Journal of Plastic Reconstructive and Aesthetic Surgery最新文献_第7页

Rib-sparing subclavian vein decompression in venous thoracic outlet syndrome 锁骨下静脉减压术治疗胸廓出口静脉综合征。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-28 DOI: 10.1016/j.bjps.2024.10.038

Florian J. Jaklin , Hannes Platzgummer , Lukas Reissig , Udo Maierhofer , Andreas Gohritz , Konstantin D. Bergmeister , Oskar C. Aszmann

Objective

Venous thoracic outlet syndrome (VTOS), a compression syndrome of the subclavian vein at the costoclavicular junction, is commonly treated with first rib resection. This invasive procedure carries a risk of serious complications. The purpose of this single-center cross-sectional study was to evaluate the long-term outcome of non-bony decompression by resection of the subclavius muscle and tendon and to provide a detailed description of the procedure.

Methods

Patients who underwent rib-sparing decompression for VTOS between July 2014 and September 2023 were analyzed using clinical and radiological examinations. Patient-reported measures were used to assess functional disability and residual symptoms (Disabilities of the Arm, Shoulder and Hand—DASH) and disease-specific quality of life and symptoms (VEINES-QOL/SYM).

Results

Ten patients were included in the study. Seven were treated for Paget-Schroetter syndrome and three for McCleery syndrome. At a mean follow-up of 45.4 (standard deviation [SD] 31.0) months, all patients reported significant resolution of initial symptoms with patent vasculature on Doppler ultrasonography. All patients had a Villalta post-thrombotic syndrome score of <4, indicating the absence of post-thrombotic syndrome. A mean DASH score of 3.8 (SD 5.3) indicated minimal functional disability. Patients reported minimal overall impact on their quality of life, as reflected by a mean VEINES-QOL score of 92.6 (SD 8.9), and low severity of venous symptoms, as indicated by a mean VEINES-SYM score of 92.7 (SD 9.8).

Conclusion

Our analysis suggests that non-bony decompression with resection of the subclavius muscle and tendon is a safe and effective intervention for the definitive treatment of VTOS that is less invasive than first rib resection.

目的：静脉胸廓出口综合征（VTOS）是锁骨下静脉在肋锁交界处的压迫综合征，通常采用第一肋骨切除术进行治疗。这种侵入性手术存在严重并发症的风险。这项单中心横断面研究的目的是评估通过切除锁骨下肌肉和肌腱进行非骨性减压的长期疗效，并提供手术的详细描述：方法：对2014年7月至2023年9月期间因VTOS接受保肋减压术的患者进行临床和放射学检查分析。采用患者报告的方法评估功能障碍和残余症状（手臂、肩部和手部残疾-DASH）以及疾病特异性生活质量和症状（VEINES-QOL/SYM）：研究共纳入了 10 名患者。结果：研究共纳入了 10 名患者，其中 7 人接受了 Paget-Schroetter 综合征治疗，3 人接受了 McCleery 综合征治疗。在平均 45.4 个月（标准差 [SD] 31.0）的随访中，所有患者的最初症状均明显缓解，多普勒超声检查显示血管通畅。所有患者的 Villalta 血栓后综合征评分均为 "结论"：我们的分析表明，非骨性减压加锁骨下肌肉和肌腱切除术是一种安全有效的最终治疗 VTOS 的干预措施，其创伤性低于第一肋骨切除术。

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引用次数: 0

Redefining infection management in implant-based breast reconstruction: Insights and innovations from an 11-year retrospective analysis 重新定义假体乳房重建术中的感染管理：来自11年回顾性分析的见解和创新

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-28 DOI: 10.1016/j.bjps.2024.10.037

Glenda Giorgia Caputo , Anna Scarabosio , Jacopo Di Filippo , Alberto Pagotto , Carlo Tascini , Yanis Berkane , Pier Camillo Parodi

Background

Infections associated with implant-based breast reconstructive surgery are challenging for both patients and surgeons, often implying high recurrence rate, long treatments (both medical and surgical management), multiple invasive procedures, and delay of the end-result and, in some cases, even reconstruction failure. Early diagnosis is crucial but not always easy to achieve. Various treatment options are available and have been described in literature, with no clear winning strategy. Recent improvements in microbiological and therapeutic tools have led the authors to question what would be considered the best plan for reconstruction salvage approach.

Methods

All patients who underwent implant-based breast reconstruction between 2012 and 2023 were enrolled. Clinical records regarding infections and treatment were retrospectively analyzed.

Results

Among a total of 506 patients, 26 (5.14%) developed implant-associated infections. Discussing the results, we realized that previous protocol was old-fashioned and required improvements. Through a multidisciplinary approach, a new prevention and treatment algorithm was derived. First, microbiological screening through nasal and rectal swab allows for proper decontamination prior to intervention. However, the keystone improvement consists in the use of molecular biology analysis, thus minimizing diagnosis timing and allowing targeted antibiotic therapy shortly after the removal of the infected implant. In addition, a fundamental role is played using instillation negative pressure wound therapy as a temporary spacer to ensure the maintenance of the periprosthetic pocket.

Conclusions

By following these precise steps in case of implant-associated infection, treatment can be optimized to reduce both therapy and hospitalization time, allowing the patient to achieve a reconstruction in a relatively short period.

Level of evidence

IV

背景植入式乳房再造术相关的感染对患者和外科医生都是一个挑战，通常意味着高复发率、长期治疗（包括内科和外科治疗）、多次侵入性手术、延迟最终结果，在某些情况下甚至是重建失败。早期诊断至关重要，但并不总是容易实现。各种治疗方案可供选择，并已在文献中描述，没有明确的获胜策略。最近微生物学和治疗工具的改进使作者质疑什么是重建挽救方法的最佳计划。方法纳入2012 - 2023年间所有接受假体乳房重建术的患者。回顾性分析有关感染和治疗的临床记录。结果506例患者中，26例（5.14%）发生种植体相关感染。讨论结果时，我们意识到以前的协议是过时的，需要改进。通过多学科方法，推导出一种新的防治算法。首先，通过鼻腔和直肠拭子进行微生物筛查，可以在干预之前进行适当的去污。然而，关键的改进在于分子生物学分析的使用，从而最大限度地缩短了诊断时间，并允许在移除感染植入物后不久进行靶向抗生素治疗。此外，灌注负压创面治疗作为一种临时间隔物，对假体周围囊袋的维持起着重要的作用。结论在种植体相关感染的情况下，通过遵循这些精确的步骤，可以优化治疗，减少治疗和住院时间，使患者在相对较短的时间内实现重建。证据水平

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引用次数: 0

Clinicopathologic features and surgical management in vulvovaginal melanoma – A retrospective single-center study 外阴阴道黑色素瘤的临床病理特征和手术治疗--一项回顾性单中心研究。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-28 DOI: 10.1016/j.bjps.2024.10.035

Telma Lumiala, Virve Koljonen, Kaisu Ojala

Background and aims

Vulvovaginal melanoma is a rare malignancy with a poor prognosis. This study aimed to review cases of vulvovaginal melanoma treated at Helsinki University Hospital. Objective was to evaluate the clinicopathologic features, treatment, and factors affecting outcome.

Methods

A single-center retrospective review was conducted on patients treated between 2001 and 2021. Data were collected from medical records. Clinicopathologic features, treatment, survival, and prognostic factors were analyzed.

Results

A total of 21 patients were included in the analysis. Localization was vulvar in 86% (n = 18) and vaginal in 14% (n = 3). The median age at diagnosis was 80 years. Initial treatment included surgery in 18 patients (86%), with wide local excision in 19%, radical excision in 62%, and pelvic exenteration in 4.8%. Negative margins were achieved in 83% (n = 15). Eleven (52%) patients underwent inguinal treatment: sentinel lymph node biopsy in 33%, direct lymphadenectomy in 14%, and both in 4.8%. Nine patients experienced melanoma recurrence. Recurrences were locoregional (n = 1), distant (n = 4), and both locoregional and distant (n = 4). Median disease-free survival was 18.9M and median overall survival (OS) was 36.5M. The 5-year relative OS was 20%. Melanoma was the cause of death in seven patients (33%). Vaginal localization tended to worsen prognosis. Nodal status was the only melanoma characteristic significantly associated with survival. Surgical radicality did not affect survival.

