Evaluating the Impact of Resident Participation and the July Effect on Outcomes in Autologous Breast Reconstruction

2018 ◽  
Vol 81 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Winona W. Wu ◽  
Caroline Medin ◽  
Alexandra Bucknor ◽  
Parisa Kamali ◽  
Bernard T. Lee ◽  
...  
2018 ◽  
Vol 34 (07) ◽  
pp. 530-536 ◽  
Author(s):  
Daniel Rais ◽  
Jian Farhadi ◽  
Giovanni Zoccali

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.


2017 ◽  
Vol 140 (6) ◽  
pp. 1121-1131 ◽  
Author(s):  
Eugenia H. Cho ◽  
Ronnie L. Shammas ◽  
Adam D. Glener ◽  
Rachel A. Greenup ◽  
E. Shelley Hwang ◽  
...  

Microsurgery ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 352-360 ◽  
Author(s):  
Jonas A. Nelson ◽  
John P. Fischer ◽  
Chen Yan ◽  
Joshua Fosnot ◽  
Jesse C. Selber ◽  
...  

2019 ◽  
Vol 27 (6) ◽  
pp. 1877-1888 ◽  
Author(s):  
Jonas A. Nelson ◽  
Nikhil Sobti ◽  
Aadit Patel ◽  
Evan Matros ◽  
Colleen M. McCarthy ◽  
...  

2017 ◽  
Vol 33 (09) ◽  
pp. 624-629 ◽  
Author(s):  
Geoffrey Hespe ◽  
Joseph Disa ◽  
Colleen McCarthy ◽  
Robert Allen ◽  
Joseph Dayan ◽  
...  

Background Microsurgical breast reconstructions (MBRs) are time and labor intensive procedures. To circumvent these barriers, plastic surgeons have started working together as cosurgeons (CSs). This study aims to evaluate the impact of the CS model (CSM) specifically on bilateral MBR. The hypothesis is that CS procedures reduce operative time and surgical complications. Study Design This was a single institutional retrospective cohort study, which included all consecutive patients who underwent bilateral MBR from 2014 to 2016. Patients were grouped into single surgeon (SS) or CSs based on the number of the attending plastic surgeons present. Demographic and clinical characteristics including age, body mass index, smoking, American Society of Anesthesiologist class, radiation, and the timing of the reconstruction were assessed. Univariate and multivariate analyses were performed for outcomes including operative time and postoperative complications. Results Of the 136 patients included in the study, 41% had breast reconstruction performed by CSs, whereas 59% had a SS. Sociodemographic features were evenly distributed with the exception of a greater number of delayed reconstructions in the SS group (33 vs. 13%; p <0.01). Pedicle TRAMS (transverse rectus abdominis musculocutaneous flaps) were performed in 5 versus 0% of SS versus CS cases, respectively. Rates of major (4 vs. 16%) and minor (11 vs. 24%) complications were significantly lower in CS procedures. Multivariate analyses demonstrated CS operations required significantly shorter operative time by 73 minutes (p <0.001), and trended toward a reduced postoperative complication rate (p = 0.07). Conclusion The CSM is associated with improved operative efficiency for bilateral MBR. Further evaluation of the CSM may prove useful in other surgical disciplines with time and labor intense procedures.


2021 ◽  
Vol 149 (1) ◽  
pp. 15-27
Author(s):  
Sabine Oskar ◽  
Jonas A. Nelson ◽  
Madeleine E. V. Hicks ◽  
Kenneth P. Seier, M.S. ◽  
Kay See Tan ◽  
...  

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