1
|
Aguilar HA, Palacios Huatuco RM, Ruffa T, Chirvechez A, Mayer HF. Synchronous pneumothorax and venous thromboembolism after body contouring surgery. Int J Surg Case Rep 2024; 119:109706. [PMID: 38678998 PMCID: PMC11063891 DOI: 10.1016/j.ijscr.2024.109706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Lipoabdominoplasty is one of the most common abdominal body contouring procedures performed today; however, it carries the risk of significant complications. Pneumothorax is a rare complication of liposuction, while, venous thromboembolism has a low short-term mortality and long-term morbidity. PRESENTATION OF CASE A 57-year-old woman with a history of diabetes mellitus, hypertension, obesity, and severe COVID-19 three years earlier. The patient underwent 360-degree liposuction and abdominoplasty. In the immediate postoperative period, the patient developed a right pneumothorax and followed by deep vein thrombosis (DVT) and pulmonary embolism (PE), which were diagnosed and treated early. After six months of follow-up, the patient presented a complete recovery. DISCUSSION Pneumothorax is recognized as a rare complication of liposuction and has been limited to case reports and small case series in the medical literature with an incidence of 0.04 %. In plastic and aesthetic surgery, body contouring procedures such as lipoabdominoplasty are associated with a risk of DVT and PE of 0.2-0.6 %, and 0.3 %, respectively. In addition, we believe that performing combined aesthetic procedures may increase the risk of complications. CONCLUSION This is the first reported case of pneumothorax, DVT and PE after body contouring surgery. We highlight the importance of awareness of these complications and the need for a high index of suspicion for early diagnosis and treatment, which is critical for patient survival.
Collapse
Affiliation(s)
- Hernán A Aguilar
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - René M Palacios Huatuco
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina.
| | - Tatiana Ruffa
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - Alejandra Chirvechez
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| |
Collapse
|
2
|
Mechanical Thromboprophylaxis Alone in Body Contouring Surgery for Post Massive Weight Loss Patients: Is this Good Enough? Aesthetic Plast Surg 2022; 46:248-254. [PMID: 34268591 DOI: 10.1007/s00266-021-02449-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although the use of pharmacological thromboprophylaxis effectively reduces Deep vein thrombosis (DVT) incidence after body contouring surgery, this might increase the risk of bleeding and hematoma formation. In this scenario, the use of mechanical prophylaxis alone could be an attractive alternative. We aimed to evaluate the incidence of DVT in patients with massive weight loss undergoing body contouring surgeries in whom mechanical prophylaxis alone was indicated. METHODS This retrospective cohort study included all patients who underwent body contouring surgery after massive weight loss between 09/01/16-12/31/19 and received solely mechanical prophylaxis of VTD. Data collected included smoking habit, body mass index, history of cancer, use of contraceptives, magnitude of weight loss, Caprini scale, American society of anesthesiology physical status (ASA-PS) classification, and type and length of procedures. An analysis of DVT events during the postoperative period up to 90 days was undertaken. RESULTS Sixty-four patients, in whom 82 BCS were performed, were included in this study. Most of them (89.1%) were female with a mean age of 47 ± 12 years. Mechanical prophylaxis methods used were elastic compression stockings, intermittent pneumatic compression boots, and early deambulation. In all cases, the average length of hospital stay was 26.3 ± 9.6 hours. Surgical times were less than 155,7 minutes in all procedures. Global incidence of DVT was 1.2% in a patient receiving mechanical prophylaxis alone. There were no bleeding complications or pulmonary embolism episodes. CONCLUSIONS In this series, DVT incidence in patients with mechanical prophylaxis alone was deemed acceptable if compared to the incidence reported in the literature. Individualization of the risk of thrombosis and bleeding in this group of patients is of paramount importance to reduce complications. LEVEL OF EVIDENCE IV 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 .
