scholarly journals 1106 Timing of Free Flap Reconstruction in Sarcoma Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A T Misky ◽  
S Williams ◽  
A Woollard
Keyword(s):  
Free Flap ◽  
Negative Impact ◽  
Trauma Surgery ◽  
Surgical Reconstruction ◽  
Complication Rates ◽  
Tissue Destruction ◽  
Microsurgical Reconstruction ◽  
Operative Complications ◽  
Extremity Reconstruction ◽  
Post Operative Complications

Abstract Aim In 1986 Godina reported that microsurgical reconstruction of traumatic wounds in the extremities undertaken with >72-hour delay caused significant tissue damage, hampering the microsurgical reconstruction and significantly increasing complication rates. It is our opinion that surgical treatment of sarcoma in the extremity is comparable to trauma surgery, given the extent of tissue destruction. The nature of sarcoma management often means that performing definitive reconstruction within 72 hours is not possible. We analyse the outcomes of our ‘delayed’ extremity reconstruction. Method We performed a retrospective analysis of 52 consecutive cases of free flap extremity reconstruction following sarcoma excision. Data was analysed for time from resection to reconstruction, significant patient demographics, details of the flap and post-operative complications. Results Between March 2017 and December 2020, we performed 52 free flaps for sarcoma reconstruction in the extremities. Mean time to reconstruction was 28 days (Median 15 days, Range: 0-316 days), with two reconstructions within 72 hours of excision. 9 patients had neoadjuvant chemo- or radiotherapy. Three patients had significant post-operative complications; two flaps failed intra-operatively (3.8%) and one patient (1.9%) experienced wound infection. Conclusions Godina’s study demonstrated the negative impact of delaying surgical reconstruction in the traumatised extremity, with a 12% failure and 17.5% infection rate in delayed reconstruction (72 hours to 3 weeks). Our results show that with advancements in microsurgical techniques and physiological optimization, it is possible to safely and successfully undertake delayed (>72 hours) microsurgical extremity reconstruction in sarcoma patients and achieve low flap failure and infection rates.

scholarly journals The impact of pre-operative biologic therapy on post-operative surgical outcomes in ulcerative colitis: a systematic review and meta-analysis

2020 ◽  
Vol 13 ◽  
pp. 175628482093708
Author(s):  
Jasmine Zanelli ◽  
Subashini Chandrapalan ◽  
Abhilasha Patel ◽  
Ramesh P. Arasaradnam
Keyword(s):  
Ulcerative Colitis ◽  
Biologic Therapy ◽  
Meta Analysis ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Biologic Treatment ◽  
Operative Care ◽  
Operative Complications ◽  
The Impact ◽  
Post Operative Complications

Background and aims: Biologic therapy has emerged as an effective modality amongst the medical treatment options available for ulcerative colitis (UC). However, its impact on post-operative care in patients with UC is still debatable. This review evaluates the risk of post-operative complications following biologic treatment in patients with UC. Methods: A systematic search of the relevant databases was conducted with the aim of identifying studies that compared the post-operative complication rates of UC patients who were either exposed or not exposed to a biologic therapy prior to their surgery. Outcomes of interest included both infection-related complications and overall surgical morbidity. Pooled odds-ratio (OR) and 95% confidence intervals (CI) were calculated using Review Manager 5.3. Results: In all, 20 studies, reviewing a total of 12,494 patients with UC, were included in the meta-analysis. Of these, 2254 patients were exposed to a biologic therapy prior to surgery. The pooled ORs for infection-related complications ( n = 8067) and overall complications ( n = 11,869) were 0.98 (95% CI 0.66–1.45) and 1.14 (95% CI 1.04–1.28), respectively, which suggested that there was no significant association between the use of pre-operative biologic therapy and post-operative complications. Interestingly, the interval between the last dose of biologic therapy and surgery did not influence the risk of having a post-operative infection. Conclusions: This meta-analysis suggests that pre-operative biologic therapy does not increase the overall risk of having post-operative infection-related or other complications. PROSPERO registration id-CRD42019141827.

scholarly journals Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4792
Author(s):  
George E. Richardson ◽  
Conor S. Gillespie ◽  
Mohammad A. Mustafa ◽  
Basel A. Taweel ◽  
Ali Bakhsh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Performance Status ◽  
Progression Free Survival ◽  
World Health ◽  
Intracranial Meningioma ◽  
Complication Rates ◽  
Patient Goals ◽  
Operative Complications ◽  
Post Operative Complications

The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration.

