Journal of plastic surgery and hand surgery
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J Plast Surg Hand Surg · Dec 2014
Case ReportsSuccessful repair of flayed tissue in a degloving injury of the hand by arteriovenous anastomosis.
We report the case of a 43-year-old man who had a degloving injury of the left hand from a printer machine. There was no response to a pin prick test over the peripheral portion of the degloved skin, so a branch of a digital artery was selected for anastomosis to a subcutaneous vein, which resulted in survival of the degloved tissue with no signs of congestion. Postoperative care and rehabilitation were straightforward, and functional results.were satisfactory.
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J Plast Surg Hand Surg · Dec 2014
Improved results after implementation of the Ghent algorithm for subcutaneous mastectomy in female-to-male transsexuals.
The subcutaneous mastectomy is an important step in the treatment of female-to-male transsexual patients. At the Sahlgrenska University Hospital, a two-step procedure was used for mastectomies through 2002-2011. With this procedure, all patients were operated on with a concentric circular incision in the first session of surgery, followed by a second session 7-12 months later. ⋯ Complications (e.g., haematoma, nipple necrosis, seroma, wound dehiscence, and infection) occurred in 50% of the patients following the first surgery in the two-step, concentric-circular approach group, for a total of 71.43% of patients with complications following either the first- or the second-step surgery; complications occurred only in 25% of the patients in the one-step, algorithm-based group. The mean number of surgeries per breast was 2.5 for the two-step concentric circular approach, and 1.25 for the single step, algorithm-based approach; particularly, when the concentric circular technique was chosen for the single step, algorithm-based approach, only two of the patients required revision surgery to improve the cosmetic outcome. This study shows that the number of complications and the total number of surgeries performed to satisfy patients were lower after Monstrey's algorithm for mastectomies was implemented as routine practice at the Sahlgrenska University Hospital.
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J Plast Surg Hand Surg · Oct 2014
Comparative StudyA population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: can it be performed safely?
Morbid obesity is increasing at an alarming rate and a significant portion of patients presenting for complex abdominal wall reconstruction (AWR) and component separation fall into this category, creating added medical and surgical challenges to an already difficult operation. The goal of this study was to utilise the Nationwide 2005-2010 American College of Surgeons National Surgical Quality Improvement database (ACS-NSQIP) to perform a population level analysis of the role of morbid obesity on 30-day perioperative morbidity with the hope of improving patient care, counselling and risk stratification. Morbidly obese patients (BMI > 40 kg/m(2)) were compared to non-obese patients (BMI < 30 kg/m(2)). ⋯ However, it was significantly associated with ROR (OR = 2.8, p < 0.001) and VTE (OR = 5.2, p = 0.04). Morbid obesity is an independent risk factor for ROR and VTE related complications, in the 30 day post-operative period. Additional perioperative care is warranted to decrease such early re-operations and for preventable complications.
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J Plast Surg Hand Surg · Oct 2014
Comparative StudyEffect of BMI on modality-specific outcomes in immediate breast reconstruction (IBR)--a propensity-matched analysis using the 2005-2011 ACS-NSQIP datasets.
Obesity is a prevalent, multisystem disease emerging as a pervasive risk factor for surgical morbidity. This study aims to perform a modality-specific risk assessment of IBR outcomes using the World Health Organisation (WHO) obesity stratification. This study reviewed the 2005-2011 ACS-NSQIP databases, identifying encounters for either implant or autologous-based reconstruction. ⋯ This study characterises the modality-specific risk of surgical and medical morbidity in patients undergoing IBR across BMI-stratified cohorts. The risk-adjusted models of early morbidity in IBR reveal a significant BMI-specific risk divergence that occurs at class II obesity cohorts and above. These data serve as a useful benchmark for early, modality-specific morbidity across BMI-stratified cohorts and can be used to better tailor preoperative risk counselling in patients considering autologous reconstructions.
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J Plast Surg Hand Surg · Oct 2014
Comparative StudyObesity and early complications following reduction mammaplasty: an analysis of 4545 patients from the 2005-2011 NSQIP datasets.
Reduction mammoplasty is a proven treatment for symptomatic macromastia, but the association between obesity and early postoperative complications is unclear. The purpose of this study was to perform a population level analysis in an effort to determine the impact of obesity on early complications after reduction mammaplasty. This study examined the 2005-2011 NSQIP datasets and identified all patients who underwent reduction mammoplasty. ⋯ This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort.