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Clinical Cardiology Jul 2024We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG.
METHODS
A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET).
RESULTS
A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue.
CONCLUSION
The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
Topics: Humans; Coronary Artery Bypass; Myocardial Ischemia; Ventricular Function, Left; Tissue Survival; Myocardium; Cardiomyopathies; Ventricular Dysfunction, Left; Coronary Artery Disease; Magnetic Resonance Imaging, Cine; Echocardiography, Stress; Tomography, Emission-Computed, Single-Photon
PubMed: 38953367
DOI: 10.1002/clc.24307 -
Archives of Dermatological Research Jul 2024
Topics: Humans; Alopecia; Cicatrix; Metabolic Diseases
PubMed: 38951274
DOI: 10.1007/s00403-024-03197-5 -
Pediatric Surgery International Jun 2024The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for... (Meta-Analysis)
Meta-Analysis Comparative Study Review
The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for Ramstedt's pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis (IHPS). PubMed, EMBASE, Web of Science and Scopus databases were systematically searched. The studies where any one of the main outcomes of interest, i.e., operative time, wound infection rate, mucosal perforation rate were reported were eligible for inclusion. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa Scale. Fifteen studies comprising 2964 infants were included. As compared to the UMB group, the RUQ group showed a significantly lower mean operative time (p = 0.0004), wound infection rate (p < 0.0001) and mucosal perforation rate (p = 0.02). Although UMB incision produces an almost undetectable scar, this approach results in significantly more complications. Therefore, the risks and benefits must be weighed and discussed with the caregivers in deciding the surgical approach in patients with IHPS. However, due to a poor methodological quality of nine out of fifteen studies, further studies need to be conducted for an optimal comparison between the two groups.
Topics: Humans; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Umbilicus; Infant; Postoperative Complications; Surgical Wound Infection; Operative Time; Infant, Newborn
PubMed: 38935193
DOI: 10.1007/s00383-024-05747-4 -
Journal of Reconstructive Microsurgery Jun 2024When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect...
BACKGROUND
When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction.
METHODS
A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted.
RESULTS
A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports ( = 11) and case series ( = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures ( = 46, 73.0%) and chronic wounds secondary to H&N masses ( = 9, 14.3%). Defects were most commonly located in the neck ( = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous ( = 48, 71.6%) and based on the dorsal scapular artery ( = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% ( = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years.
CONCLUSION
This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.
PubMed: 38917840
DOI: 10.1055/s-0044-1787741 -
Journal of Maxillofacial and Oral... Jun 2024A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely... (Review)
Review
INTRODUCTION
A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction.
MATERIALS AND METHODS
The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps.
RESULTS
A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap.
CONCLUSION
The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).
PubMed: 38911406
DOI: 10.1007/s12663-022-01698-2 -
Lasers in Medical Science Jun 2024This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to... (Meta-Analysis)
Meta-Analysis Review
This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to determine the optimal timing for intervention. A systematic search was conducted across four databases using a predefined search strategy. Studies included were randomized controlled trials, non-randomized studies, and case series focusing on laser therapy for CL/P scars. Data extraction and analysis were performed using Revman Software. A total of two randomized controlled trials, four non-randomized studies, and three case series were included in the analysis. The fractional CO laser was the most commonly utilized type of laser. Following laser therapy, there was a significant decrease in Vancouver Scar Scale (VSS) scores by 4.05 (95% CI, 2.10-5.99). Meta-analysis revealed that laser treatment groups exhibited a significantly lower mean VSS score (1.3; 95% CI, 0.02-2.67) compared to control groups. Moreover, initiating laser therapy intervention at one month postoperatively resulted in a significantly lower VSS score compared to initiation at three months postoperatively (difference of 1.70; 95% CI, 1.33-2.08). No severe complications were reported. Laser therapy demonstrates effectiveness and safety in improving CL/P scars, with earlier intervention yielding greater benefits.
Topics: Humans; Cicatrix; Cleft Lip; Cleft Palate; Laser Therapy; Lasers, Gas; Low-Level Light Therapy; Treatment Outcome
PubMed: 38902432
DOI: 10.1007/s10103-024-04082-3 -
Skin Research and Technology : Official... Jun 2024Successful usage of autologous skin cell suspension (ASCS) has been demonstrated in some clinical trials. However, its efficacy and safety have not been verified. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Successful usage of autologous skin cell suspension (ASCS) has been demonstrated in some clinical trials. However, its efficacy and safety have not been verified. This latest systematic review and meta-analysis aim to examine the effects of autologous epidermal cell suspensions in re-epithelialization of skin lesions.
METHODS
Relevant articles were retrieved from PubMed, Embase, Cochrane Database, Web of Science, International Clinical Trials Registry Platform, China National Knowledge Infrastructureris, VIP Database for Chinese Technical Periodicals and Wanfang database. The primary output measure was the healing time, and the secondary outputs were effective rate, size of donor site for treatment, size of study treatment area, operation time, pain scores, repigmentation, complications, scar scale scores and satisfaction scores. Data were pooled and expressed as relative risk (RR), mean difference (MD) and standardized mean difference (SMD) with a 95% confidence interval (CI).