scholarly journals The Impact of Multidisciplinary Team Approach on Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

2021 ◽  
Vol 11 (12) ◽  
pp. 1313
Author(s):  
Hao-Chien Hung ◽  
Po-Jung Hsu ◽  
Ting-Chang Chang ◽  
Hung-Hsueh Chou ◽  
Kuan-Gen Huang ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
P Value ◽  
Team Approach ◽  
Complication Rates ◽  
Operative Complication ◽  
Operative Complications ◽  
Post Operative Complications

Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) is a therapeutic approach used to achieve curative treatment in intra-abdominal malignancy with peritoneal carcinomatosis (PC). However, it is a complicated procedure with high post-operative complication rates. Thus, we analyzed our preliminary data to establish whether multidisciplinary teamwork (MDT) implementation is beneficial for CRS–HIPEC outcomes. Method: A series of 132 consecutive patients with synchronous or recurrent PC secondary to gastrointestinal or gynecologic cancer who received CRS–HIPEC operation between May 2015 and September 2017 were included. Ninety-nine patients were categorized into the MDT group, with the 33 other patients into the non-MDT group. Results: The mean PCI score was 16.3 ± 8.8. Patients in the MDT group more often presented a higher PCI score (p value = 0.038). Regarding CRS completeness (CCR 0–1), it was distributed 81.8% and 57.6% in the MDT and the non-MDT group, respectively (p value = 0.005). Although post-operative complications were common (n = 62, 47.0%), post-operative complication rates did not differ between the two groups. The cumulative OS survival rate at the first year was 75.5%. Older age (p = 0.030, HR = 4.58, 95% CI = 1.16–18.10), ECOG 2 (p = 0.030, HR = 6.41, 95% CI = 1.20–34.14), and incomplete cytoreduction (p = 0.048, HR = 2.79, 95% CI = 1.04–8.27) were independent prognostic factors for survival. Conclusions: Our experience suggests that the CRS–HIPEC performed under MDT cooperation may result in higher complete cytoreduction rates without increasing post-operative complications and hospital mortalities.

scholarly journals Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

2011 ◽  
Vol 93 (8) ◽  
pp. 620-623 ◽  
Author(s):  
SR Markar ◽  
A Karthikesalingam ◽  
J Cunningham ◽  
C Burd ◽  
G Bond-Smith ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Appendicitis ◽  
Medical Records ◽  
Operative Time ◽  
University Teaching ◽  
Complication Rates ◽  
Operative Complications ◽  
Negative Appendicectomy ◽  
Appendiceal Perforation ◽  
Post Operative Complications

INTRODUCTION The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London. METHODS This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications. RESULTS All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009 (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445), perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029) or perforation (p=0.014). CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery

2019 ◽  
Vol 29 (9) ◽  
pp. 1417-1424 ◽  
Author(s):  
Maria D Iniesta ◽  
Javier Lasala ◽  
Gabriel Mena ◽  
Andrea Rodriguez-Restrepo ◽  
Gloria Salvo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Operative Outcomes ◽  
Tertiary Center ◽  
Operative Complications ◽  
Eras Protocol ◽  
Post Operative Complications

ObjectiveThe aim of this study was to evaluate if varying levels of compliance with an enhanced recovery after surgery (ERAS) protocol impacted post-operative outcomes (length of stay, complications, readmissions, and re-operations) in gynecologic surgery at a tertiary center.MethodsWe included 584 patients who had open gynecologic surgery between November 1, 2014 and December 31, 2016. Patients were categorized into subgroups according to their date of surgery from the time of the ERAS protocol implementation. Patients were categorized by their per cent compliance into two groups:<80% versus ≥80%. We analyzed compliance with the elements of the protocol over time and its relation with post-operative outcomes, length of stay, post-operative complications, readmission, and re-operations rates. We modeled the probability of having a post-operative complication within 30 days of surgery as a function of overall compliance.ResultsOverall compliance was 72.3%. Patients with compliance ≥80% had significantly less complications (P<0.001) and shorter length of stay (P<0.001). Readmission and re-operation rates were not impacted by compliance (P=0.182, P=0.078, respectively). Avoidance of salt water overload, early mobilization, early oral nutrition, and early removal of Foley catheter were significantly associated with less post-operative complications within 30 days.ConclusionsCompliance with an ERAS pathway exceeding 80% was associated with lower complication rates and shorter length of stay without impacting on re-operations or readmissions.

