搜索结果：Journal of plastic and reconstructive surgery

To quantify national trends in the incidence, treatment patterns, and direct medical costs of malignant melanoma (MM) and non-melanoma skin cancer (NMSC) in South Korea between 2011 and 2019. We analyzed data from the National Health Insurance Service and Korea Central Cancer Registry and also identified incident cases of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and MM. Age-standardized incidence rates (ASIRs; Segi World Standards) were calculated. Surgical procedures (wide excision, flap, skin graft, Mohs micrographic surgery), recurrence (repeat surgery ≥6 mo), and medical costs were evaluated. Overall, 43,521 incident skin cancer cases were recorded (BCC 58.9%; SCC 29.7%, MM 11.3%). ASIR doubled from 6.9/100,000 person years between 2011 and 12.0/100,000 in 2019 (average annual percentage change +7.9%). Rural regions had higher incidence rates than metropolitan areas (14.9 vs. 9.8/100,000). Complex reconstructions escalated; flap procedures increased threefold (1341-4038) and Mohs surgery (387-1236). Annual direct medical costs increased from US $66 million to US $177 million (+168%). Recurrence rates were 1.15% for BCC, 1.88% for SCC, and 2.13% for MM. The absolute skin cancer burden in Korea remains modest; however, its incidence, operative complexity, and costs are increasing than what demographic aging alone would predict. Targeted ultraviolet (UV) protection policies, early detection strategies, and resource planning for the reconstruction capacity are required.

Background and Objectives: Head and neck cancer (HNC) frequently necessitates reconstructive surgery due to defects following oncologic resection. The influence of age on reconstructive outcomes in head and neck cancer remains controversial. This study aimed to evaluate the impact of age on oncologic characteristics, reconstructive strategies, and functional outcomes following microvascular free flap reconstruction. Materials and Methods: A retrospective review was conducted on 286 patients who underwent free flap reconstruction for head and neck cancer between 2016 and 2020. Patients were stratified into three age groups: <40 years, 40-60 years, and >60 years. Demographic characteristics, tumor features, reconstructive approaches, complications, and functional outcomes-including postoperative dietary tolerance and tube feeding dependency-were analyzed. Results: The oral cavity was the most common tumor site across all age groups. Advanced-stage tumors (T4) were more frequently observed in older patients (>60 years), although the difference was not statistically significant (p = 0.0575). The overall flap survival rate was 98.6%. The mean hospital stay was 24.6 &#xb1; 15.86 days and was significantly longer in the >60-years group (p < 0.001). Postoperative dietary tolerance was comparable across age groups, with 56.8% of patients resuming a regular diet. Tube feeding dependency was slightly higher in the >60-years group but did not reach statistical significance (p = 0.1599). Conclusions: Age alone does not significantly affect reconstructive outcomes following microvascular free flap reconstruction for head and neck cancer. Despite a higher prevalence of comorbidities in and longer hospital stays for older patients, flap success rates and functional outcomes were comparable across age groups.

Administrative inpatient datasets are cornerstone tools for health surveillance, yet their validity in tracking elective, self-pay surgical markets remain poorly defined. This study evaluates the utility of nationwide inpatient data for monitoring aesthetic surgery by quantifying 18-year trends, assessing the COVID-19 pandemic's impact, and benchmarking hospital capture rates against national estimates to identify critical public health surveillance gaps. We conducted a descriptive longitudinal epidemiologic analysis of mandatory German hospital quality reports (2006-2023). Four high-volume procedures (liposuction, blepharoplasty, breast augmentation, and abdominoplasty) were identified via procedure-specific codes. To evaluate diagnostic validity, we analyzed the usage of ICD-10 code Z41.1 ("Procedures for purposes other than remedying health states"). Inpatient volumes were benchmarked against ISAPS national estimates to determine the "hospital share" of the total market. Between 2006 and 2023, 352,468 inpatient procedures were recorded. Annual volumes tripled from 11,593 to 33,170. While inpatient liposuction (+611%) and abdominoplasty (+424%) surged, breast augmentation declined by 33%. Liposuction volumes showed no significant immediate 2020 level decline in segmented analysis and continued to increase during the post-pandemic period. Benchmarking suggested limited hospital visibility of the broader national aesthetic-surgery market: by 2023, hospitals captured only 2.0% of national breast augmentations and 13.5% of liposuctions. ICD-10 Z41.1 was utilized in only 0.4% of cases, suggesting limited utility as an indication-specific surveillance marker. While hospital data serve as a vital sentinel for high-complexity cases, the massive discrepancy between inpatient volumes and national estimates highlights a large data gap in elective surgery surveillance. The limited use of Z41.1 suggests that current diagnostic coding frameworks are insufficient, on their own, for monitoring elective self-pay procedures. Transitioning to integrated, cross-sectoral registries and ICD-11 is essential for accurate epidemiological mapping and surgical workforce planning.

