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Archives of Plastic Surgery May 2022Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged...
Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 nonduplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.
PubMed: 35832166
DOI: 10.1055/s-0042-1748646 -
Journal of Plastic Surgery and Hand... 2023The objective is to evaluate the inter-recti distance on ultrasound measurement at different locations in healthy nulliparas. Electronic databases were searched for... (Meta-Analysis)
Meta-Analysis Review
The objective is to evaluate the inter-recti distance on ultrasound measurement at different locations in healthy nulliparas. Electronic databases were searched for studies describing the inter-recti distance measured by ultrasound in healthy nulliparas. We excluded studies without descriptions of the measurement position or the condition of the abdominal wall. A meta-analysis was performed to evaluate the inter-recti distance on ultrasound measurement. Seven eligible studies with 295 healthy nulliparas were included. The location of the inter-recti distance measurement by ultrasound was not uniform. The pooled data divided the measurement locations into three areas. The meta-analytic summary values of the umbilical inter-recti distance of the nulliparas was 8.77 mm (6.56-10.99 mm), the distance at the epigastric area was 7.22 mm (2.76-11.68 mm), and that at the infraumbilical area was 4.09 mm (1.55-6.64 mm). The maximal reported inter-recti distance in healthy nulliparous women is smaller than 10 mm on ultrasound measurement at all locations and the range in the umbilical area is larger than that in the epigastric, infraumbilical areas. The values for the inter-recti distance reported in this systematic review can be used as the reference of feasible and desirable distance of the rectus muscles after rectus fascia plication. The limitation was that the methodological quality of the assessment in most studies was unclear or low.
Topics: Humans; Female; Rectus Abdominis; Abdominal Wall; Ultrasonography
PubMed: 35001809
DOI: 10.1080/2000656X.2021.2024555 -
Brazilian Journal of Physical Therapy 2021Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period.
OBJECTIVE
To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum.
METHODS
Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI).
RESULTS
Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA.
CONCLUSION
There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum.
Topics: Diastasis, Muscle; Exercise Therapy; Female; Humans; Pelvic Floor; Postpartum Period; Randomized Controlled Trials as Topic; Rectus Abdominis
PubMed: 34391661
DOI: 10.1016/j.bjpt.2021.06.006 -
Cancers Feb 2021Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative... (Review)
Review
BACKGROUND
Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis myocutaneous flap (VRAMf) and mesh closure on perineal morbidity following APR and PE (mainly for anal and rectal cancers).
METHODS
We searched PubMed, Cochrane, and EMBASE for eligible studies as of the year 2000. After data extraction, a meta-analysis was performed to compare perineal wound morbidity. The studies were distributed as follows: Group A comparing primary closure (PC) and VRAMf, Group B comparing PC and mesh closure, and Group C comparing PC and VRAMf in PE.
RESULTS
Our systematic review yielded 18 eligible studies involving 2180 patients (1206 primary closures, 647 flap closures, 327 mesh closures). The meta-analysis of Groups A and B showed PC to be associated with an increase in the rate of total (Group A: OR 0.55, 95% CI 0.43-0.71; < 0.01/Group B: OR 0.54, CI 0.17-1.68; = 0.18) and major perineal wound complications (Group A: OR 0.49, 95% CI 0.35-0.68; < 0.001/Group B: OR 0.38, 95% CI 0.12-1.17; < 0.01). PC was associated with a decrease in total (OR 2.46, 95% CI 1.39-4.35; < 0.01) and major (OR 1.67, 95% CI 0.90-3.08; = 0.1) perineal complications in Group C.
CONCLUSION
Our results confirm the contribution of the VRAMf in reducing major complications in APR. Similarly, biological prostheses offer an interesting alternative in pelvic reconstruction. For PE, an adapted reconstruction must be proposed with specialized expertise.
PubMed: 33578769
DOI: 10.3390/cancers13040721 -
Plastic and Reconstructive Surgery.... Oct 2020Transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flaps are the most common abdominally based breast reconstruction...
