Was the Surgeon a Satisfactory Informant? How to Minimize Room for Claims

Bracaglia, Roberto; D’Ettorre, Marco; Gentileschi, Stefano; Tambasco, Damiano

doi:10.1177/1090820x14528504

Cited by 32 publications

(13 citation statements)

References 3 publications

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“…In conclusion, a substantial number of patients present with LLL 5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of not only the risk of late-onset LLL but also possible primary or secondary preventive approaches [27].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study

Yoshihara

Shimono

Tsuru

et al. 2020

European Journal of Surgical Oncology

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Introduction: Late-onset lower limb lymphedema (LLL) is a significant clinical challenge for physicians dealing with patients that undergo treatment involving the pelvic cavity. We aimed to clarify the prevalence of and risk factors for late-onset LLL after treatment for gynecological cancer. Methods: We conducted a multicenter retrospective study using records of cases in which LLL diagnosed by physical findings and measurement of limbs girths. Patients with LLL after treatment for uterine cervical, endometrial, and ovarian cancer were sequentially enrolled. We examined the timing of LLL onset and the associations between the time to onset and clinical characteristics, including age, type of cancer, lymphadenectomy sites, and performance of radiotherapy. We also investigated the risk factors for late-onset LLL and their effects on the cumulative incidence of late-onset LLL. Results: In total, 711 patients fulfilled the required criteria. Mean age of was 50.2 years old and median follow-up period was 5.05 years. More than half of them (50.5%) presented with LLL 5 years after undergoing treatment for gynecological cancer. A substantial number of patients (29.4%) developed LLL 10 years after undergoing treatment for gynecological cancer. Being aged <50 years [(odds ratio (OR): 1.919, P ¼ 0.001), cervical cancer (OR: 1.912, P ¼ 0.001), and radiotherapy (OR: 1.664, P ¼ 0.017) were identified as significant risk factors for late-onset LLL in multivariate logistic regression analysis. Conclusions: A substantial number of patients present with LLL 5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of the risk of late-onset LLL.

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Section: Discussionmentioning

confidence: 99%

Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study

Yoshihara

Shimono

Tsuru

et al. 2020

European Journal of Surgical Oncology

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“…Patients must know that it will be a slow process, understand it and accept it; otherwise, a surgical technique may be used from the outset. In this regard, Bracaglia et al [24] proposed to insert a question in the informed consent that allows the evaluation of whether a patient is sufficiently engaged and has completely understood the verbal and written information. All this requires the patience and availability of the surgeon to give all the necessary explanations.…”

Section: Discussionmentioning

confidence: 99%

Classical McIndoe Technique Versus the McIndoe Technique with a Neovaginal PACIENA Prosthesis® and No Skin Graft

Navarro

Acién

2020

JCM

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An observational, retrospective study was completed to compare the results of the PACIENA clinical trial (using the modified McIndoe technique) with a historical control group of nine patients who were operated on at San Juan University Hospital (1992–2015) using the classic technique. The PACIENA clinical trial included seven patients with vaginal agenesis who were operated on at two reference sites (May 2017–May 2018) using a neovaginal polylactic acid (PLA) prosthesis (PACIENA® prosthesis) and avoiding the use of a skin graft. The results illustrate a reduction in the length of surgery, 86.43 ± 4.75 min in the group with no skin graft compared to 155.56 ± 28.44 in the control group (p < 0.05); and reduction in the length of hospitalization time. Differences were also registered in the length of the neovagina, the average being 8.93 ± 1.42 cm for cases and 6.56 ± 1.13 cm for controls, with no differences in neovaginal epithelialization times or in the satisfaction of sexual relations occurring between groups. The modification of the classical McIndoe technique using the neovaginal PACIENA® prosthesis appears to be successful, obtaining good clinical results with shorter surgery and hospitalization times.

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“…Postoperative sensory function recovery was not investigated in these patients; anyway, the possibility of a sensory deficit must be discussed with the patient before surgery. 29 When performing a free transfer, to overcome the problem of short pedicle without giving up the advantage of the better size of the superficial branch, Yoshimatsu et al described a system to elongate a short-superficial pedicle by including the deep branch and using a retrograde flow. 30 Dealing with the size of these vessels, we found that when both the superficial and the deep branches are present, usually one of the two is dominant on the other, and in most of the cases the bigger vessel is the superficial branch that confirms Koshima et al's description.…”

Section: Discussionmentioning

confidence: 99%

Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

Gentileschi

Servillo

Bonis

et al. 2019

J reconstr Microsurg

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Background The superficial circumflex iliac perforator (SCIP) flap has many ideal features, such as fast dissection, possibility to harvest thin, pliable, wide skin island, and concealed donor site scar. In spite of these features, its use was limited because of the wide anatomical variation of the pedicle, which is relatively shorter and has a smaller caliber than other more popular perforator flaps. Several names were given to the branches and perforators in the literature, thus adding confusion to the understanding of its anatomy. Methods We performed a surgical and a radioanatomical study of the SCIP pedicles analyzing high-resolution contrast-enhanced computed tomography (CT) scan of 95 groins, with particular attention to the deep branch (DB) of the superficial circumflex iliac artery (SCIA). Twenty-three of these patients were also studied by detecting the surgical anatomy during SCIP flap harvest. We employed a system of coordinates based on the line between pubic tubercle (PT) and anterior superior iliac spine (ASIS) to describe the position of the perforator of the DB. Results We found a 100% correlation between surgical and radiological findings. The length of the DB from the origin to the point in which its perforator pierced the sartorius fascia ranged from 1.6 to 6.5 cm, mean = 3.62 ± 0.92 cm. The distance between the origin of the DB and the inguinal ligament ranged from 1.1 to 7.5 cm, mean = 2.8 ± 1 cm. The perforator of the DB could be found in 91% of the cases within a box of 4 cm × 3 cm drawn caudally to the line joining the PT with the ASIS. This vessel can show a vertical or horizontal course in the subcutaneous layer. Conclusion Our findings confirm other previous studies and add new information about the position and the course of the perforator of the DB of the SCIA. Important features of the SCIP pedicles can be investigated by the color Doppler ultrasound and CT scan.

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Was the Surgeon a Satisfactory Informant? How to Minimize Room for Claims

Cited by 32 publications

References 3 publications

Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study

Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study

Classical McIndoe Technique Versus the McIndoe Technique with a Neovaginal PACIENA Prosthesis® and No Skin Graft

Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

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