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Phlebology Sep 2021The aim of this study was to systemically review and analyze the efficacy of cyanoacrylate ablation (CA) in comparison with endovenous thermal ablation (ETA) for the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this study was to systemically review and analyze the efficacy of cyanoacrylate ablation (CA) in comparison with endovenous thermal ablation (ETA) for the treatment of incompetent saphenous veins.
METHODS
A systematic literature search was conducted using databases of Pubmed, Embase, and Cochrane Library from the times of their inception to April 2020. Studies were selected based on inclusion and exclusion criteria after assessing the risk of bias in comparative studies with Cochrane and rating quality of evidence with the GRADE methodology. The meta-analysis was carried out using the Review Manager 5.4 program to conduct homogeneity tests.
RESULTS
One cohort study and three randomized controlled trials (RCT), including a total of 1457 participants were included in the meta-analysis. ETA included endovenous laser ablation (ELVA) and radiofrequency ablation (RFA) in the selected studies. Comparison between CA and a combination of EVLA and RFA or RFA alone were carried out in two of RCTs, while comparison between CA with EVLA was conducted in one RCT and the cohort study. There was no statistical difference in closure rates between CA and ETA after pooled analysis. Similar symptom alleviation observed between different groups. However, the CA group showed a lower ecchymosis rate than RFA and a significantly lower incidence of adverse events, such as ecchymosis, phlebitis and paresthesia, than EVLA. Compared with ETA, the patients received CA treatment exhibited lower pain scores in a shorter procedure duration without needing compression stocking, returned to normal life sooner, and had significantly better quality of care. There was no significant difference in the number needed to treat for additional therapy after three months of follow-up between groups.
CONCLUSIONS
This meta-analysis indicates that CA has better overall outcomes than ETA and offers superior clinical benefits in the treatment of incompetent saphenous veins.
Topics: Catheter Ablation; Cyanoacrylates; Humans; Laser Therapy; Radiofrequency Ablation; Randomized Controlled Trials as Topic; Saphenous Vein; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 33870789
DOI: 10.1177/02683555211008762 -
JAMA Facial Plastic Surgery May 2019Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used... (Meta-Analysis)
Meta-Analysis
Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty: A Systematic Review and Meta-analysis.
IMPORTANCE
Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss.
OBJECTIVE
To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.
DATA SOURCES
A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications.
STUDY SELECTION
The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included.
DATA EXTRACTION AND SYNTHESIS
The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size.
MAIN OUTCOMES AND MEASURES
The primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis.
RESULTS
Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 (7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of -41.6 mL (95% CI, -69.8 to -13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high.
CONCLUSIONS AND RELEVANCE
Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.
LEVEL OF EVIDENCE
4.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Ecchymosis; Edema; Humans; Postoperative Complications; Rhinoplasty; Tranexamic Acid
PubMed: 30605219
DOI: 10.1001/jamafacial.2018.1737 -
Journal of Rehabilitation Medicine Apr 2021To conduct a systematic review of randomized controlled trials about the safety (number and severity of adverse events) and efficacy (pain reduction and functional... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To conduct a systematic review of randomized controlled trials about the safety (number and severity of adverse events) and efficacy (pain reduction and functional improvement) of mesotherapy in musculoskeletal disorders, and to compare them with other therapeutic options, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.
METHODS
A search of PubMed, Cochrane Library and Scopus database resulted in an initial total of 16,253 records. A total of 931 articles were included in the study. A final total of 7 articles, published from 1 Jan 1999 until 30 Apr 2020 were selected. Two independent reviewers selected potentially relevant studies based on the inclusion criteria for full-text reading. They evaluated the methodological quality of each study and included only studies of high methodological quality, according to the Physiotherapy Evidence Database scale.
RESULTS
Seven studies were included in the meta-analysis, and visual analogue scale scores before and after mesotherapy were considered. A statistically significant reduction in visual analogue scale score in the mesotherapy group was reported in comparison with the control group in all except 1 of the trials. Mesotherapy was found to be a safe procedure with mild and temporary side-effects, such as nausea, fatigue, numbness, sweating, headache, ecchymosis, bleeding, pain and local reaction at the injection site.
