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Plastic and Reconstructive Surgery.... Mar 2021Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall...
BACKGROUND
Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall survival. Several interventions have been found to successfully reduce surgical bleeding, including the antifibrinolytic agent. After aprotinin was withdrawn from the market in 2008, TXA remained the most commonly used medication. The safety and efficacy of TXA has been well studied in other specialties. TXA has been rarely used in plastic surgery, except in craniofacial procedures. Since the last review, the number of articles examining the use of TXA has doubled; so the aim of this systematic review is to update the readers on the current knowledge and clinical recommendations regarding the efficacy of TXA in plastic surgical procedures.
METHODS
A systematic literature search was conducted in Medline, SciELO, Cochrane, and Google Scholar to evaluate all articles that discussed the use of TXA in plastic surgery in the fields of aesthetic surgery, burn care, and reconstructive microsurgery.
RESULTS
A total of 233 publications were identified using the search criteria defined above. After examination of titles and abstracts, and exclusion of duplicates, a total of 23 articles were selected for analysis.
CONCLUSIONS
The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events. Also, TXA elicits a potent anti-inflammatory response with a decrease in postoperative edema and ecchymosis, which improves recovery time. Further investigations are needed to standardize the optimal administration route and dosage of TXA.
PubMed: 33907653
DOI: 10.1097/GOX.0000000000003172 -
Current Oncology Reports Sep 2023Breast cancer-related lymphedema (BCRL) is a debilitating progressive disease resulting in various impairments and dysfunctions. Complete decongestive therapy embodies... (Review)
Review
PURPOSE OF REVIEW
Breast cancer-related lymphedema (BCRL) is a debilitating progressive disease resulting in various impairments and dysfunctions. Complete decongestive therapy embodies conservative rehabilitation treatments for BCRL. Surgical procedures performed by plastic and reconstructive microsurgeons are available when conservative treatment fails. The purpose of this systematic review was to investigate which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes.
RECENT FINDINGS
Studies published between 2002 and 2022 were grouped for analysis. This review was registered with PROSPERO (CRD42022341650) and followed the PRISMA guidelines. Levels of evidence were based upon study design and quality. The initial literature search yielded 296 results, of which, 13 studies met all inclusion criteria. Lymphovenous bypass anastomoses (LVB/A) and vascularized lymph node transplant (VLNT) emerged as dominant surgical procedures. Peri-operative outcome measures varied greatly and were used inconsistently. There is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists. A core set of outcome measures for BCRL is vital to unify terminological differences in the multidisciplinary care of BCRL. Complete decongestive therapy embodies conservative rehabilitation treatments for breast cancer-related lymphedema (BCRL). Surgical procedures performed by microsurgeons are available when conservative treatment fails. This systematic review investigated which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. Thirteen studies met all inclusion criteria and revealed that there is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Furthermore, peri-operative outcome measures were inconsistent. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists.
Topics: Humans; Female; Breast Neoplasms; Lymphedema; Outcome Assessment, Health Care
PubMed: 37402044
DOI: 10.1007/s11912-023-01439-9 -
World Journal of Surgery Jan 2022The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic. (Review)
Review
BACKGROUND
The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic.
METHODS
This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020-August 8, 2020) and second 6-month period (August 9-March 4, 2021) of the COVID-19 pandemic.
RESULTS
Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty.
CONCLUSION
Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown.
Topics: COVID-19; Humans; Orthopedics; Pandemics; SARS-CoV-2; Telemedicine
PubMed: 34743242
DOI: 10.1007/s00268-021-06348-1 -
International Journal of Surgery... Dec 2023Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties.
METHODS
The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design.
RESULTS
A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001).
CONCLUSION
Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
Topics: Humans; Aftercare; Patient Discharge; Postoperative Complications; Prospective Studies; Sarcopenia
PubMed: 37696253
DOI: 10.1097/JS9.0000000000000688 -
Indian Journal of Plastic Surgery :... May 2019To assess the effectiveness and harm of music to reduce anxiety and pain in a plastic surgery setting. A search strategy was conducted in the MEDLINE, CENTRAL,... (Review)
Review
To assess the effectiveness and harm of music to reduce anxiety and pain in a plastic surgery setting. A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE, and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects was conducted. The primary outcomes were anxiety and pain. The secondary outcomes were length of stay, physiological parameters, and adverse effects. The measure of the effect was the mean difference (MD) and standardized MD (SMD) with a 95% confidence interval (CI). The planned interventions were music versus no music. Four articles were included in the qualitative and quantitative analysis. A total of 306 patients were found among the four studies. A low risk of bias was shown for most of the study items. The overall standardized mean difference (SMD) for anxiety -3.64 [95%CI -5.71 to -1.56 (p-value = 0.0006)] favoring music compared with no intervention, and for pain the mean difference (MD) was -12.06 [95%CI -33.47 to 9.35 (p-value = 0.2696)] showing no statistical differences. Playing music is a safe and free intervention that diminishes anxiety in patients who undergo plastic surgery procedures.
