The differential effect of BMI on prosthetic versus autogenous breast reconstruction: A multivariate analysis of 12,986 patients

BackgroundThe comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes.MethodsUtilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI ≥ 30) and non-obese (BMI < 30). Overall postoperative morbidity, flap complications, non-flap complications, and reoperation rates were compared among the groups.ResultsOf 12,986 patients who underwent breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction (p < 0.05). BMI was correlated with increased surgical complications for tissue expander, pedicled TRAM, and free flap reconstructions (OR = 1.09, OR = 1.05, OR = 1.10, respectively; p < 0.05). Medical complications were higher in obese patients undergoing tissue expander and pedicled TRAM reconstructions (p = 0.001 and p < 0.001), but no significant difference was observed in latissimus and free flap reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%).ConclusionsThe NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity.     

Innovation and Change in Medical Technology: Interactions Between Physicians and Engineers

Intraperitoneal adhesions following surgical procedures cause considerable morbidity. Hyaluronic acid/carboxymethylcellulose (HA/CMC) films have been shown to be effective agents in decreasing adhesion formation. However, when there is an inadvertent leak of bowel contents into the peritoneum due to incomplete anastomosis, adhesion formation about a defect in order to prevent further leakage and to promote healing of the wound is important for the prevention of morbidity and mortality. The purpose of this study was to determine if an antiadhesion film (HA/CMC) impairs these potentially beneficial adhesions to bowel anastomoses, thus predisposing them to enteric leaks with subsequent peritonitis. Sixty-four rabbits were divided in two groups, each undergoing a complete or partial (90% anastomosis to simulate anastomotic leak) large bowel anastomosis. Half of each of the above groups were treated by wrapping a HNCMC film over the anastomosis and the other half were untreated controls. These two subgroups were then further divided equally and sacrificed at either 7 or 14 days for evaluation of anastomosis integrity and strength. The average anastomtic bursting pressures did not change significantly between those groups treated with HMCMC when compared to untreated controls at 7 or 14 days or in the complete or partial anastomosis group (Student's t test). Adhesion formation to the anastomosis was not impaired in either group independent of HAKMC film application. This study suggests that while HA/CMC film has been shown to decrease adhesions in other models, healing of u rabbit colonic unastomosis even in the presence of an anastomotic defect takes place, further suggesting that the stimulus for adhesion formation can overcome the antiadhesion properties of HA/CMC. Therefore, HA/CMC is a potentially safe adjuvant for preventing postoperative intraabdominal adhesions.     

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: Technical note

Abstract

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon’s ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS. [Neural Res 2000; 22: 522-526]     

Microvascular decompression of the cochlear nerve in patients with severe tinnitus. Preoperative findings and operative outcome in 22 patients

Abstract

We evaluated the operative outcome in 22 consecutive patients who underwent microvascular decompression (MVO) of the intracranial portion of the cochlear nerve to relieve incapacitating tinnitus and related it to preoperative findings. The patients were selected for operation from the following criteria: severe tinnitus with sensorineural hearing loss and/or changes in brainstem auditory evoked potentials (BAEPs). Fifty percent had unilateral tinnitus. Before operation, 77 patients (77%) had sensorineural hearing loss in their affected ear. BAEPs were abnormal in 27 patients (95%) and acoustic middle ear reflex response was abnormal in six patients (27%). Vascular compression of the cochlear nerve was found in all patients during the operation. After the operation, 33% had relief of their tinnitus (two patients were totally free of tinnitus and five were markedly improved). Eight patients were slightly improved (38%), and the tinnitus did not change in four patients; two patients (70%) became worse. Of the patients with unilateral tinnitus, 63% had relief oftheir tinnitus. In one patient hearing was noticeably improved after the operation. Five patients (23%) had mild to moderate sensorineural hearing loss due to the operation. No other complications were detected. [Neural Res 1998; 20: 242-248]     

显微血管减压手术治疗舌咽神经痛远期疗效分析

目的评价显微血管减压手术治疗舌咽神经痛（glossopharyngeal neuralgia,GN）的远期疗效,提高治疗效果。方法观察并分析我科自2001年1月到2011年10月收治的19例接受显微血管减压手术的舌咽神经痛患者的相关资料。所有患者均行地卡因实验明确诊断,影像学提示血管对舌咽神经存在不同程度的压迫。手术采取经乙状窦后-幕下入路行微血管减压术,术后对其进行疗效随访。结果所有患者术后早期疗效明显,随访时间1．5～12．5年,平均5．6年。随访过程中1例出现复发,1例疼痛程度及次数较术前明显缓解。本组1例患者术后出现轻度声音嘶哑和吞咽困难,1例出现脑脊液漏,经处理后均痊愈。结论显微血管减压手术是治疗舌咽神经痛的一种安全、有效的方法,影像学诊断对判断神经-血管压迫有重要意义。显微血管减压手术远期效果良好。     

神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效

目的初步探讨神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析山东大学齐鲁医院神经外科2019年6月至2021年3月收治的97例面肌痉挛患者的临床资料。97例患者术前均行影像学检查,以明确责任血管与面神经出脑干区的关系。所有患者均采用神经内镜经小脑绒球下入路面神经显微血管减压术,术中在神经电生理监测下充分解剖后组脑神经背侧的蛛网膜,从而显露面神经出脑干区,明确责任血管,并准确置入垫片。术后疗效评估分为即刻治愈、延迟治愈、复发和未治愈。结果97例患者术中发现责任血管为小脑前下动脉59例;小脑后下动脉3例;椎-基底动脉35例,其中单纯椎-基底动脉8例,椎-基底动脉联合小脑前下动脉24例,椎-基底动脉联合小脑后下动脉3例。术后即刻治愈68例(70.1%)。术后发热13例,听力减退4例,耳鸣2例,一过性面瘫5例。97例患者的术后中位随访时间为9个月(1~19个月),末次随访显示,93例(95.9%)患者的面部抽动完全消失,其中延迟治愈者25例;未治愈者4例;无复发病例。结论神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛,不仅可以提高手术治愈率,而且可以减少术后并发症。     

神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效

目的初步探讨神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析山东大学齐鲁医院神经外科2019年6月至2021年3月收治的97例面肌痉挛患者的临床资料。97例患者术前均行影像学检查,以明确责任血管与面神经出脑干区的关系。所有患者均采用神经内镜经小脑绒球下入路面神经显微血管减压术,术中在神经电生理监测下充分解剖后组脑神经背侧的蛛网膜,从而显露面神经出脑干区,明确责任血管,并准确置入垫片。术后疗效评估分为即刻治愈、延迟治愈、复发和未治愈。结果97例患者术中发现责任血管为小脑前下动脉59例;小脑后下动脉3例;椎-基底动脉35例,其中单纯椎-基底动脉8例,椎-基底动脉联合小脑前下动脉24例,椎-基底动脉联合小脑后下动脉3例。术后即刻治愈68例(70.1%)。术后发热13例,听力减退4例,耳鸣2例,一过性面瘫5例。97例患者的术后中位随访时间为9个月(1~19个月),末次随访显示,93例(95.9%)患者的面部抽动完全消失,其中延迟治愈者25例;未治愈者4例;无复发病例。结论神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛,不仅可以提高手术治愈率,而且可以减少术后并发症。