Journal of plastic, reconstructive & aesthetic surgery : JPRAS最新文献

Background: Plastic surgery has historically been underrepresented within UK undergraduate curricula. This perpetuates misconceptions and limits informed career choice. Student-led initiatives may provide a pragmatic means of identifying and addressing these gaps.

Methods: The authors organised a national plastic surgery undergraduate conference. The programme combined lectures, poster presentations, and simulation workshops. Pre- and post-conference questionnaires assessed knowledge, awareness of professional organisations, confidence in surgical skills, and career interest using 5-point Likert scales. Data was analysed using Wilcoxon signed-rank tests.

Results: 105 delegates from 34 UK medical schools completed paired surveys. Familiarity with BAPRAS (2.74 ± 1.41 to 3.98 ± 0.93; p = 0.01) and PLASTA (2.38 ± 1.27 to 4.12 ± 0.89; p < 0.01) improved significantly. Knowledge of global reconstructive surgery (2.26 ± 1.15 to 4.09 ± 0.76), innovations (2.17 ± 1.06 to 3.89 ± 0.90), and military trauma (2.11 ± 1.18 to 4.17 ± 0.72) also increased (all p < 0.01). Confidence in suturing (2.88 ± 1.20 to 4.34 ± 0.73), tendon repair (1.53 ± 0.94 to 3.76 ± 0.90), and microsurgical nerve repair (1.31 ± 0.70 to 3.69 ± 1.25) increased significantly (all p < 0.01). 80.0% (84) of delegates reported increased interest in plastic surgery as a career.

Conclusions: This study highlights the lack of plastic surgery exposure currently provided to UK medical undergraduates. The conference significantly enhanced delegates' knowledge, practical skills, and career interest, highlighting the educational value of undergraduate initiatives in addressing gaps within undergraduate curricula and fostering early career development.

Background: Supraorbital hollowing from age-related volume loss or post-blepharoplasty overresection causes upper sulcus deflation. Hyaluronic acid (HA) fillers are frequently used in the upper eyelid, but prospective clinical follow-up data remain limited.

Methods: This prospective single-centre cohort study enroled 46 adults with mild-moderate supraorbital hollowing who underwent supraperiosteal injection of cross-linked hyaluronic acid (0.2-0.4 mL per eyelid, Lorient No. 2) using a 25G blunt cannula via a lateral entry point. Standardised photographs were obtained at baseline and 6 months. Global Aesthetic Improvement Scale (GAIS; 1-5) was independently assessed at 6 months by two board-certified physicians blinded to each other's ratings based on comparative photographic evaluation, and separately by patients. Adverse events were prospectively recorded.

Results: All patients completed 6-month follow-up. Mean physician GAIS was 4.3 ± 0.5 and mean patient GAIS was 4.5 ± 0.6; 91% were rated "very good" or "exceptional". Transient bruising (28%) and oedema (26%) resolved without intervention. No serious complications occurred.

Conclusion: Deep supraperiosteal HA filler delivered by blunt cannula provided reproducible correction of supraorbital hollowing with high satisfaction and a low rate of self-limited adverse events at 6 months.

Level of evidence: IV.

The management of burn resuscitation requires frequent fluid adjustments based on physiological response. This process is difficult to maintain accurately over time without decision support. Existing digital solutions, however, often present barriers such as high costs or the need for proprietary hardware. To address this, we developed an open-access, web-based platform to assist providers with protocol-driven resuscitation. The application features a customizable interface that allows clinical teams to adapt protocol parameters to match their specific guidelines, including urine output targets and fluid types. Beyond simple tracking, the tool functions as a dynamic guide, recommending rate adjustments and prompting for colloid administration when indicated. The platform also displays a real-time dashboard of the patient's course to aid decision-making. Designed for future integration with Electronic Medical Records, this tool offers a transparent framework to standardize care and simplify the complex workflow of acute burn management. LAY SUMMARY: Treating severe burns requires careful hourly fluid titration that can be complex and prone to errors. The authors created a free web tool to automate and guide resuscitation to help practitioners provide safer, standard care without needing expensive special equipment.

Background: Orofacial clefts are associated with neurodevelopmental conditions. However, whether or not this risk is different among children with unilateral compared with bilateral clefts is not known. The aim of this study was to compare children with bilateral clefts to those with unilateral clefts regarding psychiatric disorders, suicide, and self-harm.

Methods: We utilized data on all children born in Sweden between 1973 and 2012 with unilateral cleft lip (UCL), bilateral cleft lip (BCL), unilateral cleft lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). We performed Cox regression analyses with direct comparisons between bilateral and unilateral clefts and comparisons to matched community cohorts, adjusting for confounders.

Results: Children with BCL compared with UCL showed risk increases for any psychiatric disorder (adjusted Cox-derived hazard ratios [aHRs], 2.13; 95% confidence interval [CI], 1.04-4.36), including intellectual disability (aHR, 5.31; 95% CI, 1.29-21.78). Children with BCLP compared with UCLP demonstrated risk increases for any psychiatric disorder (aHR, 1.55; 95% CI, 1.20-2.01), including speech and language disorders (aHR, 1.99; 95% CI, 1.00-3.97), neurodevelopmental disorders (aHR, 1.66; 95% CI, 1.11-2.47), and other psychiatric disorders (aHR, 1.54; 95% CI, 1.11-2.15), including personality disorders (aHR, 5.76; 95% CI, 2.13-15.55). No significant associations were observed for suicide or self-harm.

Conclusions: This large nationwide register study showed, for the first time, that individuals with bilateral clefts demonstrated elevated risks of psychiatric disorders compared with unilateral clefts. This is of clinical relevance to professionals as well as information that needs to be conveyed to families of children with orofacial clefts.

Objective: To investigate if academic achievement among children with nonsyndromic orofacial clefts (OFC) differs compared to nonaffected children and whether this association is modified by sex and psychiatric comorbidity.

Methods: A register-based cohort of children born with cleft lip (CL), cleft lip and palate (CLP), and cleft palate only (CPO) in Sweden between 1973 and 2004 (n = 6286) was compared to a matched community cohort (n = 61,352). Outcomes were academic achievements in mathematics and Swedish in school years 3, 5, 6, 9, and upper secondary school; all subjects' grades in school year 9; and university degree. Binomial-, ordinal logistic-, linear-, and binary logistic regression were used.

Results: For the majority of outcomes, no statistically significant group differences were observed, and generally children with CL were less affected than those with CLP and CPO. Children with CPO demonstrated lower achievement in the third school year (Swedish; aOR 0.54, 95% CI 0.40-0.72, mathematics; aOR 0.54, 95% CI 0.42-0.70), in Swedish in the ninth school year (aOR 0.89, 95% CI 0.80-0.99), and in mathematics in upper secondary school (aOR 0.87, 95% CI 0.76-1.00). Individuals with CPO had reduced odds of graduating from university (aOR 0.81, 95% CI 0.67-0.98). Children with CLP demonstrated lower achievement in mathematics in the third school year (aOR 0.72, 95% CI 0.54-0.95) and in both Swedish and mathematics in the ninth school year (Swedish; aOR 0.89, 95% CI 0.80-0.99, mathematics; aOR 0.87, 95% CI 0.78-0.97). The majority of outcomes were less favorable in females but not for those with psychiatric comorbidity.

Conclusions: Our findings emphasize the need to screen children with clefts for learning difficulties to provide additional support in school. Girls with OFC appeared to be particularly vulnerable in this regard.