The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature

We report a case of a 51 years old female with a 25 pack year smoking history who underwent bilateral mastectomy and immediate tissue expander reconstruction for newly diagnosed right breast cancer. The patient reported herself as a non-smoker despite significant e-cigarette use, with resulting significant mastectomy skin flap necrosis and breast reconstruction failure. Little is known about the physiologic effect of e-cigarettes on wound healing and tissue perfusion. To this end, we provide an updated review of the impact of e-cigarettes on surgical outcomes. PubMed, Ovid MEDLINE, and PRS GO were searched for the terms “e-cigarette”, “electronic cigarette”, “e-cig”, “electronic nicotine delivery system”, “vaping”, “surgery”, “surgical”, “peri-operative”, “operate”, “operative”, and “wound healing”. Abstract review of all articles was performed. 123 articles returned that contained both variants of e-cigarettes and surgery as keywords. Of those, manual assessment returned three articles which were found to be relevant to e-cigarette use in the surgical patient. No articles were found that compared perioperative complications in e-cigarette versus traditional cigarette users in humans. In conclusion, our case report depicts the potential dangers associated with e-cigarette use in the surgical patient. There is a public misconception that e-cigarettes are healthier than traditional cigarettes and as such their use may go unreported by patients. Early evidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, and may have a significant deleterious effect on wound healing.

The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature

We report a case of a 51 years old female with a 25 pack year smoking history who underwent bilateral mastectomy and immediate tissue expander reconstruction for newly diagnosed right breast cancer. The patient reported herself as a non-smoker despite significant e-cigarette use, with resulting significant mastectomy skin flap necrosis and breast reconstruction failure. Little is known about the physiologic effect of e-cigarettes on wound healing and tissue perfusion. To this end, we provide an updated review of the impact of e-cigarettes on surgical outcomes. PubMed, Ovid MEDLINE, and PRS GO were searched for the terms “e-cigarette”, “electronic cigarette”, “e-cig”, “electronic nicotine delivery system”, “vaping”, “surgery”, “surgical”, “peri-operative”, “operate”, “operative”, and “wound healing”. Abstract review of all articles was performed. 123 articles returned that contained both variants of e-cigarettes and surgery as keywords. Of those, manual assessment returned three articles which were found to be relevant to e-cigarette use in the surgical patient. No articles were found that compared perioperative complications in e-cigarette versus traditional cigarette users in humans. In conclusion, our case report depicts the potential dangers associated with e-cigarette use in the surgical patient. There is a public misconception that e-cigarettes are healthier than traditional cigarettes and as such their use may go unreported by patients. Early evidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, and may have a significant deleterious effect on wound healing.

Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis / 한국유방암학회지

PURPOSE: Prosthetic-based breast reconstruction is performed with increasing frequency in the United States. Major mastectomy skin flap necrosis is a significant complication with outcomes ranging from poor aesthetic appearance to reconstructive failure. The present study aimed to explore the interactions between intraoperative fill and other risk factors on the incidence of flap necrosis in patients undergoing mastectomy with immediate expander/implant-based reconstruction. METHODS: A retrospective review of 966 consecutive patients (1,409 breasts) who underwent skin or nipple sparing mastectomy with immediate tissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status, premastectomy and postmastectomy radiation, acellular dermal matrix use, and application of the tumescent mastectomy technique were analyzed as potential predictors of flap necrosis both independently and as synergistic variables with high intraoperative fill. The following three measures of interaction were calculated: relative excess risk due to interaction, attributable proportion of risk due to interaction, and synergy index (SI). RESULTS: Intraoperative tissue expander fill volume was high (> or =66.7% of the maximum volume) in 40.9% (576 of 1,409 breasts) of cases. The unadjusted flap necrosis rate was greater in the high intraoperative fill cohort than in the low fill cohort (10.4% vs. 7.1%, p=0.027). Multivariate logistic regression did not identify high intraoperative fill volume as an independent risk factor for flap necrosis (odds ratio 1.442, 95% confidence interval 0.973-2.137, p=0.068). However, four risk factors were identified that interacted significantly with intraoperative fill volume, namely tumescence, age, hypertension, and obesity. The SI, or the departure from additive risks, was largest for tumescence (SI, 25.3), followed by hypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50 years (SI, 1.17). CONCLUSION: In the postmastectomy, hypovascular milieu, multiple risk factors decreasing flap perfusion interact with high intraoperative fill volume to cross a threshold and synergistically increase the risk of flap necrosis.

A Sustained Release Human Growth Hormone (LB03002):Efficacy and Safety Following Six-month Treatment in Children with Growth Hormone Deficiency (GHD) / 대한소아내분비학회지

BACKGROUND: LB03002[somatropin(rDNA origin) for injectable suspension] is a sustained release formulation of human growth hormone to be administered by once-a-week subcutaneous injections. Less frequent administration could provide a considerable improvement on compliance and convenience. OBJECTIVE: To determine the efficacy and safety of a LB03002 administered in children with GHD once weekly for 6 months. DESIGN: Open-label, active-controlled, randomised, parallel group, phase II study. PATIENTS: A total of forty-two naive or previously treated, pre-pubertal children with GHD, confirmed by two different GH provocation tests, were randomised and received either LB03002(0.3 or 0.5 mg/kg/week) or Eutropin(TM)(daily rhGH, 0.3 mg/ kg/week divided 6 times a week) for 6 months. RESULTS: The pre-treatment(HV0) and 6-month annualised height velocity(HV6) are shown(mean+/-SD) in the table below: ----------------------------------------------------------------------- LB03002 LB03002 EutropinTM 0.3 mg/kg/week 0.5 mg/kg/week 0.3 mg/kg/week ----------------------------------------------------------------------- N 10 13 13 HV0 3.1+/-1.0 3.9+/-1.5 3.0+/-1.1 HV6 9.3+/-2.3 10.2+/-2.3 11.1+/-2.5 ----------------------------------------------------------------------- Mean IGF-I and IGFBP-3 levels were significantly elevated from baseline values in all the study groups. LB03002 at all dose groups was safe and well tolerated. No clinically relevant adverse events or abnormal laboratory parameters were observed and there were no remarkable differences between groups or changes over time within groups regarding parameters for glucose and lipid metabolism including fasting glucose and haemoglobin A1c. Injection site reactions were mostly mild to occasionally moderate and resolved within 2 to 3 days post-dose without intervention. CONCLUSIONS: Treatment with LB03002 by weekly administration of the doses tested in the study resulted in comparable safety and efficacy to daily rhGH in pre-pubertal children with GHD.