Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

英文中文

Congenital palatal fistula associated with submucous cleft palate: Surgical outcomes and insights from a case series of 27 patients 先天性腭瘘合并黏膜下腭裂：27例患者的手术结果和见解。

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-05 DOI: 10.1016/j.bjps.2025.11.061

Muhammad Daiem , Ghulam Qadir Fayyaz , Muhammad Mustehsan Bashir , Sohaib Irfan , Marvee Turk , Nivaldo Alonso , Oksana Jackson , Roberto Flores , Marshall G. Miles , Domenico Scopelliti , Jitske Nolte , Corstiaan Breugem

Background

Congenital palatal fistula (CPF), most often associated with submucous cleft palate (SMCP), is a rare clinical entity. Surgical management is challenging owing to anatomical variation and risk of persistent velopharyngeal insufficiency (VPI). We reported outcomes from a case series of 27 patients with CPF associated with SMCP managed using a standardized institutional algorithm.

Methods

A retrospective review was conducted at CLAPP Hospital, Lahore, from 2015 to 2020. Patients with CPF associated with SMCP were included; acquired fistulae and syndromic cases were excluded. Fistulae were classified using the Pakistan Comprehensive Fistula Classification Scheme. SMCP was further stratified according to the CLAPP Classification and Treatment Algorithm, guiding surgical approach (midline incision, modified Langenbeck, or standard Langenbeck with/without adjunctive procedures). Outcomes included fistula recurrence and speech results.

Results

The cohort comprised 27 patients (mean age 9.9 years; range 1–23 years), and 52% were female. Two patients (7.4%) developed postoperative fistula recurrence. Preoperatively, 94% of patients had severe hypernasality (G3). Postoperatively, mean composite speech scores improved by 52.3% (14.9→7.1). Fourteen patients [14/17 (82.4%)] achieved G0/G1 (normal resonance). Younger patients (<12 years) showed greater improvement (90% to G0/G1) compared to older patients (71.4%). No middle-ear sequelae were observed.

Conclusions

A tailored algorithmic approach for CPF associated with SMCP yielded low recurrence (7.4%) and substantial speech improvement. Younger patients demonstrated greater postoperative speech benefit, underscoring the importance of early diagnosis and repair.

背景：先天性腭瘘（CPF）是一种罕见的临床疾病，通常与黏膜下腭裂（SMCP）有关。由于解剖变异和持续性腭咽功能不全（VPI）的风险，手术治疗具有挑战性。我们报告了使用标准化机构算法管理的27例与SMCP相关的CPF患者的病例系列的结果。方法：对2015 - 2020年在拉合尔CLAPP医院进行回顾性分析。纳入CPF合并SMCP的患者；排除获得性瘘管和综合征病例。采用巴基斯坦综合瘘管分类方案对瘘管进行分类。根据CLAPP分类和治疗算法对SMCP进行进一步分层，指导手术入路（中线切口、改良Langenbeck或标准Langenbeck伴/不伴辅助手术）。结果包括瘘管复发和语言结果。结果：该队列包括27例患者（平均年龄9.9岁，范围1-23岁），52%为女性。术后瘘管复发2例（7.4%）。术前，94%的患者有严重的鼻窦炎（G3）。术后平均综合语音评分提高52.3%（14.9→7.1）。14例患者[14/17(82.4%)]达到G0/G1（正常共振）。结论：针对与SMCP相关的CPF的定制算法方法具有低复发率（7.4%）和显著的语言改善。年轻患者术后表现出更大的语言改善，强调早期诊断和修复的重要性。

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引用次数: 0

Racial and ethnic differences in rates of reduction mammoplasty among women with macromastia: An analysis of the All of Us Research Program 巨乳症女性缩乳率的种族和民族差异：对我们所有人研究项目的分析

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-04 DOI: 10.1016/j.bjps.2025.11.065

Dylan K. Kim, Hao Huang, Jeffrey A. Ascherman, Christine H. Rohde

Background

Reduction mammoplasty, or breast reduction, provides improvements in quality of life for women with macromastia. Existing literature has not thoroughly characterized potential socioeconomic differences in receiving breast reduction in this patient population. We explored such differences using a large multicenter patient registry.

