Background: Patients undergoing autologous breast reconstruction are at high risk of perioperative venous thromboembolic events. The efficacy of chemoprophylaxis in decreasing venous thromboembolic events is well established, but the timing of chemoprophylaxis remains controversial. The authors compare the incidence of bleeding following preoperative versus postoperative initiation of chemoprophylaxis in microvascular breast reconstruction. Methods: A retrospective chart review was performed from August of 2010 to July of 2016. Initiation of chemoprophylaxis changed from postoperative to preoperative in 2013, dividing subjects into two groups. Patient demographics, comorbidities, and complications were reviewed. Results: A total of 196 patients (311 flaps) were included in the study. A total of 105 patients (166 flaps) received preoperative enoxaparin (40 mg) and 91 patients (145 flaps) received postoperative chemoprophylaxis. A total of five patients required hematoma evacuation (2.6 percent). Of these, one hematoma (1 percent) occurred in the preoperative chemoprophylaxis group. Seven patients received blood transfusions: three in the preoperative group and four in the postoperative group (2.9 percent versus 4.4 percent; p = 0.419). There was a total of one flap failure, and there were no documented venous thromboembolic events in any of the groups. Conclusions: This study demonstrates that preoperative chemoprophylaxis can be used safely in patients undergoing microvascular breast reconstruction. The higher rate of bleeding in the postoperative group may be related to the onset of action of enoxaparin of 4 to 6 hours, which allows for intraoperative hemostasis in the preoperative group and possibly potentiating postoperative oozing when administered postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Background The COVID-19 pandemic has necessitated masking in public spaces. Masks cover the wearer’s face partially and thus may impact the perceived attractiveness of individuals and hence, interpersonal relations. Objective To determine if facial coverings affect attractiveness. Methods An online survey was conducted using 114 headshot images, two each- unmasked and masked- of 57 individuals. 207 participants rated them on an ordinal scale from 1 (least attractive) to 10 (most attractive). Parametric and non-parametric tests were performed, as appropriate, for comparison. Results For the first quartile, the average rating increased significantly when wearing a mask (5.89 ± 0.29 and 6.54 ± 0.67; p = 0.01). For control images ranked within the fourth quartile, the average rating decreased significantly when wearing a mask (7.60 ± 0.26 and 6.62 ± 0.55; p <0.001). In the female sub-group (n= 34), there was a small increase in average rating when masked, while in the male sub-group (n = 23), there was a small decrease in average rating when masked, but the change was not statistically significant (p > 0.05). For unmasked female images ranked within the first quartile, the average rating increased significantly when wearing a mask (5.77 ± 0.27 and 6.76 ± 0.36; p = 0.001). For the female sub-group with mean ratings within the fourth quartile, the average decreased significantly when wearing a medical mask (7.53 ± 0.30 and 6.77 ± 0.53; p < 0.05). For unmasked male images ranked within the first quartile, the average rating increased when wearing a medical mask but the change was not statistically significant (p > 0.05) whereas for the control male images within the fourth quartile, the average rating decreased significantly when masked (7.72 ± 0.18 and 6.50 ± 0.54; p < 0.05). Conclusions While wearing a facial covering significantly increased attractiveness for images less attractive at baseline, and decreased attractiveness for those that are more attractive at baseline; it did not cause a significant overall change in attractiveness in the study population.
Background Hidradenitis suppurativa (HS) severely impacts patients’ quality of life (QoL). Surgery has shown potential in improving a patient's QoL in severe disease. Previous studies have evaluated QoL after surgery, but lack a disease-specific questionnaire to better evaluate the unique burden of disease that patients with HS experience. Objective To measure postoperative QoL in patients with HS using a modified version of the disease-specific questionnaire, the Hidradenitis Suppurativa Burden of Disease (HSBOD) Tool. Methods A retrospective study was conducted using 19 patients who underwent surgery for HS. A demographic form and a 19-item disease-specific questionnaire were emailed to patients who consented to complete the survey. Patient-reported outcomes were recorded on a 0-100 scale (100 representing the highest burden of disease). Results Of the 24 patients that received the survey, 19 completed it in its entirety. The mean±SD Burden of Disease (BoD) score for each of the five domains assessed by the survey were: symptoms and feelings (62±27), daily activities (65±30), leisure (57±31), work and school (48±32), and personal relationships (56±27). Pearson’s correlation between the number of surgeries each patient underwent and their reported BoD scores were not significant. BoD scores were significantly higher in the symptoms and feelings domain for complex closure compared to both secondary intention and split-thickness skin grafting (STSG). Conclusion Despite having surgery, patients with hidradenitis still report impaired QoL. Further study is ongoing to determine how these measures compare to baseline preoperative values. This instrument provides a valuable tool to determine QoL in patients with hidradenitis.
bdominal computed tomography angiograms have become an integral part of preoperative evaluation for autologous breast reconstruction at many centers. The benefits of computed tomographic angiograms are well documented and include mapping the intramuscular course and fascial exit sites of vascular structures, easier flap harvest with reliable selection of dominant perforators, fewer surgical complications, decreased morbidity, and reduced operative times and surgeon stress. [1][2][3][4][5][6][7][8][9][10] The anatomical variability of the abdominal perforator vasculature is well known, further supporting the use of computed tomographic angiography for surgical mapping in perforator-based breast reconstruction. However, with the increased use of abdominal computed
Background Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. Objectives The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. Methods A literature search for hematoma and facelift surgery was performed which identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size less than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text with their recommendations. Results Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia over general anesthesia, and strict blood pressure control of at least <140mmHg were found to significantly reduce hematoma formation. The use of quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors (SSRIs), and perioperative steroids had no significant effect on hematoma formation. Conclusions In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunctive measures have been shown to reduce post-operative hematoma formation in facelift procedures.
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