CONCLUSION
Mesotherapy proved to be more effective than systemic therapy in the treatment of local pain and functional limitations caused by a variety of musculoskeletal conditions. However, because of the heterogeneity of the analysed studies in terms of injected drugs, administration technique, associated treatments, frequency and total number of sessions, more randomized controlled trials are needed, comparing a standardized mesotherapy protocol with a systemic treatments.
Topics: Adult; Female; Humans; Male; Mesotherapy; Middle Aged; Musculoskeletal Diseases; Physical Therapy Modalities; Randomized Controlled Trials as Topic
PubMed: 33764479
DOI: 10.2340/16501977-2817 -
JAMA Otolaryngology-- Head & Neck... Sep 2018Evidence has emerged on the efficacy of tranexamic acid to control blood loss and postoperative complications after rhinoplasty. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Evidence has emerged on the efficacy of tranexamic acid to control blood loss and postoperative complications after rhinoplasty.
OBJECTIVE
To investigate the results of tranexamic acid use to reduce intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis in rhinoplasty.
DATA SOURCES AND STUDY SELECTION
For this systematic review of randomized clinical trials, searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, Science Direct, Google Scholar, OpenThesis, and ClinicalTrials.gov from inception to December 23, 2017. Key words included tranexamic acid, rhinoplasty, and nasal surgical procedures. The following elements were used to define eligibility criteria: (1) population: patients undergoing rhinoplasty surgery; (2) intervention and controls: tranexamic acid vs placebo solution or no-treatment control group; (3) outcomes: intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis, and thromboembolic events; and (4) study type: randomized clinical trials.
DATA EXTRACTION AND SYNTHESIS
Two reviewers extracted data and assessed study quality according to the Cochrane guidelines for randomized clinical trials. Treatment effects were defined as weighted mean difference (WMD) and 95% CIs. The strength of evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation rating system.
MAIN OUTCOMES AND MEASURES
Intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis. To calculate the effect sizes, means and SDs were obtained for each study group and outcome of interest.
RESULTS
Five studies comprising 276 patients were included in the systematic review: 177 patients (64.1%) were women, and mean age was 26.8 (range, 16-42) years. Four studies comprising 246 patients estimated the amount in intraoperative bleeding as a primary outcome and were included in the meta-analysis. Eyelid edema and ecchymosis were evaluated as outcomes in 2 studies. Tranexamic acid was associated with reduced bleeding during rhinoplasty was found (WMD, -42.28 mL; 95% CI, -70.36 to -14.21 mL), with differences (P = .01) between oral (WMD, -61.70 mL; 95% CI, -83.02 to -40.39 mL; I2 = 0%) and intravenous (WMD, -23.88 mL; 95% CI, -45.19 to -2.58 mL; I2 = 56%) administration. Eyelid edema and ecchymosis scores in patients receiving tranexamic acid were significantly lower compared with the control group within the first postoperative week: lower eyelid edema, WMD, -0.76; 95% CI, -1.04 to -0.49 and lower eyelid ecchymosis, WMD, -0.94; 95% CI, -1.80 to -0.08. No cases of thromboembolic events were reported.
