Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.bjps.2025.12.012
Joshua McKenna
{"title":"Correspondence: Publication counts and research productivity: Contrasting scientific and surgical publishing cultures","authors":"Joshua McKenna","doi":"10.1016/j.bjps.2025.12.012","DOIUrl":"10.1016/j.bjps.2025.12.012","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 582-583"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829461","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}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.bjps.2025.11.040
Nadeem E. Jones, Alexander F. Dagi, Jarrod T. Bogue
Background
Access to plastic surgery services remains unevenly distributed across the United States, particularly in rural and underserved areas. This study provides a 10-year update on the geographic distribution of plastic surgeons using 2022 data from the Area Health Resources File.
Methods
Plastic surgeon density was calculated for 942 Health Service Areas (HSAs) and stratified by demographic and healthcare infrastructure characteristics. Longitudinal changes in access from 2012 to 2022 were assessed. Practice type (office-based vs. hospital-employed) was also analyzed.
Results
In 2022, 49.9% of HSAs had no plastic surgeons, leaving 25.9 million Americans without local access. National plastic surgeon density declined from 2.42 to 2.14 per 100,000 population over the decade. Forty-one HSAs lost access to plastic surgeons, while 34 gained access. Regions that lost access had lower income, greater rurality, older populations, and fewer physicians per capita. Practice types were similarly distributed across HSAs regardless of plastic surgeon density in 2022.
Conclusion
Geographic disparities in access to plastic surgery persist, with nearly half of U.S. regions lacking local providers. These disparities are shaped more by regional sociodemographic and infrastructure factors than by practice type. Policy interventions, training reforms, and rural workforce incentives are needed to address these inequities.
{"title":"A decade later: Geographic access to plastic surgery in the U.S. using the 2022 Area Health Resource File","authors":"Nadeem E. Jones, Alexander F. Dagi, Jarrod T. Bogue","doi":"10.1016/j.bjps.2025.11.040","DOIUrl":"10.1016/j.bjps.2025.11.040","url":null,"abstract":"<div><h3>Background</h3><div>Access to plastic surgery services remains unevenly distributed across the United States, particularly in rural and underserved areas. This study provides a 10-year update on the geographic distribution of plastic surgeons using 2022 data from the Area Health Resources File.</div></div><div><h3>Methods</h3><div>Plastic surgeon density was calculated for 942 Health Service Areas (HSAs) and stratified by demographic and healthcare infrastructure characteristics. Longitudinal changes in access from 2012 to 2022 were assessed. Practice type (office-based vs. hospital-employed) was also analyzed.</div></div><div><h3>Results</h3><div>In 2022, 49.9% of HSAs had no plastic surgeons, leaving 25.9 million Americans without local access. National plastic surgeon density declined from 2.42 to 2.14 per 100,000 population over the decade. Forty-one HSAs lost access to plastic surgeons, while 34 gained access. Regions that lost access had lower income, greater rurality, older populations, and fewer physicians per capita. Practice types were similarly distributed across HSAs regardless of plastic surgeon density in 2022.</div></div><div><h3>Conclusion</h3><div>Geographic disparities in access to plastic surgery persist, with nearly half of U.S. regions lacking local providers. These disparities are shaped more by regional sociodemographic and infrastructure factors than by practice type. Policy interventions, training reforms, and rural workforce incentives are needed to address these inequities.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 721-723"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728028","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}
Pub Date : 2026-02-01Epub Date: 2025-11-05DOI: 10.1016/j.bjps.2025.11.004
Jose E. Telich-Tarriba , Alexander Cardenas-Mejia
{"title":"Craniofacial surgery needs in the Moebius syndrome population","authors":"Jose E. Telich-Tarriba , Alexander Cardenas-Mejia","doi":"10.1016/j.bjps.2025.11.004","DOIUrl":"10.1016/j.bjps.2025.11.004","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 92-94"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580016","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}
Pub Date : 2026-02-01Epub Date: 2025-11-08DOI: 10.1016/j.bjps.2025.11.006
Shune Xiao , Miaomiao Wei , Junzhe Chen , Xiangkui Wu , Hai Li , Bihua Wu , Chengliang Deng
Purpose
Conventional therapies for postmastectomy upper extremity lymphedema often provide limited and temporary relief, especially in advanced cases. Although surgical interventions such as liposuction have improved outcomes, combining regenerative cell-based strategies with surgical volume reduction has not been systematically evaluated. This prospective study assessed the feasibility, safety, and efficacy of combining stromal vascular fraction (SVF)-gel grafting with liposuction, targeting physical debulking and lymphatic regeneration in breast cancer-related upper extremity lymphedema.