Collapse
|
3
|
Niederstätter IM, Schiefer JL, Fuchs PC. Surgical Strategies to Promote Cutaneous Healing. Med Sci (Basel) 2021; 9:medsci9020045. [PMID: 34208722 PMCID: PMC8293365 DOI: 10.3390/medsci9020045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022] Open
Abstract
Usually, cutaneous wound healing does not get impeded and processes uneventfully, reaching wound closure easily. The goal of this repair process is to restore the integrity of the body surface by creating a resilient and stable scar. Surgical practice and strategies have an impact on the course of wound healing and the later appearance of the scar. By considering elementary surgical principles, such as the appropriate suture material, suture technique, and timing, optimal conditions for wound healing can be created. Wounds can be differentiated into clean wounds, clean–contaminated wounds, contaminated, and infected/dirty wounds, based on the degree of colonization or infection. Furthermore, a distinction is made between acute and chronic wounds. The latter are wounds that persist for longer than 4–6 weeks. Care should be taken to avoid surgical site infections in the management of wounds by maintaining sterile working conditions, using antimicrobial working techniques, and implementing the principles of preoperative antibiotics. Successful wound closure is influenced by wound debridement. Wound debridement removes necrotic tissue, senescent and non-migratory cells, bacteria, and foreign bodies that impede wound healing. Additionally, the reconstructive ladder is a viable and partially overlapping treatment algorithm in plastic surgery to achieve successful wound closure.
Collapse
|
4
|
Starnoni M, Pinelli M, Porzani S, Baccarani A, De Santis G. Standardization and Selection of High-risk Patients for Surgical Wound Infections in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3472. [PMID: 33907656 PMCID: PMC8062150 DOI: 10.1097/gox.0000000000003472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of the present study was to show that the Infection Risk Index (IRI), based on only 3 factors (wound classification, American Society of Anesthesiologists score, and duration of surgery), can be used to standardize selection of infection high-risk patients undergoing different surgical procedures in Plastic Surgery. METHODS In our Division of Plastic Surgery at Modena University Hospital, we studied 3 groups of patients: Group A (122 post-bariatric abdominoplasties), Group B (223 bilateral reduction mammoplasties), and Group C (201 tissue losses with first intention healing). For each group, we compared surgical site infection (SSI) rate and ratio between patients with 0 or 1 risk factors (IRI score 0 or 1) and patients with 2 or 3 risk factors (IRI score 2 or 3). RESULTS In group A, patients with IRI score 0-1 showed an SSI Ratio of 2.97%, whereas patients with IRI score 2-3 developed an SSI ratio of 27.27%. In group B, patients with IRI score 0-1 showed an SSI ratio of 2.99%, whereas patients with IRI score 2-3 developed an SSI ratio of 18.18%. In group C, patients with IRI score 0-1 showed an SSI ratio of 7.62%, whereas patients with IRI score 2-3 developed an SSI ratio of 30.77%. CONCLUSIONS Existing infection risk calculators are procedure-specific and time-consuming. IRI score is simple, fast, and unspecific but is able to identify patients at high or low risk of postoperative infections. Our results suggest the utility of IRI score in refining the infection risk stratification profile in Plastic Surgery.
