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Eltahir Y, Bosma E, Teixeira N, Werker PMN, de Bock GH. Satisfaction with cosmetic outcomes of breast reconstruction: Investigations into the correlation between the patients' Breast-Q outcome and the judgment of panels. JPRAS Open 2020; 24:60-70. [PMID: 32420440 PMCID: PMC7215106 DOI: 10.1016/j.jpra.2020.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives We aimed to determine the relation between breast reconstruction method, patient satisfaction, and surgeon reported cosmetic outcome among women who underwent breast reconstruction after mastectomy. Study Design A cross-sectional study of patients treated between 2006 and 2010. Main Outcome Women's satisfaction with cosmetic outcomes after breast reconstruction. Measures Cosmetic outcomes were evaluated by (1) women using the Breast-Q to rate satisfaction with breasts outcomes, and (2) an independent panel using the Strasser score. The relationships between the Breast-Q rating, Strasser scores, and breast reconstruction methods, including laterality and timing, were evaluated by Mann–Whitney U tests, Spearman's rank correlations, and Wilcoxon signed-rank tests. Results Ninety-four women were included. Patients were more satisfied with their breasts if they had undergone autologous, unilateral, or secondary breast reconstruction compared with those who underwent alloplastic, bilateral, or primary breast reconstruction (p-values 0.008, 0.011, and 0.001, respectively). The Strasser system did not reveal significant cosmetic differences, with all breast reconstructions graded as mediocre or poor. Conclusions Patient satisfaction with breast outcomes, as measured by the Breast-Q, was described as mediocre or poorly reflected by the Strasser score. If doctors are to support patients to make informed decisions on the optimal method of breast reconstruction, we need a more sensitive, comprehensive tool reflecting patients’ cosmetic outcomes.
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Affiliation(s)
- Y Eltahir
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, BB81, 9700 RB Groningen, the Netherlands
| | - E Bosma
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, BB81, 9700 RB Groningen, the Netherlands
| | - N Teixeira
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, BB81, 9700 RB Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Sadok N, Krabbe-Timmerman IS, de Bock GH, Werker PMN, Jansen L. The Effect of Smoking and Body Mass Index on The Complication Rate of Alloplastic Breast Reconstruction. Scand J Surg 2019; 109:143-150. [PMID: 30712467 DOI: 10.1177/1457496919826711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the effect of smoking and body mass index on the occurrence of complications after alloplastic breast reconstruction. MATERIALS AND METHODS A consecutive series of 56 patients treated with immediate or delayed alloplastic breast reconstruction, including six cases combined with latissimus dorsi flap, at three hospitals between 2012 and 2018 were included. Complications were scored and defined according to Clavien-Dindo. To evaluate the impact of smoking, body mass index, and other potential risk factors on the occurrence of any and severe complications, univariate and multivariate logistic regression analyses were applied to estimate odds ratios and 95% confidence intervals. RESULTS In 56 patients, 22 patients had a complication. As much as 46% of smokers had severe complications compared to 18% of non-smokers. Of patients with body mass index ⩾ 25, 40% had severe complications compared to 10% with body mass index < 25. Smokers had eight times more chance of developing severe complications than non-smokers (ORadjusted = 8.0, p = 0.02). Patients with body mass index ⩾ 25 had almost 10 times more severe complications compared to patients with body mass index ⩽ 25 (ORadjusted = 9.9, p = 0.009). No other risk factors were significant. CONCLUSION Smoking and body mass index ⩾ 25 both increased the complication rate to such an extent that patients should be informed about their increased risk for complications following alloplastic breast reconstruction and on these grounds surgeons may delay alloplastic breast reconstruction. It is an ethical dilemma whether one should deny overweight and obese patients and those who smoke an immediate alloplastic breast reconstruction. For both life style interventions, adequate guidance should be made available.