The growing proportion of women in medicine and shifting expectations toward shared family responsibilities contrast with traditionally inflexible surgical careers. Comparative European data on how plastic surgeons perceive the compatibility of academic careers and parenthood remain limited. A cross-sectional online survey was distributed via European national plastic surgery societies and academic centres. Items covered demographics, working models, parental status, parental leave, childcare, institutional support, and perceived discrimination. Group differences were tested using chi-square and non-parametric methods; predictors of perceived compatibility were assessed using multivariable logistic regression. A total of 456 academic plastic surgeons from 18 European countries participated (median age 44 years; 54.5% female). Perceived compatibility varied, from 35.1% in Germany to 78% in the Netherlands and 70% in Scandinavia (p&#x202f;<&#x202f;0.001). In multivariable analysis, openness in discussing family planning with superiors (OR 5.49, 95% CI 2.51-12.05; p&#x202f;<&#x202f;0.001) and permission to work part-time (OR 2.92, 95% CI 1.40-6.02; p&#x202f;=&#x202f;0.004) were the strongest positive predictors. Career-related impact on family planning (OR 0.39; p&#x202f;=&#x202f;0.033) and perceived discrimination against mothers (OR 0.41; p&#x202f;=&#x202f;0.019) reduced compatibility; actual part-time employment was not independently associated. Across Europe, perceived compatibility of parenthood with an academic surgical career vary widely between countries. These differences are primarily driven by structural flexibility and a supportive culture than by actual reduced working hours. Normalising parenthood should be treated as a structural prerequisite for a sustainable and diverse academic workforce in surgery.

Exercise- and nutrition-based prehabilitation programs are promising emerging strategies for enhancing surgical recovery. However, earlier studies have reported mixed findings about their impact on postoperative outcomes. The purpose of this study is to investigate the efficacy of exercise- and nutrition-based prehabilitation on postoperative outcomes, including length of stay (LOS), complications, quality of life (QoL), pain, and mental health. A systematic review and meta-analysis was conducted, using Medline, Cochrane Central, EMBASE, and Web of Science, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies published between 2004 and 2024 were identified with search terms including "prehabilitation," "exercise," "nutrition," and "surgery." Eligible studies (n&#x2009;=&#x2009;293) were randomized controlled trials (RCTs) evaluating exercise or nutrition-based prehabilitation programs and reporting LOS and complications as primary outcomes. Secondary outcomes included QoL, pain, and mental health scores. Random-effects meta-analyses estimated pooled effect sizes. Twenty-three RCTs were included (2,182 participants). Exercise or nutrition-based prehabilitation reduced complications (odds ratio 0.52. 95% CI 0.35 to 0.78, p&#x2009;<&#x2009;0.002, I2&#x2009;=&#x2009;47.1%) and LOS (mean difference [MD] -0.44 days, 95% CI -0.78 to -0.11, p&#x2009;=&#x2009;0.01, I2&#x2009;=&#x2009;44.8%) compared with standard treatment. When comparing interventions, nutrition only had a greater reduction in LOS than exercise only (MD -1.09 days, 95% CI -1.72 to -0.47 vs MD -0.20 days, 95% CI -0.51 to 0.09; p&#x2009;=&#x2009;0.01). Although QoL was not reported in nutrition-only RCTs, exercise alone improved QoL measures (standardized MD 0.94, 95% CI 0.24 to 1.64, p&#x2009;=&#x2009;0.01, I2&#x2009;=&#x2009;93.6%) compared with standard treatment. Exercise or nutrition-based prehabilitation programs reduce LOS and complications across multiple surgical contexts. Further work is needed to elucidate the effects of different intervention protocols on postoperative outcomes.