Methods
In this prospective, single-arm exploratory study, 12 patients with stage II or III breast cancer-related upper extremity lymphedema underwent liposuction followed by SVF-gel transplantation. The primary endpoint was change in excess arm volume at 12 months. Secondary outcomes included symptom severity, quality of life (QoL; Disabilities of the Arm, Shoulder and Hand [DASH] and Lymphedema Quality-of-Life Questionnaire [LYMQOL] questionnaires), incidence of cellulitis, and reliance on compression therapy. Safety was monitored throughout. Statistical analyses included repeated measures analysis of variance (ANOVA) with Bonferroni corrections, Wilcoxon, and multi-linear regression to compare changes from baseline and identify factors influencing arm volume.
Results
At 12 months, the combined intervention achieved a mean 51% reduction in excess arm volume (from 668.3 ± 275.1 to 327.5 ± 164.1 mL, P < 0.05). Significant improvements were observed in limb heaviness, tension, upper extremity function, and LYMQOL subscales (all P < 0.01). Three patients discontinued compression therapy. No cellulitis or serious adverse events occurred; minor complications resolved without intervention.
Conclusion
Combining liposuction with SVF-gel grafting is a feasible, safe, and effective approach for advanced postmastectomy upper limb lymphedema and for improving symptoms and QoL. Given the lack of published data on this combined technique, our findings lay the foundation for future controlled studies.
目的：乳房切除术后上肢淋巴水肿的常规治疗通常提供有限和暂时的缓解，特别是在晚期病例中。尽管抽脂等手术干预措施改善了结果，但将再生细胞为基础的策略与手术体积缩小相结合尚未得到系统评估。这项前瞻性研究评估了基质血管分数（SVF）凝胶移植联合吸脂治疗乳腺癌相关上肢淋巴水肿的可行性、安全性和有效性，目标是物理减容和淋巴再生。方法在这项前瞻性单臂探索性研究中，12例II期或III期乳腺癌相关上肢淋巴水肿患者行吸脂术后svf凝胶移植。主要终点是12个月时多余臂体积的变化。次要结局包括症状严重程度、生活质量（QoL；手臂、肩和手的残疾[DASH]和淋巴水肿生活质量问卷[lyqol]问卷）、蜂窝织炎的发生率和对压迫治疗的依赖。安全受到全程监控。统计分析包括使用Bonferroni校正、Wilcoxon和多元线性回归的重复测量方差分析（ANOVA），以比较基线的变化并确定影响臂体积的因素。结果12个月后，联合干预使手臂多余体积平均减少51%（从668.3±275.1 mL降至327.5±164.1 mL, P < 0.05）。在肢体重、张力、上肢功能和lyqol亚量表上观察到显著改善（P均为0.01）。3例患者停止压迫治疗。未发生蜂窝织炎或严重不良事件；轻微并发症无需干预即可解决。结论吸脂联合svf凝胶移植治疗晚期乳房切除术后上肢淋巴水肿是一种可行、安全、有效的方法，可改善患者症状和生活质量。鉴于缺乏关于这种联合技术的公开数据，我们的发现为未来的对照研究奠定了基础。
{"title":"A novel combined approach of stromal vascular fraction gel grafting and liposuction for postmastectomy upper extremity lymphedema: A prospective study","authors":"Shune Xiao , Miaomiao Wei , Junzhe Chen , Xiangkui Wu , Hai Li , Bihua Wu , Chengliang Deng","doi":"10.1016/j.bjps.2025.11.006","DOIUrl":"10.1016/j.bjps.2025.11.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Conventional therapies for postmastectomy upper extremity lymphedema often provide limited and temporary relief, especially in advanced cases. Although surgical interventions such as liposuction have improved outcomes, combining regenerative cell-based strategies with surgical volume reduction has not been systematically evaluated. This prospective study assessed the feasibility, safety, and efficacy of combining stromal vascular fraction (SVF)-gel grafting with liposuction, targeting physical debulking and lymphatic regeneration in breast cancer-related upper extremity lymphedema.