Conclusions

Vulvovaginal melanoma is associated with extremely poor survival rates and high recurrence rates, primarily involving distant metastasis. In local control, wide local excision seems to be a viable alternative to more radical surgery. Nodal status is a key prognostic factor emphasizing the importance of further research into the applicability of sentinel lymph node biopsy for vulvovaginal melanoma.

背景和目的：外阴黑色素瘤是一种罕见的恶性肿瘤，预后较差。本研究旨在回顾赫尔辛基大学医院治疗的外阴阴道黑色素瘤病例。目的是评估临床病理特征、治疗方法和影响预后的因素：方法：对2001年至2021年间接受治疗的患者进行单中心回顾性研究。数据来自病历。分析临床病理特征、治疗、生存率和预后因素：结果：共有21名患者纳入分析。86%的患者为外阴癌（18 例），14%的患者为阴道癌（3 例）。诊断时的中位年龄为 80 岁。18名患者（86%）的初始治疗包括手术，其中19%为局部广泛切除术，62%为根治性切除术，4.8%为盆腔切除术。83%的患者（15 人）达到阴性边缘。11名患者（52%）接受了腹股沟治疗：33%的患者接受了前哨淋巴结活检，14%的患者接受了直接淋巴结切除术，4.8%的患者同时接受了前哨淋巴结活检和直接淋巴结切除术。九名患者黑色素瘤复发。复发类型包括局部复发（1 例）、远处复发（4 例）以及局部和远处复发（4 例）。中位无病生存期为1890万，中位总生存期（OS）为3650万。5年相对生存率为20%。7名患者（33%）的死因是黑色素瘤。阴道定位往往会使预后恶化。结节状态是唯一与生存率显著相关的黑色素瘤特征。手术根治性并不影响存活率：结论：外阴阴道黑色素瘤的生存率极低，复发率高，主要是远处转移。在局部控制方面，大范围局部切除似乎是根治性手术的可行替代方案。结节状态是一个关键的预后因素，强调了进一步研究前哨淋巴结活检对外阴阴道黑色素瘤的适用性的重要性。

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引用次数: 0

Assessing racial disparities in gender-affirming surgery utilization and hospital-level experience 评估性别确认手术使用方面的种族差异和医院层面的经验。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-25 DOI: 10.1016/j.bjps.2024.10.034

Peter E. Shamamian , Daniel Y. Kwon , Olachi Oleru , Nargiz Seyidova , Rebecca Suydam , Carol Wang , Keisha Montalmant , Elan Horesh , Peter J. Taub

Racial and ethnic minority groups as well as gender minorities seeking gender-affirming care and surgery have historically had difficulties with healthcare access and experience. The intersection of these two groups may result in deficient healthcare for patients of minority racial and ethnic groups seeking gender-affirming surgery. This study sought to explore differences in gender-affirming genital surgery experience by race. The 2018–2021 Healthcare Utilization Project National Inpatient Survey was queried for gender-affirming surgeries. Demographic, inpatient safety, and hospital-level characteristics were collected. Results were stratified by race and evaluated for significant differences. A total of 4605 patients were included in the study, 3345 patients were identified as White (73%), 320 as Black/African American (7%), 485 as Hispanic/Latino (11%), and 110 as Asian/Pacific Islander (2%). Black/African American patients experienced a higher rate of inpatient medical complications than the overall population (1% vs. 3%, P = 0.004) and had a longer length of stay (3 vs. 5 days, P < 0.001). The highest total charges were observed among Black/African American patients ($130,873, IQR $119,235, P < 0.001). Black/African American patients also less often experienced routine discharge (94% vs. 81%, P < 0.001) and more often required a higher level of care upon discharge, such as home healthcare or transfer to another facility (6% vs. 17%, P < 0.001). While the healthcare population is becoming more diverse, healthcare disparities still exist among non-White individuals receiving gender-affirming genital surgery. The present data suggest that Black/African American patients receiving gender-affirming genital surgery have more complicated hospital and discharge courses, and experience higher total hospital charges.