INTRODUCTION
Transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flaps are the most common abdominally based breast reconstruction procedures. Each technique has its advantages and disadvantages; however, how morbidity relates to satisfaction is not well-understood. Our aim was to compare complications and patient-reported outcomes following pedicled TRAM (pTRAM), free TRAM (fTRAM), and DIEP flaps to guide flap selection.
METHODS
A systematic literature search was conducted, and 2 independent reviewers identified comparative studies of abdominally based flaps. Data were extracted on patient characteristics, complications, and patient-reported outcomes. Meta-analyses were conducted using random effects modeling with the DerSimonian and Laird method.
RESULTS
The search retrieved 5090 articles, of which 18 were included in this review. pTRAM flaps trended toward a higher risk of abdominal bulge/hernia compared with DIEP flaps, particularly in low-volume hospitals. While fTRAM flaps had a higher risk of abdominal morbidity compared with DIEP flaps, relative risk decreased when obese patients were excluded and when only muscle-sparing fTRAM flaps were compared. Muscle-sparing flaps had a higher risk of flap loss than fTRAM flaps. Compared with DIEP flaps, pTRAM flaps were associated with lower general satisfaction but comparable emotional well-being.
CONCLUSIONS
Our findings indicate that safety and satisfaction following abdominally based breast reconstruction depend on flap type and patient characteristics. When possible, DIEP or muscle-sparing fTRAM flaps should be performed for obese patients to decrease the risk of abdominal bulge/hernia. Although pTRAM flaps are associated with a greater risk of flap loss, they are still an appropriate option when microsurgery is not available.
PubMed: 33173667
DOI: 10.1097/GOX.0000000000003120 -
Medicine Sep 2020Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation.
METHODS
To address this research need, PubMed, Ovid, Medline, EMBASE, and Scopus databases were searched through systematically from January 1, 1990, to January 1, 2019 to retrieve the relevant studies on the risk of postoperative complications after unilateral vs bilateral abdominal flap breast reconstruction. According to the pre-designed inclusion criteria, available data were extracted from the relevant studies, and then analyzed comparatively in order to identify the relative risk (RR) and 95% confidence intervals (CI) applying either a random or a fixed effects model.
RESULTS
Eventually, 20 studies involving 8122 female subjects met the inclusion criteria. It was found that unilateral reconstruction involved a significantly higher risk of flap loss (RR: 1.56, 95% CI: 1.21-2.00; P < .05) and fat necrosis (RR: 1.60, 95% CI: 1.23-2.09; P < .05) compared to bilateral reconstruction, while bilateral reconstruction involved a greater risk of abdominal hernia/bulge (RR: 1.67, 95% CI: 1.25-2.24; P < .05). The risk was found to be higher following bilateral free transverse rectus abdominis myocutaneous (fTRAM) flaps in comparison with deep inferior epigastric perforator (DIEP) flaps (RR: 2.62, 95% CI: 1.33-5.15; P < .05).
CONCLUSION
The risk of postoperative flap complications in unilateral breast reconstruction is significantly higher than that in bilateral reconstruction. Contrarily, the abdominal complications were significantly higher in the bilateral group vs the unilateral group. Meanwhile, the risk of abdominal hernia/bulge complication after bilateral breast reconstruction was significantly higher with fTRAM vs DIEP. Therefore, DIEP flaps are recommended in priority for bilateral breast reconstruction, unless specifically contraindicated.
Topics: Female; Humans; Mammaplasty; Postoperative Complications; Surgical Flaps
PubMed: 32925752
DOI: 10.1097/MD.0000000000022096 -
International Journal of Environmental... Jun 2020The aim of this study was to systematically review the current literature on the electromyographic (EMG) activity of six core muscles (the rectus abdominis, the internal...
