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

Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma – A systematic review of literature 乳房植入物相关间变性大细胞淋巴瘤的流行病学-文献系统综述。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-20 DOI: 10.1016/j.bjps.2025.11.038

Michail Sorotos , Guido Firmani , Theodor Mareş , Alessandra Ceccaroni , Fabio Santanelli di Pompeo

Introduction

Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL) cases are steadily increasing worldwide. When considering only the patients with textured implant as the active population, prevalence appears higher than previously reported, and uncertainty regarding incidence rate (IR) trends. We aimed to provide comprehensive estimates by identifying epidemiologic studies reporting prevalence, risk, and IR.

Methods

A systematic review was conducted up to November 2024 across PubMed, Google Scholar, and Web of Science. Epidemiological data were extracted from the “Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology” (PROFILE) registry (US-specific), Food and Drug Administration (FDA)-Medical Device Reporting (MDR) (US/global), and BIA-ALCL Global Network (worldwide), providing granular data for 2019–2024, enabling yearly IR analysis. All findings were normalized using textured implants patients as the denominator. Interrupted time-series analysis was used to determine the impact of the COVID-19 pandemic on BIA-ALCL reporting.

Results

Among the 1949 studies, 23 were analyzed. Prevalence: 1.0–397.9/100,000 persons; risk: 1:250–1:99,992; and IR 0.021–124/100.000 persons/year. Nationally (US), PROFILE and FDA-MDR data showed IR peaking in 2020 (16.4 and 25.7/100,000) and then declining. Globally, FDA-MDR estimates peaked in 2021 (0.95/100,000) and plummeted in 2022 (0.14/100,000). Global Network data peaked in 2018 (0.68/100,000), dropped in 2020 (0.18/100,000), but rose again in 2024 (0.73/100,000). Significant IR declines (p = 0.02), were identified during the COVID-19 pandemic (2020–2022). Global data suggest transient underreporting and diagnostic delays.

Conclusion

BIA-ALCL IR decreased in 2022, then rose globally in 2023–2024, but not in the US, where it continued declining. IR trends were increasing but were influenced by COVID-19, with differences in absolute values likely reflecting smooth vs. textured implant market share variations. Contextualizing epidemiology by surface type and geography remains fundamental.

简介：乳房植入物相关的间变性大细胞淋巴瘤（BIA-ALCL）病例在世界范围内稳步增加。当仅考虑有纹理植入物的患者作为活动人群时，患病率似乎高于先前报道，并且发病率（IR）趋势不确定。我们的目的是通过确定报告患病率、风险和IR的流行病学研究来提供全面的估计。方法：到2024年11月，通过PubMed、b谷歌Scholar和Web of Science进行系统评价。流行病学数据提取自“乳房植入物和间变性大细胞淋巴瘤病因学和流行病学的患者登记和结果”（PROFILE）登记（美国特定），食品和药物管理局(FDA)-医疗器械报告（MDR）（美国/全球）和BIA-ALCL全球网络（全球），提供2019-2024年的颗粒数据，实现年度IR分析。所有结果均以有纹理植入物患者为分母进行归一化。采用中断时间序列分析确定COVID-19大流行对BIA-ALCL报告的影响。结果：在1949项研究中，分析了23项。患病率：1.0-397.9/10万人；风险:1:250-1:99,992;IR为0.021-124/ 100000人/年。在全国范围内（美国），PROFILE和FDA-MDR数据显示IR在2020年达到峰值（16.4和25.7/100,000），然后下降。在全球范围内，FDA-MDR估计在2021年达到峰值（0.95/10万），并在2022年暴跌（0.14/10万）。全球网络数据在2018年达到峰值（0.68/10万），在2020年下降（0.18/10万），但在2024年再次上升（0.73/10万）。在2019冠状病毒病大流行期间（2020-2022年），IR显著下降（p = 0.02）。全球数据显示短暂的少报和诊断延误。结论：BIA-ALCL IR在2022年下降，然后在2023-2024年全球上升，但在美国没有继续下降。IR趋势正在增加，但受COVID-19的影响，绝对值的差异可能反映了光滑与纹理植入物市场份额的变化。根据地表类型和地理将流行病学背景化仍然是基本的。

