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The Cochrane Database of Systematic... Oct 2017Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable... (Review)
Review
BACKGROUND
Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. This review compares the use of titanium versus bioresorbable plates in orthognathic surgery and is an update of the Cochrane Review first published in 2007.
OBJECTIVES
To compare the effects of bioresorbable fixation systems with titanium systems used during orthognathic surgery.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 20 January 2017); MEDLINE Ovid (1946 to 20 January 2017); and Embase Ovid (1980 to 20 January 2017). We searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov; searched 20 January 2017), and the World Health Organization International Clinical Trials Registry Platform (searched 20 January 2017) for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials comparing bioresorbable versus titanium fixation systems used for orthognathic surgery in adults.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We resolved disagreement by discussion. Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented.
MAIN RESULTS
This review included two trials, involving 103 participants, one comparing titanium with resorbable plates and screws and the other titanium with resorbable screws. Both studies were at high risk of bias and provided very limited data for the primary outcomes of this review. All participants in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow-up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates.
AUTHORS' CONCLUSIONS
We do not have sufficient evidence to determine if titanium plates or resorbable plates are superior for fixation of bones after orthognathic surgery. This review provides insufficient evidence to show any difference in postoperative pain and discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials.
Topics: Absorbable Implants; Bone Plates; Bone Screws; Device Removal; Humans; Internal Fixators; Mandible; Maxilla; Osteotomy; Randomized Controlled Trials as Topic; Titanium
PubMed: 28977689
DOI: 10.1002/14651858.CD006204.pub3 -
Journal of Pediatric Surgery May 2021Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces the best results.
METHODS
In this prospectively registered study, the PubMed, Ovid MEDLINE, Cochrane Library, Centre for Reviews and Dissemination Database, and ScienceDirect databases were searched. English language studies published between January 1980 and August 2017 evaluating TiA and/or AdT for primary skin closure of surgical wounds or lacerations in patients aged ≤18 years were included. Study endpoints included clinician-rated wound cosmesis and incidence of wound complications.
RESULTS
Thirty-one studies were included in the systematic review and 16 studies in the meta-analysis. Amongst heterogeneous studies, AdT yielded marginally better cosmetic outcomes than TiA (p = 0.04). There was no difference in cosmesis between sutured wounds and those closed with TiA (p = 0.2). No difference in overall risk of wound infection or dehiscence was identified when comparing TiA with AdT (p = 0.3), and TiA with sutures (p = 0.9 and 0.3 respectively).
CONCLUSIONS
TiA, AdT, and sutures can all be used for wound closure with equivalent risk of wound infection and dehiscence. AdT appears to convey better cosmesis. Further adequately powered studies directly comparing techniques are required.
LEVELS OF EVIDENCE
Level IV.
Topics: Child; Humans; Surgical Tape; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures; Tissue Adhesives
PubMed: 32888718
DOI: 10.1016/j.jpedsurg.2020.07.037 -
The British Journal of Surgery Apr 2016Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.
METHODS
This was a systematic review and meta-analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.
RESULTS
Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.
CONCLUSION
Compared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.
Topics: Humans; Models, Statistical; Negative-Pressure Wound Therapy; Postoperative Complications; Seroma; Surgical Wound Dehiscence; Surgical Wound Infection; Treatment Outcome
PubMed: 26994715
DOI: 10.1002/bjs.10084 -
Journal of Pediatric Surgery Aug 2022Postoperative feeding practices are not uniform in children undergoing bowel anastomosis surgery. Primary aim of this review was to evaluate the safety and efficacy of... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of safety and efficacy of early enteral nutrition as an isolated component of Enhanced Recovery After Surgery [ERAS] in children after bowel anastomosis surgery.
BACKGROUND
Postoperative feeding practices are not uniform in children undergoing bowel anastomosis surgery. Primary aim of this review was to evaluate the safety and efficacy of early enteral nutrition (EEN) as an isolated component of enhanced recovery in children undergoing bowel anastomosis surgery.
METHODS
Medical search engines (PubMed, CENTRAL, Google scholar) were accessed from inception to January 2021. Randomized Controlled Trials (RCT)s, non-randomized controlled trials, observational studies and retrospective studies comparing EEN, initiated within 48 h vs late enteral nutrition (LEN), initiated after 48 h in children ≤ 18 years undergoing bowel anastomosis surgery were included. Primary outcome measure was the incidence of postoperative complications (anastomotic leak, abdominal distension, surgical site infection, wound dehiscence, vomiting and septic complications). Secondary outcome measures were the time to passage of first feces and the length of hospital stay.