</div></div><div><h3>Methods</h3><div>In this prospective, single-arm exploratory study, 12 patients with stage II or III breast cancer-related upper extremity lymphedema underwent liposuction followed by SVF-gel transplantation. The primary endpoint was change in excess arm volume at 12 months. Secondary outcomes included symptom severity, quality of life (QoL; Disabilities of the Arm, Shoulder and Hand [DASH] and Lymphedema Quality-of-Life Questionnaire [LYMQOL] questionnaires), incidence of cellulitis, and reliance on compression therapy. Safety was monitored throughout. Statistical analyses included repeated measures analysis of variance (ANOVA) with Bonferroni corrections, Wilcoxon, and multi-linear regression to compare changes from baseline and identify factors influencing arm volume.</div></div><div><h3>Results</h3><div>At 12 months, the combined intervention achieved a mean 51% reduction in excess arm volume (from 668.3 ± 275.1 to 327.5 ± 164.1 mL, P < 0.05). Significant improvements were observed in limb heaviness, tension, upper extremity function, and LYMQOL subscales (all P < 0.01). Three patients discontinued compression therapy. No cellulitis or serious adverse events occurred; minor complications resolved without intervention.</div></div><div><h3>Conclusion</h3><div>Combining liposuction with SVF-gel grafting is a feasible, safe, and effective approach for advanced postmastectomy upper limb lymphedema and for improving symptoms and QoL. Given the lack of published data on this combined technique, our findings lay the foundation for future controlled studies.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 29-38"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580026","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}
Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.bjps.2025.12.013
Berk B. Ozmen, Graham S. Schwarz
{"title":"Correspondence on: “Structural barriers and pathways to artificial intelligence integration in plastic surgery”","authors":"Berk B. Ozmen, Graham S. Schwarz","doi":"10.1016/j.bjps.2025.12.013","DOIUrl":"10.1016/j.bjps.2025.12.013","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 566-567"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796790","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}
Pub Date : 2026-02-01Epub Date: 2025-11-28DOI: 10.1016/j.bjps.2025.11.059
Lewis Price, Rob Duncan, Nick Wilson-Jones
Aims
Dog bites are a significant burden on the individual and NHS. This study aimed to identify social and environmental predictors to aid treatment, planning and prevention.
Methods
Data were collected for all incidences of people bitten/struck by dogs in Wales from April 2018 to March 2023, including age, sex, location, and socioeconomic status. Archived meteorological data for Wales was analysed, including maximum daily temperature, humidity, pressure and lunar phase. Finally, weekday/weekend, school holidays, season and COVID restrictions were also included as potential predictors.
Results
Overall, 3167 bites were identified (mean age = 40.2 years; 52.9% female). Poisson regression, ANOVA and Chi-squared tests were used to analyse different variables. An increase in dog bites was observed on weekends vs weekdays (p=0.033), during school holidays (p<0.001), on days with higher temperatures (p<0.001), when there were no COVID restrictions (p<0.001), post-COVID (p<0.001) and in summer vs winter and spring (p=0.015, p<0.001). Primary school children were more likely to be bitten in the most deprived areas (p<0.001), densely populated areas (p=0.002), and summer months (p<0.001).
Conclusions
These findings suggest that public health campaigns aimed at awareness surrounding the higher risk of dog bites in socially deprived areas, on warmer days, school holidays, on weekends and during the summer may help to reduce the burden of dog bites in Wales.