The aim of this study was to systematically review the current literature on the electromyographic (EMG) activity of six core muscles (the rectus abdominis, the internal and external oblique, the transversus abdominis, the lumbar multifidus, and the erector spinae) during core physical fitness exercises in healthy adults. A systematic review of the literature was conducted on the Cochrane, EBSCO, PubMed, Scopus, and Web of Science electronic databases for studies from January 2012 to March 2020. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. The inclusion criteria were as follows: a) the full text available in English; b) a cross-sectional or longitudinal (experimental or cohorts) study design; c) the reporting of electromyographic activity as a percentage of maximum voluntary contraction (% MVIC), millivolts or microvolts; d) an analysis of the rectus abdominis (RA), transversus abdominis (TA), lumbar multifidus (MUL), erector spinae (ES), and the internal (IO) or external oblique (EO); e) an analysis of physical fitness exercises for core training; and f) healthy adult participants. The main findings indicate that the greatest activity of the RA, EO, and ES muscles was found in free-weight exercises. The greatest IO activity was observed in core stability exercises, while traditional exercises showed the greatest MUL activation. However, a lack of research regarding TA activation during core physical fitness exercises was revealed, in addition to a lack of consistency between the studies when applying methods to measure EMG activity.
Topics: Cross-Sectional Studies; Electromyography; Exercise; Exercise Therapy; Humans; Muscle, Skeletal; Physical Fitness
PubMed: 32560185
DOI: 10.3390/ijerph17124306 -
Gland Surgery Apr 2020The surgical treatment of lymphedema can be conducted alone or in combination with microsurgical autologous breast reconstruction. We performed a systematic review of... (Review)
Review
The surgical treatment of lymphedema can be conducted alone or in combination with microsurgical autologous breast reconstruction. We performed a systematic review of the literature at PubMed database regarding autologous breast reconstruction for deep inferior epigastric perforators (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) and vascularized lymph node transfer (VLNT) in patients with lymphedema following breast cancer surgery. We hypothesized that autologous breast reconstruction combined with VLNT has positive outcomes. Eligibility criteria included investigations reporting data studies evaluating female patients with lymphedema in an upper extremity after breast cancer who underwent autologous breast reconstruction combined with VLNT. The search resulted in 93 potential papers, but only 6 studies fulfilled the study eligibility criteria. The total number of patients was 103. Most of the studies evaluated the outcomes in patients treated with DIEP or ms-TRAM combined with VLNT. The studies described groin lymph node transfer as treatment for lymphedema. In most of the studies, all patients reported a reduction of arm circumference, volume, and symptoms of the upper extremity with lymphedema comparing the preoperative to the postoperative period. Overall, patients experienced successful breast reconstruction. All authors reported reduction of the circumferential size of the affected upper limb, as well as a decrease in cellulitis, in addition to favorable breast reconstruction results.
PubMed: 32420287
DOI: 10.21037/gs.2020.02.11 -
Acta Bio-medica : Atenei Parmensis Dec 2019The rectus-adductor syndrome is a common cause of groin pain. In literature the adductor longus is reported as the most frequent site of injury so that the syndrome can... (Comparative Study)
Comparative Study
BACKGROUND AND AIM OF THE WORK
The rectus-adductor syndrome is a common cause of groin pain. In literature the adductor longus is reported as the most frequent site of injury so that the syndrome can be fitted into the adductor related groin pain (ARGP) group. The aim of this study was to define what is the best treatment between surgical and conservative in athletes affected by ARGP in terms of healing and return to play (RTP) time.
METHODS
A systematic review was performed searching for articles describing studies on RTP time for surgical or conservative interventions for ARGP. A qualitative synthesis was performed. Only 10 out 7607 articles were included in this systematic review. An exploratory meta-analysis was carried out. Due to high heterogeneity of the included studies, raw means of surgery and conservative treatment groups were pooled separately. A random effects model was used.
RESULTS
The results showed quicker RTP time for surgery when pooled raw means were compared to conservative treatments: 11,23 weeks (CI 95%, 8.18,14.28, p<0.0001, I^2=99%) vs 14,9 weeks (CI 95%, 13.05,16.76, p<0.0001, I^2 = 77%). The pooled results showed high statistical heterogeneity (I^2), especially in the surgical group.
CONCLUSIONS
Surgical interventions are associated with quicker RTP time in athletes affected by ARGP, but due to the high heterogeneity of the available studies and the lack of dedicated RCTs this topic needs to be investigated with dedicated high quality RCT studies.
Topics: Athletic Injuries; Conservative Treatment; Groin; Humans; Pain; Rectus Abdominis; Syndrome
PubMed: 31821279
DOI: 10.23750/abm.v90i12-S.8962