Browsing by Subject "Reconstructive Surgical Procedures"
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Item Application of the Caprini Risk Assessment Model in Evaluation of Non-Venous Thromboembolism Complications in Plastic and Reconstructive Surgery Patients(2014-02-04) Jeong, Haneol S.; Miller, Travis J.; Davis, Kathryn; Matthew, Anoop; Lysikowski, Jerzy; Lazcano, Eric; Reed, Gary; Kenkel, Jeffrey M.GOALS/PURPOSE: The Caprini Risk Assessment Model (RAM) is an ordinal scoring tool used to quantify and categorize a patient's risk for venous thromboembolism in the post-surgery setting. However, there has been no similar exploration into predictive associations of this score with the other potential complications of surgical procedures. This is surprising because the full list of variables that comprise an individual Caprini score involve a host of systemic factors that involve multiple organ systems. This study investigates whether Caprini scores can be applied to non-VTE complications. METHODS/TECHNIQUE: Authors undertook a retrospective chart review of 1598 encounters for a series of complex reconstructive and body-contouring operations at an academic medical institution. Input variables included Caprini score components, patient co-morbidities, and prophylactic use. Output variables were postoperative complications. Tests for proportions were performed on percentile data. Non-percentile data was treated with comparison of means (t-test). Odds ratios for complications were calculated for stratified risk groups and compared. RESULTS/COMPLICATIONS: The overall complication rate was 28.03%. DVT incidence was 1.50%. In comparing complication vs. complication-free patients, age, BMI, operation time, hypertension, diabetes, renal disease, and cancer were statistically significant. For DVT versus DVT-free patients, sex, BMI, operation time, smoking status, diabetes, hypertension, and prior DVT were significant. Increasing Caprini scores are associated with increasing odds ratios (OR) for dehiscence (1.73, p = 0.028), infection (2.04, p = 0.0003), seroma (1.52, p = .045), hematoma (2.12, p = 0.050), and necrosis (2.83, p = 0.0004) with a corresponding overall OR increase of 1.69 (p < 0.0001). These odds ratios parallel similar increases in the baseline occurrence rates for the noted complications. CONCLUSIONS: The data demonstrates that Caprini scores can be applied preoperatively to categorize a patient's risk of developing multiple non-VTE complications. Patients in the higher risk categories will be at an increased risk of suffering from wound dehiscence, infection, seroma, hematoma, and necrosis. Considering these potential complications as a single group, a high-risk patient has a 69% increased odds of suffering at least one problem compared with low-risk individuals. Unfortunately, few preoperative steps can be taken to directly address the complications that the Caprini model is predictive for. However, these results can help physicians better understand which complications to keep watch for most rigorously during postoperative monitoring. In addition, the data can guide conservations with patients during initial preoperative consultations.Item Barbed Sutures and Wound Complications in Plastic Surgery(2013-01-22) Cortez, Roberto; Kenkel, Jeffrey M.; Farkas, Jordan; Lazcano, Eric; Hein, Rachel; Miller, Travis; Sciano, Natalie; Constantine, Ryan; Anigian, Kendall; Jewell, JamesGOALS: Technological advancements, along with their refinements, have substantially increased the amount of wound closure tools at the disposal of the surgeon. Barbed sutures, with a unique design containing circumferentially located barbs, could potentially decrease operation time and facilitate wound healing by eliminating the need to tie knots and providing even tension distribution across the wound. This study was conducted: 1) to determine whether using a barbed suture device in wound closure showed an increase, decrease, or no difference in wound complication development when compared to conventional non-barbed sutures 2) to analyze complication rates observed within the barbed suture population (Angiotech QuillTM SRS vs. Covidien V-LocTM) to test for any significant difference between the two competing brands. METHODS: An IRB-approved retrospective chart review identified 1709 patients undergoing plastic surgery procedures from January of 2008 to January of 2012. In our database, a barbed suture device was used in a total of 372 cases and the type used (Angiotech QuillTM SRS vs. Covidien V-LocTM) was recorded in each case. The QuillTM SRS device was used in 106 cases, while the V-LocTM device was used in 266 total cases. Outcomes following these procedures were compared to outcomes of the same CPT codes where a barbed suture device was not used. Wound complications were defined as one or more of the following: infection, dehiscence, erythema, necrosis, seroma, hematoma, and delayed wound healing. RESULTS: Using multivariate analysis, barbed sutures appear to be associated with an increased incidence of wound complications (p=0.012), to include dehiscence (p=0.007), erythema (p=0.008), and necrosis (p=0.03) when compared to their non-barbed counterparts. Further exploration within the barbed suture population found the Covidien brand associated with an increased incidence of wound complications (p=0.03), particularly dehiscence (p=0.009), while the Quill brand was found to have a higher association with erythema (p=0.001) along the incision site. CONCLUSIONS: Barbed sutures appear to be associated with an increased incidence of wound complications in plastic and reconstructive surgery procedures, with the Covidien V-LocTM device showing a higher incidence of wound complication development compared to Angiotech QuillTM SRS device.Item Is It Safe to Combine Excisional Procedures with Liposuction in Body Contouring Surgery?