Fondaparinux Significantly Reduces Postoperative Venous Thromboembolism After Body Contouring Procedures Without an Increase in Bleeding Complications.

BACKGROUND: It is well established that abdominoplasty confers a uniquely high risk of venous thromboembolism (VTE) complications. However, chemoprophylaxis is not routinely utilized due to the risk of bleeding complications. Fondaparinux, a factor Xa inhibitor FDA approved in 2001 for postoperative VTE prophylaxis, has emerged as a safe option for preventing VTE complications after high-risk surgeries. OBJECTIVES: The goal of this study was to examine the effectiveness and safety of fondaparinux for VTE chemoprophylaxis in patients undergoing abdominoplasty. METHODS: This is a single-center retrospective chart review from January 2008 to December 2014 of 492 patients who underwent abdominoplasty with or without an additional body procedure. Prior to 2011, no VTE chemoprophylaxis was utilized (n = 233). In 2011, the routine employment of postoperative chemoprophylaxis with fondaparinux was implemented (n = 259). Patient demographics and 2005 Caprini scores were evaluated. Primary outcomes included postoperative VTE and bleeding complications. RESULTS: There were no statistical differences in patient demographics or median Caprini score. The treatment group demonstrated a statistically significant reduction in the rate of VTE compared with the nontreatment group (0% vs 2.1%, respectively, P = 0.02). There was no statistically significant difference in the rate of hematoma requiring reoperation between the nontreatment and treatment groups (1.7% vs 2.3%, P = 0.76) or blood loss requiring transfusion (0% vs 0.8%, P = 0.5). CONCLUSIONS: Fondaparinux for VTE chemoprophylaxis after abdominoplasty is efficacious in decreasing the risk of VTE in this susceptible patient population without increasing the risk of postoperative bleeding complications.

The role of the latissimus dorsi flap in reconstruction of the irradiated breast.

BACKGROUND: The role of the latissimus dorsi flap with a prosthesis in reconstruction of the previously irradiated breast is examined in this retrospective review of one surgeon's 10-year experience. METHODS: Twenty-eight patients with available charts were divided into five groups: (1) 11 patients with previous breast conservation therapy and recurrence; (2) eight patients with previous mastectomy and radiation; (3) four patients with an expander that had been irradiated; (4) three patients with prior irradiation and implant reconstruction presenting for revision; and (5) two patients with breast deformity from breast conservation therapy. RESULTS: Eighteen patients had a latissimus flap placed at the time of the expander and 10 had a latissimus flap at the time of implant placement or exchange. Average follow-up was 28.8 months (range, 1 week to 7 years). All patients had soft breasts at follow-up, with no evidence of capsular contracture. Donor-site complications included five donor-site seromas. The majority of patients (65 percent) underwent a planned two-stage reconstruction, and the majority of the revision operations were for exchanges to smaller implants. The response rate to a patient satisfaction survey was 67 percent. The average cosmetic satisfaction rating was 8.5 of 10 (with 10 being the highest). The average pain rating was 1.7 of 10 (with 10 being the worst). The overall satisfaction rating was 8.8 of 10. Fourteen of 16 patients indicated that they would undergo this procedure again. CONCLUSIONS: Although purely autologous reconstructions may be the best choice for many irradiated breasts, it has been shown in this study that a cosmetically acceptable reconstruction with manageable risk can be performed using a prosthesis combined with a latissimus dorsi flap.

Reduction mammaplasty in conjunction with breast conservation.

Breast conservation therapy, consisting of lumpectomy or segmental mastectomy with negative margins followed by breast irradiation, has become a standard and safe alternative to mastectomy in selected patients with early-stage breast cancer. As the inclusion criteria for breast conservation therapy have continued to evolve to include lower quadrant tumors, very large breasts, and central tumors, the potential for significant disfigurement after breast conservation therapy has increased. Bilateral reduction mammaplasty in conjunction with tumor-directed partial mastectomy is a surgical approach that can benefit these patients by creating symmetric, aesthetically pleasing breasts in a single-stage operation.