q is a validated tool that provides a comprehensive assessment of scar appearance, symptoms, and psychosocial impact and should be considered in future evaluations of surgical outcomes for CMN.

先天性黑素细胞痣（CMN）是出生时或出生后不久黑色素细胞的良性增生。手术治疗主要是由美容和社会心理因素驱动的，特别是面部病变。本研究首次应用SCAR-Q患者报告结果测量（PROMs）来评估面部CMN患者切除和重建的结果。在10年的时间里，纳入了71例患者，其中28例（39%）完成了Scar - q和患者与观察者疤痕评估量表（POSAS）问卷调查。手术时平均年龄为6.25岁，收集资料时平均年龄为15岁。手术方法多种多样，包括初步闭合切除、连续切除、皮肤移植和组织扩张。总体而言，患者对美容效果和最小的疤痕心理影响表示高度满意。然而，性别、病变部位或手术技术与PROMs评分之间没有统计学上显著的相关性。scar - q是一种经过验证的工具，可提供疤痕外观、症状和心理社会影响的综合评估，在未来评估CMN手术结果时应予以考虑。

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