{"title":"Social and environmental predictors for dog bites in Wales: A retrospective study","authors":"Lewis Price, Rob Duncan, Nick Wilson-Jones","doi":"10.1016/j.bjps.2025.11.059","DOIUrl":"10.1016/j.bjps.2025.11.059","url":null,"abstract":"<div><h3>Aims</h3><div>Dog bites are a significant burden on the individual and NHS. This study aimed to identify social and environmental predictors to aid treatment, planning and prevention.</div></div><div><h3>Methods</h3><div>Data were collected for all incidences of people bitten/struck by dogs in Wales from April 2018 to March 2023, including age, sex, location, and socioeconomic status. Archived meteorological data for Wales was analysed, including maximum daily temperature, humidity, pressure and lunar phase. Finally, weekday/weekend, school holidays, season and COVID restrictions were also included as potential predictors.</div></div><div><h3>Results</h3><div>Overall, 3167 bites were identified (mean age = 40.2 years; 52.9% female). Poisson regression, ANOVA and Chi-squared tests were used to analyse different variables. An increase in dog bites was observed on weekends vs weekdays (p=0.033), during school holidays (p<0.001), on days with higher temperatures (p<0.001), when there were no COVID restrictions (p<0.001), post-COVID (p<0.001) and in summer vs winter and spring (p=0.015, p<0.001). Primary school children were more likely to be bitten in the most deprived areas (p<0.001), densely populated areas (p=0.002), and summer months (p<0.001).</div></div><div><h3>Conclusions</h3><div>These findings suggest that public health campaigns aimed at awareness surrounding the higher risk of dog bites in socially deprived areas, on warmer days, school holidays, on weekends and during the summer may help to reduce the burden of dog bites in Wales.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 428-434"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770224","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}
Pub Date : 2026-02-01Epub Date: 2025-11-13DOI: 10.1016/j.bjps.2025.11.020
Mark Fricke, Branislav Kollar, Ayla A. Hohenstein, Nico Leibig, Steffen U. Eisenhardt, Jakob B.W. Weiss
Background
In unilateral facial paralysis, overactivity of the contralateral depressor labii inferioris muscle (DLI) often contributes to persistent lower lip asymmetry after free functional gracilis transfer (FFGT). This issue can be addressed through dissection of DLI. We objectively evaluated the long term effects of DLI dissection after FFGT.
Methods
Patients with unilateral facial paralysis who underwent smile reconstruction with FFGT and subsequent DLI dissection between 2014 and 2023 were retrospectively analyzed. Lower lip height deviation was measured at different time points after DLI dissection.
Results
Thirty patients were included with a mean follow-up of 8.41 months. For smiling with exposed teeth, the mean lower lip height deviation significantly decreased from 5.06 mm to 2.58 mm (p < 0.001) following DLI dissection. When first clinical follow-up was conducted within six months, lower lip height deviation was reduced to 2.00 mm (p = 0.0003), follow-ups beyond six months showed a nonsignificant reduction to 3.72 mm. Long-term evaluations revealed initial improvements, followed by a partial regression of results over time (4.83 mm preoperatively, 1.59 mm at 3–7 months [p < 0.01], 3.66 mm at 13–17 months, 2.54 mm at 26–30 months postoperatively). One patient required revision surgery due to a neuroma of the lower lip and two underwent a second DLI dissection.
Conclusions
Dissection of the DLI is a safe and effective technique for improving lower lip symmetry after FFGT in the short term. However, the diminishing effect over time highlights the need for patient education about the expected long-term outcomes.
