Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Evaluating the role of the ‘Accessible Novel Solutions for Widespread Emergency Reconstructive Surgery’ (ANSWERS) 3D-printed perineal training model for conflict-related sexual violence injuries","authors":"Stephen R. Ali ,&nbsp;HRH The Duchess of Edinburgh ,&nbsp;Gloire Byabene ,&nbsp;Carys Edwards ,&nbsp;Beth Norman ,&nbsp;Octavian Parkes ,&nbsp;Hari Arora ,&nbsp;Denis Mukwege ,&nbsp;Iain S. Whitaker","doi":"10.1016/j.bjps.2025.11.051","DOIUrl":"10.1016/j.bjps.2025.11.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Conflict-related sexual violence (CRSV) causes considerable physical and psychological harm, often leading to complex urogenital injuries that require specialised reconstructive surgery. Despite the growing global demand for specialised surgical care, access to niche specialities and training resources remain limited, particularly in high-conflict and resource-constrained areas. This study evaluates the effectiveness of the Accessible Novel Solutions for Widespread Emergency Reconstructive Surgery (ANSWERS) 3D-printed model, developed in collaboration with the Panzi Foundation, as a training tool for urogenital fistula repair associated with CRSV.</div></div><div><h3>Methods</h3><div>Conducted at Panzi Hospital in the Democratic Republic of Congo, this study employed a cross-sectional survey design involving 13 healthcare professionals. Participants engaged in hands-on practice with the 3D-printed model, creating and repairing simulated defects to closely replicate CRSV injuries. The survey assessed the model’s anatomical fidelity, usability and impact on surgical preparedness, incorporating quantitative ratings and qualitative feedback.</div></div><div><h3>Results</h3><div>Our findings revealed strong support for the model's training value, with most participants reporting increased confidence in their technical skills. Areas for improvement due to limitations of anatomical detail and material durability were noted. Qualitative insights indicated that integrating the Panzi score—a classification system for fistula severity—and augmented reality or extended reality technology could enhance the model's relevance and interactivity.</div></div><div><h3>Conclusion</h3><div>The study highlights the use of the ANSWERS 3D-printed model in building competency-based training protocols in CRSV care. Future refinements in the multilayered materials, novel bioengineering approaches to enhance biomimicry, anatomical accuracy based on CT scans and Panzi score classifications hold great potential. Ultimately, digital integrations could lead to the development of a standardised, immersive training curriculum that aligns with Panzi Hospital’s holistic approach, improving surgical outcomes for CRSV survivors globally.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 96-105"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777007","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}

{"title":"From patient to partner: Crowdsourcing and digital innovations reshaping scar research and scar care management","authors":"K.J.P. Maertens ,&nbsp;T. Demarbaix ,&nbsp;J. Meirte ,&nbsp;U. Van Daele ,&nbsp;P. Moortgat","doi":"10.1016/j.bjps.2025.10.024","DOIUrl":"10.1016/j.bjps.2025.10.024","url":null,"abstract":"<div><div>Traditional scar research has historically prioritized clinician-driven outcomes, often neglecting patient-identified needs and real-world experiences. This narrative review synthesizes developments in patient-powered innovation across scar research, drawing from the last decade of literature on patient-reported outcome measures (PROMs), real-world data, digital health tools, and participatory models. Increased adoption of PROMs (e.g., Patient and Observer Scar Assessment Scale 3.0 and SCAR-Q), crowdsourced initiatives, and digital tools (e.g., ScarPath, smartphone apps, and AI-based assessments) are transforming scar research and management by centering patient priorities. Patient-powered approaches—through digital tools, crowdsourcing, and participatory research—are reshaping scar care by promoting real-world engagement and more meaningful, personalized outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 86-95"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472566","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}

{"title":"Commentary to accompany: Surgical reconstruction of severe pressure ulcers in England from 01/04/2011 to 30/09/2018: Retrospective cohort study using routinely collected data","authors":"James Chan","doi":"10.1016/j.bjps.2025.06.023","DOIUrl":"10.1016/j.bjps.2025.06.023","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 64-65"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651618","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}