Collapse
Affiliation(s)
- Marta Starnoni
- From the Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Massimo Pinelli
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Silvia Porzani
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Alessio Baccarani
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Giorgio De Santis
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| |
Collapse
|
5
|
Wan M, Zhang JX, Ding Y, Jin Y, Bedford J, Nagarajan M, Bucevska M, Courtemanche DJ, Arneja JS. High-Risk Plastic Surgery: An Analysis of 108,303 Cases From the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Plast Surg (Oakv) 2020; 28:57-66. [PMID: 32110646 PMCID: PMC7016398 DOI: 10.1177/2292550319880921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is a lack of large-scale data that examine complications in plastic surgery. A description of baseline rates and patient outcomes allows better understanding of ways to improve patient care and cost-savings for health systems. Herein, we determine the most frequent complications in plastic surgery, identify procedures with high complication rates, and examine predictive risk factors. METHODS A retrospective analysis of the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Program plastic surgery data set was conducted. Complication rates were calculated for the entire cohort and each procedure therein. Microsurgical procedures were analyzed as a subgroup, where multivariate logistic regression models determined the risk factors for surgical site infection (SSI) and related reoperation. RESULTS We identified 108 303 patients undergoing a plastic surgery procedure of which 6 264 (5.78%) experienced ≥1 complication. The outcome with the highest incidence was related reoperation (3.31%), followed by SSI (3.11%). Microsurgical cases comprised 6 148 (5.68%) of all cases, and 1211 (19.33%) experienced ≥1 complication. Similar to the entire cohort, the related reoperation (12.83%) and SSI (5.66%) were common complications. Increased operative time was a common independent risk factor predictive of a related reoperation or development of an SSI (P < 001). Of all microsurgeries, 23.3% had an operative time larger than 10 hours which lead to faster increase in reoperation likelihood. CONCLUSIONS The complication rate in plastic surgery remains relatively low but is significantly increased for microsurgery. Increased operative time is a common risk factor. Two-team approaches and staged operations could be explored, as a large portion of microsurgeries are vulnerable to increased complications.
Collapse
Affiliation(s)
- Melissa Wan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacques X. Zhang
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yichuan Ding
- Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yiwen Jin
- Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Bedford
- Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Mahesh Nagarajan
- Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marija Bucevska
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Douglas J. Courtemanche
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Jugpal S. Arneja
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Elsamadicy AA, Adogwa O, Lydon E, Reddy G, Kaakati R, Sergesketter A, Gottfried ON, Karikari IO. Impact of Intraoperative Monitoring During Elective Complex Spinal Fusions (≥4 Levels) on 30-Day Complication and Readmission Rates: A Single-Institutional Study of 643 Adult Patients with Spinal Deformity. World Neurosurg 2017; 101:283-288. [PMID: 28192259 DOI: 10.1016/j.wneu.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study is to determine if there are differences in 30-day postoperative complication and readmission rates between patients with spinal deformity undergoing complex spinal fusion with and without intraoperative monitoring (IOM). METHODS The medical records of 643 adult patients with spine deformity undergoing elective complex spinal fusion (≥4 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 122 cases (19%) that involved IOM including electromyography, somatosensory evoked potential, and/or transcranial motor evoked potential and 521 (81%) that did not (IOM, n = 122; no-IOM, n = 521). The primary outcome investigated was the rate of 30-day postoperative complications and readmission. RESULTS Patient demographics and comorbidities were similar between both groups, including age, gender, body mass index, and smoking status. IOM cases had significantly increased operative time (IOM, 360.9 ± 153.8 minutes vs. no-IOM, 290.3 ± 127.1 minutes; P < 0.0001), with no differences in the incidences of spinal cord injury, nerve injury, and durotomy. Both cohorts had similar postoperative complications and length of hospital stay, with the no-IOM cohort having a greater incidence of intensive care unit transfer (no-IOM, 27.1% vs. IOM, 16.1%, P = 0.015). There was no significant difference in 30-day readmission between the cohorts (IOM, 8.2% vs. no-IOM, 12.3%; P = 0.27) or differences in sensorimotor deficits. Although the overall 30-day complication rate trended to be higher in the no-IOM cohort, these factors were not attributed to IOM use. CONCLUSIONS Our study suggests that the use of IOM may not have a significant impact on overall surgical outcomes and 30-day readmission rates.