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引用次数: 0

Surgical management of pediatric facial Congenital Melanocytic Naevi and use of the novel Patient-Reported Outcome Measure: SCAR-Q to assess outcomes 儿童面部先天性黑素细胞痣的手术治疗和使用新的患者报告的结果测量：SCAR-Q来评估结果。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-20 DOI: 10.1016/j.bjps.2025.11.036

Theodore Howard , Arwa Sindi , Whitney Quong , Gaynor Osman , Brigitte Harrison , Debra Lomas , Veronica Kinsler , Neil Bulstrode

Congenital Melanocytic Naevi (CMN) are benign proliferations of melanocytes present at birth or shortly thereafter. Surgical management is primarily driven by cosmetic and psychosocial considerations, particularly for facial lesions. This study represents the first application of the SCAR-Q Patient-Reported Outcome Measure (PROMs) to assess the outcomes of excision and reconstruction in patients with facial CMN. Over a 10-year period, 71 patients were included, with 28 (39%) completing the SCAR-Q and Patient & Observer Scar Assessment Scale (POSAS) questionnaires. The mean age at surgery was 6.25 years and mean age at data collection was 15 years. Surgical procedures varied and included excision with primary closure, serial excision, skin grafting, and tissue expansion. Overall, patients expressed high satisfaction with the cosmetic outcomes and minimal psychological impact from scarring. However, no statistically significant correlations were found between gender, lesion location, or surgical technique and PROMs scores. The SCAR-Q is a validated tool that provides a comprehensive assessment of scar appearance, symptoms, and psychosocial impact and should be considered in future evaluations of surgical outcomes for CMN.

先天性黑素细胞痣（CMN）是出生时或出生后不久黑色素细胞的良性增生。手术治疗主要是由美容和社会心理因素驱动的，特别是面部病变。本研究首次应用SCAR-Q患者报告结果测量（PROMs）来评估面部CMN患者切除和重建的结果。在10年的时间里，纳入了71例患者，其中28例（39%）完成了Scar - q和患者与观察者疤痕评估量表（POSAS）问卷调查。手术时平均年龄为6.25岁，收集资料时平均年龄为15岁。手术方法多种多样，包括初步闭合切除、连续切除、皮肤移植和组织扩张。总体而言，患者对美容效果和最小的疤痕心理影响表示高度满意。然而，性别、病变部位或手术技术与PROMs评分之间没有统计学上显著的相关性。scar - q是一种经过验证的工具，可提供疤痕外观、症状和心理社会影响的综合评估，在未来评估CMN手术结果时应予以考虑。

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引用次数: 0

Can we “overcorrect” our way to normal appearance in metopic craniosynostosis? A single-center’s 33 year odyssey 异位性颅缝闭闭是否可以“矫枉过正”以达到正常的外观？一个单一中心的33年奥德赛。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-20 DOI: 10.1016/j.bjps.2025.11.041

Allison C. Hu, Carrie Z. Morales, Aaron T. Zhao, Philip D. Tolley, Nicholas A. Han, Isabel A. Ryan, Dominic J. Romeo, Jordan W. Swanson, Scott P. Bartlett, Jesse A. Taylor

Background

To better expand the anterior cranial fossa and account for growth and relapse after traditional fronto-orbital advancement (FOA), an intentional “overcorrection” technique was adopted by our institution in 2012. This study compared long-term clinical and aesthetic outcomes between traditional (T-FOA) and overcorrection (O-FOA) approaches.

Methods

A retrospective review was performed of all children who underwent FOA for isolated metopic craniosynostosis from 1987 to 2020. Patients with ≥4 years follow-up were included.

Results

Among the 270 patients who underwent FOA, 166 (61.5%) patients met the inclusion criteria (n=100 (60.2%) T-FOA and n=66 (39.8%) O-FOA). Mean age at surgery was 10.9±6.3 months with follow-up of 9.5±4.1 years. There were 13 (7.8%) surgical complications, and 40 (24.1%) patients underwent at least one secondary surgery, more commonly in the T-FOA cohort (35.0% vs. 7.6%, p<0.001). In the intermediate term, T-FOA patients had higher Whitaker scores (2.2±1.0 vs. 1.5±0.8, p<0.001) and were more likely to have palpable bony irregularities (64.0% vs. 21.2%, p<0.001), visible irregularity (68.0% vs 48.5%, p=0.012), and lateral orbital retrusion (48.0% vs. 15.2%, p<0.001) compared to O-FOA. However, in subgroup analysis of patients ≥10 years old postoperatively (n=85), aesthetic outcomes (Whitaker 2.1±1.0 vs. 2.4±1.0, p=0.167) and revisions (48.6 vs. 26.7%, p=0.122) were comparable between the cohorts.

Conclusion

FOA with overcorrection is a safe and effective approach for improving aesthetic outcomes in the intermediate term. Its association with aesthetic decline over time highlights the importance of long-term follow-up until skeletal maturity. Further research is needed to better understand the underlying causes of relapse.

背景：为了更好地扩大颅前窝，考虑传统额眶前进（FOA）术后的生长和复发，我院于2012年采用了一种有意的“过矫”技术。本研究比较了传统（T-FOA）和过度矫正（O-FOA）方法的长期临床和美学结果。方法：回顾性分析1987年至2020年所有接受FOA治疗孤立性异位颅缝闭锁的儿童。纳入随访≥4年的患者。结果：270例FOA患者中，166例（61.5%）患者符合纳入标准，其中T-FOA 100例（60.2%），O-FOA 66例（39.8%）。平均手术年龄10.9±6.3个月，随访9.5±4.1年。有13例（7.8%）手术并发症，40例（24.1%）患者至少接受了一次二次手术，在T-FOA队列中更为常见（35.0% vs. 7.6%）。结论：FOA过度矫正是一种安全有效的中期改善美学效果的方法。随着时间的推移，它与审美下降的关系突出了长期随访直到骨骼成熟的重要性。需要进一步的研究来更好地了解复发的潜在原因。

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引用次数: 0

The hidden brain in cleft: Clinical presentation in patients with median cerebrofacial dysgenesis 腭裂隐脑：中位脑面发育不全患者的临床表现。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-20 DOI: 10.1016/j.bjps.2025.11.039

Anna Tan, Rafael Denadai, Joseph Luo, Lun-Jou Lo

Background

Median cerebrofacial dysgenesis (MCFD) is a rare subset of median cerebrofacial malformations, characterized by cleft, hypoplasia/agenesis of midline facial structures in association with brain anomalies. It remains underrecognized and poorly characterized. This study defines craniofacial and neuroimaging features and evaluates the correlations in MCFD.

Methods

A retrospective review was conducted on 33 patients with MCFD at Chang Gung Memorial Hospital. Inclusion criteria were cleft lip/palate and median craniofacial anomalies with available brain scans. Craniofacial morphology, neuroimaging findings, and survival were analyzed.

Results

There were 13 males and 20 females. Nineteen had bilateral and 14 had unilateral clefts. They exhibited microcephaly with their head circumference less than 3rd percentile for age and gender. Common brain anomalies included hypoplastic to absent septum pellucidum/corpus callosum, frontal lobe fusion, thalamic/basal ganglia fusion, and ventriculomegaly. Craniofacial findings included absent to hypoplastic prolabium/premaxilla, absent upper labial frenulum, nasal hypoplasia, and hypotelorism. Twelve patients survived with severe psychomotor delay and 21 died with a mean lifespan of 9.2 months. Greater forebrain fusion was significantly associated with lower survival. In contrast, there was no significant difference in survival between patients with absent and those with hypoplastic prolabium/premaxilla. No correlation was found between craniofacial severity and brain anomalies.

Conclusions

MCFD represents a distinct clinical and radiological entity in patients with clefts. Neuroimaging plays a pivotal role in diagnosis, prognosis, and treatment planning. Reduced head circumference serves as an early indicator of underlying cerebral malformations. Optimal management of these patients requires multidisciplinary evaluation and individualized consideration.

背景：中位脑面发育不良（MCFD）是一种罕见的中位脑面畸形，其特征是面部中线结构的裂缝、发育不全或发育不全，并伴有脑异常。它仍然未被充分认识和描述。本研究定义了颅面和神经影像学特征，并评估了MCFD的相关性。方法：对长庚纪念医院33例MCFD患者进行回顾性分析。纳入标准为唇裂/腭裂和中位颅面异常，伴有可用的脑部扫描。分析颅面形态学、神经影像学结果和生存率。结果：男性13例，女性20例。19例为双侧唇裂，14例为单侧唇裂。他们表现出小头畸形，他们的头围小于年龄和性别的第3个百分位数。常见的脑异常包括发育不良至透明隔/胼胝体缺失、额叶融合、丘脑/基底节区融合和脑室肿大。颅面表现包括缺失至发育不全的前唇/上颌骨，缺失上唇系带，鼻发育不全和上睑下垂。12例患者生存严重精神运动迟缓，21例死亡，平均寿命9.2个月。较大的前脑融合与较低的生存率显著相关。相比之下，唇腭裂缺失患者和唇腭裂发育不全患者的生存率无显著差异。颅面严重程度与脑异常无相关性。结论：MCFD在唇腭裂患者中具有独特的临床和放射学特征。神经影像学在诊断、预后和治疗计划中起着关键作用。头围减小是潜在脑畸形的早期指标。这些患者的最佳管理需要多学科评估和个体化考虑。

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引用次数: 0

Algorithmic recipient vessel selection for vessel-depleted lower limbs 下肢血管衰竭的受体血管选择算法

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-19 DOI: 10.1016/j.bjps.2025.11.011

Alex Sorkin , Chad Chang , Marco Marcasciano , Kai Yuan Cheng , Filippo Di Meglio , Michela Schettino , Hung Chi-Chen

Background

Lower limb reconstruction is a complex challenge that requires careful selection of recipient vessels to achieve optimal outcomes. We aimed to develop an algorithm for selecting recipient vessels based on defect location, size, composition, and lower limb vasculature.

Methods

We retrospectively reviewed 518 consecutive lower limb free flap reconstructions from 1983 to 2022. Using our hospital database, we developed an algorithm to identify suitable recipient vessels and matched them with appropriate reconstructive techniques.

Results

The algorithm classifies patients into four groups based on vascular availability. Group I included 419 patients with intact vessels who underwent direct anastomosis to a suitable flap. Group II comprised 25 patients with no accessible vessels below the medial sural artery. These patients were reconstructed with a free flap using a long vascular pedicle (anterolateral thigh flap, latissimus dorsi, and fibular flap), anastomosed to the medial sural artery. Twenty-one patients in Group III had accessible vessels only in the thigh and underwent reconstruction with a vein loop or two free flaps to reach the defect. A radial forearm flap served as a bridge flap, connecting an additional flap to cover the defect. Fifty-three patients in Group IV had no vessels available in the lower limb, but the foot remained perfused and sensate. This group underwent a two-stage procedure: first, a radial forearm bridge flap was connected to a recipient vessel in the healthy limb; after maturation, a second free flap was anastomosed to the bridge flap to cover the defect.

Conclusions

Our database shows that this algorithm offers a thorough and reproducible method for selecting recipient vessels in microsurgical lower limb reconstruction.

背景：下肢重建是一项复杂的挑战，需要仔细选择受体血管以达到最佳效果。我们的目标是开发一种基于缺陷位置、大小、组成和下肢血管系统选择受体血管的算法。方法回顾性分析1983 ~ 2022年518例连续下肢游离皮瓣重建病例。利用我们的医院数据库，我们开发了一种算法来识别合适的受体血管，并将它们与合适的重建技术相匹配。结果该算法根据血管可用性将患者分为四组。第一组包括419例血管完整的患者，直接吻合到合适的皮瓣。第二组包括25例腓肠内侧动脉下无血管可达的患者。这些患者采用长血管蒂（股前外侧皮瓣、背阔肌和腓骨皮瓣）与腓肠内侧动脉吻合的游离皮瓣重建。第三组21例患者仅在大腿有可达血管，并通过静脉环或两个自由皮瓣重建以达到缺损。前臂桡骨皮瓣作为桥状皮瓣，连接另一个皮瓣覆盖缺损。IV组53例患者下肢无血管可用，但足部仍有灌注和感觉。该组接受了两阶段手术：首先，将前臂桡骨桥皮瓣连接到健康肢体的受体血管；成熟后，将第二游离皮瓣与桥瓣吻合以覆盖缺损。结论sour数据库表明，该算法为显微外科下肢重建中受体血管的选择提供了一种全面、可重复的方法。