背景：在单侧面瘫中，游离功能性股薄肌转移（FFGT）后，对侧下唇下降肌（DLI）的过度活动通常导致持续的下唇不对称。这个问题可以通过剖析DLI来解决。我们客观评价FFGT后DLI剥离的长期效果。方法回顾性分析2014 ~ 2023年单侧面瘫患者行FFGT微笑重建及DLI剥离术的临床资料。在DLI解剖后不同时间点测量下唇高度偏差。结果30例患者入组，平均随访8.41个月。对于露出牙齿的微笑，DLI剥离后的平均下唇高度偏差从5.06 mm显著降低到2.58 mm （p < 0.001）。首次临床随访6个月时，下唇高度偏差减小至2.00 mm (p = 0.0003)， 6个月后随访，下唇高度偏差减小至3.72 mm，差异无统计学意义。长期评估显示初步改善，随后随着时间的推移结果部分回归（术前4.83 mm， 3-7个月1.59 mm [p < 0.01]， 13-17个月3.66 mm，术后26-30个月2.54 mm）。一名患者因下唇神经瘤需要翻修手术，两名患者接受了第二次DLI夹层。结论游离下唇夹层是改善FFGT术后下唇对称性的一种安全、有效的方法。然而，随着时间的推移，效果逐渐减弱，这凸显了对患者进行预期长期结果教育的必要性。
{"title":"Long-term outcomes of dissection of the depressor labii inferioris muscle to enhance symmetry after free functional gracilis muscle transfer in patients with facial paralysis","authors":"Mark Fricke, Branislav Kollar, Ayla A. Hohenstein, Nico Leibig, Steffen U. Eisenhardt, Jakob B.W. Weiss","doi":"10.1016/j.bjps.2025.11.020","DOIUrl":"10.1016/j.bjps.2025.11.020","url":null,"abstract":"<div><h3>Background</h3><div>In unilateral facial paralysis, overactivity of the contralateral depressor labii inferioris muscle (DLI) often contributes to persistent lower lip asymmetry after free functional gracilis transfer (FFGT). This issue can be addressed through dissection of DLI. We objectively evaluated the long term effects of DLI dissection after FFGT.</div></div><div><h3>Methods</h3><div>Patients with unilateral facial paralysis who underwent smile reconstruction with FFGT and subsequent DLI dissection between 2014 and 2023 were retrospectively analyzed. Lower lip height deviation was measured at different time points after DLI dissection.</div></div><div><h3>Results</h3><div>Thirty patients were included with a mean follow-up of 8.41 months. For smiling with exposed teeth, the mean lower lip height deviation significantly decreased from 5.06 mm to 2.58 mm (p < 0.001) following DLI dissection. When first clinical follow-up was conducted within six months, lower lip height deviation was reduced to 2.00 mm (p = 0.0003), follow-ups beyond six months showed a nonsignificant reduction to 3.72 mm. Long-term evaluations revealed initial improvements, followed by a partial regression of results over time (4.83 mm preoperatively, 1.59 mm at 3–7 months [p < 0.01], 3.66 mm at 13–17 months, 2.54 mm at 26–30 months postoperatively). One patient required revision surgery due to a neuroma of the lower lip and two underwent a second DLI dissection.</div></div><div><h3>Conclusions</h3><div>Dissection of the DLI is a safe and effective technique for improving lower lip symmetry after FFGT in the short term. However, the diminishing effect over time highlights the need for patient education about the expected long-term outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 113-120"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624701","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}
Pub Date : 2026-02-01Epub Date: 2025-11-15DOI: 10.1016/j.bjps.2025.11.029
Parhom Towfighi , John Hajj , Cynthia Cahya , Larry Chen , Angad S. Sidhu , Rachel M. Danforth , Aladdin H. Hassanein , Anthony J. Archual
Background
Postoperative wound complications remain a significant challenge in complex spinal fusion, particularly in patients with multiple comorbidities. Prophylactic muscle flap coverage can reduce these complications, but the specific patient populations most likely to benefit have not been consistently defined. This study evaluated the utility of the five-item modified frailty index (mFI-5) scores in identifying high-risk patients who may benefit from prophylactic muscle flap closure.
Methods
The American College of Surgeons National Surgical Quality Improvement Program database (2005–2020) was queried for patients ≥50 years old undergoing posterior-approach spinal surgery with and without prophylactic muscle flap closure. Patients with mFI-5 scores ≥2 were included, while revision and non-spine procedures were excluded. A 4:1 propensity score match was performed, comparing nonflap to flap patients. Postoperative complications were assessed with chi-square and Fisher’s exact tests, and outcomes were further analyzed using multivariate logistic regression.
Results
A total of 680 patients who underwent nonflap reconstruction were matched to 170 patients who underwent flap reconstruction. On univariate analysis, flap coverage was associated with reduced superficial surgical site infection (SSI) (0.6% vs 3.4%, p = 0.049) and increased bleeding requiring transfusion (35.3% vs 5.1%, p < 0.0001). On multivariate analysis, flap reconstruction was independently associated with a 94% reduction in odds of superficial SSI (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.008–0.498; p = 0.022), while higher body mass index (kg/m2) independently predicted SSI risk (OR, 1.09 per unit; 95% CI, 1.03–1.16; p = 0.003). Bleeding requiring transfusion was no longer significant.