VASCULAR MALFORMATION OF HAND: CAVERNOUS LYMPHANGIOMA

Hand Surgery ◽  
2004 ◽  
Vol 09 (02) ◽  
pp. 229-231
Author(s):  
Semih Takka ◽  
Kazuteru Doi ◽  
Yasunori Hattori
Keyword(s):  
Free Flap ◽  
Vascular Malformation ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Operative Complications ◽  
One Year ◽  
Post Operative Complications

A case of congenital cavernous lymphangioma of the hand presenting in a newborn is presented. The mass on the dorsum of the hand was removed with the overlying skin and underlying paratenon at three years of age. Re-surfacing was performed with a free flap transfer. There were no post-operative complications during one year of follow-up.

scholarly journals Quality of life and surgical outcomes of laparoscopic cholecystectomy in patients over the age of 80: a retrospective study

2020 ◽  
Vol 7 (12) ◽  
pp. 3902
Author(s):  
Husam Ebied ◽  
Andrew Refalo ◽  
Mohammed Saad Aboul-Enien
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Life Questionnaire ◽  
Complication Rates ◽  
Operative Morbidity ◽  
Operative Complications ◽  
Elective Cholecystectomy ◽  
Post Operative Complications

Background: As the United Kingdom’s population ages an increasing number of patients undergoing elective cholecystectomy are over the age of eighty. The current literature base focuses on a younger patient cohort and fails to consider quality of life benefit from the intervention. Assessing quality of life benefit as well as operative morbidity and post-operative complications together is important in the assessment of whether patients of this age should be managed surgically or conservatively.Methods: A retrospective study was conducted on all patients above the age of eighty undergoing elective cholecystectomy between January 2017 to January 2019 at a tertiary care centre in London. Intra-operative morbidity and post-operative complications were obtained from inpatient notes and quality of life was measured using the gastrointestinal quality of life questionnaire (GIQLI) pre and post operatively.Results: 120 patients over the age of eighty underwent laparoscopic cholecystectomy in the three-year timeframe. 11% experienced post-operative complications. A statistically significant improvement in GIQLI score was noted post-operatively across all domains including social function, gastrointestinal symptoms, physical function and emotional function.Conclusions: Post-operative complication rates were higher amongst this cohort compared to series studying a younger cohort of patients. However, quality of life significantly benefited from the intervention for patients over the age of 80. Hence, amongst carefully selected patients, laparoscopic cholecystectomy remains a viable treatment option and can greatly benefit the individual.

scholarly journals Impact of Radiation Dose on Postoperative Complications in Esophageal and Gastroesophageal Junction Cancers

2021 ◽  
Vol 11 ◽  
Author(s):  
Noah Kastelowitz ◽  
Megan D. Marsh ◽  
Martin McCarter ◽  
Robert A. Meguid ◽  
Narine Wandrey Bhardwaj ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Chemoradiation ◽  
Complication Rates ◽  
Trimodality Therapy ◽  
Significant Difference ◽  
Operative Complications ◽  
The Cross ◽  
The Impact ◽  
Post Operative Complications

Introduction: The impact of radiation prescription dose on postoperative complications during standard of care trimodality therapy for operable stage II-III esophageal and gastroesophageal junction cancers has not been established.Methods: We retrospectively reviewed 82 patients with esophageal or gastroesophageal junction cancers treated between 2004 and 2016 with neoadjuvant chemoradiation followed by resection at a single institution. Post-operative complications within 30 days were reviewed and scored using the Comprehensive Complication Index (CCI). Results were compared between patients treated with &lt;50 Gy and ≥ 50 Gy, as well as to published CROSS study neoadjuvant chemoradiation group data (41.4 Gy).Results: Twenty-nine patients were treated with &lt;50 Gy (range 39.6–46.8 Gy) and 53 patients were treated with ≥ 50 Gy (range 50.0–52.5 Gy) delivered using IMRT/VMAT (41%), 3D-CRT (46%), or tomotherapy IMRT (12%). Complication rates and CCI scores between our &lt;50 Gy and ≥ 50 Gy groups were not significantly different. Assuming a normal distribution of the CROSS data, there was no significant difference in CCI scores between the CROSS study neoadjuvant chemoradiation, &lt;50 Gy, or ≥ 50 Gy groups. Rates of pulmonary complications were greater in the CROSS group (50%) than our &lt;50 Gy (38%) or ≥ 50 Gy (30%) groups.Conclusions: In selected esophageal and gastroesophageal junction cancer patients, radiation doses ≥ 50 Gy do not appear to increase 30 day post-operative complication rates. These findings suggest that the use of definitive doses of radiotherapy (50–50.4 Gy) in the neoadjuvant setting may not increase post-operative complications.