少数种族和少数族裔群体以及寻求性别确认护理和手术的少数性别群体在获得医疗保健服务和体验方面历来存在困难。这两个群体的交集可能会导致寻求性别确认手术的少数种族和少数族裔患者在医疗保健方面的不足。本研究旨在探索不同种族在性别确认生殖器手术体验方面的差异。2018-2021年医疗保健利用项目全国住院患者调查对性别确认手术进行了查询。收集了人口统计学、住院患者安全和医院层面的特征。结果按种族进行分层，并评估是否存在显著差异。共有 4605 名患者被纳入研究，其中 3345 名患者被确认为白人（73%），320 名患者被确认为黑人/非洲裔美国人（7%），485 名患者被确认为西班牙裔/拉丁美洲人（11%），110 名患者被确认为亚洲/太平洋岛民（2%）。黑人/非洲裔美国人患者的住院医疗并发症发生率高于总人口（1% 对 3%，P = 0.004），住院时间也更长（3 天对 5 天，P = 0.005）。

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引用次数: 0

The impact of cosmetic tourism across one year on an NHS breast surgery unit 美容旅游对英国国家医疗服务体系乳腺外科一年的影响。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-25 DOI: 10.1016/j.bjps.2024.10.036

Daniel Ahari , Zara R. Zaccariah , Michael Preston , Lyndsey Highton

Background

This is a review of patients managed by our single-site breast surgery service for complications of cosmetic surgeries performed abroad and within the UK, across September 2022–2023.

Methods

A retrospective review of outpatient clinic and emergency theatre lists was used to identify patients; data was collected from their electronic records.

Results

25 patients (23 female) were identified, 20 had surgery abroad. Turkey was the most common destination that patients travelled to (n = 15), with bilateral breast augmentation being the most common procedure (n = 15). Post-operative infection and wound dehiscence (n = 10 and n = 8, respectively) were the most common complications; 72% (n = 18) of patients presented within 8 weeks of their surgery. There was incomplete recording of surgical details including precise date (recorded for 48%), clinic name (8%), and name of the surgeon (0%). 17 microbiological samples were sent, with 11 resulting in a named organism - Staphylococcus aureus was most common (n = 5). 17 (68%) cases were treated conservatively, without radiological or surgical interventions. When surgical management occurred (n = 6), it was for removal of breast implants (n = 5) or evacuation of haematoma (n = 1). The cost of managing these complications was at least £37,000.

Conclusion

Complications from cosmetic tourism present more commonly to the NHS than those resulting from private surgery performed in the UK. This has significant financial implications for the NHS. More accurate recording of relevant data, engagement in audits, and disseminating findings may help raise awareness of the risks and complications of cosmetic surgery performed abroad.

背景：这是一项对 2022 年 9 月至 2023 年 9 月期间，由我们的单点乳房手术服务管理的、在国外和英国国内进行的整容手术并发症患者进行的审查：这是对2022年9月至2023年9月期间，由我们的单点乳房外科服务管理的、在国外和英国国内进行的整容手术并发症患者的回顾：方法：对门诊和急诊室名单进行回顾性审查，以确定患者身份；从患者的电子记录中收集数据。结果：确定了25名患者（23名女性），其中20人在国外接受了手术。土耳其是患者最常前往的目的地（15 人），双侧隆胸是最常见的手术（15 人）。术后感染和伤口开裂（分别为10例和8例）是最常见的并发症；72%的患者（18例）在术后8周内出现并发症。手术细节记录不完整，包括精确日期（48%）、诊所名称（8%）和外科医生姓名（0%）。共发送了 17 份微生物样本，其中 11 份样本检出了指定的病原体--金黄色葡萄球菌最为常见（5 份）。17例（68%）病例采用保守治疗，未进行放射或手术干预。手术治疗的病例（6 例）主要是为了取出乳房假体（5 例）或清除血肿（1 例）。这些并发症的治疗费用至少为 3.7 万英镑：结论：与在英国进行的私人手术相比，在英国国家医疗服务系统（NHS）中出现的美容旅游并发症更为常见。这对英国国家医疗服务体系（NHS）造成了重大的财政影响。更准确地记录相关数据、参与审计和传播审计结果可能有助于提高人们对在国外进行整容手术的风险和并发症的认识。