(2014-02-04) Chen, Mo; Hardy, Krista; Davis, Kathryn; Yan, Jingsheng; Matthew, Anoop; Lysikowski, Jerzy; Reed, Gary; Kenkel, Jeffrey M.BACKGROUND: Excisional procedures, including abdominoplasty, brachioplasty, thighplasty, and body lift are often combined with liposuction with the goals of minimizing cost and hospital stays while maximizing aesthetic results. The aim of this study is to evaluate postoperative complications in patients undergoing excisional surgery with or without liposuction. Risk factors for this type of combined body contouring surgery are also evaluated. Methods: The electronic medical records of 413 patients undergoing body contouring surgery at UT Southwestern Medical Center were retrospectively reviewed. Three groups of patients were compared: liposuction only, excision only, and combined liposuction and excision surgeries. Some patients also received additional intra-abdominal, gynecologic, and breast procedures. Patient variables analyzed included age; body mass index (BMI); American Society of Anesthesiologists risk score (ASA score); Caprini score; operative time; co-morbidities (diabetes, hypertension, cardiovascular diseases, pulmonary diseases, and renal diseases); smoking status; prophylactic antibody use, and recent major surgery. RESULTS: No statistically significant differences in complication rates were found when comparing combined excision and liposuction surgeries to excision alone. Operative time was a significant risk factor for developing wound problems and overall complications. There was a trend for males and patients with higher BMI, older age (>45), and co-morbidities toward developing postoperative complications. CONCLUSIONS: Combining excisional body contouring procedures with liposuction does not increase overall complication rates in this cohort of patients. Plastic surgeons should balance the number of combined procedures with estimated operative time in order to maximize patient safety.Item Maxillary Growth and Speech Outcomes Following Staged Palatoplasty: A Single-Center Approach(2018-01-23) Leininger, Kurt; Alford, Jake; Ha, Richard; Byrd, Steve; Smartt, JamesINTRODUCTION: Cleft lip and palate are the most common craniofacial abnormalities in children. However, timing and staging of cleft palate repair remain controversial. Timing of palate repair depends on balancing the speech benefits of early repair with the improved maxillofacial growth of late palate repair. Both single stage and two staged palatoplasty have been proposed for optimizing growth and speech, each to varying success. In this study, we reviewed outcomes of the staged approach at a single center. METHODS: A retrospective chart review was performed for all patients who underwent staged palatoplasty for cleft palate at Children's Medical Center in Dallas between 2006-2012. All patients in the study underwent intra-velar veloplasty at 3 to 6 months and hard palate repair at 18 months. Exclusion criteria included patients undergoing single stage repair, initial treatment at an outside center, secondary surgery at an outside center, and inadequate follow up. 61 patients were eligible for final inclusion. Speech outcomes were evaluated based on Pittsburgh Weighted Speech Scores (PWSS) and rates of secondary operations indicated for correction of VPI. PWSS were collected after completion of staged palatoplasty, postoperatively after any surgical correction of VPI, and at latest available patient follow up. Maxillary growth outcomes were evaluated by rates of oronasal fistula, reoperation indicated for palate repair, Angle class malocclusion, and LeFort I advancement procedures. RESULTS: For the entire cohort, 26% of patients were determined to have clinical VPI. 28% required corrective VPI surgery. 11% were determined to have residual VPI refractory to corrective surgery. 31% were found to have a persistent oronasal fistula, with 30% requiring surgery. 50% had class III malocclusion. At the time of review, no patients required LeFort I advancement procedures. There were no significant differences when including syndromic patients. Compared to patient with CLP, patients with isolated CP had higher rates of clinical VPI (33% vs 24%), oronasal fistula (34% to 20%), and class III occlusion (54% to 27%). Compared to patient with complete CP, patients with incomplete CP had higher rates of clinical VPI (36% vs 23%) lower rates of oronasal fistula (14% to 36%), and lower rates of class III occlusion (29% to 53%). Compared to patients with UCLP, patients with bilateral CLP had higher rates of clinical VPI (43% vs 15%), oronasal fistula (57% to 27%), and class III occlusion (64% to 48%). CONCLUSION: In our cohort of 61 patients, speech and growth outcomes after staged palatoplasty are similar to what has been previously reported in the literature. Despite the lack of consensus on the appropriate surgical treatment for CP and a trend towards single stage palatoplasty, our data strongly suggests that staged palatoplasty is still a valuable surgical approach to the patient with cleft palate.Item [News](1977-11-18) Harrell, AnnItem [UT News](1987-08-07) Rutherford, Susan