Skin cancer is the most common malignancy worldwide, particularly among elderly individuals. Many lesions are detected at an early stage because of their visibility and can be excised under local anesthesia, thereby avoiding the risks associated with general anesthesia or sedation. This study aimed to evaluate patient- and tumor-related characteristics in skin cancer surgery performed under local anesthesia, with particular emphasis on age-related outcomes. This retrospective study included 533 patients with 613 histopathologically confirmed skin cancers excised under local anesthesia between 2019 and 2024. Demographic, histopathological, and surgical variables were recorded, including age, sex, tumor location, measured tumor area, histologic subtype, surgical margin status, reconstruction technique, and comorbid conditions. Patients were stratified into three age groups (<60, 60-80, and >80 years) for subgroup analyses. Statistical analyses were performed using the Mann-Whitney U test, Kruskal-Wallis test, chi-square test, and Spearman correlation analysis (SPSS version 26.0; IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. The mean patient age was 68.5 years. Most lesions (86.1%) were located in the head and neck region. Basal cell carcinoma (65.4%) and squamous cell carcinoma (21.0%) were the predominant histopathological diagnoses. Primary closure (43.8%) and full-thickness skin grafting (25.0%) were the most frequently performed reconstruction methods. Larger tumor area was significantly associated with positive surgical margins (p < 0.01), and tumor type was significantly associated with both surgical margin status and reconstruction method (p < 0.0001). Age showed a statistically significant positive correlation with tumor area (p = 2.22 &#xd7; 10-7) and with the presence of comorbidities (p < 0.001). Subgroup analysis demonstrated a higher proportion of squamous cell carcinoma and a larger mean tumor area in patients older than 80 years. No local anesthesia-related complications occurred. Skin cancer surgery performed under local anesthesia appears to be safe and effective across age groups, including elderly and comorbid patients. Tumor type and tumor area were significantly associated with surgical margin status and reconstruction method. These findings support age-conscious and anesthesia-sparing approaches in oncologic dermatologic surgery.

The nose is the most prominent part of the face. The postoperative evaluation of the nose is vital to check if the desired surgical result was achieved. The scarcity of standardized scales/scores for nasal assessment inspired us to develop an entirely new scoring system (Surendrakumar and Sukhen Nasal After Rhinoplasty Evaluation Score [SSNARES]), which is universally applicable to people of all ethnic groups, ages, and genders, and yields a valid, reliable result. SSNARES consists of a questionnaire of 10 parameters that assesses the nose aesthetically, functionally, and psychologically. Patient's responses are graded between 0-4 scores per parameter. The addition of all scores yields the final score, which is correlated with a satisfaction grade (a quantitative measure of patient satisfaction after surgery). SSNARES was thoroughly analyzed by an interdisciplinary panel of experts and underwent stringent statistical analysis to prove its validity and reliability upon pilot testing on 20 patients. The item content validity index and score content validity index of SSNARES were both 1 (excellent). Bartlett's Test of Sphericity showed a p-value of <0.001, indicating a highly significant test. The Kaiser-Meyer-Olkin test value for the overall score is >0.9 (marvelous category). The construct validity of SSNARES was tested by exploratory factor analysis, and questions with loadings >0.4 were considered significant to represent a specific factor. The confirmatory factor analysis of SSNARES showed a p-value of <0.001, indicating a high significance level and strong correlation. The Cronbach's &#x3b1; coefficient of SSNARES is 0.9646, which highlights excellent reliability. This cost-effective, efficient, easy-to-use, patient-oriented new score will be of prime significance for patients, clinicians, and researchers for score computation, decision-making for reintervention, and research purposes.

To strengthen preoperative preparation and improve clinical outcomes, a multimedia prehabilitation program was created for patients undergoing facial feminization surgery (FFS). This study evaluates the program and its impact on clinical outcomes. PREFACE includes five video modules, a guidebook, and a mobile application covering surgical information, preoperative preparation, and postoperative recovery. Program feasibility and acceptability were evaluated via a mixed-methods approach utilizing the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Clinical outcomes were evaluated in a hybrid prospective-retrospective cohort of 144 FFS patients (PREFACE=32, comparison=112), including hospital length of stay, 30-day complications, inpatient pain, and perioperative opioid use (morphine equivalent dose/kg). A subgroup analysis evaluated postoperative messages and phone calls one month after surgery as well as pain during the first week as an ecological momentary assessment (EMA) using the PROMIS Pain Intensity Scale. Among PREFACE participants enrolled during the first six months, engagement was 94.4%, with satisfaction averaging 9.1&#xb1;1.1. The guidebook was the most utilized format (82.3%), followed by the mobile application (58.8%). The clinical team reported straightforward adoption and integration into existing workflows. Compared with controls, PREFACE participants had lower inpatient pain (1.7(IQR:1.9) vs 2.8(IQR:2.3), p=0.03) and postoperative messages and phone calls (1.0(IQR:2.75) vs 2.0(IQR:4.0), p=0.01). Among EMA responders, PREFACE participants reported lower PROMIS Pain Intensity scores 4-5 days postoperatively (4.0(IQR:2.0) vs 6.0(IQR:4.3), p=0.02). The PREFACE Program is a feasible and well-accepted multimedia prehabilitation intervention that was associated with reduced postoperative communication as well as pain during hospitalization and in the first postoperative week.

