Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

英文中文

Lymfactin® gene therapy with vascularized lymph node transfer reduces compression-free swelling and enhances quality of life in breast cancer-related lymphedema: Final Phase I trial results lyfactin®基因治疗与血管化淋巴结转移减少无压迫性肿胀和提高乳腺癌相关淋巴水肿的生活质量：最终的I期试验结果

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.bjps.2025.10.013

Susanna Pajula , Anne Saarikko , Sinikka Suominen , Ilkka Kaartinen , Juha Kiiski , Erkki Suominen , Tiina Viitanen , Maija Mäki , Marko Seppänen , Outi Lahdenperä , Kari Alitalo , Pauliina Hartiala

Background

Lymfactin® is a gene-therapy vector encoding vascular endothelial growth factor C designed to promote lymphatic vessel growth. It is administered during vascularized lymph node transfer (VLNT) to treat breast cancer-related lymphedema. This study presents the final efficacy and long-term safety results of the Lymfactin® Phase I trial.

Methods

Between 2016 and 2018, 12 patients with breast cancer-related lymphedema received a therapeutic dose of Lymfactin® injected into the VLNT flap with or without autologous breast reconstruction. Patients were followed up annually for 4 years.

Results

The mean seven-day swelling volume, defined as the volume change after one week of compression interruption, decreased clearly compared to baseline at the three-year follow-up: 105.7 ±161.0 ml vs. 14.9 ± 174.2 ml. The total lymphedema quality of life (LQOLI) scores improved significantly from baseline to the three-year follow-up (p = 0.02). Within the LQOLI subdomains, physical (p < 0.01) and psychosocial (p = 0.01) scores showed significant improvement over 3 years postoperatively. Six of the 12 participants reduced or discontinued compression garment use within 3 years postoperatively. This group exhibited significantly smaller upper extremity volume differences than those who continued regular compression use (317.8 vs. 923.2 ml, p = 0.04). No serious adverse events were reported, and all the patients remained alive during the four-year follow-up.

Conclusion

This prospective multicenter study demonstrated that Lymfactin® with VLNT is safe and well tolerated. Although volume reduction was most evident in the first year, half of the patients reduced or discontinued compression use, and quality of life improved over long-term follow up.

背景：Lymfactin®是一种编码血管内皮生长因子C的基因治疗载体，旨在促进淋巴管生长。它是在血管化淋巴结转移（VLNT）期间给予治疗乳腺癌相关淋巴水肿。本研究展示了lyfactin®I期临床试验的最终疗效和长期安全性结果。方法：在2016年至2018年期间，12例乳腺癌相关淋巴水肿患者接受了治疗剂量的淋巴因子素®注射到VLNT皮瓣内，伴有或不伴有自体乳房重建。患者每年随访4年。结果：在3年随访期间，平均7天肿胀体积（定义为压缩中断1周后的体积变化）较基线明显下降：105.7±161.0 ml比14.9±174.2 ml。总淋巴水肿生活质量（LQOLI）评分从基线到3年随访期间显著改善（p = 0.02）。在LQOLI子域内，生理（p < 0.01）和心理社会（p = 0.01）评分在术后3年内均有显著改善。12名参与者中有6名在术后3年内减少或停止使用压缩服。该组上肢容积差异明显小于继续常规加压组（317.8 ml vs 923.2 ml, p = 0.04）。无严重不良事件报告，所有患者在四年随访期间均存活。结论：这项前瞻性多中心研究表明，lyfactin®治疗VLNT是安全且耐受性良好的。尽管容积减少在第一年最为明显，但有一半的患者减少或停止使用压迫，并且在长期随访中生活质量得到改善。

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引用次数: 0

Response to: “Correspondence on: Breast reduction outcomes in massive weight loss: A comparative analysis of GLP-1 receptor agonist users, post-bariatric surgery patients, and controls” 对“关于：大规模减肥的乳房缩小结果：GLP-1受体激动剂使用者、减肥手术后患者和对照组的比较分析”的回应。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.bjps.2025.10.036

Or Friedman, Daniel Tal

引用次数: 0

Correspondence on: Breast reduction outcomes in massive weight loss: A comparative analysis of GLP-1 receptor agonist users, post-bariatric surgery patients, and controls 大量减肥的乳房缩小结果：GLP-1受体激动剂使用者、减肥手术后患者和对照组的比较分析。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.bjps.2025.10.033