Conclusion
Prophylactic muscle flap coverage significantly reduces superficial infection in frail patients (mFI-5 scores ≥2) undergoing spinal surgery. This provides a standardized framework to identify high-risk patients most likely to benefit from this approach.
背景：在复杂脊柱融合术中，尤其是有多种合并症的患者，术后伤口并发症仍然是一个重大挑战。预防性肌瓣覆盖可以减少这些并发症，但最可能受益的特定患者群体尚未得到一致的定义。本研究评估了五项修正虚弱指数（mFI-5）评分在识别可能受益于预防性肌瓣关闭的高危患者中的效用。方法查询美国外科医师学会国家外科质量改进计划数据库（2005-2020），查询≥50岁接受后入路脊柱手术并有或没有预防性肌瓣关闭的患者。mFI-5评分≥2的患者被纳入，而翻修和非脊柱手术被排除在外。对非皮瓣患者和皮瓣患者进行了4:1的倾向评分匹配。术后并发症采用卡方检验和Fisher精确检验评估，结果采用多变量logistic回归进一步分析。结果680例非皮瓣重建患者与170例皮瓣重建患者相匹配。在单因素分析中，皮瓣覆盖与手术部位浅表感染（SSI）减少（0.6% vs 3.4%, p = 0.049）和出血需要输血增加（35.3% vs 5.1%, p < 0.0001）相关。在多变量分析中，皮瓣重建与浅表SSI发生率降低94%独立相关（比值比[OR]， 0.062； 95%可信区间[CI]， 0.008-0.498; p = 0.022），而较高的体重指数（kg/m2）独立预测SSI风险（OR， 1.09 /单位；95% CI, 1.03-1.16; p = 0.003）。出血需要输血不再显著。结论预防性肌皮瓣覆盖可显著减少脊柱手术体弱患者（mFI-5评分≥2）的浅表感染。这提供了一个标准化的框架来识别最有可能从这种方法中受益的高危患者。
{"title":"Prophylactic muscle flap coverage in frail patients undergoing spinal surgery","authors":"Parhom Towfighi , John Hajj , Cynthia Cahya , Larry Chen , Angad S. Sidhu , Rachel M. Danforth , Aladdin H. Hassanein , Anthony J. Archual","doi":"10.1016/j.bjps.2025.11.029","DOIUrl":"10.1016/j.bjps.2025.11.029","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative wound complications remain a significant challenge in complex spinal fusion, particularly in patients with multiple comorbidities. Prophylactic muscle flap coverage can reduce these complications, but the specific patient populations most likely to benefit have not been consistently defined. This study evaluated the utility of the five-item modified frailty index (mFI-5) scores in identifying high-risk patients who may benefit from prophylactic muscle flap closure.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program database (2005–2020) was queried for patients ≥50 years old undergoing posterior-approach spinal surgery with and without prophylactic muscle flap closure. Patients with mFI-5 scores ≥2 were included, while revision and non-spine procedures were excluded. A 4:1 propensity score match was performed, comparing nonflap to flap patients. Postoperative complications were assessed with chi-square and Fisher’s exact tests, and outcomes were further analyzed using multivariate logistic regression.</div></div><div><h3>Results</h3><div>A total of 680 patients who underwent nonflap reconstruction were matched to 170 patients who underwent flap reconstruction. On univariate analysis, flap coverage was associated with reduced superficial surgical site infection (SSI) (0.6% vs 3.4%, <em>p</em> = 0.049) and increased bleeding requiring transfusion (35.3% vs 5.1%, <em>p</em> < 0.0001). On multivariate analysis, fla<em>p</em> reconstruction was independently associated with a 94% reduction in odds of superficial SSI (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.008–0.498; <em>p</em> = 0.022), while higher body mass index (kg/m<sup>2</sup>) independently predicted SSI risk (OR, 1.09 per unit; 95% CI, 1.03–1.16; <em>p</em> = 0.003). Bleeding requiring transfusion was no longer significant.</div></div><div><h3>Conclusion</h3><div>Prophylactic muscle flap coverage significantly reduces superficial infection in frail patients (mFI-5 scores ≥2) undergoing spinal surgery. This provides a standardized framework to identify high-risk patients most likely to benefit from this approach.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 219-226"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624704","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}
Pub Date : 2026-02-01Epub Date: 2025-11-23DOI: 10.1016/j.bjps.2025.11.046
Dorian Hobday , Muholan Kanapathy , Benedict Reed , Jason Kwok , Stephen Hamilton , Afshin Mosahebi , Jajini Varghese , Andrew Davenport , Naghmeh Naderi
Background
Upper limb lymphoedema is a debilitating post-operative complication of axillary lymph node clearance. Preventative lymphovenous anastomosis has been reported to significantly reduce the risk of lymphoedema. We present results on the incidence of lymphoedema and quality of life outcomes for a single center, prospective cohort study.