Facial palsy is a debilitating condition that can lead to significant functional, aesthetic, and psychosocial impairments. Thus, this study aimed to systematically explore treatment preferences and values among Korean patients with facial palsy and develop clinically applicable recommendations to enhance patient-centered care. A cross-sectional questionnaire survey was conducted between June and July 2025 at a facial palsy clinic in a secondary referral hospital. A total of 51 patients with peripheral facial palsy completed a structured 21-item survey addressing preferences related to assessment and diagnosis, treatment modalities, multidisciplinary care, communication, information sources, and recovery concerns. The internal consistency of the questionnaire was evaluated using Cronbach's alpha (&#x3b1;). Participants (mean age 43.1 &#xb1; 12.4 years; 68.6% female) prioritized objective assessment methods and accurate prognostic information, favoring standardized tools and electrophysiological testing. Regarding treatment preferences, 82.4% supported active steroid therapy and 74.5% preferred combined steroid-antiviral treatment. Surgery was generally viewed as a last resort, with 51.0% favoring non-surgical rehabilitation even in chronic cases-those persisting for more than six months. Multidisciplinary care and clear, detailed communication were highly valued. The primary recovery concern was permanent facial sequelae (64.7%). Meanwhile, the internal consistency of the survey, which covered diverse and independent domains, was rather poor (Cronbach's &#x3b1; = 0.548), reflecting the multidimensional nature of the patient preferences. Korean patients with facial palsy express a strong fear of permanent sequelae, which shapes the preferences of patients toward objective information and treatments with high efficacy. Moreover, the patients were found to favor comprehensive multidisciplinary care, clear and transparent communication, and collaborative relationships with healthcare providers. These findings provide important insights for developing patient-centered clinical guidelines tailored to Korean patients with facial palsy.

This study aimed to evaluate the accuracy and simplicity of a preoperative vascular assessment method with Viewtify&#x24c7; for perforator flap elevation. To evaluate the accuracy and simplicity of this new method, we compared it with an existing reliable method based on the same contrast-enhanced computed tomography (CT) images. The evaluation included the deviation of the deep inferior epigastric artery (DIEA) course and the position of the perforators, as well as the time required for evaluation. CT images were acquired from 20 female patients who underwent DIEA perforator flap reconstruction. A third-year plastic surgery resident, new to flaps and the software, was the candidate for this new method and hand-drew a schematic diagram from three-dimensional computer graphics (3DCG) images reconstructed with Viewtify&#x24c7;. After receiving only short instructions on how to operate the software, she began the evaluations. The comparison was made with reference images that had been created by a board-certified surgeon using a reliable method from the same CT images. The average age and body mass index (BMI) of patients were 48.1 &#xb1; 7.5 years and 24.2 &#xb1; 3.3 kg/m2, respectively. Deviations in the DIEA pathway were within 7.4 &#xb1; 3.2 mm, and perforator positions matched the reference images. Evaluation times decreased significantly, stabilizing below 10 min in 5 patients. The average evaluation time across all patients was approximately 8 minutes. Viewtify&#x24c7; enables accurate and efficient preoperative vascular assessment, even for inexperienced surgeons, demonstrating a rapid learning curve. This method may offer an alternative approach for the surgical planning of perforator flap elevation.

