scholarly journals Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 926
Author(s):  
Karl Schwaiger ◽  
Laurenz Weitgasser ◽  
Maximilian Mahrhofer ◽  
Kathrin Bachleitner ◽  
Selim Abed ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Data Extraction ◽  
Free Flaps ◽  
Risk Groups ◽  
The Elderly ◽  
Demographic Development ◽  
Autologous Breast Reconstruction ◽  
Significant Difference

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

scholarly journals Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases

2018 ◽  
Vol 45 (2) ◽  
Author(s):  
WALTER KOITI MATSUMOTO ◽  
ALEXANDRE MENDONÇA MUNHOZ ◽  
ALBERTO OKADA ◽  
EDUARDO MONTAG ◽  
EDUARDO GUSTAVO ARRUDA ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
The Elderly ◽  
Advanced Age ◽  
World Health ◽  
Elderly Age ◽  
Significant Difference ◽  
Health Organization

ABSTRACT Objective: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. Methods: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age <60 years) and elderly (60 years or more). We also grouped them according to the World Health Organization classification: young people (age <44 years), middle age (45-59 years); elderly (age 60-89 years) and extreme advanced age (90 years or older). We applied the surgical risk classification of the American Society of Anesthesiologists to investigate the role of the preoperative physical state as a possible predictor of complications. Results: of the 560 patients operated on, 94 (16.8%) were 60 years of age or older. We observed a local complication rate of 49.8%, the majority being self-limited. The incidences of necrosis, infection and dehiscence were 15.5%, 10.9% and 9.3%, respectively. Patients older than 60 years presented a chance of complication 1.606 times greater than the younger ones. Forty-five (8%) patients had loss of the reconstruction; there was no statistically significant difference in the mean age of the patients who presented this result or not (p=0.321). Conclusion: in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.

scholarly journals A Systematic Review of the Effectiveness of Telerehabilitation Interventions for Therapeutic Purposes in the Elderly

2020 ◽  
Vol 59 (02/03) ◽  
pp. 104-109
Author(s):  
Farnia Velayati ◽  
Haleh Ayatollahi ◽  
Morteza Hemmat
Keyword(s):  
Systematic Review ◽  
Elderly People ◽  
Data Extraction ◽  
The Elderly ◽  
Health Conditions ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Mobility Limitations ◽  
Significant Difference

Abstract Background Many elderly people suffer from chronic health conditions and mobility limitations. Therefore, they may benefit from traditional rehabilitation or telerehabilitation interventions as an alternative for this type of services. Objective The purpose of this study was to compare the effectiveness of telerehabilitation interventions with traditional rehabilitation services for therapeutic purposes in the elderly. Methods This systematic review was conducted in 2018. The searched databases were Cochrane Library, PubMed, Scopus, Web of Science, Embase, and ProQuest. The search was conducted with no time or language limitation. The selected papers included the randomized clinical trial studies in which elderly people aged 60 and over used telerehabilitation services for treatment purposes. The quality of the studies was evaluated by using the physiotherapy evidence database (PEDro) scale. Data were extracted by using a data extraction form and findings were narratively synthesized. Results After screening the retrieved papers, eight articles were selected to be included in the study. According to the findings, telerehabilitation was used for the elderly after stroke, chronic obstructive pulmonary disease (COPD), total knee replacement, and in patients with the comorbidity of COPD and chronic heart failure. Overall, in most studies, there was no significant difference between the intervention and control groups and the level of improvements was similar for most outcomes. Conclusion Telerehabilitation services can be regarded as an alternative to traditional rehabilitation approaches to reduce outpatient resource utilization and improve quality of life. However, more rigorous studies are suggested to investigate the effectiveness of telerehabilitation services for specific diseases or health conditions.

Safety of Coupled Arterial Anastomosis in Autologous Breast Reconstruction

2020 ◽  
Author(s):  
Mariel McLaughlin ◽  
Brooke E. Porter ◽  
Rachel Cohen-Shohet ◽  
Mark M. Leyngold
Keyword(s):  
Breast Reconstruction ◽  
Operating Room ◽  
Retrospective Chart Review ◽  
Free Flaps ◽  
Recipient Site ◽  
Flap Loss ◽  
Increased Risk ◽  
Significant Difference ◽  
Internal Mammary ◽  
Arterial Anastomosis

Abstract Background This study compares the outcomes of coupled versus hand-sewn arterial anastomosis in microvascular breast reconstruction. Methods Retrospective chart review of breast reconstruction free flaps performed between 2013 and 2018 was conducted. Primary end points included flap loss, intraoperative arterial anastomosis revision, and operating room takeback. The decision to couple the arterial anastomosis was based on patient's age, surgeon's preference, history of radiation, and vessel quality. All anastomoses were performed under ×3.5 loupe magnification to internal mammary or thoracodorsal vessels. Results Authors reviewed 104 free flaps; two were lost in hand-sewn group; no flaps were lost in coupled group. There was no significant difference in anastomotic revision rate between coupled and hand-sewn arterial anastomosis (p = 0.186) or return to operating room (OR) between coupled and hand-sewn flaps (p = 1.000). Reasons for takeback included venous congestion and hematoma. Conclusion This study reflects that coupled arterial anastomosis in breast reconstruction may be safely performed without increased risk in anastomotic revision, takeback, or flap loss. Decision to couple should be based on surgeon skill, patient age and history, and assessment of flap and recipient site vasculature.

Bendamustine in the Treatment of Chronic Lymphocytic Leukemia -Consistent Superiority Over Chlorambucil in Elderly Patients and Across Clinically Defined Risk Groups.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2367-2367 ◽  
Author(s):  
Wolfgang Ulrich Knauf ◽  
Toshko Lissitchkov ◽  
Ali Aldaoud ◽  
Anna Liberati ◽  
Javier Loscertales ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Remission Rate ◽  
Risk Groups ◽  
The Elderly ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
Response To Treatment ◽  
Open Label ◽  
Significant Difference ◽  
Binet Stage

Abstract Abstract 2367 Poster Board II-344 Introduction: Bendamustine is a purine analog/alkylator hybrid agent with a unique mechanism of action, which has shown good clinical efficacy and acceptable tolerability in various hematological malignancies. Chronic lymphocytic leukemia (CLL) is a disease of the elderly, and presents with a variety of clinical characteristics which influence the prognosis. We analyzed tolerability and efficacy of bendamustine (BEN) in comparison to chlorambucil (CLB) in clinical risk groups defined by age and specific indicators of disease activity. Patients and Methods: The efficacy and safety of BEN and CLB have been compared in a randomized, open-label, multicenter, phase III trial in patients with previously untreated advanced (Binet stage B/C) CLL. Patients were randomized to receive BEN (100 mg/m2 on days 1 + 2) or CLB (0.8 mg/kg on days 1 and 15) for up to 6 treatment cycles. The primary endpoints were overall remission rate (ORR), which was defined as complete or partial response, and progression-free survival (PFS). Secondary endpoints included overall survival (OS) and safety. The response to treatment was evaluated by a blinded Independent Response Assessment Committee. Results: A total of 319 patients were randomized (162 bendamustine, 157 chlorambucil), of whom all were included in the efficacy analysis, while 312 were evaluable for safety. Median age was 64 years (35 to 78). The median number of treatment cycles was 6 in both study arms, regardless of an age above or below 65 years. The median observation time was 35 months. ORR was significantly higher with BEN than with CLB (68% versus 31%, P<0.0001). The median PFS was 21.6 months with BEN and 8.3 months with CLB (P<0.0001). So far, there is no difference in OS (median not reached with BEN versus 65.4 months with CLB; p = 0.16). No significant difference in the remission rates became apparent when comparing patients below and above the age of 65 years (ORR 71.6 % versus 63.5 % with BEN, p>0.3; and 28.4 % versus 32.5 % with CLB, p>0.6). PFS was not influenced by age above 65 years, stage of disease (Binet stage B versus C), or elevated LDH. However, patients without B symptoms had a longer median PFS with BEN than those patients with B symptoms (30.4 months versus 17.7 months; p<0.0001), whereas median PFS was not affected by the presence of B symptoms in patients with CLB (8.9 months in both patient groups). Conclusion: This study has shown that bendamustine offers significantly greater efficacy than chlorambucil in the elderly and across clinically defined major risk groups, even in the presence of B symptoms. BEN should be considered as first-line chemotherapy for patients with advanced CLL. Disclosures: Knauf: mundipharma: Consultancy, Honoraria; cephalon: Consultancy, Honoraria. Klein:mundipharma: Consultancy, Honoraria. Merkle:mundipharma: Consultancy, Honoraria. Montillo:mundipharma Italy: Consultancy, Research Funding.

Computed Tomographic Image Analysis of Proximal Femoral Nail Antirotation and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures

2019 ◽  
Vol 9 (8) ◽  
pp. 1746-1752
Author(s):  
Yugang Teng ◽  
Yuanzhen Zhang ◽  
Zhenyu Wang
Keyword(s):  
Image Analysis ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
The Elderly ◽  
Healing Time ◽  
Intertrochanteric Fractures ◽  
Ct Image ◽  
Analysis Technique ◽  
Significant Difference ◽  
Ct Image Analysis