Federica Tomaselli, Roberta Albanese, Damiano Tambasco

引用次数: 0

Acknowledgement of Reviewers 审稿人致谢

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.bjps.2025.11.035

引用次数: 0

Commentary on: Lymfactin® gene therapy with vascularized lymph node transfer reduces compression-free swelling and enhances quality of life in BCRL: Final Phase I trial results lyfactin®基因治疗与血管化淋巴结转移减少无压迫性肿胀，提高BCRL患者的生活质量：最终I期试验结果。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.bjps.2025.10.037

James T. Paget, Vahe Fahradyan

引用次数: 0

Correspondence on: Racial disparities in research productivity among integrated plastic surgery applicants 通信：在综合整形外科申请人的研究生产力的种族差异。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-29 DOI: 10.1016/j.bjps.2025.11.058

Lawrence O. Lin, Allyson L. Huttinger, Jeffrey E. Janis

引用次数: 0

Superior gluteal artery perforator flap for autologous breast reconstruction: Refined surgical technique, outcomes, and patient satisfaction 臀上动脉穿支皮瓣用于自体乳房重建：精细的手术技术、结果和患者满意度。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-29 DOI: 10.1016/j.bjps.2025.11.062

J.M. Buijtendijk , E.D.H. Zonnevylle , D.A. Young-Afat

Background

Deep inferior epigastric perforator (DIEP) flaps are the gold standard for autologous breast reconstructions, but alternatives are needed when the abdomen is not optional. The superior gluteal artery perforator (SGAP) flap, using the gluteal region as donor site, is such an alternative. However, SGAP-flaps are not widely used for breast reconstructions due to technical and anatomical challenges, and potential donor site deformity. This study presents a slightly modified SGAP-flap harvesting technique for breast reconstructions aimed at optimizing outcomes and describes surgical and patient-reported outcomes.

Methods

An observational study (retrospective and cross-sectional) was conducted by including all women who underwent SGAP-flap breast reconstruction between May 2012 and March 2024 in a high-volume cancer center. Patient and surgical characteristics, (un)planned surgical revision rates, and patient-reported satisfaction were assessed using BREAST-Q (91% response rate).

Results

In total, 33 SGAP-flap breast reconstructions were performed in 26 patients. Mean ischemia time was 156 min. Four major complications (12%) requiring unplanned surgical intervention occurred, with no (partial) flap loss (i.e., 100% flap survival). Four flaps underwent planned secondary corrections (12%) of the donor site. Patient-reported donor site deformity and/or dissatisfaction was infrequent (n=2). Five patients underwent SGAP-flap on one side and DIEP-flap reconstruction contralaterally (15%), with similarly high patient-reported satisfaction and well-being scores for both sides.

Conclusions

High patient-reported satisfaction, and low complication and donor site deformity rates were observed in patients undergoing autologous breast reconstruction using a slightly refined SGAP-flap technique. This technique may be considered as an acceptable alternative for DIEP-flap breast reconstructions.

背景：深下腹穿支（DIEP）皮瓣是自体乳房重建的金标准，但当腹部不可选择时，需要其他选择。臀上动脉穿支（SGAP）皮瓣，利用臀区作为供体，就是这样一种选择。然而，由于技术和解剖学上的挑战以及潜在的供区畸形，sgap皮瓣并未广泛用于乳房重建。本研究提出了一种略为改进的sgap皮瓣采集技术用于乳房重建，旨在优化结果，并描述了手术和患者报告的结果。方法：一项观察性研究（回顾性和横断面），纳入2012年5月至2024年3月在一个大容量癌症中心接受sgap皮瓣乳房重建术的所有女性。使用BREAST-Q评估患者和手术特征、（未计划的）手术翻修率和患者报告的满意度（91%的有效率）。结果：26例患者共行33例sgap皮瓣乳房重建术。平均缺血时间156 min。发生了四个主要并发症（12%），需要进行计划外的手术干预，没有（部分）皮瓣丢失（即皮瓣存活率100%）。4个皮瓣在供区进行了计划的二次矫正（12%）。患者报告供体部位畸形和/或不满意的情况很少（n=2）。5例患者接受了单侧sgap -皮瓣和对侧diep -皮瓣重建（15%），患者报告的满意度和两侧幸福感评分相似。结论：采用略为改良的sgap皮瓣技术进行自体乳房重建，患者满意度高，并发症低，供区畸形率低。该技术可被认为是diep皮瓣乳房重建的一种可接受的替代方法。