{"title":"Hair follicle-inspired therapies for wound healing and scar remodelling","authors":"Min Waye Chew ,&nbsp;Summik Limbu ,&nbsp;Paul Kemp ,&nbsp;Claire A. Higgins","doi":"10.1016/j.bjps.2025.07.023","DOIUrl":"10.1016/j.bjps.2025.07.023","url":null,"abstract":"<div><div>Human skin does not regenerate after severe injuries. Instead, the wound healing process repairs the skin as quickly as possible, which can lead to the formation of scar tissue. Scar tissue has reduced function compared to healthy skin; contractures limit movement, sensation is altered, the skin is itchy, and there are no functional appendages, such as sweat glands and hair follicles. As the cellular and molecular mechanisms of scarring are becoming better understood, most therapeutic strategies focus on preventing scar formation by targeting the wound healing process. One avenue of research takes inspiration from the hair follicle, as hairy skin heals with faster wound closure and reduced scar formation compared to non-hairy skin. It is thought that the hair follicle has a contributing role in this process and hair follicles transplanted into chronic (non-closing) wounds have been shown to kick-start wound closure. In the context of scarring, hair follicles transplanted into longstanding scar tissue also lead to scar remodelling. In this review, we discuss the role of hair follicles and cells or biomaterials derived from the hair follicle in both wound healing and scar remodelling.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 34-43"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805528","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}

{"title":"Surgical reconstruction of severe pressure ulcers in England from 01/04/2011 to 30/09/2018: Retrospective cohort study using routinely collected data","authors":"Barnaby C. Reeves ,&nbsp;Jessica M. Harris ,&nbsp;Maria Pufulete ,&nbsp;Jo C. Dumville ,&nbsp;Una Adderley ,&nbsp;Ross Atkinson ,&nbsp;Madeleine Clout ,&nbsp;Nicky Cullum ,&nbsp;Abby O’Connell ,&nbsp;Stephen Palmer ,&nbsp;Jeremy Rodrigues ,&nbsp;Jason KF. Wong","doi":"10.1016/j.bjps.2025.06.012","DOIUrl":"10.1016/j.bjps.2025.06.012","url":null,"abstract":"<div><h3>Introduction</h3><div><span>We identified patients in England admitted to hospital with severe pressure ulcers (SPUs), quantified how many had </span>surgical reconstruction (SR) to close SPUs and described their outcomes.</div></div><div><h3>Methods</h3><div>Using Hospital Episode Statistics (2010ꟷ2019), we identified adults with SPU who had undergone SR. Outcomes were: length of stay; time-to-next-admission with SPU diagnosis; repeat SR; death from any cause (Office for National Statistics). Maximum and minimum numbers of SRs to close SPUs (the latter comprising a subset about whom we had greatest confidence) were estimated by applying increasingly specific filters.</div></div><div><h3>Results</h3><div>A minimum of 404 and maximum of 1018 patients with SPUs had SR over 7.5 years. Patients in the minimum subset were younger than the entire SR group (median 52 versus 58 years), had fewer comorbidities and were more likely to have a cause of impaired mobility. In the subset and entire group, median hospital stays after SR were 26 (IQR 13ꟷ48) and 42 (IQR 17ꟷ90) days. By one year, more patients in the subset had a further admission with SPU (24.4%, 95% CI 20.5%ꟷ29.0% versus 21.7%, 95%CI 19.2%ꟷ24.5% vs) and fewer had died (4.0%, 95%CI 2.5%ꟷ6.4% versus 14.6%, 95%CI 12.6%ꟷ16.7%); by two years, more had a second SR (10.7%, 95%CI 7.8%ꟷ14.5% versus 7.4%, 95%CI 5.7%ꟷ9.5%). Half the entire number of SRs (505/1018) were performed by 10 of 124 English hospitals.</div></div><div><h3>Conclusion</h3><div>Patients in the subset most likely had SR to close their SPUs. Their outcomes provide evidence that SR to close an SPU is effective for such patients.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 56-63"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565586","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}