CONCLUSIONS AND RELEVANCE
Current available evidence suggests that preoperative administration of tranexamic acid is safe and may reduce intraoperative bleeding as well as postoperative eyelid edema and ecchymosis in patients undergoing rhinoplasty.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Drug Administration Schedule; Ecchymosis; Edema; Eyelids; Humans; Postoperative Complications; Preoperative Care; Rhinoplasty; Tranexamic Acid; Treatment Outcome
PubMed: 30098161
DOI: 10.1001/jamaoto.2018.1381 -
European Archives of... Jul 2017Rhinoplasty is the most common facial plastic surgical procedure, and the occurrence of periorbital edema and ecchymosis is normal after rhinoplasty. The goal of this... (Meta-Analysis)
Meta-Analysis Review
Rhinoplasty is the most common facial plastic surgical procedure, and the occurrence of periorbital edema and ecchymosis is normal after rhinoplasty. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of postoperative care of edema and ecchymosis following rhinoplasty. Two authors independently searched the databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to September 2016. We included studies that compared postoperative care methods (intervention groups) with no treatment (control group) where the outcomes of interest were edema, ecchymosis, and satisfaction rate of patients on postoperative days. Sufficient data for meta-analysis were retrieved for 11 trials with a total of 627 patients. Eyelid edema and ecchymosis during the first 7 days postoperatively were statistically decreased in the arnica administration groups versus the control group. Eyelid edema and ecchymosis during the first 24 h postoperatively were statistically decreased in the cold compression group versus the control group. The ratio of patient satisfaction was statistically higher in the tapping application group than in the control group. However, the analysis indicated that surgeons had a significant tendency to decrease intranasal packing. The administration of arnica, cold compression, and tape could reduce eyelid edema and ecchymosis. Intranasal packing was associated with more adverse effects in terms of postoperative ecchymosis compared to non-packing. However, additional trials with thorough research methodologies should be conducted to confirm the results of this study.
Topics: Arnica; Cryotherapy; Ecchymosis; Edema; Humans; Patient Satisfaction; Plant Extracts; Postoperative Care; Postoperative Complications; Rhinoplasty
PubMed: 28314960
DOI: 10.1007/s00405-017-4535-6 -
The Laryngoscope May 2020Piezosurgery, used in different otolaryngology procedures, was a breakthrough in surgery. We systematically reviewed the differences in outcomes after lateral nasal... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
Piezosurgery, used in different otolaryngology procedures, was a breakthrough in surgery. We systematically reviewed the differences in outcomes after lateral nasal osteotomy with peizosurgery and conventional osteotome and quantified the differences through a meta-analysis.
METHODS
Medline, Embase, and Cochrane library databases were selected to search for randomized clinical trials (RCTs) published before January 2019 that detailed differences between piezosurgery and conventional osteotomy. The key search terms included "rhinoplasty" and "piezosurgery." Only RCTs in English with patients >18 years who underwent lateral osteotomy by percutaneous or internal approaches were included. PRISMA guidelines were followed in data extraction and study inclusion. Two independent reviewers assessed the relevance of the studies. The point of estimate in the meta-analysis was the standardized mean difference and was pooled with the random-effects model. The measured outcomes were ecchymosis, edema, postoperative pain, and duration of surgery.
RESULTS
Five RCTs met our criteria and were analyzed in primary subsequent meta-analyses. Piezosurgery demonstrated significantly lower edema (SMD = -0.75; 95% CI, -1.26, -0.24) and ecchymosis scores (SMD = -0.85; 95% CI, -1.49, -0.20) on postoperative days (POD) 2 or 3 than conventional surgery. They were also significantly lower with piezosurgery than conventional surgery on POD 7 (SMD = -0.64; 95% CI, -1.21, -0.06; and SMD = -0.64; 95% CI, -1.14, -0.14, respectively). Two studies that estimated the degree of pain showed that after piezosurgery, patients experienced lesser pain than after conventional surgery. The mean difference was -0.73 (95% CI, -1.06, -0.39).
CONCLUSIONS
Piezosurgery causes less ecchymosis, edema, and pain than conventional osteotomy, without extending the duration of surgery. Laryngoscope, 130:1158-1165, 2020.
Topics: Humans; Osteotomy; Piezosurgery; Rhinoplasty
PubMed: 31758577
DOI: 10.1002/lary.28408 -
Clinical Otolaryngology : Official... Nov 2019This study evaluated the efficacy of piezoelectric osteotomy in reducing oedema and ecchymosis during rhinoplasty via a systematic review with meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study evaluated the efficacy of piezoelectric osteotomy in reducing oedema and ecchymosis during rhinoplasty via a systematic review with meta-analysis.
DESIGN AND SETTING
Two authors independently searched the referenced databases. PubMed, Embase, SCOPUS, the Web of Science, the Cochrane library and Google Scholar databases were systematically searched from inception to January 2019.