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引用次数: 0

Usage patterns of regional anesthesia for panniculectomy in the United States 区域麻醉在美国胰腺切除术中的使用模式。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.054

Angad S. Sidhu , George S. Corpuz , Nikola Vuckovic , Dylan K. Kim , Ivan Hadad

Regional anesthesia (RA) reduces opioid consumption, improves postoperative pain control, and facilitates recovery. Although racial and ethnic disparities in RA use have been documented in various surgical fields, limited data exist on its use in plastic surgery and body contouring procedures. We aimed to evaluate the utilization of RA and potential disparities among patients undergoing panniculectomies. We conducted a retrospective cohort study using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2014 to 2020. Patients who underwent panniculectomies were analyzed, and adjunct peripheral nerve block use was evaluated. Multivariate logistical regression was used to evaluate associations between patient characteristics and RA usage. Among 8779 patients, 594 (6.8%) received RA for panniculectomies. Unadjusted analysis showed Black patients had significantly lower odds of receiving RA compared to White patients (OR 0.77, 95% CI 0.61–0.96, p=0.023), whereas patients classified as “Other” had higher odds (OR 2.64, 95% CI 1.50–4.62, p<0.001). After adjustment for age, sex, race, ethnicity, BMI, smoking status, diabetes, hypertension, chronic steroid use, COPD, CHF, dialysis, cancer, bleeding, and ASA class, no statistically significant differences in RA receipt for panniculectomy were observed by race or ethnicity. In this national cohort of patients undergoing abdominal body contouring surgery, no statistically significant racial or ethnic disparities in RA use were observed after adjustment. The low overall utilization of RA may suggest underuse in panniculectomies and highlights opportunities to optimize prophylactic pain management strategies for patients.

区域麻醉（RA）减少阿片类药物的消耗，改善术后疼痛控制，促进康复。尽管在不同的外科领域中，类风湿关节炎的使用存在种族和民族差异，但在整形外科和身体轮廓手术中，类风湿关节炎的使用数据有限。我们的目的是评估RA的使用情况以及在输卵管切除术患者中的潜在差异。我们使用美国外科医师学会-国家手术质量改进计划（ACS-NSQIP）数据库从2014年至2020年进行了一项回顾性队列研究。我们分析了接受胰腺小管切除术的患者，并评估了辅助周围神经阻滞的使用。多变量逻辑回归用于评估患者特征与RA使用之间的关系。在8779例患者中，594例（6.8%）接受了输卵管切除术。未经调整的分析显示，与白人患者相比，黑人患者接受RA的几率明显较低（OR 0.77, 95% CI 0.61-0.96, p=0.023），而归类为“其他”的患者的几率较高(OR 2.64, 95% CI 1.50-4.62, p

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引用次数: 0

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

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 10.1016/j.bjps.2025.11.052

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

Objective

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

Methods

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

Results

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

Conclusions

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

Level of Evidence

IV—Therapeutic

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

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引用次数: 0

Social and environmental predictors for dog bites in Wales: A retrospective study 威尔士狗咬伤的社会和环境预测因素：一项回顾性研究。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-28 DOI: 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.

目的：狗咬伤是个人和NHS的重大负担。这项研究旨在确定社会和环境的预测因素，以帮助治疗、计划和预防。方法：收集2018年4月至2023年3月威尔士所有被狗咬伤/撞伤的人的数据，包括年龄、性别、地点和社会经济地位。他们分析了威尔士存档的气象数据，包括最高日温度、湿度、压力和月相。最后，工作日/周末、学校假期、季节和COVID限制也被列为潜在的预测因素。结果：共发现咬伤3167例，平均年龄40.2岁，女性占52.9%。采用泊松回归、方差分析和卡方检验对不同变量进行分析。在周末与工作日相比，在学校假期期间，狗咬伤事件有所增加（p=0.033）。结论：这些发现表明，旨在提高人们对社会贫困地区狗咬伤风险较高的认识的公共卫生运动，在温暖的日子、学校假期、周末和夏季，可能有助于减轻威尔士狗咬伤的负担。

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