RESULTS
Thirty-one studies were included in this systematic review and meta-analysis, with 914 patients who received autologous epidermal cell suspensions (treatment group) and 883 patients who received standard care or placebo (control group). The pooled data from all included studies demonstrated that the treatment group has significantly reduced healing time (SMD = -0.86; 95% CI: -1.59-0.14; p = 0.02, I= 95%), size of donar site for treatment (MD = -115.41; 95% CI: -128.74-102.09; p<0.001, I= 89%), operation time (MD = 25.35; 95% CI: 23.42-27.29; p<0.001, I= 100%), pain scores (SMD = -1.88; 95% CI: -2.86-0.90; p = 0.0002, I= 89%) and complications (RR = 0.59; 95% CI: 0.36-0.96; p = 0.03, I= 66%), as well as significantly increased effective rate (RR = 1.20; 95% CI: 1.01-1.42; p = 0.04, I= 77%). There were no significant differences in the size of study treatment area, repigmentation, scar scale scores and satisfaction scores between the two groups.
CONCLUSION
Our meta-analysis showed that autologous epidermal cell suspensions is beneficial for re-epithelialization of skin lesions as they significantly reduce the healing time, size of donar site for treatment, operation time, pain scores and complications, as well as increased effective rate. However, this intervention has minimal impact on size of treatment area, repigmentation, scar scale scores and satisfaction scores.
Topics: Humans; Randomized Controlled Trials as Topic; Epidermal Cells; Transplantation, Autologous; Re-Epithelialization; Treatment Outcome; Wound Healing; Skin Diseases
PubMed: 38898373
DOI: 10.1111/srt.13820 -
Aesthetic Plastic Surgery Jun 2024Our meta-analysis indicated favorable results in improving scar hyperpigmentation through fat grafting, but there remains a need for further investigation using...
Our meta-analysis indicated favorable results in improving scar hyperpigmentation through fat grafting, but there remains a need for further investigation using objective measures to validate these clinical findings and elucidate the underlying mechanisms. Current evidence from animal studies showed that fat grafting may exert its beneficial effects on scar hyperpigmentation through complex cellular and molecular pathways involving the regulation of melanin synthesis and skin remodeling. However, interpretation can be influenced by various factors, highlighting the importance of integrating multiple lines of evidence to draw robust conclusions.Level of Evidence V 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 .
PubMed: 38898244
DOI: 10.1007/s00266-024-04165-0 -
Indian Journal of Otolaryngology and... Jun 2024This systematic review and meta-analysis of randomized controlled trials (RCTs) compare the impact of platysma muscle layer closure technique among patients undergoing...
AIM
This systematic review and meta-analysis of randomized controlled trials (RCTs) compare the impact of platysma muscle layer closure technique among patients undergoing thyroidectomy in terms of postoperative outcomes, specifically pain.
METHODS
Five electronic databases (PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials) were searched from inception until July 22, 2023. The Cochrane risk of bias tool 2 was employed for risk of bias (ROB) assessment. Data were pooled as mean difference (MD), standardized MD (SMD), or risk ratio (RR) based on data type (continuous or dichotomous) using RevMan software.
RESULTS
This meta-analysis included four RCTs with a total of 426 patients. Three RCTs had a low risk of bias, while one had some concern regarding bias. The overall MD of the postoperative pain score favored the non-closure group over the closure group (MD = 0.63; 95% CI: [0.09, 1.18]; = 0.02). However, no significant differences were observed between the two groups in terms of patient scar assessment scale (MD= -0.61; 95% CI: [-3.39, 2.17]; = 0.67), observer scar assessment scale (SMD = 0.26; 95% CI: [-0.30, 0.81]; = 0.37), length of the scar (MD = 0.27; 95% CI: [-0.12, 0.67]; = 0.17), wound infection (RR = 0.63; 95% CI: [0.13, 3.16]; = 0.57), and seroma or hematoma (RR = 3.00; 95% CI: [0.49, 18.55]; = 0.24).
CONCLUSION
Our findings suggest that the platysma muscle layer closure during thyroidectomy might lead to increased postoperative pain but does not significantly impact scar outcomes or postoperative complications.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-024-04503-3.
PubMed: 38883518
DOI: 10.1007/s12070-024-04503-3 -
Foot and Ankle Surgery : Official... Jun 2024Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's... (Review)
Review
BACKGROUND
Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's neuroma. This systematic review and meta-analysis was conducted to evaluate and compare the clinical outcomes of neurectomy for Morton's neuroma, focusing on the differences between the plantar and dorsal approach.
METHODS
Our comprehensive literature review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilized databases including PubMed, Embase, Web of Science, and the Cochrane Library. Data investigated in this study included postoperative sensory loss, scar tenderness, reoperation, histopathology, complications, pain score, patient satisfaction, functional scores, and time to weight bearing.
RESULTS
Total eight studies were included in this study. In aggregate, 237 neuromas underwent excision using the plantar approach, while 312 neuromas were treated via the dorsal approach. A significantly higher rate of postoperative reduced sensory was found in the dorsal group: 48.5 % (64/132) Vs. 62.0 % (80/129) with the relative ratio (RR) of 0.79 (95 % CI, 0.64-0.97). A significantly higher rate of postoperative scar tenderness was noted in the plantar group: 16.7 % (32/192) Vs. 6.2 % (14/225) with the RR of 2.27 (95 % CI, 1.28-4.04). Regarding the histopathology, 99.3 % (143/144) and 97.1 % (134/138) accuracy rate was confirmed in the plantar approach and dorsal approach, respectively, with the RR of 1.02 (95 % CI, 0.98-1.07). Overall reoperations and complications were not different between groups at 5.3 % (10/189) and 8.8 % (19/216) in the plantar group versus 6.1 % and 12.0 % (35/291) in dorsal group.
CONCLUSIONS
We recommend detailed discussions with patients prior to surgery to weigh the advantages and disadvantages of each approach.
PubMed: 38880729
DOI: 10.1016/j.fas.2024.05.018