First Reconstructive Plastic Surgery of the Perineum in a Hominin Pan paniscus (Bonobo) and Plea by a Plastic Surgeon for Surgery for the Benefit of All Hominins (Members of the Human Lineage)

We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.

When the Combination of a Chinese Flap and Dufourmentel Makes It Possible to Treat a Hopeless Case of Squamous Cell Carcinoma of the Upper Lip

Cancers of the lip are the leading cause of labial defects, and treatment is essentially surgical. The success of a repair is assessed by two essential criteria: The functional character of the lip (restoration of continence allowing feeding) and the aesthetic quality of the repair. However, for many patients from countries whose medical infrastructure does not allow them to undertake complex reconstructions locally, medical transfers represent their only chance of treatment. The aim of this article is to share with you an extreme clinical case of labial reconstruction, the management of which was a real challenge, using two major flaps: the free ante-brachial flap and the DUFOURMENTEL-type bi-pediculated scalp flap.

A Short Term Review of Operated Cases in the Plastic Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: Surgical problems are of much disturbance to the world and should therefore be given serious attention. The prevalence of these surgical problems, has made plastic surgery become a broadly relevant and acceptable way for addressing problems like injuries, congenital anomalies, surgical infections and malignancies among others. Aim: This study is to quantify and characterize surgical procedures done in the plastic surgery theatre located in the new Accident and Emergency (A & E) Building of KATH. Materials and Methods: Data were obtained from the Operation Register/Theatre Books in the plastic surgery theatre at the A & E Centre on cases operated on from October 1, 2009 to September 30, 2012. Data entry, presentation and analysis were done using Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: Adults formed the majority of patients who sought for plastic surgery with a percentage of 70.3%. The male patients also outnumbered the females recording (61.5%) out of the total number of patients. Most of the cases recorded were acquired cases (93.2%). Reconstructive surgery was the commonest operation performed (30%);in 53.8% cases general anaesthesia was used. Conclusion: Among all the procedures used reconstructive surgery was the commonest surgery performed in the unit and general anaesthesia was the most type of anaesthesia used for the operations.

Cost and value of office-based facial plastic and reconstructive surgery procedures

Introduction:This chapter will provide an overview of factors affecting the cost of office-based procedures in Facial Plastics and Reconstructive Surgery(FPRS),and will discuss the value of office-based interventions.Material and Methods:An in-depth literature review was conducted using multiple primary and secondary sources.Literature from multiple disciplines was included in the review,including otolaryngology,anesthesiology,surgery,public health,and economics.Discussion/Conclusions:A wide variety of procedures can be performed in an FPRS office.Large upfront costs to the office include laser,electrocautery and surgical equipment.These investments will yield an initial negative cost margin until sufficient case volume is achieved.It is often in the best interest of the patient to perform a procedure in-office and avoid the facility and anesthesia fees associated with a surgical center or hospital.Costs and reimbursements vary greatly across regions and facilities.Additionally,overall cost depends on payer mix,procedures performed,and productivity of the practice.The scarcity of literature on this topic as it applies specifically to FPRS indicates that further research is needed to elucidate the value of common facial plastics procedures in an office-based setting.

Saudi Arabia, Breast Plastic Surgery, Breast Construction

In this review article, various preferences in breast plastic surgery particularly after breast cancer will be discussed in view of the diverse indications for the different construction procedures. The various conditions that necessitate the need for reconstruction are appraised, the important reconstructive procedures are discussed. The most important indications procedures discussed in this review include;Prophylactic subcutaneous mastectomy, Lumpectomy and Radiation, Modified Mastectomy with Axillary Sampling, Nipple reconstruction, and the contralateral breast. These procedures are discussed in view of plastic surgeon practice and patients acceptability in Saudi Arabia. Data from Saudi Arabia in particular was identified through searches of the EMBASE, and MEDLINE database, using the keywords: Saudi Arabia, breast plastic Surgery, breast reconstruction, autologous breast reconstruction, breast augmentation. Advances in prosthetic technologies and modifications in autologous flap techniques, and the development of novel tissue alternatives have allowed for sustained developments in breast reconstruction results. A variety of attitudes has been accessible for addressing the difficulties that endure after resection of breast cancer in Saudi Arabia. Patients should be educated to accept different process in this context.