{"title":"Algorithmic recipient vessel selection for vessel-depleted lower limbs","authors":"Alex Sorkin , Chad Chang , Marco Marcasciano , Kai Yuan Cheng , Filippo Di Meglio , Michela Schettino , Hung Chi-Chen","doi":"10.1016/j.bjps.2025.11.011","DOIUrl":"10.1016/j.bjps.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Lower limb reconstruction is a complex challenge that requires careful selection of recipient vessels to achieve optimal outcomes. We aimed to develop an algorithm for selecting recipient vessels based on defect location, size, composition, and lower limb vasculature.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 518 consecutive lower limb free flap reconstructions from 1983 to 2022. Using our hospital database, we developed an algorithm to identify suitable recipient vessels and matched them with appropriate reconstructive techniques.</div></div><div><h3>Results</h3><div>The algorithm classifies patients into four groups based on vascular availability. Group I included 419 patients with intact vessels who underwent direct anastomosis to a suitable flap. Group II comprised 25 patients with no accessible vessels below the medial sural artery. These patients were reconstructed with a free flap using a long vascular pedicle (anterolateral thigh flap, latissimus dorsi, and fibular flap), anastomosed to the medial sural artery. Twenty-one patients in Group III had accessible vessels only in the thigh and underwent reconstruction with a vein loop or two free flaps to reach the defect. A radial forearm flap served as a bridge flap, connecting an additional flap to cover the defect. Fifty-three patients in Group IV had no vessels available in the lower limb, but the foot remained perfused and sensate. This group underwent a two-stage procedure: first, a radial forearm bridge flap was connected to a recipient vessel in the healthy limb; after maturation, a second free flap was anastomosed to the bridge flap to cover the defect.</div></div><div><h3>Conclusions</h3><div>Our database shows that this algorithm offers a thorough and reproducible method for selecting recipient vessels in microsurgical lower limb reconstruction.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 121-128"},"PeriodicalIF":2.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625262","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}

引用次数: 0

Evaluating the performance of large language models on the ASPS In-Service Examination: A comparative analysis with resident norms 评估大型语言模型在asp在职考试中的表现：与居民规范的比较分析

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-19 DOI: 10.1016/j.bjps.2025.11.031

Ramin Shekouhi , Mary M. Holohan , Oygul Mirzalieva , Brandon Byrd , Mairin F. Guidry , Patrick A. Palines , Harvey Chim

The emergence of large language models (LLMs) has raised critical questions about their potential roles in surgical education. This study aims to evaluate the accuracy and comparative performance of three leading LLMs including ChatGPT 4.0, DeepSeek V3, and Gemini 2.5, on the American Board of Plastic Surgery Plastic Surgery In-Service Training Examination (PSITE) across a 20-year period. Our results showed that ChatGPT achieved the highest overall accuracy (75.0%), followed closely by DeepSeek (74.8%) and Gemini (74.5%), with no significant differences between models (p>0.05). When benchmarked against normative data, DeepSeek reached the highest percentile ranks (81st among residents, 89th among practitioners), followed by ChatGPT (78th and 84th), and Gemini (72nd and 90th), without significant differences in rankings across LLMs (p > 0.05). In conclusion, Modern LLMs demonstrate consistent and high-level performance on the PSITE, frequently exceeding the median performance of plastic surgery residents and practitioners.

大型语言模型（llm）的出现提出了它们在外科教育中潜在作用的关键问题。本研究旨在评估包括ChatGPT 4.0、DeepSeek V3和Gemini 2.5在内的三家领先llm在美国整形外科委员会整形外科在职培训考试（PSITE）中的准确性和比较性能，为期20年。我们的研究结果表明，ChatGPT的总体准确率最高（75.0%），其次是DeepSeek（74.8%）和Gemini(74.5%)，模型之间没有显著差异（p>0.05）。当以规范数据为基准时，DeepSeek达到了最高的百分比排名（居民排名第81位，从业者排名第89位），其次是ChatGPT（第78位和第84位）和Gemini（第72位和第90位），llm之间的排名没有显著差异（p > 0.05）。总之，现代法学硕士在PSITE上表现出一致和高水平的表现，经常超过整形外科住院医师和从业人员的中位数表现。