Demand for reconstructive surgery postmastectomy has risen, prompting evaluation of its economic impact in a publicly funded health care system. We sought to explore factors associated with increased costs of hospital admission following autologous breast reconstruction. We conducted a retrospective cohort study involving patients who underwent autologous breast reconstruction in Ontario, Canada (2005 to 2020). Patients received either a pedicled transverse rectus abdominis myocutaneous (TRAM) flap or free tissue transfer. We analyzed costs from the hospital perspective, from admission to discharge. We used generalized linear models with a &#x3b3; distribution to identify cost-associated factors. Of 2634 patients, 378 (14.4%) underwent pedicled TRAM and 2256 (85.7%) underwent free flap reconstruction. The median cost of hospital admission was $8816 (interquartile range $3383 to $90 974). Univariate analysis identified cost drivers including length of stay, reconstruction type, age, income quintile, laterality, and emergency reoperation. Multivariable analysis showed increased costs associated with free flap reconstruction (13% increase, 95% confidence interval [CI] 5% to 22%; p < 0.001), age older than 70 years (31% increase, 95% CI 7% to 61%; p < 0.01), lower income quintile (10% increase, 95% CI 3% to 18%; p = 0.01), and bilateral reconstruction (11% increase, 95% CI 1% to 23%; p = 0.03). Hospital type, geographic region, timing of reconstruction, comorbidities, and rurality were not significantly associated with cost. Free flap reconstruction, bilateral procedures, and advanced age are key drivers of hospital admission costs. These findings may inform policy and resource-allocation strategies in publicly funded systems to optimize value in breast reconstruction care. La demande pour la chirurgie reconstructive post-mastectomie a augment&#xe9;, ce qui motive l&#x2019;&#xe9;valuation de ses cons&#xe9;quences sur le plan &#xe9;conomique au sein d&#x2019;un syst&#xe8;me de soins de sant&#xe9; public. Nous avons voulu &#xe9;tudier les facteurs associ&#xe9;s &#xe0; l&#x2019;augmentation des co&#xfb;ts de l&#x2019;hospitalisation suivant une reconstruction mammaire autologue. Nous avons effectu&#xe9; une &#xe9;tude de cohorte r&#xe9;trospective comprenant des personnes ayant subi une reconstruction mammaire autologue en Ontario, au Canada, entre 2005 et 2020. Ces personnes ont subi une chirurgie reconstructive au moyen soit d&#x2019;un lambeau de grand droit abdominal (lambeau TRAM) p&#xe9;dicul&#xe9;, soit d&#x2019;un lambeau libre. Nous avons analys&#xe9; les co&#xfb;ts du point de vue d&#x2019;un h&#xf4;pital, de l&#x2019;admission au cong&#xe9;. Nous avons utilis&#xe9; des mod&#xe8;les lin&#xe9;aires g&#xe9;n&#xe9;ralis&#xe9;s avec une distribution G pour rep&#xe9;rer les facteurs associ&#xe9;s au co&#xfb;t. Au total, 2634 personnes avaient subi une intervention : une reconstruction au moyen d&#x2019;un lambeau TRAM p&#xe9;dicul&#xe9; chez 378 (14,4 %) et une reconstruction au moyen d&#x2019;un lambeau libre chez 2256 (85,7 %). Le co&#xfb;t m&#xe9;dian de l&#x2019;hospitalisation &#xe9;tait de 8816 $ (intervalle interquartile 3383 $ &#xe0; 90 974 $). Une analyse univari&#xe9;e a permis de rep&#xe9;rer les inducteurs de co&#xfb;ts, y compris la dur&#xe9;e de l&#x2019;hospitalisation, le type de reconstruction, l&#x2019;&#xe2;ge, le quintile de revenu, la lat&#xe9;ralit&#xe9; et la r&#xe9;intervention urgente. Une analyse multivari&#xe9;e a r&#xe9;v&#xe9;l&#xe9; une augmentation des co&#xfb;ts associ&#xe9;s &#xe0; la reconstruction au moyen d&#x2019;un lambeau libre (augmentation de 13 %, intervalle de confiance [IC] &#xe0; 95 % de 5 % &#xe0; 22 %; p < 0,001), &#xe0; un &#xe2;ge sup&#xe9;rieur &#xe0; 70 ans (augmentation de 31 %, IC &#xe0; 95 % de 7 % &#xe0; 61 %; p < 0,01), &#xe0; un quintile de revenu faible (augmentation de 10 %, IC &#xe0; 95 % de 3 % &#xe0; 18 %; p = 0,01) et &#xe0; une reconstruction bilat&#xe9;rale (augmentation de 11 %, IC &#xe0; 95 % de 1 % &#xe0; 23 %; p = 0,03). Le type d&#x2019;h&#xf4;pital, la r&#xe9;gion g&#xe9;ographique, le moment de la reconstruction, les maladies concomitantes et la ruralit&#xe9; n&#x2019;&#xe9;taient pas significativement associ&#xe9;s au co&#xfb;t. La reconstruction au moyen d&#x2019;un lambeau libre, les proc&#xe9;dures bilat&#xe9;rales et l&#x2019;&#xe2;ge avanc&#xe9; sont des facteurs cl&#xe9;s influen&#xe7;ant les co&#xfb;ts relatifs &#xe0; l&#x2019;hospitalisation. Ces r&#xe9;sultats pourraient guider les strat&#xe9;gies en mati&#xe8;re de politiques et d&#x2019;affectation des ressources dans les syst&#xe8;mes de soins de sant&#xe9; publics afin d&#x2019;optimiser la valeur dans les soins li&#xe9;s &#xe0; la reconstruction mammaire.

