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

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

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

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

Sam Boroumand, Ismail Ajjawi, Nancy Park, Lioba Huelsboemer, Viola A. Stögner, Karen Bach, Martin Kauke-Navarro, Siba Haykal, Bohdan Pomahac, David Colen

引用次数: 0

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

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

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

Maria Chicco , Charlotte Bendon , Benedetta Peltristo, Adam Blackburn, Katia Sindali

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

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

Fuad Abbas , Ryan Khalaf , Jose Reyes , R’ay Fodor , Filippo Perozzo , Rommy Obeid , Mazen Al-Malak , Diane Jo , Elaine Husni , Antonio Rampazzo , Bahar Bassiri Gharb

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

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

Shijie Wei , Jiong Ye , Chen Lei , Qinfeng Huang , Bifang Lin , Xiaohui Su , Houbing Zheng , Xiuying Shan , Biao Wang , Meishui Wang

Background

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

Methods

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

Results

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

Conclusion

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

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

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引用次数: 0

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

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

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

Bahram Eshraghi, Leila Babaei, Mahdi Aghajani, Ali Aghajani

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

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引用次数: 0

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

Romain Pelette , Nicolas Morel-Journel , Damien Carnicelli , Alain Ruffion , Léna Paganelli , Charles-Hervé Vacheron , Manon Terrier , François Xavier Madec , Paul Neuville

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

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

Qingfang Meng , Wenjuan Sun , Erran Li , Na Liu

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

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

Gauthier Zinner , Jérôme Martineau , Giang-Thanh Lam , Mathias Tremp , Salvatore Giordano , Edward T.C. Dong , Daniel F. Kalbermatten , Carlo M. Oranges

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 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

Baohong Wang , Yiqing Dai , Lufan Chang , Yiyuan Li , Datao Li , Feng Xu , Zhicheng Xu , Qun Zhang , Hao Liu , Xia Chen , Ruhong Zhang

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

Miguel I. Dorante , Maria J. Escobar-Domingo , Dean Kennedy , Erin J. Kim , Bernard T. Lee , Lifei Guo

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。

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