{"title":"Translational approaches manipulating mechanobiology to promote scarless healing in humans","authors":"Erika Kness-Knezinskis,&nbsp;Marwan Sheckley,&nbsp;Andrew C. Hostler,&nbsp;Maria Gracia Mora Pinos,&nbsp;Kellen Chen,&nbsp;Geoffrey C. Gurtner","doi":"10.1016/j.bjps.2025.06.041","DOIUrl":"10.1016/j.bjps.2025.06.041","url":null,"abstract":"<div><div>Wound healing is a complex biological process involving hemostasis, inflammation, proliferation, and remodeling. While this orchestrated response is essential for tissue repair, dysregulated healing often culminates in scar formation, characterized by fibrosis and loss of physiological tissue architecture. Scar formation impairs both aesthetic and functional outcomes, posing significant clinical challenges. We previously identified mechanical signaling, specifically through the Focal Adhesion Kinase (FAK) pathway, as a critical regulator of wound healing and fibrosis across various disease states. Elevated mechanical signaling drives fibrosis and scarring, whereas targeted manipulation of this pathway either by device or pharmacologic approaches blocks these adverse effects. We have performed extensive preclinical and clinical studies to demonstrate the potential of these interventions to minimize scarring, promote regenerative healing, and restore dermal architecture. This review highlights the importance of mechanical signaling modulation to achieve scarless healing in humans.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 25-33"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700779","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}

{"title":"The Renaissance Wound Man: Parallels with today’s understanding of wound repair","authors":"H. Fletcher ,&nbsp;P. Martin","doi":"10.1016/j.bjps.2025.10.008","DOIUrl":"10.1016/j.bjps.2025.10.008","url":null,"abstract":"<div><div>The image of the “Wound Man” first appeared in surgical texts from the late fourteenth century where it served as an illustrated guide to what medical practitioners might be called upon to treat. Across various incarnations, the Wound Man was depicted as suffering from wide-ranging injuries including cut and stab wounds, dog bites, thorn scratches, and insect stings. This article examines the figure of the Renaissance Wound Man, focusing in particular on the illustration featured in Hans von Gersdorff’s <em>Feldtbuch der Wundartzney</em> (Field Book of Wound Medicine) which was first published in 1517. Through our consideration of this image and its accompanying text, we explore the relationship between von Gersdorff’s early approaches to wound healing and modern treatment of wounds. Combining our expertise in sixteenth-century German medical practice and current scientific and clinical approaches, we discuss the differences and surprising similarities between the two. Von Gersdorff’s text reveals an early understanding of anesthesia/analgesia, debridement, inflammation reduction, infection prevention, wound scarring, and fracture management. We discuss each topic separately, considering how von Gersdorff’s advice relates to modern clinical practice and scientific understanding.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 3-14"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373489","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}

{"title":"Unresolved challenges in wound healing: When science meets clinical need","authors":"Paul Martin ,&nbsp;Jason K.F. Wong ,&nbsp;Gus McGrouther","doi":"10.1016/j.bjps.2025.10.039","DOIUrl":"10.1016/j.bjps.2025.10.039","url":null,"abstract":"<div><div>Tissue damage is a natural consequence of mankind’s interactions with the physical environment and leads to activation of endogenous repair mechanisms. Wound treatments developed over centuries, although largely empirical, have been incorporated into routine clinical practice while awaiting evidence of their efficacy. Based on a revisited and updated discussion from a 2013 Gordon Research Conference between basic scientists and clinicians, we outlined current knowledge of wound repair, emphasising the unique roles of diverse cell types including neutrophils, macrophages, keratinocytes, fibroblasts, and other previously overlooked lineages such as adipocytes and melanocytes. Five key clinical challenges remain unsolved: hypertrophic and keloid scarring, burns, wound infections, and chronic wounds. For each challenge, we reviewed recent basic science insights that offer potential therapeutic avenues, such as the role of inflammatory signals and mechanical cues in scarring, neutrophil dysfunction in burns, influence of the wound microbiome on infection, and epigenetic changes in chronic wounds. Although significant progress has been made, these topics remain problematic. We concluded by highlighting emerging research areas, including the overlooked roles of the nerves, fascia and fat tissue, and lessons from cancer biology, which may provide further opportunities to develop innovative strategies for wound care. By fostering greater collaboration and targeting a deeper understanding of mechanisms with unique models, the pathway to accelerate the translation of new therapies to improve patient outcomes is hopeful.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 15-24"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515426","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}

