Background Although abdominoplasty is growing in popularity, it is still encumbered with considerable postoperative pain, which prolongs recovery. Objectives Aim of this network meta-analysis is to combine the evidence from different regional nerve blocks and examine their effectiveness in the management of postoperative pain sequela and recovery following abdominoplasty. Methods An electronic literature search in MEDLINE (PubMed, National Institutes of Health, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), the Cochrane Library (London, United Kingdom) and US National Institutes of Health Ongoing Trials Register electronic databases (Bethesda, MD) was conducted from inception to July 2022. Inclusion criteria were the presence of intervention and control groups, data derived from controlled studies evaluating nerve blocks after abdominoplasty, in terms of analgesia needs, complications, and patient satisfaction, and publication in peer-reviewed journals. The quality of studies was assessed via Cochrane’s risk of bias tool. A frequentist random effects network meta-analysis was conducted for all outcomes of interest. Results A total of 12 studies met the inclusion criteria containing 543 patients with no differences in age, sex, BMI and comorbidities. Transversus abdominis plane block (TAP) blocks have been found to reduce 24h, and 48h opioid consumption (-3.70 weighted mean differences [WMD] and -5.01 WMD, respectively). Also, the nerve blocks reviewed effectively prolonged the time to first rescue analgesia request, were safe, in terms of complications, and were associated with high satisfaction rates. Conclusions Nerve blocks emerge as an effective and safe adjunct for adequate pain management following abdominoplasty. This meta-analysis provides an evidence-based strategy to optimize the current analgesia regimens following abdominoplasty.
The COVID-19 pandemic has been the epicenter of healthcare attention globally for the past two years, and large-scale adaptations in healthcare provision have been required. This study aimed to investigate the impact of the pandemic and the resulting lockdowns on cutaneous melanoma diagnosis and tumor burdens in Europe. A relevant literature search in electronic databases was conducted from inception to September 2022. The inclusion criteria were: controlled studies published in a peer-reviewed journal evaluating cutaneous melanoma in Europe and reporting data on melanoma characteristics from diagnoses. The quality of studies was evaluated using the Cochrane ROBINS-I tool for assessing bias in non-randomized studies. Meta-analysis was conducted utilizing a random effects model to synthesize the data. A total of 25 studies involving 32,231 patients were included in the data analysis models. Statistically significant increases in mean Breslow thickness (0.29 mm (0.03–0.55 mm)), ulceration rates (OR = 1.66 (1.29–2.13)), and resultant tumor staging were observed in the PostCovid group, with subgroup analysis revealing that lockdown-derived data were responsible for this trend. This meta-analysis reported on the impact of COVID-19 restrictions on melanoma diagnosis in Europe, emphasizing the higher tumor burden and disease progression state provoked by healthcare adaptations in the pandemic period.
Background Mounting evidence suggests that breast reduction surgery displays higher rates of surgical site infections (SSI) than initially presumed. Objective of this network meta-analysis is to evaluate the effectiveness of different antibiotic regimens in the prophylaxis from surgical site infections and delayed wound healing (DWH) following breast reduction. Methods A network meta-analysis was conducted using a predetermined protocol after searching the electronic databases MEDLINE, Scopus, the Cochrane Library and US National Institutes of Health Ongoing Trials Register from inception to July 2022. The included studies had to examine breast reduction in females with at least 1-month follow-up, receiving antibiotics in an intervention arm compared to a control arm. The quality of studies was assessed using the Cochrane risk of bias tool. A frequentist Mantel-Haenszel approach was adopted for the reported SSI rates while an inverse variance random effects model was used for the DWH rates. Results A total of 10 studies was included in the analysis involving 1331 patients. All but one study controlled for major risk factors, and no differences were observed in patients’ baseline characteristics. Antibiotic administration significantly reduced the SSI rate after breast reduction, with the prolonged antibiotic regimen being the most efficacious (odds ratio [OR]: 0.36 [95%CI: 0.15–0.85]). No statistically significant reduction in delayed wound healing rate was revealed among the regimens. Conclusions Antibiotics mitigate the SSI rate after breast reduction. This meta-analysis provides an evidence-based strategy to optimize antibiotic administration. Further research is needed though to examine antibiotic prophylaxis on delayed wound healing. Level of Evidence III 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.
Introduction: Eccrine porocarcinoma (EPC) is a rare subtype of non-melanoma skin cancer developing in the intraepithelial portion of eccrine sweat glands. It is branded with a highly metastatic potential and increased rate of local recurrence after treatment. EPC showcased a trend of developing on the extremities, with presentation on the face sparse. Objectives: Aim of the study was to evaluate the frequency, clinical features, and course of this malignancy presented on the face. Methods: A retrospective review of the skin cancers excised between January 2010 and June 2021 was conducted in the plastic surgery department of a tertiary hospital. Patients were included in the study if EPC on the face was histologically confirmed. A prospectively maintained clinic database and the pathological reports were used to collect data. Results: 4 EPC cases on the face out of 3984 confirmed skin cancers were identified. None of the cases was suspected clinically, but the diagnosis was established following the histopathologic examination. An aggressive postoperative behavior was confirmed in two cases. Conclusions: The variance in the clinical presentation and the non-specific characteristics are perplexing clinical diagnosis, with the histopathologic examination representing the current standard for confirmation. Early diagnosis and adequate surgical resection are recommended as treatment cornerstones. Clinical awareness ought to be raised and a definitive treatment protocol be established for optimized results.
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