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引用次数: 0

A modified two-stage ear reconstruction with integrated correction: Reduced cartilage harvest and operative time for bilateral microtia 一种改良的两期耳重建及综合矫正：减少双侧小耳软骨摘取及手术时间

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-19 DOI: 10.1016/j.bjps.2025.11.033

Dejin Gao , Qi Chen , Chenglong Wang , Rui Guo , Jiaxin Liang , Wenyang Di , Tun Liu , Yuan Zhang , Qingguo Zhang , Bingqing Wang

Background

Bilateral microtia can present with different bilateral classifications. Traditional surgical techniques require prolonged operative time and substantial amounts of costal cartilage. The surgical strategy used in this study was developed with the aim to provide a surgical technique to minimize surgery duration and costal cartilage harvest.

Methods

This retrospective study involved 84 patients in the experimental group (EG) who underwent the new surgery technique, and 65 patients in the control group (CG) who underwent traditional surgery from July 2022 to July 2024 in the Plastic Surgery Hospital. Postoperative follow-up included assessment using the Likert satisfaction scale, costal cartilage harvest number, surgery duration, and ear measurements.

Results

Patients were assessed during follow-ups ranging from 12 to 24 months postoperatively. The satisfaction rate of the EG was higher than that of CG (p<0.01). Costal cartilage harvest number and total anesthesia time of the EG were significantly less than that of CG (p<0.01). The ear measurements indicated that our surgical method achieved comparable symmetry in ear size to the traditional technique.

Conclusions

The Nagata two-stage method of auricular reconstruction combined with helix cartilage scaffold ear correction effectively addresses the bilateral microtia of lobule and concha types. This approach conserves cartilage requirement, reduces surgical time, and achieves superior long-term outcomes compared to traditional methods.

Level of evidence

Therapeutic, IV.

背景双侧小脑可表现为不同的双侧分类。传统的手术技术需要较长的手术时间和大量的肋软骨。本研究中使用的手术策略旨在提供一种外科技术，以减少手术时间和肋软骨切除。方法回顾性研究2022年7月至2024年7月在整形外科医院接受新手术技术的84例实验组（EG）和65例接受传统手术的对照组（CG）。术后随访包括使用Likert满意度量表、肋软骨收获数、手术时间和耳廓测量进行评估。结果随访时间为术后12 ~ 24个月。EG的满意率高于CG （p<0.01）。EG组肋软骨收获数和总麻醉时间明显少于CG组（p < 0.01）。耳部测量表明，我们的手术方法在耳朵大小上达到了与传统技术相当的对称性。结论Nagata两段式耳廓重建术联合螺旋软骨支架耳矫正术可有效治疗双侧小叶型和耳甲型小耳症。与传统方法相比，该方法节省了对软骨的需求，减少了手术时间，并获得了更好的长期疗效。证据水平：治疗性，IV。

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引用次数: 0

Socioeconomic disparities in access to flap reconstruction after oncologic lower extremity resection: A National Inpatient Sample analysis 肿瘤下肢切除术后皮瓣重建的社会经济差异：一项全国住院患者样本分析

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-19 DOI: 10.1016/j.bjps.2025.11.032

Dylan K. Kim , Ying Yu , Paul A. Asadourian , Alexander F. Dagi , Kathleen Gu , Lauren S. Lowe , Wakenda K. Tyler , Christine H. Rohde , Jarrod T. Bogue

Background

Resection of lower extremity malignant tumors may create soft tissue defects that may benefit from flap reconstruction. Owing to the requirement for multidisciplinary surgical services, the utilization of this procedure may be affected by systemic barriers. This study incorporated a large national inpatient database to identify the drivers of such socioeconomic disparities.

Methods

Lower extremity resection cases for malignant tumors were identified in the 2016–2022 National Inpatient Sample. A multivariable logistic regression model was used to evaluate independent predictors of flap reconstruction during admission. Nearest-neighbor propensity score matching was used to quantify the impact of flap reconstruction on the odds of wound-related complications (p<0.05).