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Affiliation(s)
- N Sadok
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - I S Krabbe-Timmerman
- Department of Plastic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - L Jansen
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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Burger BB, Veerman MM, Tellier MA, Leclercq WKG, Mouës-Vink CM, Werker PMN. Insight in Information Provision Prior to Obtaining Surgical Informed Consent-by Audiotaping Outpatient Consultations. World J Surg 2018; 43:425-430. [PMID: 30267290 DOI: 10.1007/s00268-018-4804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Literature suggests that patient-informing process prior to obtaining surgical informed consent (SIC) does not function well. This study aimed to provide insight into the current practice of SIC in the Netherlands. METHODS This is a prospective, observational, and multicenter study, conducted in one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made during outpatient consultations with patients presenting with Dupuytren Disease. The recorded informing process was scored according to a checklist. Written documentation of the SIC process in the patient's chart was compared to these scored checklists. Time spent on SIC during the consultations was also recorded. RESULTS A total of 41 outpatient consultations were included in the study. Consultations were conducted by 25 plastic surgeons and their residents. Average time spent on SIC was 55.6% of the total consultation time. Considerable variation was observed concerning the amount and type of information given and discussed. In 59% of the consultations, discrepancies were observed between written documentation of consultations and audio recordings. Information on treatment risks, the postoperative period, and the operating surgeon was addressed the least. CONCLUSION Despite a relatively large part of the consultation time being spent on SIC, patients received scarce information concerning treatment risks, postoperative period, and who their operating surgeon would be. Discrepancies were observed between the written documentation of SIC and information recorded on the audio recordings. This occurred predominantly in one hospital that used a pre-made list of 'discussed information' in its digital patient chart.
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Affiliation(s)
- B B Burger
- Department of Plastic Surgery, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - M M Veerman
- Department of Plastic Surgery, Hospital Rivierenland Tiel, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands
| | - M A Tellier
- Department of Plastic Surgery, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - W K G Leclercq
- Department of Gastrointestinal and Oncologic Surgery, Maxima Medical Center Veldhoven, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - C M Mouës-Vink
- Department of Plastic Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University of Groningen & University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Post SF, Werker PMN, Dijkstra PU. Microsurgical Reconstruction of the Oral Cavity with Free Flaps from the Anterolateral Thigh and Radial Forearm: Example of Confounding by Indication? Ann Surg Oncol 2017; 24:640. [PMID: 29159746 DOI: 10.1245/s10434-017-6225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 11/18/2022]
Affiliation(s)
- S F Post
- Department of Plastic Surgery, The University Medical Center Groningen, Groningen, The Netherlands.
| | - P M N Werker
- Department of Plastic Surgery, The University Medical Center Groningen, Groningen, The Netherlands
| | - P U Dijkstra
- Department of Oral and Maxillofacial Surgery, The University Medical Center Groningen, Groningen, The Netherlands
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Werker PMN. Commentary on Dupuytren's contracture in Ethiopia. A. Gebereegziabher, A. Baraki, Y. Kebede, I. Mohammed and V. Finsen. J Hand Surg Eur. 2017, 42: 26-8. J Hand Surg Eur Vol 2017; 42:29. [PMID: 30178713 DOI: 10.1177/1753193416654073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Bouman MA, Dijkstra PU, Reintsema H, Roodenburg JLN, Werker PMN. Surgery for extra-articular trismus: a systematic review. Br J Oral Maxillofac Surg 2015; 54:253-9. [PMID: 26455659 DOI: 10.1016/j.bjoms.2015.08.269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/27/2015] [Indexed: 01/10/2023]
Abstract
The aim of this systematic review was to identify operations that are used to improve mouth opening in patients with extra-articular trismus (caused by cancer and its treatment, oral submucous fibrosis, or noma) and to find out if they work. We searched the electronic databases PubMed, Embase, Cinahl, and the Cochrane collaboration, and then systematically selected papers before we assessed their quality, extracted the data, and did a meta-analysis. We analysed 32 studies that included 651 patients, the median (IQR) size of which was 11 (7-26). The quality of the methods used and of reporting were relatively low. Median (IQR) duration of follow-up was 12 (8-22) months. Operations resulted in a weighted mean (SD) increase in mouth opening of 19.3 (6.3) mm. None of the operations was better than the others for the improvement of mouth opening. We conclude that operations can improve mouth opening in extra-articular trismus, but the evidence is of moderate quality and there is a need for further research.