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引用次数: 0

Nail reconstruction using an osteo-onychocutaneous flap with the dorsal digital artery of the hallux as the pedicle: Techniques and anatomical insights 使用骨onychocutaneous皮瓣，以拇指背侧数字动脉为蒂进行钉子重建：技术和解剖学见解

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-24 DOI: 10.1016/j.bjps.2024.10.033

Takeo Matsusue

Nail reconstruction with preserved pulp tissue can be challenging due to the use of oversized flaps, and nail deformities often resulting from bone resorption. This study describes a novel technique using the dorsal digital artery of the hallux as a pedicle for an osteo-onychocutaneous flap. A preoperative handheld Doppler was used to identify the course of the dorsal digital artery, and intraoperatively, the flap was elevated without disturbing the plantar tissue, thereby minimizing the risk of foot complications. A prospective study was conducted on all partial toe transplantation cases between September 2020 and March 2023 to analyze the anatomical variations of the dorsal digital artery. Thirty-one patients were included in the study. The dorsal digital artery was successfully identified preoperatively and confirmed intraoperatively in all cases. It branched from the first dorsal metatarsal artery in 24 cases and the plantar digital artery in seven cases. The branching location was found to be 24.3 ± 4.5 mm proximal to the web in the former group and 3.9 ± 3.9 mm (p < 0.001) in the latter group. The vascular diameter at the branching site was measured to be 0.8 ± 0.2 mm, with no significant difference based on the location. Nail reconstruction procedures were successfully performed using this flap for defects in the thumb, index finger, and little finger. Stable nails were reconstructed in all cases with minimal foot complications. In conclusion, this technique offers a reliable approach to nail reconstruction, minimizing donor site morbidity and preserving natural nail morphology.

由于使用过大的皮瓣以及骨吸收导致的指甲畸形，使用保留的牙髓组织进行指甲重建具有挑战性。本研究介绍了一种使用拇指背侧数字动脉作为骨-腱-皮瓣蒂的新技术。术前使用手持多普勒确定背侧数字动脉的走向，术中在不干扰足底组织的情况下将皮瓣抬高，从而将足部并发症的风险降至最低。一项前瞻性研究针对 2020 年 9 月至 2023 年 3 月期间的所有足趾部分移植病例，分析了足背动脉的解剖变异。研究共纳入 31 名患者。所有病例的足背动脉均在术前成功识别，并在术中得到确认。有 24 例患者的足背数字动脉是从第一跖背动脉分支而来，有 7 例患者的足底数字动脉是从足底数字动脉分支而来。发现前一组的分支位置在蹼的近端 24.3 ± 4.5 毫米，后一组为 3.9 ± 3.9 毫米（p < 0.001）。据测量，分支部位的血管直径为 0.8 ± 0.2 毫米，不同位置的血管直径差异不大。拇指、食指和小指缺损时，使用该皮瓣成功进行了指甲重建手术。所有病例都重建了稳定的指甲，足部并发症极少。总之，这种技术为指甲重建提供了一种可靠的方法，最大限度地降低了供体部位的发病率，并保留了指甲的自然形态。

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引用次数: 0

The roles of extracranial intravascular lesion, vasodilation-induced neural entrapment, and arteriolysis in migraine treatment 颅外血管内病变、血管扩张引起的神经卡压和动脉溶解在偏头痛治疗中的作用

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-24 DOI: 10.1016/j.bjps.2024.10.032

Valdas Macionis

The few available studies of biopsies performed during migraine surgery have revealed intravascular changes of the occipital and superficial temporal arteries. It is not clear whether these abnormalities are purely of local origin or of systemic nature. This letter discusses possible associations between extracranial vascular alterations and vasodilatory neural entrapment. Exploration of spatial differences in vascular morphology of the involved arteries could provide further insights.