Enhanced recovery after surgery (ERAS) protocols have revolutionized perioperative care across surgical disciplines. In the field of plastic surgery, recent applications of ERAS principles to cleft surgery have demonstrated promising outcomes, including decreased postoperative opioid consumption, expedited return to oral feeding, and reduced hospital length of stay. However, these pathways have yet to be tested in a resource-limited environment. Therefore, a deliberately minimalist ERAS protocol was designed and implemented over several years in an international setting. The simplified regimen consisted solely of intraoperative local anesthetic, prophylactic dexamethasone, and scheduled acetaminophen and ibuprofen postoperatively. Forty-seven pediatric craniofacial operations were performed under these conditions. Despite the absence of adjunctive agents or postoperative opioids, outcomes were highly favorable: mean pain scores were 1.9/10 on the Wong-Baker FACES scale, first oral intake occurred at 6.5 hours, hospital length of stay was under 24 hours, and no readmissions or acute complications occurred. These findings challenge the prevailing assumption that enhanced recovery requires escalating protocol complexity. Instead, they suggest that simplicity-when guided by evidence-can achieve equivalent or superior outcomes. Moreover, simplified and cost-conscious protocols may be more feasible to implement broadly, increasing the applicability of enhanced recovery principles throughout the international surgical community and even in institutions with limited resources.

A keloid scar is a benign fibroproliferative disorder that is characterized by excessive tissue growth beyond the original wound. The psychosocial and surgical challenges that arise can present potentially devastating long-term consequences for patients, particularly in demographics with a high incidence of keloid scar formation. Considering the high incidence of keloids with an estimated 11 million cases annually, particularly in those of Asian and African backgrounds, an understanding of their exact pathophysiology remains challenging. Piercing-induced keloids of the ear are a common cause of ear keloids, yet the exact mechanism and optimal treatments are of considerable debate. This narrative review aims to evaluate current treatment modalities for ear keloids, focusing on their association with ear piercings and the implications for management. A systematic review of Medline, Embase, and Mendeley identified 26 studies, covering a range of surgical and non-surgical treatment methods, indicating a considerable recurrence rate, with an average of 20.3%. Surgical excision remained the primary treatment modality, which was often accompanied by adjunctive therapies such as steroid injections and radiotherapy. Fractional carbon dioxide laser therapy may also be a useful treatment modality with fewer potential complication risks. Overall, the findings identified significant variability in treatment protocols and outcomes, underscoring the need for personalized approaches based on keloid characteristics and patient preferences. Ultimately, the review highlights the importance of further research to establish standardized treatment protocols for ear keloid scars and to understand the role of piercing-specific pathophysiology in improving patient outcomes.