PubMed: 31602130
DOI: 10.1055/s-0039-1696792 -
Aesthetic Plastic Surgery Feb 2020Advances in medical technology coupled with rapid growth of web-based mass media and social networking services have considerably increased public access to cosmetic... (Meta-Analysis)
Meta-Analysis
PURPOSE
Advances in medical technology coupled with rapid growth of web-based mass media and social networking services have considerably increased public access to cosmetic surgery. In South Korea, in particular, the number of people undergoing cosmetic surgery has been rapidly increasing, and studies related to cosmetic surgery have markedly increased. We report an integrative review of studies examining the relationship between cosmetic surgery and self-esteem in Korea. We aimed to identify relevant variables and determine their overall effect sizes.
METHODS
This study was designed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two researchers separately performed the literature search, selected 16 papers based on the inclusion and exclusion criteria, and analyzed them.
RESULTS
Of the 16 papers on cosmetic surgery and self-esteem, 5 (33.3%) involved both men and women, and the remaining 11 (66.7%) involved only women. The respondents included teenagers and adults. The total number of respondents was 6296, with an average of 393.5 per paper. Most studies (n = 13, 81.3%) used the Rosenberg Self-Esteem Scale. Self-esteem was correlated with variables grouped into the following six categories: appearance management intention, cosmetic surgery intention, sociocultural attitude, body satisfaction, BMI, and stress. The effect sizes from the meta-analysis with correlation coefficients were 0.157, - 0.118, 0.023, 0.175, - 0.045, and - 0.085.
CONCLUSIONS
Among the relevant variables categorized in this study, sociocultural attitude, BMI, and stress showed weak effect sizes, and the appearance management intention, cosmetic surgery intention, and body satisfaction categories showed intermediate effect sizes. The results of this study are expected to serve as a concrete basis for the development of strategies to minimize the adverse effects of the ever-growing cosmetic surgery industry. This information can help elucidate the psychologic characteristics of individuals seeking cosmetic surgery and contribute to optimal medical outcomes.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Topics: Adolescent; Adult; Attitude; Body Image; Female; Humans; Male; Republic of Korea; Self Concept; Surgery, Plastic
PubMed: 31637500
DOI: 10.1007/s00266-019-01515-1 -
Cureus Oct 2022Burn wounds remain a prevalent problem in the developed and developing world. A multitude of remedies has been tested. This study evaluated the healing time of second-... (Review)
Review
Burn wounds remain a prevalent problem in the developed and developing world. A multitude of remedies has been tested. This study evaluated the healing time of second- and third-degree burn wounds between silver sulfadiazine (SSD) and (AV). In July 2020, a systematic review of MEDLINE (Ovid) and PubMed (National Library of Medicine) was performed to identify studies that reported healing of second- and third-degree burns using either SSD or AV. Articles meeting the inclusion criteria were screened and carefully analyzed. Our goal was to report the healing time for these burns using SSD and AV. A total of eight studies published between 1988 and 2018 reporting healing of second- and third-degree burns using SSD and AV were included in this review. Six were cohort studies and two were randomized controlled trials. The studies included both animal and human subjects. The meta-analysis demonstrated that the mean time to wound healing favored AV (RR: -1.34, 95% CI: -1.8 to 0.9, p < 0.001). It would seem that time to healing benefitted those burns in which AV was utilized. In conclusion, increased consideration and emphasis should be placed on using AV to aid the healing of second- and third-degree burns.
PubMed: 36337821
DOI: 10.7759/cureus.30815 -
World Journal of Surgery Mar 2018The timing of intestinal failure (IF) surgery has changed. Most specialized centers now recommend postponing reconstructive surgery for enteric fistula and emphasize... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The timing of intestinal failure (IF) surgery has changed. Most specialized centers now recommend postponing reconstructive surgery for enteric fistula and emphasize that abdominal sepsis has to be resolved and the patient's condition improved. Our aim was to study the outcome of postponed surgery, to identify risk factors for recurrence and mortality, and to define more precisely the optimal timing of reconstructive surgery.
METHODS
PubMed, Embase, and the Cochrane Library were systematically reviewed on the outcomes of reconstructive IF surgery (fistula recurrence, mortality, morbidity, hernia recurrence, total closure, enteral autonomy). If appropriate, meta-analyses were performed. Optimal timing was explored, and risk factors for recurrence and mortality were identified.
