ABSTRACT
Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
ABSTRACT
INTRODUCTION: The gold standard in the treatment of Dupuytren's disease is the partial fasciectomy (PF). Injection of a collagenase directly into the Dupuytren cord is an alternative method. In contrast to needle fasciotomy, destruction of the cord is achieved enzymatically and not mechanically. 24 h after injection, the treated finger can be extended passively to disrupt the Dupuytren cord. PATIENTS AND METHODS: Functional outcome and patient satisfaction were prospectively analysed in 2 comparable groups of patients with the same stage of disease. Follow-up was one year. Patients in the first group underwent partial fasciectomy (PF) (n=13), whereas patients in the second group were treated by an injection of collagenase (CG) in the diseased tissue (n=14). Besides clinical examination, outcome was evaluated by validated questionnaires (DASH/MHQ) and a customised questionnaire. RESULTS: Extension after PF (mean residual contracture 7.5°) was better than after collagenase injection (mean residual contracture 13.2°). Side-effects like numbness, impaired blood circulation and pain were less after injection of collagenase than after PF and of shorter duration. Recovery of grip strength was faster in the CG than after PF and collagenase injection was regarded as less discomforting. The results of the questionnaires showed a reduction of hand function 1 month after surgery, whereas better results were observed 1 month after collagenase injection. Recovery in the CG was significantly faster than after PF. DISCUSSION: Collagenase injection, as a less invasive technique, has less and milder side-effects than surgery and demonstrated a better total reduction of Dupuytren's contracture initially, although the residual contractures were higher in the CG after follow-up of 1 year. Patient satisfaction was higher after collagenase injection due to subjectively perceived less negative impact and a comparable functional outcome.
Subject(s)
Collagenases/administration & dosage , Dupuytren Contracture/therapy , Fasciotomy , Patient Satisfaction , Postoperative Complications/etiology , Adult , Disability Evaluation , Dupuytren Contracture/physiopathology , Fascia/physiopathology , Female , Follow-Up Studies , Hand Strength/physiology , Humans , Injections , Male , Middle Aged , Motor Skills/physiology , Prospective Studies , Range of Motion, Articular/physiology , Recurrence , Surveys and QuestionnairesABSTRACT
BACKGROUND: Soft tissue defects on the hand and on the fingers with exposed functional structures require a thin and sturdy closure. If skin grafts or local flaps are not possible the arterialized venous free flaps represent a good alternative. PATIENTS AND METHODS: This retrospective study included all arterialized venous free flaps used for hand and finger defects since 2005. We evaluated type and technique (for example antegrade vs. retrograde arterial inflow and the number of veins) and size of the flaps. Flap harvesting time was also examined. RESULTS: 11 venous flaps were used for resurfacing hand and finger defects. Most of them were retrogradely arterialized. 10 of 11 flaps healed uneventfully. Due to a thrombosis in an outflowing vein one flap was lost at the sixth postoperative day. Median size of the arterialized flaps was 6×4 cm and the median time for flap harvest was 38 (27-51) min. The donor site was primarily closed in 2 cases and in 9 cases with a skin graft. CONCLUSION: Arterialized venous free flaps represent a reliable and safe option for resurfacing hand and finger defects. Easy and fast harvesting due to the visible venous vascular system is an advantage. The flaps are thin, pliable and can be easily adjusted to the needs of the defect. Using conservative measures it is possible to control side effects like venous pooling, swelling and purplish discoloration. With arterialized venous free flaps early hand therapy is possible, in contrast to heterodigital and local flaps. In comparison to other free flaps it is not necessary to sacrifice an artery at the donor site.