scholarly journals CHANGES AND DYNAMICS OF INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS AFTER APPLYING VARIOUS TECHNIQUES OF SURGICAL TREATMENT OF CATARACT

2019 ◽  
Vol 19 (2) ◽  
pp. 74-77
Author(s):  
I. S. Steblovskaya ◽  
I. M. Bezkorovayna
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Negative Impact ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Age Related ◽  
Operative Complications ◽  
The Uk ◽  
Iol Dislocation ◽  
Post Operative Complications

Transition to the small incision surgery and the practice of cataract phacoemulsification and femtosecond-guided cataract phacoemulsification have contributed to the reduction of postoperative complications, however, despite this, there are some potentially dangerous sight problems that include infective endophthalmitis, toxic syndrome of the eye anterior segment, intraoperative suprachoroidoid hemorrhage, cystic macular edema, retinal detachment, persistent corneal edema and IOL dislocation. According to the study conducted in the UK, the overall frequency of complications following phacoemulsification was 8.7%. Complications that arise at any stage of the surgical intervention and after it have a negative impact on the immediate and remote functional outcomes of the treatment. Thus, the improvement of surgical treatment of age-related cataracts by studying the features and mechanisms of the development of postoperative edema in the central retinal zone, as well as the development of new methods for predicting this complication, is an urgent problem of ophthalmology. The aim of this study was to determine and differentiate the frequency and dynamics of intraoperative, early and late post-operative complications in various techniques of surgical treatment of age-related cataracts. Materials and methods. 558 patients (558 eyes) with cataracts participated in the examination and treatment. The first group consisted of 298 patients (298 eyes) who underwent standard phacoemulsification, and the second group involved 260 patients (260 eyes) who were performed on femtosecond-guided cataract phacoemulsification. The examination was carried out on the 1 day, and in 1, 3 6 and 12 months after cataract surgery. The use of femtosecond laser can reduce the rate of intraoperative, as well as early and late post-operative complications after the cataract removal.

Vein Grafting in Microsurgical Lower Extremity Reconstruction: Outcome Analysis of Primary versus Secondary Salvage Procedures

2021 ◽  
Author(s):  
Emre Gazyakan ◽  
Lingyun Xiong ◽  
Jiaming Sun ◽  
Ulrich Kneser ◽  
Christoph Hirche
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Free Flaps ◽  
Matched Pair ◽  
Complication Rates ◽  
Matched Pair Analysis ◽  
Flap Loss ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Pair Analysis

Abstract Objective Many microsurgeons fear high complication rates and free flap loss when vein grafting is necessary to restore blood flow at the recipient site. The aims of this study were to comparatively analyze surgical outcomes of interposition vein grafts (VG) in microsurgical primary lower extremity reconstruction and secondary salvage procedures. Patients and Methods A retrospective study was conducted on 58 patients undergoing free flap transfers with vein grafting for primary lower extremity reconstruction (cohort 1) and secondary salvage procedures (cohort 2) between 2002 and 2016. A matched-pair analysis of both cohorts and 58 non-VG flaps was performed. Patient data, preoperative conditions, flap and vein graft characteristics, postoperative outcomes such as flap failure, thrombosis, and wound complications were analyzed. Results A total of 726 free flap transfers were performed. In total, 36 primary reconstructions (5%) utilized 41 interposition VG (cohort 1). Postoperative vascular compromise was observed in 65 free flaps (9%). In total, 22 out of 65 secondary salvage procedures (33.8%) utilized 26 interposition VG (cohort 2). Two total flap losses occurred in each cohort (5.6 vs. 9.1%; p = 0.63). Postoperative complications were observed in 38.9% of free flaps in cohort 1 and 72.7% in cohort 2 (p = 0.01). Takeback for microvascular compromise was comparable in both cohorts (19.4 vs. 22.7%; p = 0.75). Microvascular complications occurred more often in cohort 2 (22.7%) than in cohort 1 (8.3%; p = 0.28). Lower extremity salvage rates were high among both cohorts (94.4 vs. 90.9%; p = 0.63). Matched-pair analysis did not show any relevant differences on takebacks and flap loss (p = 0.32 and p = 1.0). Conclusion In complex lower extremity reconstructions, VG can be performed with acceptable complication rates and outcomes in primary and especially in salvage cases. With careful planning and a consistent surgical protocol, VG can provide reliable success rates in limb salvage.

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