RESULTS
Twelve hundred and eighty-six children from 10 studies were included in this review. No difference was seen between the EEN and LEN groups in the incidence of anastomotic leak (1.69% vs 4.13%; p = 0.06), abdominal distention (13.87% vs 12.31%; p = 0.57), wound dehiscence (3.07% vs 2.69%; p = 0.69) or vomiting (8.11% vs 8.67%; p = 0.98). The incidence of surgical site infections (7.51% vs 11.72%; p = 0.04), septic complications (14.02% vs 26.22%; p = 0.02) as well as pooled overall complications (8.11% vs 11.27%; RR 0.71; 95% CI = 0.56 to 0.89; p = 0.003; I = 33%) were significantly lower in the EEN group. The time to passage of first feces (MD - 17.23 h; 95% CI -23.13 to -11.34; p < 0.00001; I = 49%) and the length of hospital stay (MD -2.95 days; 95% CI -3.73 to -2.17; p < 0.00001; I = 93%) were significantly less in the EEN group.
CONCLUSION
EEN is safe and effective in children following bowel anastomosis surgery and is associated with a lower overall incidence of complications as compared to LEN. EEN also promotes early bowel recovery and hospital discharge. However, further well designed RCTs are required to validate these findings.
LEVEL OF EVIDENCE
V.
Topics: Anastomosis, Surgical; Anastomotic Leak; Child; Enhanced Recovery After Surgery; Enteral Nutrition; Humans; Length of Stay; Postoperative Complications; Vomiting
PubMed: 34417055
DOI: 10.1016/j.jpedsurg.2021.07.020 -
Frontiers in Neuroscience 2022Surgical treatment of vertigo is performed with in-depth study of inner ear diseases. Achieving an effective control of vertigo symptoms while reducing damage to hearing...
Surgical treatment of vertigo is performed with in-depth study of inner ear diseases. Achieving an effective control of vertigo symptoms while reducing damage to hearing and reducing surgical complications is the principle followed by scholars studying surgical modalities. Semicircular canal occlusion is aimed at treatment of partial peripheral vertigo disease and has attracted the attention of scholars because of the above advantages. This article provides a review of the origins of semicircular canal occlusion, related basic research, clinical applications, and the effects of surgery on vestibular and hearing function.
PubMed: 36061608
DOI: 10.3389/fnins.2022.977323 -
Clinical Implant Dentistry and Related... Dec 2022This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management... (Review)
Review
AIM
This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies.
MATERIALS AND METHODS
Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies.
RESULTS
A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies.
CONCLUSION
Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.
Topics: Humans; Sinus Floor Augmentation; Maxillary Sinus; Dental Implantation, Endosseous; Transverse Sinuses; Postoperative Complications; Dental Implants
PubMed: 35737681
DOI: 10.1111/cid.13086 -
Plastic and Reconstructive Surgery Oct 2022The considerable increase in labiaplasty requires plastic surgeons to be acquainted with the surgical techniques, their respective complications, and satisfaction rates.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The considerable increase in labiaplasty requires plastic surgeons to be acquainted with the surgical techniques, their respective complications, and satisfaction rates. The authors conducted a systematic review of the available evidence on labia minoraplasty, looking at surgical techniques, clinical outcomes, and patient satisfaction.
METHODS
A comprehensive search across PubMed, Web of Science, SCOPUS, and CochraneCENTRAL was performed through October of 2020. A random-effects model meta-analysis was performed to assess satisfaction and complication rates.
RESULTS
Forty-six studies including 3804 patients fulfilled the inclusion criteria. The pooled satisfaction rate after labia minoraplasty was 99 percent (95 percent CI, 97 to 99 percent). Substantial heterogeneity was present across studies ( I2 = 63.09 percent; p < 0.001). The highest pooled incidence of dehiscence was reported for laser-assisted labiaplasty (5 percent; 95 percent CI, 2 to 8 percent) and wedge resection (3 percent; 95 percent CI, 1 to 5 perecent). The highest pooled incidence of hematoma formation (8 percent; 95 percent CI, <1 to 23 percent) and postoperative bleeding (2 percent; 95 percent CI, <1 to 15 percent) was reported for W-shape resection. The highest pooled incidence of transient pain or discomfort was reported for de-epithelialization (2 percent; 95 percent CI, <1 to 23 percent) and W-shape resection (2 percent; 95 percent CI, <1 to 15 percent). Three cases of flap necrosis were reported; two occurred using wedge resection labia minoraplasty and one was not specified. The most common causes for revision surgery ( n = 169) were dehiscence and aesthetic concerns.
CONCLUSIONS
Labia minoraplasty is a safe procedure, but serious complications requiring surgical management have been reported. Surgical experience, knowledge of female genital anatomy, and thorough technique selection in accordance with the patient characteristics are mandatory.
Topics: Esthetics; Female; Humans; Patient Satisfaction; Plastic Surgery Procedures; Reoperation; Vulva
PubMed: 35877939
DOI: 10.1097/PRS.0000000000009552 -
Global Spine Journal Jun 2020Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVES
Cyanoacrylate glue closure has been utilized for dermal closure in surgical incisions. Its safety and efficacy in spine surgery are not established. The authors perform a systematic review to determine the rate of surgical site infection (SSI), wound dehiscence, and wound erythema with cyanoacrylate dermal closure in spine surgery.
METHODS
A systematic review adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed utilizing the PubMed/MEDLINE, EMBASE, and Cochrane databases on patients undergoing spine surgery with cyanoacrylate dermal closure. Pooled analysis was performed with stratification of patients according to spinal level and the presence/absence of instrumentation. Risk-of-bias and methodological quality was appraised using 17 prespecified criteria.