上海某三甲医院整形外科进修医师继续教育情况分析

目的分析整形外科进修医师继续教育的现状和问题。方法收集2019年至2023年上海某三甲医院整形外科进修医师的数据信息并进行分析。结果近五年来,上海某三甲医院整形外科共培训进修医师546人。进修医师主体为男性,年龄31~40岁,大多为中级职称的当地业务中坚力量。进修医师以学士和硕士为主,大多来自三级医院,其中整形外科专业来源的进修医师不到总人数一半,跨专业进修特点明显。结论整形外科涵盖范围广泛,进修医师的教学培训需注意系统化、特色化,实现高质量的继续教育目标。

阴道再造术专家共识

阴道再造术主要应用于顺性别女性由于各种原因导致缺乏功能完善的阴道,而又存在性活动要求时;或跨性别女性要求外生殖器转换者。目前该领域仍缺乏规范统一的专业化指南。编写组在中国性学会私密整形分会的带领下,总结了国内大量该类手术的相关临床经验,经由共识编写专家团队讨论,形成了中国性学会私密整形分会《阴道再造术专家共识》。该共识旨在为临床医生开展阴道再造术时,在手术适应证的把握、手术方式的选择以及术后处理等方面提供帮助。

整形外科技术在肛肠常见疾病的临床研究进展

随着专科技术的不断发展,患者对术后肛门功能和形态需求的增加,整形外科技术在肛肠常见疾病中的运用凸显重要,促使我们不断提升手术技巧来达到更好的治疗效果。相比于传统手术而言,整形外科技术具有切除病损、维持肛门功能和形态并存,术后并发症少,临床疗效明显等优势。现将近年来关于整形外科技术在肛肠常见疾病的临床研究进展综述如下,以期为临床诊治提供全面的思路,最大限度发挥整形外科技术在肛肠常见疾病中的优势,满足广大患者的“美肛”需求。

基于Donabedian理论构建整复外科专科手术护理质量评价指标体系

目的基于Donabedian理论构建整复外科专科手术护理质量评价指标体系。方法选取国内三甲医院的整复外科专家35人为函询对象,通过文献研究、质性访谈等方法,初步构建整复外科专科手术护理质量评价指标体系雏形,采用德尔菲法进行两轮专家函询,确立整复外科专科手术护理质量评价指标体系。结果两轮函询专家人员组成一致,得到专家权威系数(Cr)为0.7771。本研究中,二级和三级指标的变异系数为0.107~0.129,变异系数≤0.15,可以认为函询条目可信,专家协调程度良好。经过两轮函询,专家对各项评价指标意见趋于集中,最终确立了整复外科专科手术护理质量评价指标,包括3项一级指标、10项二级指标、47项三级指标。结论本研究构建出较为科学、严谨、全面的整复外科专科手术护理质量评价指标体系,为优化整复外科手术护理质量、提高医护患三方满意度提供理论基础。