现有的少数偏头痛手术活检研究显示，枕动脉和颞浅动脉的血管内发生了变化。目前尚不清楚这些异常是纯粹的局部性还是全身性的。这封信讨论了颅外血管改变与血管扩张性神经卡压之间可能存在的关联。对受累动脉血管形态的空间差异进行探讨可提供进一步的见解。

引用次数: 0

Reduction mammaplasty relieves depression in women with macromastia: A systematic review 乳房缩小整形术可缓解巨乳症女性的抑郁：系统综述。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-23 DOI: 10.1016/j.bjps.2024.10.011

Kaiser O’Sahil Sadiq , Patricia Ruiz Cota , Rebekah Creamer , Monali Mahedia , Marek Krzysztof Dobke

Introduction

A total of 71,364 breast reductions were performed in 2022, which demonstrates a 54% increase from 2019. Women most often seek breast reduction surgery for pain, but psychological symptoms may be equally distressing, particularly those who are younger. These women may also suffer low self-esteem, inhibitions in intimacy, and reluctance to exercise, which may contribute to depressive symptoms.

Methods

A systematic review was conducted using PRISMA guidelines and registered on PROSPERO (CRD42023456884). Cochrane Library, Embase, and Pubmed were searched for RCTs in English irrespective of timeframe. The studies were screened using the RoB2 tool, and data was extracted using standardized tables.

Results

The search strategy yielded 84 references, and only three were eligible for inclusion. The sample size collectively amounted to 193. The tools used to assess depressive symptoms were the Beck Depression Inventory, a modification of this tool, and the Hospital Anxiety Depression Score. All three studies showed a significant reduction in depression scores.

Conclusions

Breast hypertrophy may cause impairment in several key psychological domains including depression, which may be relieved with surgery. Standardized assessment tools and scoring systems may enable more comprehensive evaluation and potentially lead to guidelines defining broader criteria as indications for surgery. Further investigation into the differences between women who seek breast reduction surgery versus those who do not may provide insights into other contributing factors that may be at play. Further trials should be designed with longer durations of follow-up to investigate the long-term effects of breast reduction surgery.

导言2022年共进行了71364例乳房缩小手术，比2019年增加了54%。女性最常因疼痛而寻求乳房缩小手术，但心理症状可能同样令人苦恼，尤其是年轻女性。这些女性还可能自卑、在亲密关系中受到抑制、不愿运动，这些都可能导致抑郁症状：采用 PRISMA 指南进行了一项系统性综述，并在 PROSPERO（CRD42023456884）上进行了注册。我们在 Cochrane Library、Embase 和 Pubmed 上搜索了英文的 RCT，不论时间框架如何。使用 RoB2 工具对研究进行筛选，并使用标准化表格提取数据：搜索策略共获得 84 篇参考文献，只有 3 篇符合纳入条件。样本量合计为 193 个。用于评估抑郁症状的工具是贝克抑郁量表（Beck Depression Inventory）、该工具的改良版以及医院焦虑抑郁评分（Hospital Anxiety Depression Score）。三项研究均显示抑郁评分明显降低：结论：乳房肥大症可能会导致包括抑郁在内的多个关键心理领域受损，而手术可能会缓解这一症状。标准化的评估工具和评分系统可以进行更全面的评估，并有可能制定出更广泛的手术适应症标准指南。进一步调查寻求乳房缩小手术的女性与不寻求手术的女性之间的差异，可能会对其他可能起作用的因素有所启发。进一步的试验应设计更长的随访时间，以调查乳房缩小手术的长期效果。

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引用次数: 0

A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients 使用带蒂IMAP皮瓣进行延迟乳房重建和对侧对称乳房成形术的乳房共享技术：病例系列和手术技术在选定患者中的演变

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-19 DOI: 10.1016/j.bjps.2024.09.087

Moustapha Hamdi, Karl Waked, Randy De Baerdemaeker, Pawel Szychta, Lisa Ramaut, Gabriele Giunta, Alexandru Nistor

Introduction

The ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety.

Patients and methods

Between April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed.

Results

In all the cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5.6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option.

Conclusions

The breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using indocyanine green imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low, and thus, the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction.