Methods

Adult female patients with macromastia were identified in the All of Us Research Program. Demographic information, including race and ethnicity, income, insurance status, and clinical information was collected for each patient. A multivariable logistic regression model was used to assess for the likelihood of receiving reduction mammoplasty. In a post-hoc analysis, incidence rates of depression and back pain were stratified by reception of reduction mammoplasty and compared (p<0.05).

Results

The final cohort included 3270 female patients with macromastia, 163 (5.0%) of whom received reduction mammoplasty. Non-Hispanic Black (OR: 0.53, 95% CI: 0.32–0.87, p=0.013) and Hispanic (OR: 0.52, 95% CI: 0.31–0.87, p=0.013) race and ethnicity predicted lower odds of reduction mammoplasty when compared to non-Hispanic White race and ethnicity. Insurance and income status were not significant predictors of receipt of reduction mammoplasty (p>0.05). Reduction mammoplasty was associated with decreased incidence rates of back pain among Hispanic, non-Hispanic Black, and non-Hispanic White cohorts.

Conclusion

The overall incidence of reduction mammoplasty in a cohort of women with macromastia was relatively low. Race and ethnicity were associated with different rates of reduction mammoplasty. These novel findings motivate further investigation on the contributors to such differences.

背景：乳房缩小成形术，或乳房缩小术，改善了巨乳症女性的生活质量。现有的文献并没有完全描述在接受乳房缩小手术的患者群体中潜在的社会经济差异。我们通过一个大型的多中心患者登记来探讨这些差异。方法在All of Us研究项目中对成年女性巨乳症患者进行鉴定。收集每位患者的人口统计信息，包括种族和民族、收入、保险状况和临床信息。采用多变量logistic回归模型评估接受乳房缩小成形术的可能性。在事后分析中，抑郁和背部疼痛的发生率通过接受乳房缩小成形术分层并进行比较（p<0.05）。结果最终纳入3270例女性巨乳症患者，其中163例（5.0%）行缩乳术。非西班牙裔黑人（OR: 0.53, 95% CI: 0.32-0.87, p=0.013）和西班牙裔（OR: 0.52, 95% CI: 0.31-0.87, p=0.013）种族和民族与非西班牙裔白人种族和民族相比，预测缩小乳房成形术的几率更低。保险和收入状况不是接受乳房缩小成形术的显著预测因素（p>0.05）。在西班牙裔、非西班牙裔黑人和非西班牙裔白人人群中，缩小乳房成形术与背部疼痛发生率降低相关。结论巨乳症患者行缩乳术的总体发生率较低。种族和民族与乳房成形术减少率不同有关。这些新颖的发现激发了对造成这些差异的因素的进一步调查。

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引用次数: 0

Early detection of viable microorganisms in “sterile” periprosthetic fluids in implant-based breast reconstruction: A bioelectrochemical approach using screen-printed electrodes 乳房植入重建中“无菌”假体周围液体中活菌的早期检测：使用丝网印刷电极的生物电化学方法

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery

Pub Date : 2025-12-02 DOI: 10.1016/j.bjps.2025.11.045

Monari Marta , Vaccari Stefano , Lupacchini Alessandro Marco , Parisi Anna , Zolesi Nicki , Beltrame Sara , Petrillo Paola , Grizzi Fabio , Hegazi Ahmed Ahmed Abdelaziz Mohamed , Di Giuli Riccardo , Klinger Francesco , Rusconi Roberto , Vinci Valeriano

Background

Early postoperative infections are an important complication after postmastectomy implant-based breast reconstruction with current diagnostic methods requiring long processing times and potentially yielding false negatives, particularly after prior antibiotic exposure. We aimed to evaluate the feasibility and diagnostic accuracy of a bioelectrochemical method, based on electrochemical impedance spectroscopy (EIS), for the early detection of viable bacteria in periprosthetic fluid following implant-based reconstruction.