Voriconazole is a broad-spectrum antifungal agent known to be associated with cutaneous squamous cell carcinoma (cSCC) in White organ transplant recipients; however, such cases are rarely reported in Asian populations. This study aimed to examine the epidemiology and treatment outcomes of Japanese patients without a history of organ transplantation who developed invasive cSCC during voriconazole therapy. This retrospective observational study analyzed data from six Japanese male patients who were treated at our hospital between the years 2013 and 2023. All patients had Fitzpatrick skin type IV and were undergoing long-term voriconazole therapy for pulmonary aspergillosis. The diagnosis of invasive cSCC was confirmed via skin biopsy. Clinical, pathological, and treatment data were collected and analyzed descriptively. Fifteen facial lesions were identified (nine at initial presentation and six during follow-up). The median duration of voriconazole treatment before cSCC diagnosis was 66.5 months. Tumors had a median diameter of 17 mm, with an estimated growth rate of 6 mm per month. Most lesions demonstrated deep invasion (Clark level IV or V), and some exhibited perineural or perivascular infiltration. All lesions were surgically excised, except for one that was treated with radiotherapy. No regional recurrence or distant metastasis was observed during a median follow-up period of 9 months. Prolonged voriconazole therapy may increase the risk of aggressive cSCC in Japanese patients, even in the absence of prior transplantation. Early identification of phototoxic skin changes and prompt intervention are crucial to prevent deep tissue invasion and improve clinical outcomes.

Length of stay (LOS) following postmastectomy breast reconstruction varies based on patient characteristics, surgical technique, and perioperative factors. Identifying independent predictors of prolonged LOS can improve preoperative planning and optimize resource utilization. Although multiple studies have evaluated outcomes following breast reconstruction, factors independently associated with LOS across different autologous reconstruction techniques remain incompletely characterized. A retrospective cohort study was conducted using American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2023. Patients were stratified by reconstruction type: free flap, pedicled transverse rectus abdominis myocutaneous (PTRAM), and latissimus dorsi (LD) flap reconstruction. Descriptive analyses evaluated LOS across demographic, clinical, and operative variables. Multivariable linear regression models were constructed separately for each reconstruction type to identify independent predictors of LOS. A total of 28,658 autologous breast reconstruction cases were included. The mean operative time differed substantially across the reconstruction types, with free flap averaging 470.54 min, PTRAM 350.44 min, and LD flaps 257.27 min (P < 0.0001). Corresponding mean LOS was 3.71 d for free flaps, 3.97 d for PTRAM, and 2.29 d for LD flaps. In multivariable analyses, operative time was the strongest predictor of LOS across all reconstruction types. Among free-flap patients, increasing age (&#x3b2; = 0.0094 per year, P < 0.0001), black race (&#x3b2; = 0.2356, P < 0.0001), higher body mass index (&#x3b2; = 0.0176 per kg/m2, P < 0.0001), insulin-dependent diabetes, and longer operative time were associated with increased LOS. Concurrent procedures and later surgical eras were associated with shorter LOS. In PTRAM reconstruction, operative time remained the only significant predictor of LOS. In LD reconstruction, operative time, smoking status, and surgical era were associated with LOS. Across autologous breast reconstruction techniques, operative time emerged as the most consistent predictor of hospital LOS. Although demographic and comorbidity factors influenced LOS in select cohorts, procedural efficiency and evolving perioperative care pathways appear to play a greater role in determining hospitalization duration following reconstruction.

Low back pain (LBP) is a global health concern with varying incidence across regions. Recognizing these regional differences is essential for creating effective prevention and control strategies. This study examines the burden and trends of LBP globally using recent data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). We extracted GBD data on prevalence, incidence, and disability-adjusted life years (DALYs) for LBP from 1990 to 2021 via the Global Health Data Exchange (GHDx). Crude and age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated globally, and by region, country, age, and sex. Decomposition, frontier, and cluster analyses were applied to identify influencing factors and trends. In 2021, there were 629 million (95% UI: 552-701 million) prevalent cases, 267 million (95% UI: 235-299 million) incident cases, and 70.16 million (95% UI: 65.76 to 83.22 million) DALYs due to LBP globally. From 1990 to 2021, ASRs of prevalence (EAPC&#x2005;=&#x2005;-0.32), incidence (EAPC&#x2005;=&#x2005;-0.29), and DALYs (EAPC&#x2005;=&#x2005;-0.32) declined. Central Europe and Hungary showed the highest burden, while Asia and China had the largest number of affected individuals. High Socio-demographic Index (SDI) regions exhibited the highest ASRs, whereas middle SDI regions had the lowest. Population growth and aging contributed to increasing case numbers, with burden peaking at ages 80-84 and being higher among females. Despite a slight decline in age-standardized rates, the global burden of LBP remains high, with marked regional and demographic disparities. Targeted health policies, particularly for elderly women in high-SDI regions, are essential to effectively reduce the burden of LBP worldwide.