PARTICIPANTS
Sufficient data were retrieved for a meta-analysis of six trials with a total of 327 patients.
MAIN OUTCOME MEASURES
They included studies that compared piezoelectric osteotomy (treatment groups) with conventional osteotomy (control group). The outcomes of interest were operative time, mucosal injury, oedema, ecchymosis and postoperative pain. Baseline study characteristics, quality of study, numbers of patients in the treatment and control groups and outcomes were extracted.
RESULTS
Intraoperative mucosal injury was significantly lower in the treatment group vs the control group, but operative time was longer in the treatment group. Eyelid oedema and ecchymosis in the first seven days postoperatively were statistically decreased in the treatment group vs the control group. In addition, pain in the first three days postoperatively was statistically decreased in the treatment group vs the control group. However, in a subgroup analysis according to osteotomy visibility in the control group (blind osteotomy vs osteotomy under direct vision), there was no significant difference in oedema and ecchymosis between treatment and osteotomy under direct vision.
CONCLUSIONS
Piezoelectric osteotomy during rhinoplasty can reduce eyelid oedema and eyelid ecchymosis compared to conventional osteotomy. However, piezoelectric osteotomy had no significant advantages in terms of postoperative oedema and ecchymosis compared to osteotomy under direct vision.
Topics: Ecchymosis; Edema; Humans; Osteotomy; Piezosurgery; Postoperative Complications; Rhinoplasty
PubMed: 31436019
DOI: 10.1111/coa.13415 -
Plastic and Reconstructive Surgery.... Nov 2022Previous systematic reviews evaluating piezoelectric osteotomy are of critically low quality. We conducted a high-quality systematic review and meta-analysis to evaluate...
UNLABELLED
Previous systematic reviews evaluating piezoelectric osteotomy are of critically low quality. We conducted a high-quality systematic review and meta-analysis to evaluate outcomes for piezoelectric versus conventional osteotomy.
METHODS
The study protocol was published a priori (PROSPERO: CRD42021287877). MEDLINE, Embase, Web of Science, and CENTRAL were searched for studies comparing piezoelectric versus conventional osteotomes and reporting at least one outcome of interest (clinical or patient-reported outcomes, PROs). Methodological quality and risk of bias were assessed using GRADE and Cochrane's RoB-2/ROBINS-I tools, respectively. Random effects models were applied.
RESULTS
Of 347 articles, 10 studies (nine randomized controlled trials; one prospective cohort study) including 554 patients were included. Piezoelectric osteotomy was associated with significantly reduced edema [standardized mean difference (SMD), -0.67; 95% confidence interval (CI), -1.03 to -0.30; < 0.0004], ecchymosis (SMD, -0.93; 95% CI, -1.13 to -0.73; < 0.00001), and pain (SMD, -1.48; 95% CI, -2.07 to -0.88; < 0.00001) compared with standard osteotomy. Odds of mucosal injury were significantly lower following piezoelectric osteotomy (odds ratio, 0.06; 95% CI, 0.01 to 0.52; = 0.01). There was no difference in duration of osteotomy (SMD, 3.15; 95% CI, -1.82 to 8.12; = 0.22) or total procedure duration (SMD, 0.46; 95% CI, -0.43 to 1.36; = 0.31). One study reported PROs, favoring piezoelectric osteotomy.
CONCLUSION
This systematic review and meta-analysis provides support (albeit weak, due to low-quality evidence) for piezoelectric over conventional osteotomy, for reducing morbidity in the early postoperative period. High-quality level I data reporting PROs will optimize shared decision-making/informed consent.
PubMed: 36448013
DOI: 10.1097/GOX.0000000000004673 -
Plastic and Reconstructive Surgery Sep 2013Steroids have been used in cosmetic plastic surgery to reduce postoperative edema and ecchymosis. We performed a systematic review of the literature addressing... (Review)
Review
BACKGROUND
Steroids have been used in cosmetic plastic surgery to reduce postoperative edema and ecchymosis. We performed a systematic review of the literature addressing postoperative steroid use after rhinoplasty. Due to a paucity of studies, a review of the literature was also performed for postoperative steroid use in rhytidectomy and body contouring surgery.