Results

The final cohort included 11,635 cases. The overall rate of flap reconstruction was 25.4%. Preoperative radiation (OR: 1.55, 95% CI: 1.41–1.72, p<0.001), private insurance (OR: 1.20, 95% CI: 1.06–1.36, p=0.0030), and higher annual institutional plastic surgery volume (OR: 1.18, 95% CI: 1.14–1.23, p<0.001 per 100 cases) predicted higher odds of flap reconstruction. After propensity score matching, flap reconstruction was associated with lower odds of total wound-related complications during admission (OR: 0.82, 95% CI: 0.68–0.98, p=0.032).

Conclusion

Socioeconomic factors drive disparities in receiving flap reconstruction after oncologic lower extremity resection. Flap reconstruction is associated with lower odds of short-term wound-related complications, emphasizing the importance of access to reconstructive services.

背景：下肢恶性肿瘤切除可能造成软组织缺损，皮瓣重建可能对软组织缺损有益。由于需要多学科的外科服务，这种程序的利用可能会受到系统障碍的影响。这项研究纳入了一个大型的国家住院病人数据库，以确定这种社会经济差异的驱动因素。方法选取2016-2022年全国住院患者中因恶性肿瘤缓慢切除的病例。采用多变量logistic回归模型评估入院期间皮瓣重建的独立预测因素。采用最近邻倾向评分匹配来量化皮瓣重建对创面相关并发症发生率的影响（p<0.05）。结果最终纳入11635例病例。皮瓣重建率为25.4%。术前放疗（OR: 1.55, 95% CI: 1.41-1.72, p<0.001）、私人保险（OR: 1.20, 95% CI: 1.06-1.36, p=0.0030）和较高的年度机构整形手术量（OR: 1.18, 95% CI: 1.14-1.23, p<；0.001 / 100例）预测皮瓣重建的几率较高。倾向评分匹配后，皮瓣重建与入院时总伤口相关并发症的发生率较低相关（OR: 0.82, 95% CI: 0.68-0.98, p=0.032）。结论社会经济因素导致了肿瘤下肢切除术后皮瓣重建的差异。皮瓣重建与较低的短期伤口相关并发症相关，强调了获得重建服务的重要性。

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引用次数: 0

Perioperative cannabis use on postoperative pain in immediate alloplastic breast reconstruction 围手术期大麻对即刻同种异体乳房再造术术后疼痛的影响

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-17 DOI: 10.1016/j.bjps.2025.11.013

Nancy Qin , Lucy Wei , Carson Gundlach , Theresa K. Webster , Malini Chinta , Annie B. McVeigh , Leslie E. Cohen , David M. Otterburn

Background

Cannabis use has increased substantially in recent years owing to changing legalization across the United States. This study evaluated its impact on postoperative pain and opioid consumption in patients undergoing mastectomy and alloplastic reconstruction.

Methods

A retrospective review was conducted on consecutive patients who underwent mastectomy with immediate bilateral tissue expander (TE) reconstruction between January 2021 and 2025. Patients were grouped as cannabis users or non-users. Postoperative opioid consumption and pain scores were assessed at 12-h intervals, and discharge opioid quantities and refill rates were recorded.

Results

The study included 40 cannabis users and 197 non-users. Length of stay and complication rates were comparable between the groups. However, cannabis users reported significantly higher pain scores at 0–12 h (4.42 vs. 3.68, p = 0.018), 12–24 h (4.53 vs. 3.36, p = 0.004), and overall (4.46 vs. 3.53, p = 0.002). Opioid use was also higher at 0–12 h (29.55 vs. 19.73 MME, p = 0.001), 12–24 h (26.09 vs. 15.35 MME, p = 0.038), and cumulatively (67.40 vs. 44.38 MME, p = 0.010). Although discharge quantities were similar, cannabis users had more refill requests (42.5% vs. 22.8%, p = 0.017). On multivariable regression, cannabis use was not an independent predictor of inpatient or outpatient opioid use. Moreover, it showed a non-significant trend toward higher odds of refill requests (OR = 2.56, 95% CI 0.92–7.34, p = 0.073).

Conclusion

Cannabis use was associated with higher postoperative pain and opioid use on unadjusted analyses but was not an independent predictor after adjustment for confounders. These findings indicate that cannabis use may be a marker of increased analgesic requirement and support individualized perioperative pain management.