RESULTS
Fifteen studies were included. The weighted pooled fistula recurrence rate was 19% (95% CI 15-24). Lower recurrence rates were found in studies with a longer median time and/or, at the minimum of the range, a longer time interval to surgery. Overall mortality was 3% (95% CI 2-5). Total fistula closure rates ranged from 80 to 97%. Enteral autonomy after reconstructive surgery, mentioned in four studies, varied between 79 and 100%.
CONCLUSIONS
Postponed IF surgery for enteric fistula is associated with lower recurrence. Due to the wide range of time to definitive surgery within each study, optimal timing of surgery could not be defined from published data.
Topics: Cutaneous Fistula; Digestive System Surgical Procedures; Elective Surgical Procedures; Humans; Intestinal Fistula; Postoperative Complications; Plastic Surgery Procedures; Recurrence; Risk Factors; Time-to-Treatment
PubMed: 28924879
DOI: 10.1007/s00268-017-4224-z -
Plastic and Reconstructive Surgery.... Dec 2022Artificial intelligence (AI) is presently employed in several medical specialties, particularly those that rely on large quantities of standardized data. The integration...
UNLABELLED
Artificial intelligence (AI) is presently employed in several medical specialties, particularly those that rely on large quantities of standardized data. The integration of AI in surgical subspecialties is under preclinical investigation but is yet to be widely implemented. Plastic surgeons collect standardized data in various settings and could benefit from AI. This systematic review investigates the current clinical applications of AI in plastic and reconstructive surgery.
METHODS
A comprehensive literature search of the Medline, EMBASE, Cochrane, and PubMed databases was conducted for AI studies with multiple search terms. Articles that progressed beyond the title and abstract screening were then subcategorized based on the plastic surgery subspecialty and AI application.
RESULTS
The systematic search yielded a total of 1820 articles. Forty-four studies met inclusion criteria warranting further analysis. Subcategorization of articles by plastic surgery subspecialties revealed that most studies fell into aesthetic and breast surgery (27%), craniofacial surgery (23%), or microsurgery (14%). Analysis of the research study phase of included articles indicated that the current research is primarily in phase 0 (discovery and invention; 43.2%), phase 1 (technical performance and safety; 27.3%), or phase 2 (efficacy, quality improvement, and algorithm performance in a medical setting; 27.3%). Only one study demonstrated translation to clinical practice.
CONCLUSIONS
The potential of AI to optimize clinical efficiency is being investigated in every subfield of plastic surgery, but much of the research to date remains in the preclinical status. Future implementation of AI into everyday clinical practice will require collaborative efforts.
PubMed: 36479133
DOI: 10.1097/GOX.0000000000004608 -
Aesthetic Plastic Surgery Aug 2021Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes... (Review)
Review
INTRODUCTION
Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes of cosmetic tourism, in particular, for aesthetic breast surgery. The majority of the literature involves retrospective case series with no defined comparator. We aimed to amalgamate the published data to date to ascertain the risks involved and the outcomes of cosmetic tourism for aesthetic breast surgery on a global basis.
METHODS
A systematic review of PubMed, Google Scholar, EMBASE, the Cochrane library and OVID Medline was conducted using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. Keywords such as "medical tourism", "cosmetic tourism", "tourism", "tourist", "surgery", "breast" and "outcomes" were used. Seven hundred and seventy-one titles were screened, and 86 abstracts were reviewed leaving 35 full texts. Twenty-four of these met the inclusion criteria and were used to extract data for this systematic review.
RESULTS
One hundred and seventy-one patients partook in cosmetic tourism for aesthetic breast surgery. Forty-nine percent of patients had an implant-based procedure. Other procedures included: mastopexy (n=4), bilateral breast reduction (n=11) and silicone injections (n=2). Two-hundred and twenty-two complications were recorded, common complications included: wound infection in 39% (n=67), breast abscess/ collection in 12% (n=21), wound dehiscence in 12% (n= 20) and ruptured implant in 8% (n=13). Clavien-Dindo classification of the complications includes 88 (51%) IIIb complications with 103 returns to theatre, 2 class IV complications (ICU stay) and one class V death of a patient. Explantation occurred in 39% (n=32) of implant-based augmentation patients.
CONCLUSIONS
Aesthetic breast surgery tourism is popular within the cosmetic tourism industry. However, with infective complications (39%) and return to theatre rates (51%) significantly higher than expected, it is clear that having these procedures abroad significantly increases the risks involved. The high complication rate not only impacts individual patients, but also the home country healthcare systems. Professional bodies for cosmetic surgery in each country must highlight and educate patients how to lower this risk if they do choose to have cosmetic surgery abroad. In this current era of an intra-pandemic world where health care is already stretched, the burden from cosmetic tourism complications must be minimised.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Medical Tourism; Retrospective Studies; Surgery, Plastic; Tourism; Treatment Outcome
PubMed: 33876284
DOI: 10.1007/s00266-021-02251-1