Background
Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient ...satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors.
Methods
A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis.
Results
Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity.
Conclusions
Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.
Unfulfilled expectations can lead to patient dissatisfaction with surgical outcomes. Understanding expectations allows surgeons to identify those patients who hold inaccurate expectations ...preoperatively, and to reset those expectations through focused preoperative education. The purpose of this study was to investigate preoperative expectations of women undergoing implant breast reconstruction. Identifying inaccurate or unfulfilled expectations is a critical step toward the advancement of preoperative education and subsequently improving patient satisfaction with surgical outcomes.
In-depth, open-ended interviews were conducted with 28 women undergoing implant breast reconstruction. The interviews were recorded and transcribed, and data were coded using standard qualitative techniques.
Interviews ascertained that implant-based breast reconstruction patients may have inaccurate expectations regarding the results of their surgery despite having received standard preoperative teaching. Specifically, patients often had unclear expectations regarding the appearance and physical outcome of the reconstructed breast(s). Some patients were surprised by the "flatness" of the tissue expander immediately after its insertion. Most patients felt unprepared for the "unnatural" final appearance of the breast(s). Furthermore, they did not expect many of the physical outcomes, including loss of sensation, firmness of the reconstructed breast(s), and lack of movement of the reconstructed breast(s). Inaccurate expectations corresponded to areas of dissatisfaction highlighted by the patients in postoperative interviews.
This study has important implications for preoperative education of women undergoing implant breast reconstruction. Physicians and nurses involved in the preoperative preparation process should take care to explore patients' expectations regarding the appearance, feel, sensation, and movement of reconstructed breasts to increase overall postoperative satisfaction.
Background
Suction lipectomy is the most common aesthetic surgery performed in North America. The safety of the procedure has recently been questioned, particularly with respect to large volume ...aspiration.
Objective
To delineate Canadian liposuction practice patterns and perceived complication rates.
Subjects and Methods
A survey was mailed to all plastic surgeons registered with the Canadian Society of Plastic Surgeons. The survey assessed surgeon demographics, hospital admission rates following liposuction, techniques used, wetting solutions, aspirate volumes and complications.
Results
A total of 322 surveys were mailed. The response rate was 44%. Of the 142 surgeons who responded, 119 regularly performed suction lipectomy. They reported that 70% of patients had suction lipectomy performed on an outpatient basis. Forty per cent of procedures were performed in private clinics. On average, surgeons performed 40 liposuctions/year without ancillary procedures and 27 liposuctions/year with ancillary procedures. Fifteen per cent of surgeons used ultrasound-assisted liposuction as an adjunct to traditional liposuction, although less than 1% used it exclusively. The ratio of aspirate to infiltrate was 0.25 to one in 45% of cases, 0.5 to one in 37%, one to one in 17% and one to one in fewer than 1%. In 69% of patients, 1 to 2 L was aspirated, while in fewer than 5% of patients, more than 3.5 L was aspirated. Early complication rates were as follows: hematoma and seroma 2.6%, infection 1.3% and skin loss 0.01%. Contour irregularity was the main late complication, occurring in 12% of patients. No cases of venous thrombosis, or pulmonary or fat emboli were reported. No deaths were reported.
Conclusions
Suction lipectomy is performed commonly by Canadian plastic surgeons, with the majority using a wet or superwet technique. In the vast majority of patients, fewer than 3500 cm
3
are aspirated. The complication rate is perceived to be low.
The impact of hard-to-heal wounds extends beyond traditional clinical metrics, negatively affecting a patient's health-related quality of life (HRQoL). Yet treatment outcomes are seldom measured from ...the patient's perspective. The purpose of the present study was to perform in-depth qualitative interviews with patients diagnosed with varying types of hard-to-heal wounds to identify outcomes important to them.
Participants were recruited from wound care clinics in Canada, Denmark, the Netherlands and the US, and were included if they had a hard-to-heal wound (i.e., lasting ≥3 months), were aged ≥18 years, and fluent in English, Dutch or Danish. Qualitative interviews took place between January 2016 and March 2017. An interpretive description qualitative approach guided the data analysis. Interviews were audio-recorded, transcribed and coded line-by-line. Codes were categorised into top-level domains and themes that formed the final conceptual framework.
We performed 60 in-depth interviews with patients with a range of wound types in different anatomic locations that had lasted from three months to 25 years. Participants described outcomes that related to three top-level domains and 13 major themes: wound (characteristics, healing); HRQoL (physical, psychological, social); and treatment (cleaning, compression stocking, debridement, dressing, hyperbaric oxygen, medication, suction device, surgery).
The conceptual framework developed as part of this study represents the outcome domains that mattered the most to the patients with hard-to-heal wounds. Interview quotes were used to generate items that formed the WOUND-Q scales, a patient-reported outcome measure for patients with hard-to-heal wounds.
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