RESULTS
Five articles (1 retrospective cohort study, 4 cases series) with a total of 1282 patients were included. A total of 967 patients, all diagnosed with degenerative spine disease, were suitable for pooled analysis. In 290 patients who underwent anterior cervical discectomy and fusion, and in 23 patients with posterior cervical decompression (without instrumentation), there was 0% rate of SSI, wound dehiscence, and erythema. In 489 patients who underwent lumbar microdiscectomy, there was 0.41% rate of SSI, 0.20% rate of wound dehiscence, and 0.20% rate of wound erythema. In 165 lumbar laminectomy patients, there was a 1.82% rate of SSI, 0.61% rate of wound dehiscence, and 0% rate of wound erythema.
CONCLUSION
Cyanoacrylate dermal closure for the aforementioned procedures is associated with low rates of wound complications (SSI, dehiscence, and erythema). Further studies should be performed, especially in nondegenerative surgery, instrumented thoracic and lumbar spine surgery.
PubMed: 32435571
DOI: 10.1177/2192568219861619 -
Supportive Care in Cancer : Official... Jul 2022The use of acellular dermal matrices (ADMs) and mesh reopened the possibility for the prepectoral single-stage breast reconstruction (PBR). The complications of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of acellular dermal matrices (ADMs) and mesh reopened the possibility for the prepectoral single-stage breast reconstruction (PBR). The complications of single-stage breast reconstruction after PRB are controversial. We conducted a systematic review and meta-analysis of the impact of implant plane on single-stage breast reconstruction. Our aim was to evaluate the different postoperative complications between patients receiving prepectoral breast reconstruction and subpectoral breast reconstruction (SBR) on single-stage breast reconstruction.
METHODS
A comprehensive research on databases including PubMed, Embase, and Cochrane libraries was performed to retrieve literature evaluating the effect of implant plane on single-stage breast reconstruction from 2010 to 2020. All included studies were evaluated the complications after single-stage breast reconstruction. Only studies comparing patients who underwent prepectoral reconstruction with a control group who underwent subpectoral reconstruction were included.
RESULTS
A total of 13 studies were included in the meta-analysis, with a total of 1724 patients. In general, compared with SBR group, the PBR significantly reduced the risk of total complications (including seroma, hematoma, necrosis, wound dehiscence, infection, capsular contraction, implant loss/remove, and rippling) after single-stage breast reconstruction (OR: 0.54, 95% CI: 0.44-0.67, p < 0.001). Compared with the SBR group, the PBR had remarkably decreased capsular contracture (OR: 0.40, 95% CI: 0.27-0.58, p < 0.001) and postoperative infection (OR: 0.58, 95% CI: 0.36-0.95, p = 0.03).
CONCLUSION
The PBR is a safe single-stage breast reconstruction with fewer postoperative complications. It is an alternative surgical method for SBR.
Topics: Breast Implantation; Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Postoperative Complications; Retrospective Studies
PubMed: 35182228
DOI: 10.1007/s00520-022-06919-5 -
Annals of Plastic Surgery Mar 2023There remains an unclear definition of the term "gigantomastia," with many studies using different parameters and measurements. Currently, the operative management and...
INTRODUCTION
There remains an unclear definition of the term "gigantomastia," with many studies using different parameters and measurements. Currently, the operative management and patient education for gigantomastia are outdated. The historical teaching that a free nipple graft is necessary in elongated pedicles to avoid nipple necrosis may not be factual. The principal goal of our review aims to determine the safety of nipple-sparing breast reductions on large ptotic breasts via complication rate analysis.
METHODS
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of conduct for systematic review and meta-analysis. In October 2021, PubMed was used to search the US National Library of Medicine database. Rayyan Intelligent Systematic Review aided in screening studies by title then abstract. If inclusion criteria were met, the entire article was reviewed.
RESULTS
Twenty-two articles satisfied the inclusion and exclusion criteria. The study was composed of 1689 total patients with a mean body mass index of 32.9 (±3.4). Mean midclavicle-to-nipple distance and resection weight per breast was 39 cm (±3.8) and 1423.8 g (±268.9), respectively. A Wise pattern was preferred in 77.3% of the studies, with an inferior (45.5%) and superomedial (45.5%) pedicle used most commonly. Complete nipple areolar complex necrosis (1.7%) was found in 4 studies, whereas partial (5.9%) was observed in 11. More common complications included delayed wound healing (17.4%), surgical site infection (14.3%), seroma (10.5%), scar hypertrophy (9.9%), and wound dehiscence (9.2%).
CONCLUSION
Nipple-sparing breast reduction surgery can be safely performed on hypertrophic and severely ptotic breasts with nipple areolar complications, such as partial or complete nipple areolar complex loss, at a rate less than previously believed.
Topics: Humans; Hypertrophy; Mammaplasty; Necrosis; Nipples; Retrospective Studies; Treatment Outcome
PubMed: 36796050
DOI: 10.1097/SAP.0000000000003415