Keystone design perforator island flap in facial defect reconstruction

Facial defect coverage is a common subject in the field of reconstructive surgery.There are many methods for facial defect reconstruction,and reconstructive surgeons should choose the most appropriate method on a case-by-case basis to achieve both functional and aesthetic improvement.Among various options for facial reconstruction,the local flap technique is considered the best reconstructive modality to provide good tissue matches of color and texture,which is consistent with the ideal goal of reconstruction(replacement of like-with-like).Keystone design perforator island flap(KDPIF),devised by Behan in 2003,has been applied to various fields of reconstructive surgery in the past decade due to its design simplicity,robust vascular supply,and reproducibility.Several studies have reported KDPIF reconstruction of facial defects,such as large parotid defects,small-to-moderate nasal defects,and eyelid defects.However,KDPIF has been used relatively less in facial defects than in other body regions,such as the trunk and extremities.The purpose of this review is to provide an organized overview of facial KDPIF reconstruction including the classification of KDPIF,modifications,physiology,mechanism of flap movement,consideration of facial relaxed skin tension lines and aesthetics,surgical techniques,clinical applications,and precautions for successful execution of KDPIF reconstruction.

Clinical outcomes for Conduits and Scaffolds in peripheral nerve repair

The gold standard of peripheral nerve repair is nerve autograft when tensionless repair is not possible. Use of nerve autograft has several shortcomings, however.These include limited availability of donor tissue,sacrifice of a functional nerve, and possible neuroma formation. In order to address these deficiencies,researchers have developed a variety of biomaterials available for repair of peripheral nerve gaps. We review the clinical studies published in the English literature detailing outcomes and reconstructive options.Regardless of the material used or the type of nerve repaired, outcomes are generally similar to nerve autograft in gaps less than 3 cm. New biomaterials currently under preclinical evaluation may provide improvements in outcomes.

Facial microcystic adnexal carcinoma-treatment with a “jigsaw puzzle” advancement flap and immediate esthetic reconstruction: A case report

BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.

2016至2020年《中华整形外科杂志》和Plastic and Reconstructive Surgery杂志皮瓣类论著文章发文情况简要对比研究

目的通过对比分析中、美两国2种整形外科领域权威期刊的皮瓣类论著文献, 寻找异同点, 探讨将来的研究方向。方法 2021年5月, 以"皮瓣"为关键词检索2016年1月至2020年12月《中华整形外科杂志》(CJPS)和Plastic and Reconstructive Surgery(PRS)杂志发表的文题或摘要内含有相关关键词的论著类文献。通过万方数据知识服务平台及中国知网检索、获取CJPS发表的相关文献, 通过PubMed数据库及Scopus数据库检索获取PRS杂志发表的相关文献。去除重复文献后, 阅读文题及摘要, 排除非皮瓣研究及非论著类文献。阅读全文并运用文献计量学方法, 对总发文量、皮瓣研究发文量、循证医学证据级别、作者国籍及机构分布、皮瓣类型、皮瓣应用及新技术应用等方面进行综合分析。结果 CJPS近5年总发文量为1 166篇, 244篇纳入研究;PRS杂志近5年总发文量为4 562篇, 268篇纳入研究。PRS杂志作者以美国学者居多, 中国学者发文总量位居第2位, 近5年内中国内地作者共发文21篇。CJPS发文以带蒂皮瓣研究居多, PRS杂志则以游离皮瓣为主;CJPS传统皮瓣发文量多于穿支皮瓣, PRS杂志则与之相反;CJPS发文以局部皮瓣、股前外侧皮瓣和腓动脉穿支皮瓣为主, 而PRS杂志以腹壁下动脉穿支皮瓣、腓骨骨瓣或骨皮瓣和股前外侧皮瓣等类型的皮瓣为主。CJPS报道的皮瓣主要用于修复缺损, 而PRS杂志报道的皮瓣则主要用于乳房再造等领域。此外, 两本杂志都报道了许多皮瓣外科领域的新技术和新方法, 如计算机辅助成像、吲哚菁绿成像技术、螺旋桨皮瓣、分叶皮瓣等, 已经得到了广泛应用。结论近5年, 我国的皮瓣研究整体处在国际领先水平, 具有一定的国际竞争力。但我国的研究局限于报道临床经验, 循证医学级别低, 与国际前沿研究尚有一定的差距。