Method
Preventative lymphovenous anastomosis following axillary lymph node clearance, for breast cancer or skin cancer of the trunk, was performed at Royal Free Hospital London from March 2021 to October 2024 for 41 patients. The follow-up duration was 36 months. Incidence of lymphoedema was evaluated based on relative arm volume and bioimpedance measurements. Quality-of-life was assessed via Short Form-36 and Lymphoedema Life Impact Scale questionnaires.
Results
Of 38 patients, 2 (5.3%) developed lymphoedema, with an average follow-up of 22.5 months (1–36 months). Three patients were excluded due to disease recurrence. There was an increase in relative arm volume at 3-months post-operatively across the cohort (7.2% difference), but this was not statistically significant. Analysis of bioimpedance suggested that it is a useful proxy for relative arm volume measurement. Quality of life in this cohort did not appear to be markedly affected by post-operative time or incidence of lymphoedema. Subjective physical symptoms of lymphoedema occur in patients both with and without clinically diagnosed lymphoedema.
Conclusion
This is the first study to report the long-term outcomes with a follow-up of 36 months and correlate clinical and objective bioimpedance measurements alongside quality-of-life data. These data could guide the design of future clinical trials.
{"title":"Lymphovenous anastomosis for prevention of upper limb lymphoedema following axillary clearance: A prospective cohort study on clinical and quality of life outcomes","authors":"Dorian Hobday , Muholan Kanapathy , Benedict Reed , Jason Kwok , Stephen Hamilton , Afshin Mosahebi , Jajini Varghese , Andrew Davenport , Naghmeh Naderi","doi":"10.1016/j.bjps.2025.11.046","DOIUrl":"10.1016/j.bjps.2025.11.046","url":null,"abstract":"<div><h3>Background</h3><div>Upper limb lymphoedema is a debilitating post-operative complication of axillary lymph node clearance. Preventative lymphovenous anastomosis has been reported to significantly reduce the risk of lymphoedema. We present results on the incidence of lymphoedema and quality of life outcomes for a single center, prospective cohort study.</div></div><div><h3>Method</h3><div>Preventative lymphovenous anastomosis following axillary lymph node clearance, for breast cancer or skin cancer of the trunk, was performed at Royal Free Hospital London from March 2021 to October 2024 for 41 patients. The follow-up duration was 36 months. Incidence of lymphoedema was evaluated based on relative arm volume and bioimpedance measurements. Quality-of-life was assessed via Short Form-36 and Lymphoedema Life Impact Scale questionnaires.</div></div><div><h3>Results</h3><div>Of 38 patients, 2 (5.3%) developed lymphoedema, with an average follow-up of 22.5 months (1–36 months). Three patients were excluded due to disease recurrence. There was an increase in relative arm volume at 3-months post-operatively across the cohort (7.2% difference), but this was not statistically significant. Analysis of bioimpedance suggested that it is a useful proxy for relative arm volume measurement. Quality of life in this cohort did not appear to be markedly affected by post-operative time or incidence of lymphoedema. Subjective physical symptoms of lymphoedema occur in patients both with and without clinically diagnosed lymphoedema.</div></div><div><h3>Conclusion</h3><div>This is the first study to report the long-term outcomes with a follow-up of 36 months and correlate clinical and objective bioimpedance measurements alongside quality-of-life data. These data could guide the design of future clinical trials.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 389-398"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746117","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}
Pub Date : 2026-02-01Epub Date: 2025-12-23DOI: 10.1016/j.bjps.2025.12.024
I. Ibrahim, X. Chalhoub, F.P. Henry, J. Hunter