Methods

A total of 47 patients undergoing immediate implant-based breast reconstruction were prospectively enrolled. Periprosthetic fluid samples were collected from the drainage tube at postoperative days 7 and/or 14 (107 samples in total). Each sample was analyzed using 3 diagnostic platforms: (1) EIS, (2) molecular diagnostics, and (3) conventional microbiology. The EIS signal (Z′) was interpreted against a cut-off calibrated using gram-positive and gram-negative reference suspensions.

Results

Infection was confirmed in 8 out of 47 patients (17.0%). EIS correctly identified all infected cases, showing full concordance with culture and molecular results. The technique distinguished gram-positive (Z′ 6000–20,000 Ohms) from gram-negative infections (Z′ 21,000–35,000 Ohms). The analytical time for EIS was approximately 9 min. Among positive patients, gram-positive infections were mostly asymptomatic or mild, whereas gram-negative infections were associated with severe clinical outcomes, including explantation.

Conclusion

EIS offers a rapid, low-cost, and easy-to-use method for detecting bacterial presence in periprosthetic fluids. Unlike standard microbiological or molecular tests, it does not require bacterial growth, sample preparation, or nucleic acid extraction. With further validation, it has strong potential to support earlier, more tailored interventions.

背景：早期术后感染是乳房切除术后植入式乳房再造术的重要并发症，目前的诊断方法需要较长的处理时间，并可能产生假阴性，特别是在先前接触抗生素后。我们的目的是评估基于电化学阻抗谱（EIS）的生物电化学方法在植入体重建后早期检测假体周围液体中活菌的可行性和诊断准确性。方法：前瞻性纳入47例接受即刻假体乳房重建术的患者。术后第7天和/或14天从引流管中收集假体周围液体样本（共107份样本）。每个样本使用3个诊断平台进行分析：(1)EIS,(2)分子诊断和(3)常规微生物学。利用革兰氏阳性和革兰氏阴性参比悬浊液对EIS信号（Z′）进行了解释。结果：47例患者中确诊感染8例（17.0%）。EIS正确识别所有感染病例，显示与培养和分子结果完全一致。该技术区分了革兰氏阳性（Z' 6000-20,000欧姆）和革兰氏阴性感染（Z' 21,000-35,000欧姆）。EIS分析时间约为9分钟。在阳性患者中，革兰氏阳性感染大多无症状或轻微，而革兰氏阴性感染与严重的临床结果相关，包括外植体。结论：EIS是一种快速、低成本、易于使用的检测假体周围液体细菌存在的方法。与标准的微生物或分子测试不同，它不需要细菌生长、样品制备或核酸提取。经过进一步验证，它具有支持更早、更有针对性的干预措施的强大潜力。

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引用次数: 0

Response to Commentary on “Phase I trial of Lymfactin® combined with vascularized lymph node transfer for breast cancer-related lymphedema” 对“淋巴因子联合血管化淋巴结转移治疗乳腺癌相关淋巴水肿的I期试验”评论的回应。

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.2025.10.048

Susanna Pajula, Pauliina Hartiala

引用次数: 0

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。

{"title":"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","authors":"Susanna Pajula , Anne Saarikko , Sinikka Suominen , Ilkka Kaartinen , Juha Kiiski , Erkki Suominen , Tiina Viitanen , Maija Mäki , Marko Seppänen , Outi Lahdenperä , Kari Alitalo , Pauliina Hartiala","doi":"10.1016/j.bjps.2025.10.013","DOIUrl":"10.1016/j.bjps.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"111 ","pages":"Pages 312-321"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423653","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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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

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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

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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

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