No abstract available
Σάββατο 1 Σεπτεμβρίου 2018
“Impact of Chronic Steroid Use on Plastic Surgery Outcomes: Analysis of 94,140 Cases”
Background: Steroids, commonly used to treat many chronic conditions, have been proven to suppress inflammation, edema, autoimmunity, and delay wound healing. Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), this study aims to characterize the risk of perioperative chronic steroid use for complications in plastic surgery cases. Methods: A retrospective study was performed on 94,140 plastic surgery cases from the ACS NSQIP database for the years 2006-2015. Current procedural terminology codes were used to categorize the operations. Patients were separated into two cohorts based on chronic steroid use status. Univariate analysis was performed using χ2, Fisher's exact tests, or Wilcoxon rank sum tests. Logistic regression models were fitted to evaluate the association between chronic steroid use and postoperative complications. Total hospital length of stay was compared for cohorts. Odds ratios were computed at the 95% confidence interval. Results: Chronic steroid users were more likely to develop surgical complications (OR 1.3; p=0.0452) and medical complications (OR 1.8; p=0.0002) compared to non-steroid users. Among the ten most frequent procedures performed on chronic steroid users, steroid use was a significant risk factor for postoperative complications after reduction mammoplasty (OR 2.2; p=0.001); delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction (OR 2.2; p=0.049); and in trunk muscle, myocutaneous or fasciocutaneus flap (7.2; p=0.0029). Conclusion: With this information in hand, plastic surgeons will be better equipped to counsel patients and adequately design perioperative protocols for chronic steroid users. Financial Disclosure: Nothing to disclose. Presented at: None applicable Acknowledgement: We would like to thank Dr. Ari Rubenfeld and Julie Moore for their assistance and guidance with access to the ACS NSQIP database and their guidance with this project. DISCLAIMER: American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Matthew J Ranzer, MD, Assistant Professor of Surgery, University of Illinois at Chicago, Division of Plastic, Reconstructive, and Cosmetic Surgery, 820 S Wood St, Suite 515 CSN, Chicago, IL 60612 USA. Office: 312-996-9313 Fax: 312-413-0495, E-mail: ranzerm@uic.edu ©2018American Society of Plastic Surgeons
Preclinical experience using a new robotic system created for microsurgery
Background: Completing microsurgical anastomosis requires great technical skills. Robotic assistance in microsurgery can exceed the maximum human level of precision and manual dexterity to improve clinical outcomes. Since no robotic device has been designed primarily for microsurgery the authors developed a dedicated microsurgical robotic system (MSR). This preclinical study investigates whether microsurgical anastomosis can be successfully completed on silicone vessels using a prototype of this newly developed robotic system, and compares outcomes of robotic-assisted versus conventional anastomotic microsurgery. Methods: Three participants at different levels of microsurgical training completed ten anastomoses by hand and ten anastomoses with robotic assistance. Four blinded experienced microsurgeons evaluated the quality of the microsurgical skills using a modified version of the Structured Assessment of Microsurgical Skills (SAMS). Time to perform the anastomosis and adverse events were recorded. Results: The total time to perform the anastomoses with and without robotic assistance decreased to 35.1 minutes and 12.5 minutes respectively during the study. The overall performance and indicative skill of the SAMS improved during the conventional method (from respectively 2.8 to 3.6 and 2.6 to 3.7) and the robotic-assisted method (from respectively 2.3 to 3.0 and 2.3 to 3.1). Conclusions: It is feasible to complete anastomotic microsurgery on silicone vessels using the MSR. In comparison to the conventional method, time to perform the anastomosis was longer and quality of the microsurgical skills were lower in the robotic-assisted group. However, the robotic-assisted performance showed steeper learning curves (faster improvement) compared to the conventional performance for both surgical time and domains of microsurgical skills. The encouraging results indicate further development of the MSR and additional preclinical trials as step up towards clinical validation. FINANCIAL DISCLOSURE STATEMENT: Tom van Mulken has a financial disclosure, as he is Chief Medical Officer of the spin off company MicroSure: costs of travel and share in company. Rene van der Hulst has a financial disclosure as shareholder of MicroSure. Raimondo Cau has a financial disclosure, as he is Chief Technical Officer and shareholder of MicroSure. Ferry Schoenmakers is a software developer for MicroSure. The other authors have no financial disclosures. ACKNOWLEDGEMENTS: The four microsurgeons, forming the assessment panel, are gratefully acknowledged for their efforts. CORRESPONDING AUTHOR: Tom J.M. van Mulken, MD, Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands, Tel: (+31) 043-3875474; Fax: (+31) 043-3875473, Email: tom.van.mulken@mumc.nl ©2018American Society of Plastic Surgeons
Donor Site Morbidity and Functional Status Following Medial Femoral Condyle Flap Harvest
Background: The medial femoral condyle (MFC) free vascularized bone flap is a valuable alternative to other types of vascularized bone grafts. The donor site morbidity and functional outcomes after flap harvest have not been fully appreciated. Herein, we report the postoperative outcomes and analyze the impact of increasing the size of the flap on the knee donor site morbidity. Methods: A retrospective chart review of patients who underwent MFC flap between 2001 and 2012 at our institution was done. The size of the flap was stratified, based on the largest dimension, into 3 groups. Demographics, outcomes, and complications related to the flap donor site were recorded and analyzed. Subsequently, functional status was assessed by administering a validated condition-specific measure: the Lower Extremity Functional Scale (LEFS) questionnaire. A univariate logistic regression analysis was done, and results were analyzed. Results: A total of 75 patients were identified. Average age was 29.5 ± 15.2 years (range: 14-72). Average follow-up time was 13 months postoperatively. Overall Complication rate was 18.6%. Donor site paresthesia in the saphenous nerve distribution was the most common complication. Increasing size of the flap did result in a significant elevation in complication risk (p<.05 a total of patients completed the lefs questionnaire. average score was scored points indicating normal level function on average. conclusions: mfc flap has overall acceptable donor site morbidity with good post-operatively. larger flaps are associated greater number complications. meetings at which paper partially presented: none financial disclosures: authors interest in any products devices or drugs mentioned this manuscript. corresponding author: brian t. carlsen md division plastic surgery department mayo clinic first street sw rochester minnesota usa. phone: fax: email: carlsen.brian society surgeons>
Introducing Knowledge Translation to Plastic Surgery: Turning Evidence into Practice
Best evidence has no bearing on quality of life if it is not implemented in clinical practice. We introduce knowledge translation as a theoretical framework for closing the gap between evidence and practice in plastic surgery. The current state of published evidence in plastic surgery is reviewed and evaluated, with the recommendation to utilize the EQUATOR network's guidelines for reporting clinical research findings. Tools and strategies are offered for the reader to understand and integrate evidence at the bedside. Systemic solutions are also proposed for the dissemination of best evidence to facilitate its translation into practice. Financial Disclosure: The authors have no financial conflicts of interest or sources of funding to declare. Correspondence: Dr. Achilleas Thoma, 101-206 James Street South Hamilton, ON, L8P 3A9,, Phone (905) 523-0019, Fax (905) 523-0229, Email: drathoma@cogeco.net ©2018American Society of Plastic Surgeons
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