scholarly journals Carbon Dioxide based versus Saline Tissue Expansion for Breast Reconstruction; A Meta-Analysis

2021 ◽  
Vol 107 (1_suppl) ◽  
pp. 14-14
Author(s):  
A.M.E. Elkholy ◽  
A. Awadeen
Keyword(s):  
Carbon Dioxide ◽  
Breast Reconstruction ◽  
Meta Analysis ◽  
Tissue Expander ◽  
Radical Mastectomy ◽  
Tissue Expansion ◽  
Wound Dehiscence ◽  
Self Esteem ◽  
Significant Difference ◽  
Review Manager

Introduction: Radical mastectomy shall be a lifesaving procedure for patients with breast cancer. However, it is associated with considerable alteration of patients’ self-esteem and body image. Currently, 40% of women are subjected to breast reconstruction subsequent to radical mastectomy, ranking such surgery the most common reconstruction approach. Two-stage tissue expander-to-implant is the preferable technique that accomplished the desired aesthetic outcomes. The current study was executed to assess the safety and efficacy of Carbon-dioxide based tissue expansion, in contrast to saline-based tissue expansion. Materials and Methods: Comprehensive literature review up to 1 December 2020 was carried out throughout the following databases; PubMed, Google Scholar, Web of Science, Scopus, WHO Global Health Library, Clinical trials, Cochrane, SIGLE, NYAM, mRCT, and ICTRP to identify all clinical studies compared carbon-dioxide based and saline-based tissue expansion. Data analysis was done using Review Manager version 5.3 (RevMan5.3). The significant difference was established at P < 0.05. Results: This meta-analysis included four articles which comprised 619 reconstructed breasts. Of them, 374 breasts were reconstructed using carbon-dioxide based tissue expander, whereby 245 breasts were reconstructed using saline-based tissue expander. Carbon-dioxide based tissue expander accomplished statistically significant shorter duration to accomplish complete expansion (MD-36.28;95%CI-44.09,-28.47; P<0.001) and shorter duration to achieve complete reconstruction (MD-41.91;95%CI-54.24,-29.58; P<0.001). There was no statistically significant difference between carbon-dioxide and saline-based tissue expanders regarding the success rate (RR 1;95%CI 0.96, 1.06; P=0.85), device malfunction (RR 0.94;95%CI 0.11, 8.06; P=0.96), and implant extrusion (RR 0.71;95%CI 0.14, 3.62; P=0.68). There was no statistically significant difference between both methods regarding total; complications (RR 0.93;95%CI 0.64, 1.37; P=0.72). This includes wound infection (RR 0.46;95%CI 0.08, 2.72; P=0.39), wound dehiscence (RR 0.47;95%CI 0.10, 2.25; P=0.34), seroma (RR 1.01;95%CI 0.40, 2.57; P=0.99), and hematoma (RR 0.28;95%CI 0.06, 1.29; P=0.1). Conclusions: Carbon-dioxide based tissue expander is a safe, effective, and promising approach with considerable advancement relative to saline-based tissue expander, principally regarding the time to accomplish complete implant expansion and the time to achieve complete breast reconstruction.

scholarly journals 1443 Comparison of Outcomes Between Immediate Direct-to-Implant Breast Reconstruction versus Two-Stage Implant Breast Reconstruction; a Systematic Review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Kelly ◽  
I Balasubramanian ◽  
C Cullinane ◽  
R Prichard
Keyword(s):  
Systematic Review ◽  
Breast Reconstruction ◽  
Meta Analysis ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Two Stage ◽  
Significant Difference ◽  
Implant Reconstruction ◽  
Implant Breast Reconstruction

Abstract Background Direct-to-implant (DTI) breast reconstruction is increasingly performed as the preferred method of immediate breast reconstruction following mastectomy. The proposed advantages of DTI over two-stage tissue expander (TE)/implant reconstruction relate to fewer surgical procedures. This systematic review and meta-analysis aims to evaluate the safety and efficacy of DTI versus conventional TE/implant breast reconstruction. Method A systematic review was performed (PubMed, Embase, Scopus) to identify relevant studies that compared outcomes between DTI and TE/Implant reconstructions. Publications up to October 2020 were included. The primary outcome was overall complication rate. Secondary outcomes included infection rate and implant loss. Results Nineteen studies, including 32,971 implant-based breast reconstructions, were analysed. Median age was 48 years. Mean BMI was 25.9. There was no statistically significant difference between the two groups. Duration of follow up ranged from 1-60 months. Overall complications were significantly more likely to occur in the DTI group (OR 1.81 [1.17-2.79]). Overall complications refers to all reported complications including seroma, haematoma, would dehiscence, infection, skin necrosis and capsular contracture. Implant loss was also significantly higher in the DTI cohort (OR 1.31 [1.12-1.78]). There was no significant difference in infection rates between the two groups. Subgroup analyses, focusing on high-powered multicentre studies showed that the risks of overall complications were significantly higher in the DTI group (OR 1.51 [1.06-2.14]). Conclusions This meta-analysis demonstrates significantly greater risk of complications and implant loss in the DTI breast reconstruction group. These findings serve to aid both patients and clinicians in the decision-making process regarding implant reconstruction following mastectomy