2019-2022年度《组织工程与重建外科》杂志文献计量学分析

目的统计分析近4年来《组织工程与重建外科》杂志的主要文献计量学指标变化,并与其他美容整形外科类期刊进行比较。方法依据《中国科技期刊引证报告(核心版)》的统计数据,对《组织工程与重建外科》的主要文献计量学指标,包括总被引频次、影响因子、基金论文比、他引率等进行统计及纵向分析,并将办刊背景较为相似的美容整形外科类5本期刊进行横向比较。结果4年来,《组织工程与重建外科》总被引频次、载文量稳步上升,而影响因子、基金论文比、综合评价总分总体呈下降趋势,他引率均保持在0.9左右。与其他美容整形外科类期刊比较,本刊总被引频次、影响因子、载文量居于末位,但是他引率、基金论文比及综合评价总分均排名前列。结论组稿高质量论文、增强组稿广泛性是本刊短期的工作目标和方向。

三维重建工具在胸外科教学中的应用探析——以全自动胸部CT三维重建为例

研究全自动胸部CT三维重建工具在胸外科规培学员教学过程中的应用效果。选取在胸外科轮转的临床医学规培学员为研究对象,随机分为试验组和对照组,试验组采用全自动胸部CT三维重建工具结合PBL和手术教学法,对照组采用传统的PBL结合手术教学法,随后两组学员进行理论考试、技能考试及问卷调查。结果显示,试验组出科理论考试成绩和技能考试成绩均高于对照组,试验组调查问卷的教学满意度高于对照组。综上得出,全自动胸部CT三维重建工具在胸外科规培学员的临床教学中起到了良好的作用,值得应用和推广。

基于多层螺旋CT乳腺三维重建及打印数据库的构建在普外科专业型硕士研究生教学实践中的应用

目的探讨基于多层螺旋CT乳腺(MSCT)三维(3D)重建及打印数据库的构建在普外科专业型硕士研究生教学实践中的可行性及应用效果。方法选取2020年1—6月在本院乳腺外科术前空心针穿刺确诊为乳腺癌的10例患者,运用3D重建及打印技术,将其双侧乳房和患侧肿瘤基于MSCT数据做成数据库,术前1︰1模拟并打印出患者乳房及肿瘤形态,真实展示肿瘤位置与周围组织解剖结构。选择2020年1月—2022年6月未曾在乳腺外科轮转过的本院普外科专业型硕士研究生100名为研究对象,随机分为传统教学组(对照组)和3D重建及打印教学组(实验组)两组,分别应用传统教学法和基于MSCT的3D重建及打印教学法进行基础理论及临床教学,1周后进行理论学习成绩、临床技能考核、调查问卷等多种教学效果评价方法进行效果评价,应用SPSS 24.0对两组的成绩及满意度等评分进行统计分析。结果实验组学生的理论学习成绩和临床技能考核成绩均显著高于对照组,实验组学生对教学内容单位丰富性、教学模式的合理性、教学模式临床实践指导价值等方面评价效果均高于对照组,实验组研究生对自我的理论知识掌握、自主学习能力、临床诊疗思维的提高均优于对照组,差异均有统计学意义(P<0.05)。结论本研究成功构建了基于MSCT的乳腺3D重建及打印数据库,并将其在普外科专业型硕士研究生乳腺外科理论及实践教学中进行应用,教学效果显著,学生考核成绩优秀,学习兴趣度高,教师评价高,值得在临床教学中推广。

PBL联合CBL教学法在整复外科相关罕见病教学中的应用

近年来,随着罕见病在社会中得到越来越广泛的关注,与罕见病相关的基础和临床知识也逐渐成为医学生必须掌握的内容。传统的教学模式已无法满足整复外科相关罕见病的教学需求。目前,PBL联合CBL教学法已成为一种新兴、高效、灵活的教学模式,两者的联合在整复外科相关罕见病教学中有着很好的应用前景。

基于5G物联网技术构建患者安全智能预警系统在整复外科护理工作中的应用

目的开发基于5G物联网技术的患者安全智能预警系统,探讨其在整复外科护理工作中的应用效果。方法组建研究开发小组,构建患者安全智能预警系统,利用文献检索和德尔菲专家咨询法,筛选患者安全预警指标,构建安全指标智能预警模块,利用5G网络将构建的安全指标评估内容及所涉及的物连设备与研发的预警系统相整合。人员培训后,患者安全智能预警系统在整复外科病区应用,在系统应用前及应用后2个月统计住院患者潜在并发症的发现率、术后并发症及不良事件发生率,对分级护理质量进行评分,并自行设计问卷对医护人员进行该系统的满意度调查。结果患者安全智能预警系统应用后,患者潜在并发症的发现率显著提高(P<0.05);该系统应用后,患者术后并发症及不良事件发生率有所下降,但未见显著性差异(P>0.05);该系统应用后分级护理质量得分由97分提高到99分;医护人员对患者安全智能预警系统的整体满意度得分为(4.59±0.49)分。结论基于5G物联网技术构建的患者安全智能预警系统,可以提高患者潜在并发症的发现率,增强医护对患者安全风险的预见性及安全风险管理意识,促进临床干预措施的及时跟进,保障患者安全。

脊柱后路内固定术后切口愈合不良的整形外科治疗

目的:探讨不同整形外科治疗方案在脊柱后路内固定术后切口愈合不良中的临床意义。方法:回顾性纳入16例脊柱后路内固定术后切口愈合不良患者,根据创面特征及缺损情况决定不同整形外科治疗方案,包括清创、创面密闭式负压吸引(vacuum sealing drainage,VSD)、根据创面缺损部位及程度设计不同组织皮瓣覆盖等。结果:共纳入符合标准的患者16例,其中3例使用清创联合VSD治疗后创面直接缝合,6例使用清创联合Z皮瓣修复创面,1例使用双侧骶棘肌肌瓣修补硬脊膜缺损联合Z皮瓣修复皮肤创面,1例使用背阔肌皮瓣修复创面,3例使用第四腰动脉穿支皮瓣修复创面,1例使用局部旋转皮瓣修复创面,1例使用臀大肌肌皮瓣修复创面。16例患者中,有7例创面细菌培养阳性,其中3例为金黄色葡萄球菌,1例铜绿假单胞杆菌,1例表皮葡萄球菌,1例大肠埃希菌,1例肺炎克雷波杆菌,其余9例创面细菌培养均为阴性。术后有7例患者出现创面不同程度愈合不良,其中3例进行换药治疗,2例进行二次清创缝合,1例采用头皮游离皮片移植,1例进行局部积液抽吸,以上7例患者均好转出院,其余9例患者手术后创面均一期愈合良好。16例患者均未行内固定取出。结论:多种因素可以导致脊柱后路内固定术后切口愈合不良,早期干预、彻底清创、去除坏死/感染组织、选择合适的皮瓣有效创面填充覆盖是保证脊柱术后创面愈合、减少内固定取出的重要手段。

课程思政在整复外科教学中的实践与探索

新时代背景下,健康中国战略的实施和立德树人目标的确立,均对医学院校及其附属医院的思想政治教育工作提出了更高层面的要求。在夯实专业教学的基础上加强医学生思政教育,全面推进课程思政建设是首要途径。充分认识课程思政在整复外科理论与实践教学中的应用价值的前提下,结合学科实际构建具有鲜明学科特色的课程思政教育体系,将思想政治融入整复外科医生培育的全过程,是培养有本领、有温度、有担当的卓越医学创新人才的重要保障。课程思政实际开展过程中,要求医学院校在注重隐性教育和显性教育相协同、理论传授和实践锻炼相结合的基础上,从教学团队组建、思政元素挖掘、课程方案设计等各个环节全方位探索并落实,形成“教师-课程-实践”全融合育人体系。