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Microsurgery Jan 2023Microsurgical free tissue transfer (FTT) is a widely employed surgical modality utilized for reconstruction of a broad range of defects, including head and neck,... (Review)
Review
BACKGROUND
Microsurgical free tissue transfer (FTT) is a widely employed surgical modality utilized for reconstruction of a broad range of defects, including head and neck, extremity, and breast. Flap survival is reported to be 90%-95%. When FTT fails, salvage procedures aim at establishing reperfusion while limiting ischemia time-with salvage rates between 22% and 67%. There are limited data-driven predictors of successful salvage present in the literature. This systematic review aims to identify predictors of flap salvage.
METHODS
A systematic literature review was conducted per PRISMA guidelines. Articles included in the final analysis were limited to those investigating FTT salvage procedures and included factors impacting outcomes. Cohort and case series (>5 flaps) studies up until March 2021 were included. Chi-square tests and linear regression modeling was completed for analysis.
RESULTS
The patient-specific factors significantly associated with salvage included the absence of hypercoagulability (p < .00001) and no previous salvage attempts (p < .00001). Case-specific factors significantly associated with salvage included trunk/breast flaps (p < .00001), fasciocutaneous/osteocutaneous flaps (p = .006), venous compromise (p < .00001), and shorter time from index procedure to salvage attempt (R = .746). Radiation in the head and neck population was significantly associated with flap salvage failure.
CONCLUSIONS
Given the complexity and challenges surrounding free flap salvage procedures, the goal of this manuscript was to present data helping guide surgical decision-making. Based on our findings, patients without documented hypercoagulability, no previous salvage attempts, fasciocutaneous/osteocutaneous flaps, trunk/breast flaps, and a shorter time interval post-index operation are the best candidates for a salvage attempt.
Topics: Humans; Free Tissue Flaps; Plastic Surgery Procedures; Treatment Outcome; Retrospective Studies; Postoperative Complications; Thrombophilia; Demography
PubMed: 35611652
DOI: 10.1002/micr.30921 -
Indian Journal of Plastic Surgery :... Feb 2024There are varying reports about United Kingdom medical students' exposure and teaching methods regarding plastic and reconstructive surgery. To date, no systematic... (Review)
Review
There are varying reports about United Kingdom medical students' exposure and teaching methods regarding plastic and reconstructive surgery. To date, no systematic review has been done looking at this topic. Three databases (PubMed, Embase, and Medline) were searched from January 1, 2011 to July 20, 2023 for studies that assessed United Kingdom medical students' exposure to plastic surgery and suggested recommendations to improve teaching. Three authors performed data extraction and screening, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifteen studies were included. Medical students' average current exposure to plastic surgery was 29.44%, but this was highly variable across the studies. The most common method of currently teaching plastic surgery was through lectures (34% of studies), and the most common suggested method of teaching was through courses (40% of studies). Many of the studies (12/15) were deemed as being at high risk of bias. More recent studies need to be performed to assess current levels of teaching of plastic surgery in the United Kingdom medical school curriculum. Greater exposure to plastic surgery through lectures and integrated clinical placements is needed to ensure equitable access for all medical students to plastic surgery as a profession.
PubMed: 38450015
DOI: 10.1055/s-0044-1779480 -
Cureus Jul 2023Thromboembolism is a feared complication in plastic surgery and is linked to higher rates of morbidity and mortality. Despite extensive research, there is a lack of... (Review)
Review
Thromboembolism is a feared complication in plastic surgery and is linked to higher rates of morbidity and mortality. Despite extensive research, there is a lack of consistency between recommendations and clinical protocols to be implemented pre and post-surgery to reduce the incidence of thromboembolism. A systematic literature review was conducted using Pubmed and Scopus databases to determine the risk factors, screening methods, and existing treatment models for thromboembolism prevention. Articles in non-English languages were excluded. Analysis indicated that predominant risk factors include age (>35), elevated body mass index, coagulation disorders, smoking, estrogen therapies, genetic predisposition, vascular endothelium damage, stasis, and use of general anesthesia in patients with a history of cancer. Implementation of a proper prophylactic protocol is dependent on understanding the interplay between the aforementioned risk factors and the utilization of well-defined, evidence-based guidelines, such as the 2005 Caprini Risk Assessment Model and ultrasound surveillance. The literature review revealed that mechanical prophylaxis is the primary prevention method, followed by thromboprophylaxis for patients with higher Caprini scores. Plastic surgeons often underestimate the present risk stratification tools available for the prophylactic intervention of thromboembolism due to the fear of bleeding or hematoma complications postoperatively. In summary, this literature review emphasizes the importance of plastic surgeons selecting protocols that is inclusive of the patient's risk profile to yield a reduced risk of thromboembolism.