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Affiliation(s)
- M A Bouman
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - P U Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - H Reintsema
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - J L N Roodenburg
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - P M N Werker
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
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Molenkamp S, Waterbolk TW, Mariani MA, Werker PMN. 122 * PREDICTORS OF COMPLICATIONS AFTER PECTORALIS MAJOR TRANSPOSITION FOR STERNAL DEHISCENCE. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The cutaneous ligaments of the digits have been recognized by anatomists for several centuries, but the best known description is that of John Cleland. Subsequent varying descriptions of their morphology have resulted in the surgical community having an imprecise view of their structure and dynamic function. We micro-dissected 24 fresh frozen fingers to analyze the individual components of Cleland's ligamentous system. Arising from the proximal interphalangeal (PIP) joint, proximal, and sometimes middle phalanx, we found strong ligaments that ran proximally (PIP-P) and distally (PIP-D). On each side of each finger there was a PIP-P ligament present, which passed obliquely from the lateral side of the proximal and sometimes middle phalanx towards its insertion into the skin at the level of the proximal phalanx. The distal (PIP-D) ligaments were found to pass obliquely distally on the radial and ulnar aspects of the digit towards cutaneous insertions around the middle phalanx. A similar arrangement exists more distally with fibres originating from the DIP joint and middle phalanx (the DIP-P pass obliquely proximally, and the DIP-D, distally). Each individual PIP ligament consisted of three different layers originating from fibres overlying the flexor tendon sheath, periosteum or joint capsule, and extensor expansion. Ligaments arising at the DIP joint had two layers equivalent to the anterior two layers of the proximal ligaments. Cleland's ligaments act as skin anchors maintaining the skin in a fixed relationship to the underlying skeleton during motion and functional tasks. They also prevent the skin from 'bagging', protect the neurovascular bundle, and create a gliding path for the lateral slips of the extensor tendon.
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Affiliation(s)
- R L Zwanenburg
- University Medical Center Groningen, Groningen, The Netherlands
| | - P M N Werker
- University Medical Center Groningen, Groningen, The Netherlands
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Korteweg SFS, Van de Graaf RC, Werker PMN. Sir Charles Bell was not affected by facial paralysis himself! Arq Neuropsiquiatr 2010; 68:321-2; author reply 322. [PMID: 20464311 DOI: 10.1590/s0004-282x2010000200035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- S F S Korteweg
- Department of Plastic Surgery, University Medical Center Groningen, The Netherlands.
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Korteweg SFS, Van de Graaf RC, Werker PMN. About the right facial palsy of Charles Bell: was Sir Charles Bell himself really affected by facial paralysis? - Comment on 'peripheral facial palsy in the past. Contributions from Avicenna, Nicolaus Friedreich and Charles Bell'. Arq Neuro-Psiquiatr 2009; 67:783; author reply 783-4. [DOI: 10.1590/s0004-282x2009000400041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Werker PMN. [Plastic surgery in patients with facial palsy]. Ned Tijdschr Geneeskd 2007; 151:287-94. [PMID: 17326471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In short-term irreversible paralysis caused by facial nerve problems the aim is to re-innervate the paralysed facial musculature. Whenever a paralysis remains untreated for longer than 12-18 months successful re-innervation is unlikely. In longer-term paralysis the symmetry of the face at rest can be restored by a static procedure, a skin resection or a fascial suspension for example. Restoration of movement in the paralysed side of the face is possible by means of a dynamic procedure. For many years the temporal muscle and the masseter muscle have been used to improve the position of the mouth and closure of the eye. Spontaneous laughter can again be made possible by using a muscle from elsewhere in the body (e.g. the gracilis or possibly pectoralis minor) and attaching it to the nerve supply of the opposite side of the face.
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Affiliation(s)
- P M N Werker
- Universitair Medisch Centrum Groningen, afd. Plastische Chirurgie, Postbus 30.001, 9700 RB Groningen.
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van Rijssen AL, Werker PMN. Percutaneous needle fasciotomy in dupuytren's disease. ACTA ACUST UNITED AC 2006; 31:498-501. [PMID: 16766101 DOI: 10.1016/j.jhsb.2006.03.174] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Revised: 03/14/2006] [Accepted: 03/29/2006] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine our results of 74 percutaneous needle fasciotomies for Dupuytren's contracture. Pre-operative and postoperative total passive extension deficit was measured. Patients were seen at the outpatient clinic at 32 months for final follow-up. Extension deficit and sensibility were measured and flexor tendon function assessed. Recurrence, defined as an increase of the passive extension deficit of 30 degrees or more compared to the immediate postoperative measurement, and other complications were also noted. Immediate outcome was excellent with an average improvement of 77%. After 32 months, we reviewed 55 rays. Their recurrence rate was 65%. Two patients experienced a slightly diminished sensibility on one side of the finger. There were no flexor tendon injuries. This procedure has a good short-term effect. It may be suitable for patients who want a minimally invasive treatment and to whom long-term results are less important. It may also have a place in delaying fasciectomy.
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Affiliation(s)
- A L van Rijssen
- Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Zwolle, The Netherlands
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