Collapse
Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
| | - Emily Lydon
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gireesh Reddy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rayan Kaakati
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Amanda Sergesketter
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
7
|
Thorarinsson A, Fröjd V, Kölby L, Modin A, Lewin R, Elander A, Mark H. Blood loss and duration of surgery are independent risk factors for complications after breast reconstruction. J Plast Surg Hand Surg 2017; 51:352-357. [PMID: 28122466 DOI: 10.1080/2000656x.2016.1272462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Complications after breast reconstructive surgery are common, and they can be caused by a wide range of factors. The aim of the present study was to identify independent perioperative risk factors for postoperative complications after breast reconstruction. METHODS A retrospective study was performed of 623 consecutive breast cancer patients who had undergone deep inferior epigastric perforator (DIEP) flap, latissimus dorsi (LD) flap, lateral thoracodorsal flap (LTDF), or tissue expander with secondary implant (EXP). Data on demography, perioperative parameters, and complications were collected. Logistic regression models adjusted to the reconstruction method and to confounding demographic factors were used for statistical analysis. RESULTS Increased blood loss for each 10-ml step increased the risk for overall early complications (p = 0.017), early seroma (p = 0.037), early resurgery (p = 0.010), late local overall complications (p = 0.024), and late fat necrosis (p = 0.031). Longer duration of surgery for each 10-minute step increased the risk of overall early complications (p = 0.019), but, in the univariate model, there was an increased risk for nine different types of complications (p = 0.004-0.029). There was no association between the experience of the surgeon performing the procedure and the frequency of complications. CONCLUSIONS Duration of surgery and blood loss during surgery are independent risk factors for postoperative complications, and should be minimised. Further research is needed to establish the association between the experience of the surgeon and the occurrence of complications.
Collapse
Affiliation(s)
- Andri Thorarinsson
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Victoria Fröjd
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Lars Kölby
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Albert Modin
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Richard Lewin
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Anna Elander
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Hans Mark
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| |
Collapse
|
8
|
Grant DW, Mlodinow A, Ver Halen JP, Kim JYS. Catastrophic Outcomes in Free Tissue Transfer: A Six-Year Review of the NSQIP Database. PLASTIC SURGERY INTERNATIONAL 2014; 2014:704206. [PMID: 25478221 PMCID: PMC4248358 DOI: 10.1155/2014/704206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/31/2014] [Accepted: 11/02/2014] [Indexed: 11/17/2022]
Abstract
Background. No studies report robust data on the national incidence and risk factors associated with catastrophic medical outcomes following free tissue transfer. Methods. The American College of Surgeons (ACS) multicenter, prospective National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent free tissue transfer between 2006 and 2011. Multivariable logistic regression was used for statistical analysis. Results. Over the 6-year study period 2,349 patients in the NSQIP database underwent a free tissue transfer procedure. One hundred and twenty-two patients had at least one catastrophic medical outcome (5.2%). These 122 patients had 151 catastrophic medical outcomes, including 93 postoperative respiratory failure events (4.0%), 14 pulmonary emboli (0.6%), 13 septic shock events (0.5%), 12 myocardial infarctions (0.5%), 6 cardiac arrests (0.3%), 4 strokes (0.2%), 1 coma (0.0%), and 8 deaths (0.3%). Total length of hospital stay was on average 14.7 days longer for patients who suffered a catastrophic medical complication (P < 0.001). Independent risk factors were identified. Conclusions. Free tissue transfer is a proven and safe technique. Catastrophic medical complications were infrequent but added significantly to length of hospital stay and patient morbidity.
Collapse
Affiliation(s)
- David W. Grant
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Alexei Mlodinow
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jon P. Ver Halen
- Division of Plastic and Reconstructive Surgery, Baptist Cancer Center, Vanderbilt Ingram Cancer Center, St. Jude Children's Research Hospital, Memphis, TN 38139, USA
| | - John Y. S. Kim
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| |
Collapse
|
9
|
Mlodinow AS, Fine NA, Khavanin N, Kim JYS. Risk factors for mastectomy flap necrosis following immediate tissue expander breast reconstruction. J Plast Surg Hand Surg 2014; 48:322-6. [DOI: 10.3109/2000656x.2014.884973] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|