Level of evidence

Level IV

导言 "乳房共享 "手术使用一次性组织作为皮瓣来重建乳房切除术后的缺损。这样就可以同时进行乳房重建和对侧对称，而不会增加供体部位的发病率。然而，有关该手术的肿瘤安全性的争议阻碍了它的广泛应用。我们旨在介绍这种基于带蒂乳腺内动脉穿孔器（IMAP）皮瓣的技术，并讨论其技术可行性和肿瘤安全性。患者和方法在2013年4月至2022年5月期间，连续10名患者接受了使用带蒂IMAP皮瓣进行乳房重建的乳房共享手术。结果在所有病例中，乳房共享技术可同时实现乳房重建和对侧乳房对称。即刻并发症包括两例全静脉充血和一例血肿。三个皮瓣远端充血。一个皮瓣需要清创和局部皮瓣重建。所有皮瓣都需要在二次手术中进行脂肪移植，以改善乳房的对称性。平均随访 5.6 年，无复发迹象。结论基于IMAP皮瓣的乳房共享技术结合了乳房重建和对侧对称，对选定的患者具有良好的美学效果。该皮瓣与静脉引流相关的并发症发生率较高。修改皮瓣设计和使用吲哚菁绿成像可减少静脉充血。如果皮瓣持续充血，强烈建议在腋窝进行二次静脉微吻合。据报道，对侧乳腺癌的发病率很低，因此，对侧乳房乳房皮瓣成形术中获得的残余组织可安全地用于乳房重建。

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引用次数: 0

Impact of intraoperative intravenous tranexamic acid on hematomas and bleeding events in gender-affirming vaginoplasty patients 术中静脉注射氨甲环酸对性别确认阴道成形术患者血肿和出血事件的影响。

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2024-10-18 DOI: 10.1016/j.bjps.2024.10.031

Peter E. Shamamian , Anya Wang , Subha Karim , Derek Chen , Carol Wang , Keisha Montalmant , John Henry Pang , Avra Laarakker , Bella Avanessian , Jess Ting , Elan Horesh

One of the more common and disruptive complications of gender-affirming vaginoplasty is postoperative bleeding. The present study aimed to evaluate the impact of intraoperative intravenous tranexamic acid (IV TXA) administration on postoperative bleeding events in a large sample of gender-affirming vaginoplasty patients. Patients undergoing gender-affirming vaginoplasty between June 2019 and July 2023 were evaluated retrospectively. IV TXA use, estimated blood loss, and bleeding complications were evaluated. Postoperative complications included minor hematomas, defined as hematomas requiring conservative treatment; major hematomas, defined as hematomas requiring intervention such as return to the operating room and readmission; major bleeding, defined as continuous bleeding from the surgical site requiring intervention; and readmission and reoperation related to bleeding. Statistical significance was set at p < 0.05. In total, 628 patients were included in the study, 271 did not receive IV TXA and 357 received IV TXA. Surgeon preference dictated IV TXA use. Significantly fewer patients in the IV TXA group had hematoma (18% vs. 2%, p < 0.001), minor hematoma (16% vs. 3%, p < 0.001), postoperative major bleeding (4% vs. 2%, p = 0.008), and readmission for bleeding (6% vs. 1%, p = 0.018). Logistic regression analysis revealed that IV TXA use was associated with decreased odds of developing any type of hematoma (OR 0.140, 95% CI 0.071–0.277, p < 0.001), minor hematoma (OR 0.126, 95% CI 0.059–0.270, p < 0.001), and postoperative bleeding (OR 0.348, 0.153–0.794, p = 0.012). The use of IV TXA reduced certain bleeding events and complications that can cause distress in the postoperative period in gender-affirming vaginoplasty patients.

术后出血是性别确认阴道成形术中较为常见且具有破坏性的并发症之一。本研究旨在评估术中静脉注射氨甲环酸（IV TXA）对大样本性别确认阴道成形术患者术后出血事件的影响。对2019年6月至2023年7月期间接受性别确认阴道成形术的患者进行了回顾性评估。对静脉注射 TXA 的使用情况、估计失血量和出血并发症进行了评估。术后并发症包括：轻微血肿，定义为需要保守治疗的血肿；严重血肿，定义为需要干预的血肿，如返回手术室和再次入院；大出血，定义为需要干预的手术部位持续出血；以及与出血相关的再次入院和再次手术。统计显著性以 p

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