High body mass index (BMI) patients undergoing autologous breast reconstruction with the deep inferior epigastric perforator (DIEP) flap face the increased risk of wound healing complications, fat necrosis, and donor-site morbidity. While postoperative outcomes are well documented, the intraoperative technical challenges of flap harvest in this population are underreported. The heavy abdominal pannus complicates exposure, often necessitating experienced assistance and prolonging operative times. We describe a reproducible, single-operator DIEP flap harvest technique designed to overcome these challenges. The method involves limited incision and dissection to island only the required flap dimensions, sequential exposure down to fascia, and use of a suspension suture to secure the superior abdominal skin. Directional gravity and simple retraction thereby replace continuous assistant involvement. The superficial inferior epigastric vein (SIEV) is identified through a focussed longitudinal incision, eliminating the need for wide inferior pannus retraction. This approach minimises operator strain, reduces dependence on experienced assistance and provides controlled access to the flap perforators, as well as a long length of SIEV. In our experience, this technique has streamlined flap harvest, reduced surgeon energy expenditure, and shortened overall operative times in a technically demanding patient subgroup. By simplifying pannus management and optimising exposure, the technique enhances the safety, efficiency, and reproducibility of DIEP flap elevation in high-BMI patients. Adoption of this approach may broaden access to safe, autologous reconstruction for high-BMI patients and contribute to improved outcomes in this growing and often underserved population.
Lay summary
A new surgical approach makes breast reconstruction using tummy tissue safe and easier for patients with higher BMI. It improves visibility during surgery, reduces operating time and effort, and may help more patients access successful natural-tissue reconstructions.
{"title":"A single-operator technique for DIEP flap raise in high-BMI patients","authors":"I. Ibrahim, X. Chalhoub, F.P. Henry, J. Hunter","doi":"10.1016/j.bjps.2025.12.024","DOIUrl":"10.1016/j.bjps.2025.12.024","url":null,"abstract":"<div><div>High body mass index (BMI) patients undergoing autologous breast reconstruction with the deep inferior epigastric perforator (DIEP) flap face the increased risk of wound healing complications, fat necrosis, and donor-site morbidity. While postoperative outcomes are well documented, the intraoperative technical challenges of flap harvest in this population are underreported. The heavy abdominal pannus complicates exposure, often necessitating experienced assistance and prolonging operative times. We describe a reproducible, single-operator DIEP flap harvest technique designed to overcome these challenges. The method involves limited incision and dissection to island only the required flap dimensions, sequential exposure down to fascia, and use of a suspension suture to secure the superior abdominal skin. Directional gravity and simple retraction thereby replace continuous assistant involvement. The superficial inferior epigastric vein (SIEV) is identified through a focussed longitudinal incision, eliminating the need for wide inferior pannus retraction. This approach minimises operator strain, reduces dependence on experienced assistance and provides controlled access to the flap perforators, as well as a long length of SIEV. In our experience, this technique has streamlined flap harvest, reduced surgeon energy expenditure, and shortened overall operative times in a technically demanding patient subgroup. By simplifying pannus management and optimising exposure, the technique enhances the safety, efficiency, and reproducibility of DIEP flap elevation in high-BMI patients. Adoption of this approach may broaden access to safe, autologous reconstruction for high-BMI patients and contribute to improved outcomes in this growing and often underserved population.</div></div><div><h3>Lay summary</h3><div>A new surgical approach makes breast reconstruction using tummy tissue safe and easier for patients with higher BMI. It improves visibility during surgery, reduces operating time and effort, and may help more patients access successful natural-tissue reconstructions.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 687-689"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938560","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}
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