METHODS
An exhaustive literature search was performed using: MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PubMed. A total of 12 articles were chosen to be included in the rhinoplasty systematic review. Cohen's kappa for level of agreement between the two reviewers was 1.0. Data recorded from each of the studies included: author, year, sample size, age, follow-up, statistical analyses, eyelid/edema assessment, significant findings, p values, and steroid regimens. A general review of the current rhytidectomy and body contouring literature associated with corticosteroids was performed as well.
RESULTS
No statistically significant long-term reduction in postoperative edema or ecchymosis after rhinoplasty. Significant reductions were noted in the short term (<2 days). Review of the rhytidectomy literature described no significant decrease in postoperative edema or ecchymosis. Steroid use was noted to reduce postoperative nausea and vomiting when combined with other therapies in body contouring.
CONCLUSIONS
Steroid use is not warranted in the postoperative period and only reduces transient edema and ecchymosis. A significant benefit for steroid use after rhytidectomy is not evident as well. Steroid use may benefit in postoperative nausea and vomiting.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Cosmetic Techniques; Ecchymosis; Edema; Humans; Postoperative Care; Postoperative Complications; Rhinoplasty; Rhytidoplasty; Treatment Outcome
PubMed: 23985647
DOI: 10.1097/PRS.0b013e31829acc60 -
Facial Plastic Surgery & Aesthetic... 2020There is controversy surrounding the management of orbital roof fractures. Guidelines with regard to when to operate and type of reconstruction are lacking....
There is controversy surrounding the management of orbital roof fractures. Guidelines with regard to when to operate and type of reconstruction are lacking. Categorizing these data will help clinicians make informed decisions about the management of orbital roof fractures and avoid preventable complications. To perform a systematic review evaluating underlying causes, associated complications, and management of orbital roof fractures including reconstructive options in the general population of children and adults. A systematic review using the PubMed, EmBase, Cochrane, and MEDLINE databases identified relevant studies for inclusion. Studies were included from 1987 to 2017. Demographics, symptoms, management, reconstruction, and outcomes were reported following preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria included articles discussing management of traumatic orbital roof fractures across all ages. Included studies were assessed for level of evidence. Forty-seven studies encompassing 526 patients met inclusion criteria. There were 28 case reports, 15 retrospective case series and 4 retrospective cohort studies. The most common etiologies were motor vehicle accidents (39.5%), falls (30.3%), and assault (11.8%). Periorbital ecchymosis, exophthalmos, and dystopia were the most common initial symptoms. In total, 60.0% of patients underwent surgical repair and 40% of patients were managed conservatively. The most common surgical approach was bicoronal (94.8%), followed by a superolateral orbital rim approach and transpalpebral (5.1%). A variety of grafting materials were utilized, including titanium miniplates (46.2%), bone graft (37.7%), porous polyethylene (2.8%), and silastic implants (2.8%). Overall patients undergoing surgery were adults with clinical symptoms including exophthalmos, diplopia, and gaze restriction as well as patients with dura exposure. Most patients undergoing surgery were those with concomitant fractures. The most common fractures among the surgical patients were frontal bone (32.2%), ethmoid (25.2%), and zygomaticomaxillary complex/zygoma (12.2%). Management of orbital roof fractures varies based on individual clinical features including the presence of exophthalmos, gaze restriction, and concomitant injuries such as dural tears. Surgically, bicoronal approaches were performed most commonly along with reconstruction utilizing titanium miniplates. Conservative management was more common among the pediatric population. This systematic review demonstrates both conservative and surgical measures can lead to positive outcomes in appropriately selected patients.
Topics: Evidence-Based Medicine; Humans; Orbital Fractures; Practice Patterns, Physicians'; Plastic Surgery Procedures
PubMed: 32779938
DOI: 10.1089/fpsam.2020.0029