Objective: Based on the observation of Computed Tomography (CT) image analysis technique, the efficacy of Proximal Femoral Nail Antirotation (PFNA) and Dynamic hip screw (DHS) in the treatment of intertrochanteric fractures in the elderly was analyzed. Methods: Thirty-nine elderly patients with unstable intertrochanteric fractures were randomly divided into two groups: 19 patients in the DHS internal fixation group and 20 patients in the PFNA group. They were treated with DHS and PFNA internal fixation, and were observed based on CT image analysis techniques. The patient performs follow-up testing of the procedure before and after surgery. Results: There was a statistically significant difference in mean operative time and intraoperative blood loss between the groups (P < 0.01). The incidence of intraoperative and postoperative complications was statistically different between the two groups (P < 0.05). The incidence of postoperative and postoperative complications in the PFNA group was lower than that in the DHS group. The excellent and good rates of DHS group and PFNA group were 89.47% and 95.00%, respectively. There was no significant difference between the two groups (P > 0.05). There was a significant difference in fracture healing time between the PFNA group and the DHS group (P < 0.01). Discussion: Compared with DHS, PFNA has the advantages of short operation time, low bleeding volume and short hospital stay. There were 7 cases of internal fixation failure or non-union in the DHS group and 1 case of delayed healing in the PFNA group. Conclusion: DHS and PFNA were used to treat intertrochanteric fractures in the elderly. After observation by CT image analysis technique, there was no significant difference in efficacy. The average operative time of PFNA was the shortest, the intraoperative blood loss was the least, the incidence of intraoperative and postoperative complications was low, and the fracture healing time was short. PFNA has a lesser effect on the blood circulation and bone destruction at the fracture end, and it is more secure. It is a reasonable surgical method for the treatment of senile osteoporotic intertrochanteric fractures.

scholarly journals Short-term Outcomes and Safety of Radiotherapy for Immediate Breast Reconstruction with Autologous Flap Transfer Following Breast-conserving Surgery

2020 ◽  
Author(s):  
Shu-Ling Zhang ◽  
Jun Song ◽  
Yan-Ru Wang ◽  
Yi-Jia Guo ◽  
Jian-Zhu Zhao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Skin Color ◽  
Postoperative Radiotherapy ◽  
Partial Mastectomy ◽  
Breast Cancer Patients ◽  
Flap Transfer ◽  
Significant Difference ◽  
Good Cosmetic ◽  
The Impact

Abstract Background: The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer.Method: A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. Results: No significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P=1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT (7 months after IABR) significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P<0.001). No significant difference in the reduction of flap size was observed at any timepoint between the RT and non-RT groups. The flap size was significantly reduced at 4 months after IABR compared with the initial size during surgery, and then tended to be stable in both groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P>0.05). Finally, no grade 3 or greater RT-associated adverse events occurred during or after RT.Conclusion: RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

Immediate Bilateral Breast Reconstruction Using Abdominally Based Flaps: An Analysis of the Nationwide Inpatient Sample Database

2019 ◽  
Vol 35 (08) ◽  
pp. 594-601 ◽  
Author(s):  
Kathleen A. Holoyda ◽  
Andrew M. Simpson ◽  
Xiangyang Ye ◽  
Jayant P. Agarwal ◽  
Alvin C. Kwok
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Nationwide Inpatient Sample ◽  
Free Flaps ◽  
Hospital Charges ◽  
Single Type ◽  
Bilateral Mastectomy ◽  
Complication Rates ◽  
Total Cost ◽  
Nationwide Inpatient Sample Database

Abstract Background Bilateral mastectomy rates are increasing in the United States. The abdomen is the most common harvest site for autologous reconstruction. Nationwide data were examined to determine differences in hospital charges, length of stay (LOS), and early postoperative complications following immediate bilateral pedicled transverse rectus abdominis myocutaneous (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) perforator flaps and were compared with unilateral reconstruction. Methods Patients who underwent immediate bilateral breast reconstruction using a single method of abdominally based reconstruction were identified using the 2009 to 2014 Nationwide Inpatient Sample Database. Outcomes included total hospital charges, LOS, and immediate postoperative complications. Results We identified 13,348 cases of bilateral mastectomy with a single type of immediate bilateral autologous flap reconstruction. The majority were bilateral DIEP flaps. Mean total cost for bilateral pTRAM, fTRAM, DIEP, and SIEA flaps was US $21,886.80, US $28,839.40, US $30,051.30, and US $33,784.90, respectively (p < 0.0001). Mean LOS for bilateral pTRAM, fTRAM, DIEP, and SIEA was 4.3, 4.9, 4.5, and 5.4 days, respectively (p = 0.0002), and hematoma rates were 1.93, 2.61, 3.68, and 16.59%, respectively, (p = 0.0001), whereas return to the operating room for vascular anastomosis revision was 0, 1.63, 1.99, and 19.07%, respectively (p < 0.0001). Cost is less for unilateral pTRAM, fTRAM, and DIEP flaps (p < 0.0001). LOS is shorter for unilateral fTRAM versus bilateral (p < 0.0001). No differences were appreciated between unilateral and bilateral hematoma and reoperation rates for any reconstruction (p > 0.1). Conclusion Immediate complication rates were higher in bilateral free flaps compared with bilateral pedicled flaps. pTRAM and fTRAM flap reconstructions are still performed frequently with acceptable immediate results without considering long-term morbidity, aesthetics, and abdominal muscle function. Bilateral SIEA free flaps were associated with significantly higher total cost, LOS, and complication rates compared with other groups. Complications were similar between unilateral and bilateral reconstruction procedures. While cost is significantly greater for bilateral procedures compared with unilateral pTRAM, fTRAM, and DIEP flaps, it is not doubled.

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