Quality-of-life outcomes after operative management of primary and secondary lymphoedema: a systematic review.

BACKGROUND: Lymphoedema is an incurable and progressive disease that affects not only physical function but overall quality of life. Surgical treatment options for the management of lymphoedema are being increasingly performed. This study aims to review post-operative health-related quality of life (HRQOL) following surgical treatment of lymphoedema. METHODS: A systematic search of the PubMed and Medline databases was performed from the date of their inception until September 2018 to evaluate HRQOL following different surgical options for the treatment of lymphoedema. RESULTS: One hundred and thirteen articles were identified. Twenty-one articles were included in the final review, comprising a total of 736 patients. HRQOL improvements appear to be sustained for at least 6-12 months post-operatively. In particular, major benefits were noted in the domains based around physical functioning. Patient satisfaction similarly mirrors HRQOL improvements, following an initial dip in the immediate post-operative period. CONCLUSION: All surgical treatment modalities for the management of lymphoedema confer significant HRQOL improvements across a diverse range of health domains, with this critical outcome of surgery an important pre-operative consideration. Recommendations for ongoing research are suggested.

Virtual surgical planning in fibula free flap head and neck reconstruction: A systematic review and meta-analysis.

BACKGROUND: The traditional approach to head and neck reconstruction is considered challenging, requiring a subjective assessment of an often-complex defect followed by careful modelling of a bony flap to match this. The introduction of Virtual Surgical Planning (VSP) has provided the surgeon with a means to increase efficiency, precision and overall patient outcomes. This study aims to compare VSP and traditional head and neck reconstructions utilising fibula free flaps with regards surgical efficiency and patient outcomes. METHODS: A systematic search of the PubMed and Medline databases was performed from the date of their inception through to August 2018 to evaluate and compare VSP and non-VSP cohorts in the context of fibula free flap head and neck reconstruction. Primary comparative outcomes included operative and ischaemic time, with secondary outcomes including complications rates, measures of accuracy and financial benefits. RESULTS: One hundred and fifty-three articles were identified. Twenty-three articles were included in the review, comprising a total of 713 patients. VSP was associated with significantly decreased intraoperative time (Standardised Mean Difference -1.01; 95% CI -1.23 to 0.80; p = 0.000) and ischaemic time (Standardised Mean Difference -1.55; 95% CI -1.87 to -1.23, p = 0.002). VSP was also associated with reduced orthognathic deviation from an ideal outcome when compared to conventional techniques. No statistically significant differences in complication rates between conventional and VSP techniques were identified. CONCLUSION: The results of this meta-analysis suggests that VSP confers significant benefits with respect to improved orthognathic accuracy, ischaemic times and intraoperative times without any significant increase in complications. Recommendations for ongoing research are suggested.