{"title":"Application of prognostic research to understand and improve complex wound healing outcomes: A narrative review","authors":"Joe Harvey ,&nbsp;Sara Lloyd-John ,&nbsp;Nichola J. Barron ,&nbsp;Sarah E. Herrick","doi":"10.1016/j.bjps.2025.10.050","DOIUrl":"10.1016/j.bjps.2025.10.050","url":null,"abstract":"<div><div>Wound healing is essential for maintaining the integrity and barrier function of the skin. However, complex or chronic wounds are difficult to treat and are often associated with extended healing times. Increasing prevalence of complex wounds poses a challenge to NHS resources and has a detrimental effect on patients’ health-related quality of life. Therefore, it is vital to understand healing complications to optimize complex wound management. Clinical assessment, wound review and biological marker analysis are essential tools that guide prognosis, diagnosis and treatment. This review outlines the value of prognostic factors, models and tools when applied to complex wounds. It explores why prognosis is important to patients and health service providers and considers how understanding of wound healing prognosis may confer patient benefit. Prognostic factors include clinical data such as age, wound characteristics encompassing infection and biological markers such as protease expression. This review highlights some of the limitations of current evidence including issues with study design, methodological quality and considerations for clinical translation into relevant prognostic tools. In future, larger prognostic studies using multivariate analysis methods are essential to consider potential confounding factors. Additional systematic reviews would be valuable to provide a more comprehensive overview of findings and identify areas for improvement. Following published guidelines for prognosis research study design, analysis and reporting would improve research quality. Furthermore, a multifaceted approach to model development which incorporates robustly identified prognostic factors, uses rigorous external validation and considers clinical integration to provide meaningful patient benefit should be adopted in future studies.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"112 ","pages":"Pages 76-85"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535150","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}

{"title":"Trends and costs of plastic surgery claims in the NHS: A national analysis (2006–2025)","authors":"Kian Daneshi ,&nbsp;Sebastian Mitchell ,&nbsp;Vivienne Lewis ,&nbsp;Panagiotis Bompolas ,&nbsp;Kiamehr Karagah ,&nbsp;Vimal J. Gokani","doi":"10.1016/j.bjps.2025.12.023","DOIUrl":"10.1016/j.bjps.2025.12.023","url":null,"abstract":"<div><h3>Background</h3><div>Litigation within surgical specialties continues to impose a growing financial burden on the National Health Services (NHS). Plastic surgery may be especially vulnerable to claims arising from clinical complications and unmet patient expectations. However, national trends in plastic surgery litigation have not been well characterised. To analyse the national trends, causes and costs associated with NHS plastic surgery litigation from 2006/07 to 2024/25 were assessed.</div></div><div><h3>Methods</h3><div>We analyzed anonymized clinical negligence claim data related to plastic surgery obtained from NHS Resolution (NHSR). Structured fields included Specialty, administrative year (notification/closure), primary cause, and paid amounts (damages, claimant legal costs, and NHS legal costs). We defined three windows: Baseline (to 2019/20), Pandemic/Recovery (2020/21–2022/23) and Recent (2023/24–2024/25; right-censored). Costs are reported as median (IQR) with mean (SD) and range. Only primary cause was analysable and sub-causes were not used.</div></div><div><h3>Results</h3><div>Over 2006/07–2024/25, 1455 plastic-surgery claims were notified to NHSR (Baseline 1120; Pandemic/Recovery 208 and Recent 127; 2024/25 partial). Among 54 closed claims with damages (component data consistently available from 2018/19), the median total paid amount was £665,757 (IQR £386,570–£899,071), wherein aggregate payments across these claims exceeded £38.8 million. Within this subset, damages represented approximately 38–45% of the total payments by window, claimant legal costs 45–53%, and NHS legal costs 9–12%. The share of ‘Fail/Delay Treatment’ increased during and after the pandemic within a smaller pool of notifications.</div></div><div><h3>Conclusion</h3><div>This is the first national analysis of NHS plastic surgery litigation, offering insights into the specialty’s unique medico-legal risks. Data showed declining notifications since 2019/20 and persistently high legal costs, with delay-related causes being prominent. Systemic delays and communication failures are the key drivers of claims. Enhancing perioperative care pathways, informed consent and early dispute resolution could reduce patient harm and financial impact.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 678-686"},"PeriodicalIF":2.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938562","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}