scholarly journals The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze Lin ◽  
Yun Sun ◽  
Hang Xue ◽  
Lang Chen ◽  
Chenchen Yan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Venous Thrombosis ◽  
Meta Analysis ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Cord Injury ◽  
Review Manager ◽  
Evident Difference

Abstract Background Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined. Materials and methods Cohort studies comparing the use of LMWH and UFH in the prevention of lower limb venous thrombosis in patients with spinal cord injury were identified using PubMed. The risk of bias and clinical relevance of the included studies were assessed using forest plots. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the included studies. The main results of the study were analyzed using Review Manager 5.3. Results A total of five studies were included in this meta-analysis. Four studies compared the effectiveness and safety of LMWH and UFH in preventing thrombosis in patients with spinal cord injury. No significant differences were found between the therapeutic effects of the two drugs, and the summary RR was 1.33 (95% CI 0.42–4.16; P = 0.63). There was also no significant difference in the risk of bleeding between the two medications, and the aggregate RR was 0.78 (95% CI 0.55–1.12; P = 0.18). When comparing the efficacy of LMWH in preventing thrombosis in different segments and different degrees of spinal cord injury, no significant differences were found. Conclusions The results of this analysis show that compared with UFH, LMWH has no obvious advantages in efficacy nor risk prevention, and there is no evident difference in the prevention of thrombosis for patients with injuries at different spinal cord segments.

scholarly journals Preoperative exercise and recovery after cardiac surgery: a meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yu-Ting Zheng ◽  
Jiang-Xu Zhang
Keyword(s):  
Cardiac Surgery ◽  
Meta Analysis ◽  
Exercise Group ◽  
Control Group ◽  
Inclusion Criteria ◽  
Blood Cell Count ◽  
Bias Analysis ◽  
Significant Difference ◽  
Preoperative Exercise ◽  
Review Manager

Abstract Background To evaluate the association between preoperative exercise and recovery after cardiac surgery. Methods Literature comparing preoperative exercise and the control group for patients receiving cardiac surgery was retrieved in multiple databases. Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis and bias analysis. Results Finally, 6 relevant studies satisfied the inclusion criteria. There was significant difference in length of stay in intensive care unit (ICU) (MD- = 1.35, 95%CI [− 2.64, − 0.06], P = 0.04; P for heterogeneity < 0.0001, I2 = 88%) and physical function after operation (P of heterogeneity = 0.32, I2 = 12%, Z = 9.92, P of over effect< 0.00001). The meta-analysis suggested that there was no significant difference in white blood cell count (WBC) at postoperative day 7 and mental health after operation between the exercise group and the control group. Limited publication bias was observed in this study. Conclusion Preoperative exercise including inhaled muscle training, aerobics, resistance training and stretching could promote recovery after cardiac surgery.

scholarly journals Accidental Magnetic Resonance Imaging Activation of Carbon Dioxide Tissue Expanders

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Carissa L Patete ◽  
Michael Plastini ◽  
Prakash J Mathew ◽  
Jason J Yoo ◽  
Zubin Panthaki
Keyword(s):  
Magnetic Resonance Imaging ◽  
Carbon Dioxide ◽  
Case Report ◽  
Magnetic Resonance ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Resonance Imaging ◽  
Level Of Evidence ◽  
Tissue Expanders ◽  
Permanent Implants

Abstract Implant-based reconstruction is the most common form of breast reconstruction following mastectomy. It is most often performed in 2 stages using saline-based tissue expanders, which are then exchanged for permanent implants. Serial expansions are performed by accessing a port in the office, an inconvenient and sometimes painful process. A carbon dioxide tissue expander is a device that provides a needle-free, patient-controlled expansion utilizing a remote-controlled CO2 canister. While a patient-controlled expansion offers convenience, given that the CO2 reservoir holds approximately 1500 mL of gas, the potential for malfunction resulting in an uncontrolled expansion in unique to this device. The authors present a case report of a patient with bilateral pre-pectoral tissue expanders who underwent magnetic resonance imaging, resulting in uncontrolled expansion. Level of Evidence: 5

scholarly journals Outcome and safety of upper pole versus non-upper pole single puncture PCNL for staghorn stones: a systematic review and meta-analysis