PubMed: 37554601
DOI: 10.7759/cureus.41557 -
Ear, Nose, & Throat Journal Jul 2018Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of... (Review)
Review
Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.
Topics: Adult; Aged; Female; Free Tissue Flaps; Head; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Risk Factors; Treatment Failure
PubMed: 30036435
DOI: 10.1177/014556131809700712 -
Handchirurgie, Mikrochirurgie,... Aug 2021Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the...
BACKGROUND
Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the outpatient setting, tumescent anaesthesia is used in various forms. There is ambiguity about the amount of lipoaspirate that can be removed safely in an outpatient setting, and also about the monitoring of parameters and the duration of postoperative care.
MATERIAL AND METHODS
A systematic literature review was conducted with the help of the MEDLINE data base of the U. S. National Library of Medicine (NLM) and the bibliographic search engine Google Scholar (https://scholar.google.com) of Google LLC. The key words "Liposuction Anesthesia" and "Liposuction Guidelines" were used. All items resulting from the search were checked for thematic concordance and further analysed by their level of evidence, significance and availability.
RESULTS
After the literature review, a total of 197 items were identified for further analysis. The analysis of the international and German literature yielded a systematic overview of recommendations.
CONCLUSIONS
Tumescence anaesthesia in an outpatient setting has various advantages, e. g. cost reduction for provider and patient as well as avoidance of the risk profile of general anaesthesia. Also patients can change their position autonomously, which can be beneficial for surgery. However, there are limitations in terms of the lipoaspirate volume that can be removed safely. With increasing lipoaspirate volumes, more local anaesthetic is needed, which also increases the postoperative monitoring time. In the authors view, tumescent anaesthesia should only be used for small-volume and localised liposuctions. Liposuction in general anaesthesia offers more advantages, especially with increasing lipoaspirate volumes.
Topics: Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Humans; Lipectomy; United States
PubMed: 33525036
DOI: 10.1055/a-1333-2696 -
British Journal of Nursing (Mark Allen... Jun 2017This systematic literature review explores and considers whether registered nurse staffing levels affect patient mortality in acute secondary care settings. A discussion... (Review)
Review
This systematic literature review explores and considers whether registered nurse staffing levels affect patient mortality in acute secondary care settings. A discussion makes particular reference to the philosophical foundations of contrasting research approaches used within the literature. At the time of writing, the author was a modern matron for surgery, managing the ear, nose and throat; head and neck; airway; and reconstructive plastic surgery services in a large acute teaching hospital in central London. Effective management and leadership of acute clinical areas requires appropriate nurse:patient ratios. In practice settings, patient to staff ratios are based on care being provided by highly skilled and competent nurses providing best-quality, evidence-based practice.
Topics: Adult; Aged; Aged, 80 and over; Female; Hospital Mortality; Humans; Male; Middle Aged; Nursing Staff, Hospital; Patient Safety; Personnel Staffing and Scheduling; Quality of Health Care; Secondary Care; State Medicine; United Kingdom
PubMed: 28640732
DOI: 10.12968/bjon.2017.26.12.698 -
Journal of Reconstructive Microsurgery Mar 2023Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure.
METHODS
A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005 to 2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed.
RESULTS
The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean Medical Research Council (MRC) score of 3.78 (95% confidence interval: 2.97-4.56; < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy ( = 0.03), radiotherapy ( = 0.05), pedicled FMTs ( = 0.01), and a recipient femoral nerve ( = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range: 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery ( = 0.87, = 0.002).
CONCLUSION
FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.