Breast cancer-related lymphedema (BCRL) is a frequent and burdensome complication of oncologic treatment with substantial impact on physical, functional, and psychosocial well-being. The LYMPH-Q Upper Extremity Module is a validated, lymphedema-specific patient-reported outcome measure (PROM) designed to evaluate lymphedema severity and quality of life among patients with arm lymphedema. To date, no translated and culturally adapted French version is available. As part of the LYMPH trial, we conducted a structured translation and cross-cultural adaptation of the LYMPH-Q Upper Extremity Module into French following the Q-Portfolio Translation and Cultural Adaptation Guidelines, in alignment with the ISPOR and COSMIN recommendations. The translation process involved the following steps: dual forward translation, reconciliation, back translation, expert back translation review, and cognitive debriefing interviews with French-speaking patients. The translations were then adjusted based on patient feedback. Five French-speaking women with unilateral BCRL participated in cognitive debriefing interviews. Overall, the French LYMPH-Q was well understood, with only minor wording and phrasing adjustments identified for selected items. Fourteen linguistic refinements were noted across the Symptoms, Function, Information, and Arm Sleeve scales. All discrepancies were resolved through targeted modifications, without altering the underlying constructs of the original instrument. The French version of the LYMPH-Q Upper Extremity Module demonstrated satisfactory linguistic and cultural acceptability among Swiss French-speaking patients and provides an important step toward implementing PROMs in French-speaking patients with upper extremity lymphedema.

The rising incidence of massive weight loss (MWL) in women has led to an increased demand for breast surgery. Autoaugmentation and implant-based augmentation mastopexy represent well-established procedures in this patient population. However, there is a notable lack of direct comparison of these 2 surgical approaches in the current literature. This retrospective study included 100 consecutive patients with MWL over the past 7.6 years (64 autoaugmentation and 36 implant-based). Complication and surgical revision rates were collected retrospectively. During a follow-up examination, postoperative BREAST-Q scores, 36-item Short Form Health Survey scores, and aesthetic outcomes were evaluated. The included patients had a mean age of 39 &#xb1; 10.6 years and a median follow-up time of 2.8 years (range, 0.3 to 7.6 years). In the autoaugmentation group, most aesthetic evaluation criteria and postoperative BREAST-Q scores for Satisfaction with Breasts (P < 0.001) and Satisfaction with Outcome (P < 0.001) were significantly higher. According to Clavien-Dindo classification, complications in the autoaugmentation group were mainly managed conservatively, whereas most complications in the implant group required surgical revision (P = 0.009). Recurrent ptosis occurred more frequently in the implant group. The 36-item Short Form Health Survey results indicated no significant group differences. A tendency toward increased use of autoaugmentation techniques among 100 patients with MWL was observed, achieving significantly higher outcome scores and lower complication rates. If sufficient breast tissue is available, implant use should be avoided in this patient population. If an implant is required, patients should be thoroughly informed about the higher complication rates and potential need for revision surgery.

Breast cancer remains a leading public health issue in low- and middle-income countries (LMICs), where 5-year survival rates range from 12% to 53%. Although post-mastectomy breast reconstruction is a key part of cancer care, its uptake remains low in LMICs. This review identifies the main barriers limiting reconstruction access to inform potential interventions. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five databases were searched for English-language, peer-reviewed articles published between January 2013 and October 2023 on challenges to post-mastectomy breast reconstruction. Eligible studies were original research. Two reviewers extracted and categorized findings into socio-cultural, structural, and financial themes, summarized through descriptive analysis. The search identified 15 papers from 11 countries across four continents. Of the included studies, 73% (n = 11) mentioned barriers under two or more categories; 20% (n = 3) mentioned only structural barriers, and 7% (n = 1) mentioned only socio-cultural factors. Ten studies (67%) described socio-cultural barriers, with the most prevalent themes being the perception of reconstruction as purely aesthetic (47%), fear of anesthesia and recovery time (33%). Thirteen studies (87%) described structural barriers, with the most prevalent structural barrier being a lack of patient awareness, especially before mastectomy (47%). Limited numbers of practicing plastic surgeons (40%), urban-clustered tertiary treatment facilities (33%), and low surgeon referral rates (27%) reduced reconstruction utilization. Twelve studies (80%) described financial barriers with self-payment cited as the most significant limitation to reconstruction and the most significant barrier overall (60%). Reconstruction in LMICs faces intertwined socio-cultural, structural, and financial barriers that limit access and patient willingness.