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 537
Author(s):  
Steven Gunawan ◽  
Ponco Birowo ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Meta Analysis ◽  
Direct Access ◽  
Risk Of Bleeding ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Complications Rate ◽  
Staghorn Stone ◽  
Review Manager ◽  
Free Rate ◽  
Staghorn Stones

Background: Staghorn stones are mostly treated by percutaneous nephrolithotomy (PCNL), either with an upper-pole (UP) or non-upper (lower- or middle-) pole (NP) approach. NP access has a lower risk of bleeding and thoracic complications but may not be sufficient for complete stone clearance. UP access is advocated as the preferred approach, because of direct access to the collecting system. However, it is associated with a higher complications rate, including pneumothorax and hydrothorax, and a higher risk of bleeding. This meta-analysis aimed to describe the outcomes and safety of PCNL for staghorn stones using UP and NP approaches. Methods: A systematic literature review was conducted using several databases such as: PubMed; EBSCO; Science Direct; Cochrane and Google Scholar. Data from all selected articles were extracted by two independent reviewers. Relevant parameters explored using Review Manager V5.3. Results: Five comparative studies of staghorn stones involving 384 renal units were analyzed; 176 cases used the UP approach and 208 the NP approach. There was no significant difference in stone-free rate between these approaches, with 74.4% undergoing the UP approach and 71.1% the NP approach considered stone-free (OR: 1.55; 95% CI: 0.92-2.63; P=0.10). The rate of thoracic complications (hydrothorax and pneumothorax) did not differ significantly (OR: 3.14; 95% CI: 0.63-15.62; P=0.16). However, we noted that 5 of 176 patients that underwent the UP approach experienced thoracic complications. The incidence of post-procedural fever and sepsis is similar (OR: 1.18; 95% CI: 0.52-2.64; P=0.69). Neither post-procedural urine leakage (OR: 2.03; 95% CI: 0.70-5.85; P=0.19) nor requirement of blood transfusions (OR: 0.49; 95% CI: 0.14-1.76; P=0.27) differed significantly. Conclusion: PCNL with UP access for staghorn stone has a similar stone-free rate to the NP approach. Thoracic complication rate which was believed to be higher in the UP group is also deemed similar with NP access.

scholarly journals A meta-analysis of the impact of COVID-19 on liver dysfunction

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Zeng-hong Wu ◽  
Dong‑liang Yang
Keyword(s):  
Liver Dysfunction ◽  
Meta Analysis ◽  
Elevated Serum ◽  
Clinical Severity ◽  
The Novel ◽  
Significant Difference ◽  
Novel Coronavirus ◽  
The Impact ◽  
Review Manager ◽  
Different Levels

Abstract Background The novel coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is leading to a worldwide pandemic. Except representative manifestation of pneumonia and acute respiratory symptoms, COVID-19 patients have also shown different levels of liver injury or liver dysfunction. The aim of our study was to explore the probable clinical severity and mortality of COVID-19 patients and their liver dysfunction. Method A combination of computer and manual retrieval was used to search in Medline through PubMed, EMBASE and Web of Science. Review Manager 5.3 software was used to examine the heterogeneity among the studies and to calculate the combined effect value (OR, 95CI). Subgroup analysis, sensitivity analysis, and publication bias test were also performed. Results We found a significant connection between liver dysfunction and mortality of COVID-19 patients with a pooled OR of 1.98 (95% CI 1.39–2.82; P = 0.0002). There was a significant association between AST and severity of COVID-19 with a pooled OR of 4.48 (95% CI 3.24–7.21; P < 0.001), and a pooled WMD of 3.35 (95% CI, 2.07 to 4.64; P < 0.001). In addition, there was a significant difference between TBIL and severity of COVID-19, with a pooled OR of 1.91 (95% CI 1.40–2.60; P < 0.001), and with a pooled WMD of 1.18 (95% CI, 0.78 to 1.58; P < 0.001). Conclusion The mortality and severity of COVID-19 patients are significantly associated with liver dysfunction. The non-survivors and severe COVID-19 patients have elevated serum AST levels than the survivors and non-severe COVID-19 patients. The results of this study form a basis for better clinical liver management of patients with COVID-19.