Topics: Humans; Plastic Surgery Procedures; Skin Transplantation; Neoplasms; Extremities; Muscles; Retrospective Studies; Treatment Outcome
PubMed: 35768008
DOI: 10.1055/a-1887-7530 -
Indian Journal of Plastic Surgery :... 2016A systematic review of the literature was performed to clarify the psychosocial characteristics of patients who have an interest in cosmetic plastic surgery. (Review)
Review
BACKGROUND
A systematic review of the literature was performed to clarify the psychosocial characteristics of patients who have an interest in cosmetic plastic surgery.
METHODS
Medical literature was reviewed by two independent researchers, and a third reviewer evaluated their results.
RESULTS
Twelve studies addressing the predictors of interest in cosmetic surgery were finally identified and analysed. Interest in cosmetic surgery was associated with epidemiological factors, their social networks, their psychological characteristics, such as body image, self-esteem and other personality traits and for specific psychopathology and found that these may either positively or negatively predict their motivation to seek and undergo a cosmetic procedure.
CONCLUSIONS
The review examined the psychosocial characteristics associated with an interest in cosmetic surgery. Understanding cosmetic patients' characteristics, motivation and expectation for surgery is an important aspect of their clinical care to identify those patients more likely to benefit most from the procedure.
PubMed: 28216822
DOI: 10.4103/0970-0358.197224 -
Medicina (Kaunas, Lithuania) Sep 2022: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting... (Review)
Review
: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting has been used as a single reconstructive technique, as well as in combination with other procedures. The aim of the present study is to systematically review available studies in the literature describing the combination of implant-based breast reconstruction and fat grafting, focusing on safety, complications rate, surgical sessions needed to reach a satisfying reconstruction, and patient-reported outcomes. : We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol. A systematic review of the literature up to April 2022 was performed using Medline, Embase, and Cochrane Library databases. Only studies dealing with implant-based breast reconstruction combined with fat grafting were included. : We screened 292 articles by title and abstract. Only 48 articles were assessed for full-text eligibility, and among those, 12 studies were eventually selected. We included a total of 753 breast reconstructions in 585 patients undergoing mastectomy or demolitive breast surgeries other than mastectomy (quadrantectomy, segmentectomy, or lumpectomy) due to breast cancer or genetic predisposition to breast cancer. Overall, the number of complications was 60 (7.9%). The mean volume of fat grafting per breast per session ranged from 59 to 313 mL. The mean number of lipofilling sessions per breast ranged from 1.3 to 3.2. : Hybrid breast reconstruction shows similar short-term complications to standard implant-based reconstruction but with the potential to significantly decrease the risk of long-term complications. Moreover, patient satisfaction was achieved with a reasonably low number of lipofilling sessions (1.7 on average).
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Segmental; Retrospective Studies
PubMed: 36143908
DOI: 10.3390/medicina58091232 -
Journal of Tissue Engineering and... Dec 2022Amniotic membrane (AM) has great potential as a scaffold for tissue regeneration in reconstructive surgery. To date, no systematic review of the literature has been... (Meta-Analysis)
Meta-Analysis Review
Amniotic membrane (AM) has great potential as a scaffold for tissue regeneration in reconstructive surgery. To date, no systematic review of the literature has been performed for the applications of AM in wound closure of internal organs. Therefore, in this systematic review and meta-analysis, we summarize the literature on the safety and efficacy of AM for the closure of internal organs. A systematic search was performed in MEDLINE-PubMed database and OVID Embase to retrieve human and controlled animal studies on wound closure of internal organs. The Cochrane Risk of Bias tool for randomized clinical trials and the SYRCLE risk of bias tool for animal studies were used. Meta-analyses (MAs) were conducted for controlled animal studies to assess efficacy of closure, mortality and complications in subjects who underwent surgical wound closure in internal organs with the application of AM. Sixty references containing 26 human experiments and 36 animal experiments were included. The MAs of the controlled animal studies showed comparable results with regard to closure, mortality and complications, and suggested improved mechanical strength and lower inflammation scores after AM application when compared to standard surgical closure techniques. This systematic review and MAs demonstrate that the application of AM to promote wound healing of internal organs appears to be safe, efficacious, and feasible.
Topics: Humans; Amnion; Wound Healing; Wound Closure Techniques; Plastic Surgery Procedures
PubMed: 36333859
DOI: 10.1002/term.3357