近年来，由于美国大麻合法化的变化，大麻的使用量大幅增加。本研究评估了其对乳房切除术和同种异体重建患者术后疼痛和阿片类药物消耗的影响。方法回顾性分析2021年1月至2025年1月期间连续行乳房切除术并立即双侧组织扩张器（TE）重建的患者。患者分为大麻使用者和非使用者。术后每隔12 h评估阿片类药物消耗和疼痛评分，并记录阿片类药物的排出量和补充率。结果该研究包括40名大麻使用者和197名非使用者。两组间的住院时间和并发症发生率具有可比性。然而，大麻使用者在0-12小时（4.42 vs. 3.68, p = 0.018）、12-24小时（4.53 vs. 3.36, p = 0.004）和总体（4.46 vs. 3.53, p = 0.002）报告的疼痛评分明显更高。阿片类药物的使用在0-12小时（29.55比19.73 MME, p = 0.001）、12-24小时（26.09比15.35 MME, p = 0.038）和累计（67.40比44.38 MME, p = 0.010）也较高。虽然排放量相似，但大麻使用者有更多的补充请求（42.5%对22.8%,p = 0.017）。在多变量回归中，大麻使用不是住院或门诊阿片类药物使用的独立预测因子。此外，它显示了更高的补充请求几率的非显著趋势（OR = 2.56, 95% CI 0.92-7.34, p = 0.073）。结论：未经调整分析，大麻使用与术后疼痛和阿片类药物使用增加有关，但在调整混杂因素后，大麻使用不是一个独立的预测因素。这些发现表明，大麻的使用可能是镇痛需求增加的标志，并支持个体化围手术期疼痛管理。

{"title":"Perioperative cannabis use on postoperative pain in immediate alloplastic breast reconstruction","authors":"Nancy Qin , Lucy Wei , Carson Gundlach , Theresa K. Webster , Malini Chinta , Annie B. McVeigh , Leslie E. Cohen , David M. Otterburn","doi":"10.1016/j.bjps.2025.11.013","DOIUrl":"10.1016/j.bjps.2025.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Cannabis use has increased substantially in recent years owing to changing legalization across the United States. This study evaluated its impact on postoperative pain and opioid consumption in patients undergoing mastectomy and alloplastic reconstruction.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on consecutive patients who underwent mastectomy with immediate bilateral tissue expander (TE) reconstruction between January 2021 and 2025. Patients were grouped as cannabis users or non-users. Postoperative opioid consumption and pain scores were assessed at 12-h intervals, and discharge opioid quantities and refill rates were recorded.</div></div><div><h3>Results</h3><div>The study included 40 cannabis users and 197 non-users. Length of stay and complication rates were comparable between the groups. However, cannabis users reported significantly higher pain scores at 0–12 h (4.42 vs. 3.68, <em>p</em> = 0.018), 12–24 h (4.53 vs. 3.36, <em>p</em> = 0.004), and overall (4.46 vs. 3.53, <em>p</em> = 0.002). Opioid use was also higher at 0–12 h (29.55 vs. 19.73 MME, <em>p</em> = 0.001), 12–24 h (26.09 vs. 15.35 MME, <em>p</em> = 0.038), and cumulatively (67.40 vs. 44.38 MME, <em>p</em> = 0.010). Although discharge quantities were similar, cannabis users had more refill requests (42.5% vs. 22.8%, <em>p</em> = 0.017). On multivariable regression, cannabis use was not an independent predictor of inpatient or outpatient opioid use. Moreover, it showed a non-significant trend toward higher odds of refill requests (OR = 2.56, 95% CI 0.92–7.34, <em>p</em> = 0.073).</div></div><div><h3>Conclusion</h3><div>Cannabis use was associated with higher postoperative pain and opioid use on unadjusted analyses but was not an independent predictor after adjustment for confounders. These findings indicate that cannabis use may be a marker of increased analgesic requirement and support individualized perioperative pain management.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"113 ","pages":"Pages 250-256"},"PeriodicalIF":2.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625112","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}

引用次数: 0

Prophylactic muscle flap coverage in frail patients undergoing spinal surgery 脊柱手术患者预防性肌瓣覆盖

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-11-15 DOI: 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。

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引用次数: 0