Risk Factors of Venous Thromboembolic Events after Breast Cancer Surgeries; A Meta-Analysis of 166929 Patients

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 6-6
Author(s):  
A.M.E. Elkholy ◽  
A. Awadeen ◽  
I.H. Kabeil ◽  
A. Sokar
Keyword(s):  
Breast Cancer ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Health Care Providers ◽  
Meta Analysis ◽  
Radical Mastectomy ◽  
Care Providers ◽  
Primary Reconstruction ◽  
Significant Difference ◽  
Venous Thromboembolic Events

Introduction: Venous thromboembolism (VTE) is the second most common cause of death among patients with breast cancer. In particular, VTE accounted for 20% of deaths after radical mastectomy. Owing to the devastating sequels associated with VTE and its financial impact, the current study was conducted to reveal the possible risk factors of VTE after breast cancer surgeries. Materials and Methods: Extensive systematic literature review, from inception up to 1 October 2019, was performed throughout 12 databases to reveal all clinical studies reported the risk factors of VTE after breast cancer surgeries. Pooled analysis was implemented using Review Manager. Results: This meta-analysis included 8 articles that encompassed an overall 166929 patients. There was no statistically significant difference between patients developed VTE and those not developed such condition regarding Caprini total score (SMD0.5;95%CI-0.58,1.57; P=0.36). Subsequently, patients developed VTE were elder than patients did not develop such complications (MD1.21;95%CI 1.06,1.35; P<0.001). Patients had pre-operative diabetes mellitus (OR 0.69;95%CI0.49,0.98; P=0.04) or pulmonary disease (OR1.43;95%CI1.09,1.88; P=0.01) were more susceptible to experience post-operative VTE, relative to other patients. Besides that, post-operative hospitalization stays were significantly longer among patients experienced VTE, relative to patients did not experience such complications (MD 2.6;95%CI 2.54,2.66; P<0.001). Patients subjected to radical mastectomy and primary reconstruction were more vulnerable to have VTE post-operatively (OR 2.66;95%CI 1.90,3.71; P<0.001). Similarly, patients received concurrent venous catheterization were more susceptible to develop VTE post-operatively (OR 2.13;95%CI 1.22,3.73; P<0.00=0.008). On the contrary, post-operative hormonal therapy, radiotherapy, or chemotherapy were not statistically significant risk factors of VTE after breast cancer surgeries. Conclusions: Elderly patients and those with pre-operative diabetes mellitus or pulmonary diseases and patients subordinated to primary reconstruction after radical mastectomy were more susceptible to develop VTE. Understanding these factors will aid health care providers to optimize the optimal preventive strategies of VTE after breast cancer surgeries.

Post-Mastectomy Surgical Pocket Irrigation With Triple Antibiotic Solution vs Chlorhexidine Gluconate: A Randomized Controlled Trial Assessing Surgical Site Infections in Immediate Tissue Expander Breast Reconstruction

2021 ◽  
Author(s):  
Lyly Nguyen ◽  
Ashkan Afshari ◽  
Japjit Green ◽  
Jeremy Joseph ◽  
Jun Yao ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Tissue Expander ◽  
Surgical Site Infections ◽  
Chlorhexidine Gluconate ◽  
Bilateral Mastectomy ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Antibiotic Solution

Abstract Background Post-mastectomy pocket irrigation solution choice is debated and primarily surgeon dependent. We compare triple antibiotic solution (TAS) to 0.05% chlorhexidine gluconate (CHG). Objectives The purpose of this study was to determine surgical site infection (SSI) rates after using TAS vs CHG for breast pocket irrigation in immediate tissue expander breast reconstruction. Methods A prospective, blinded, randomized controlled trial was performed in patients (18-81 years old) undergoing bilateral mastectomy with tissue expander (TE) reconstruction. In each patient, one mastectomy pocket was randomized to TAS and the other to CHG. Both the TE and the pocket were irrigated in the respective solution. The primary outcome was the incidence of surgical site infections (SSI). Secondary outcomes were rates of mastectomy flap necrosis, hematoma, and seroma. Results Eighty-eight patients undergoing bilateral immediate breast reconstruction were enrolled. Demographic and operative characteristics were equivalent as each patient served as their own control. Between the TAS and CHG groups, there was no difference in the incidence of SSI (5 [4.5%] vs 7 [8.0%], p = 0.35), including minor infections (2 [2.3%] vs 1 [1.1%], p = 0.56), major infections (2 [2.3%] vs 6 [6.8%], p = 0.15), and those resulting in explantation (2 [2.3%] vs 5 [4.5%], p = 0.25). There was also no difference in necrosis, hematoma, or seroma formation. No patients who developed SSI had radiation. Conclusions This study does not demonstrate a statistically significant difference in SSI between TAS and CHG irrigation, though TAS approached statistical significance for lower rates of infectious complications.

