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

Penile inversion vaginoplasty (PIV) is the most common genital gender-affirming surgery for transfeminine individuals. Postoperative wound care often involves either traditional bolster dressings or incisional negative pressure wound therapy (iNPWT). While iNPWT has shown potential benefits in wound healing and infection reduction, its impact on nursing workload and practical application in perineal wounds remains underexplored. This study aims to evaluate nursing experiences with iNPWT compared to standard bolster dressings following PIV. A cross-sectional survey was conducted among floor nurses at a single institution with experience managing postoperative PIV patients. The survey assessed challenges encountered with each dressing method, strategies used to address complications, perceived workload, satisfaction, and observations on patient comfort. Descriptive statistics and thematic analysis were used to analyze the data. Sixteen nurses responded (59% response rate), most with ≥3 years of transgender surgical care experience. Overall, 81% reported satisfaction with iNPWT, and 47% perceived it as less burdensome than bolster dressings. Device malfunction, primarily due to air leaks, was the most common issue (81%). However, iNPWT was associated with improved hygiene and reduced need for dressing changes. Nurses employed strategies such as enhanced sealing techniques and increased monitoring to troubleshoot challenges. Despite early technical difficulties, iNPWT was well-received by nursing staff, offering workflow advantages and increased patient comfort. Findings suggest iNPWT is a feasible alternative to bolster dressings in PIV and highlight the importance of nursing support and training for successful implementation.

Most plastic surgery research originates in high-income countries (HICs). This does not reflect the distribution of need in the global population, and is underpinned by a lack of representation of authors working in low- and middle-income countries (LMICs). The aims of this study were to explore the barriers to publishing, including access to plastic surgery journals, among plastic surgeons working in LMICs. These themes were explored through an online questionnaire distributed via the British Foundation for International Reconstructive Surgery and Training global mailing list and professional networks across LMIC (as defined by the World Health Organization). We received 188 responses from 21 countries. Although 73% felt that publishing was beneficial to career progression, 47% of the respondents had never published as a first author, and 36% had never published as a co-author. The most common barriers to publishing were patient workload (46%), lack of guidance/mentorship (38%), and article publishing charges (35%). With regards to access to plastic surgery journals, 50% found it challenging to access this resource and cited paywalls (84%), inadequate library access (70%), and poor knowledge of resources (20%) as the most common barriers. Furthermore, 94% believed that making plastic surgery journals more accessible would increase research productivity. Common impacts of poor access to journals were difficulty staying up to date (65%), finding specific techniques (52%), and accessing references/research resources (43%). We concluded that a range of interventions is required to support plastic surgery research in LMICs. These include improving access to surgical journals, research skills, mentorship, task sharing, and removing article publishing charges.

Thumb opposition is an essential component of human hand function, and loss of the thenar musculature creates substantial disability of the hand. Additionally, first web space contracture as a result of trauma is a substantial limitation in reconstruction of thumb opposition. Reconstruction of thenar function is most commonly performed via opponensplasty tendon transfers. Although beneficial, tendon transfers require cortical retraining and fall short of native function. These may be the only option in the case of median nerve palsy. However, at times, thenar function is lost owing to thenar muscle injury with preserved median nerve function. Common examples include palmar soft tissue trauma and compartment syndrome. In such cases, intuitive thumb opposition can be restored with free functional muscle transfer innervated by the thenar motor branch of the median nerve. In addition, first web space release can be achieved in the same procedure. Here, we have demonstrate the benefits of this procedure versus opponensplasty, review long-term outcomes of successful cases including videographic documentation of function, and provide expert guidance to surgeons considering performing this procedure.

Facial burns pose complex challenges for survivors, encompassing significant physical, psychological, and social burdens. This systematic review aimed to identify the key factors influencing the stigma, social integration, and psychological wellbeing of individuals with facial burns. A comprehensive search was conducted across three major databases: PubMed, EMBASE, and Web of Science. Studies that examined the psychosocial impact of facial burns, including stigmatisation and interventions for recovery, were included. Twenty-two studies with a combined total of 1927 participants, published between 1976 and 2024, met the eligibility criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale, with an average score of 5.8, indicating moderate quality. Results demonstrated that visible scarring, functional impairments, and low socioeconomic status were associated with more severe stigma and greater psychological distress. Children, women, and individuals with financial insecurities were particularly vulnerable to negative psychosocial outcomes. Interventions such as psychological counselling, resilience training, and reconstructive surgery were shown to improve social reintegration and reduce stigma. Community education and structured reintegration programmes played an essential role in supporting recovery. Despite these advances, addressing the stigma associated with facial burns remains challenging. A multidisciplinary approach combining medical, psychological, and community-based interventions is crucial to improving outcomes. Standardised stigma assessment tools should be implemented to identify patients at risk and provide early support. Further research is needed to evaluate long-term psychological trajectories and the effectiveness of stigma-reduction strategies to optimise recovery and quality of life for survivors of facial burns.