Outcomes of Immediate Alloplastic Breast Reconstruction in Patients Receiving Post-Mastectomy Radiotherapy

2020 ◽  
pp. 229255032096964
Author(s):  
Stacy Fan ◽  
Hanny Chen ◽  
Aaron Grant ◽  
Tanya DeLyzer
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Wound Dehiscence ◽  
Fisher Exact Test ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Alloplastic Breast Reconstruction ◽  
Alloplastic Reconstruction

Background: Immediate alloplastic breast reconstruction is traditionally avoided in patients who require post-mastectomy radiation therapy (PMRT). However, a subset of patients who undergo alloplastic reconstruction may unpredictably require adjuvant radiation. The purpose of this study was to compare outcomes and complications in patients at our institution who had undergone immediate alloplastic breast reconstruction and received PMRT to either the permanent implant or temporary tissue expander. Materials and Methods: A retrospective cohort study was performed looking at patients who underwent immediate alloplastic breast reconstruction over a 10-year period (2009-2019) at our regional breast centre. All patients who underwent immediate alloplastic breast reconstruction and had PMRT were included in the study. Major (wound dehiscence with device exposure, or reconstructive failure) and minor (infection, capsular contracture, revision surgery) complication rates between those patients receiving radiation to a tissue expander versus implant were compared using Fisher exact test ( P < .05). Results: Six-hundred ninety-two patients were identified, and 43 patients met inclusion criteria. Of this group, 29 received PMRT to implants and 14 received PMRT to tissue expanders. Complication rates were similar between groups for superficial wound infection (3.4% vs 7.1%), periprosthetic infection (3.4% vs 7.1%), capsular contracture (41.4% vs 21.4%), revision surgery for aesthetics (41.4% vs 21.4%), wound dehiscence and device exposure (3.4% vs 21.3%), and reconstructive failure (10.3% vs 6.7%). Total complication rates were similar between groups (51.7% vs 42.9%). Discussion: Overall 6.4% of patients who underwent immediate alloplastic breast reconstruction required PMRT over a 10-year period. Complication rates for infection, capsular contracture, revision surgery, wound dehiscence and device exposure, and reconstructive failure were similar between both groups. Total complication rates were similar between groups. This information will help to inform decision-making regarding immediate alloplastic reconstruction and expected complications when PMRT is needed.

scholarly journals A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

2019 ◽  
Vol 2019 ◽  
pp. 1-12
Author(s):  
Bei Qian ◽  
Lingyun Xiong ◽  
Jialun Li ◽  
Yang Sun ◽  
Jiaming Sun ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Success Rate ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Safety Evaluation ◽  
Perforator Flap ◽  
Wound Dehiscence ◽  
Safety And Efficacy ◽  
Artery Perforator

Background. The profunda artery perforator (PAP) flap was first applied in breast reconstruction in 2010 by Robert J. Allen. It provided an alternative for autologous breast reconstruction in addition to traditional donor sites. Currently, literature reporting its microsurgical safety and efficacy is relatively sparse and heterogeneous. Objective. To clarify the evidence regarding microsurgical safety and efficacy of PAP flap in breast reconstruction, which may contribute to future surgical decision-making. Methods. Multiple databases were systematically searched by two independent reviewers. The result was statistically analyzed with Meta command of R GUI 3.5.1. The proportions with 95% confidence intervals (CIs) were calculated by using random-effect model. Results. There were 12 studies including 516 PAP flaps meeting the inclusion criteria. The pooled surgical success rate was 99% (95% CI: 97%–100%) and overall rate of complications was 23% (95% CI: 18%–27%). The most common individual complication was wound dehiscence with incidence of 6% (95% CI: 4%–9%). The seroma rate was 2% (95%CI: 0%–6%). The hematoma rate was 1% (95% CI: 0%–2%). The partial necrosis rate was 2% (95% CI: 0%–5%). The rate of total flap loss was 1% (95% CI: 0%–3%). Conclusion. To date, this study is the first meta-analysis of microsurgical efficacy and safety evaluation of the PAP flap in breast reconstruction. This present work confirmed that the PAP flap is safe and reliable in breast reconstruction with high success rate, but a relatively low complication rate. Moreover, it might be more than an alternative to the deep inferior epigastric perforator flap (DIEP) in microsurgical breast reconstruction in selected patients.

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