A Multiple Regression Analysis of Postoperative Complications After Body-Contouring Surgery: a Retrospective Analysis of 205 Patients : Regression Analysis of Complications.

BACKGROUND: As bariatric surgery becomes ever more popular, so does body-contouring surgery to eliminate excess skin after radical weight loss. To date, the literature has described a number of risk factors affecting the postoperative outcome. Our study aimed to define those factors more closely, focusing on abdominoplasty ("tummy tuck") patients who suffered intra- and postoperative complications. METHODS: The study collective included 205 patients over 5 years (2001-2006) who underwent dermolipectomy at our department. The mean follow-up was 5.94 years. Every abdominoplasty was performed under general anesthesia with intraoperative one-dose antibiotic. The analysis included a complete review of all medical records. Statistical analysis was performed with the R-2.5.0 Software for Windows. RESULTS: The overall rate for major complications that required operative revision and/or antibiotics was 10.2 %, including 2.9 % cases of infections. Forty-one percent had minor complications, such as seromas, hematomas, wound healing problems, and wound dehiscences. The logistic regression models demonstrated that smoking combined with the age, a BMI higher than 30 kg/m(2), and the amount of removed tissue (measured in g) lead to significantly more wound healing problems in nearly all age groups. The probability of infections correlated with later drain removal. CONCLUSIONS: Regardless of the amount of tissue removed, no main risk factor for complications could be identified. A complication-free course and good outcome can be best achieved with careful patient selection and preoperative planning.

[Is there a psychological and physiological difference between DIEP- and free TRAM-flap? A retrospective patient survey]. / Besteht ein Unterschied zwischen DIEP- und freiem TRAM-Lappen aus physiologischer und psychologischer Sicht? Eine retrospektive Patientenbefragung.

BACKGROUND: The DIEP- (Deep Inferior Epigastric Perforator) flap and the free TRAM- (Transverser Rectus Abdominis Musculocutaneous) flap are common procedures for breast reconstruction. The aim of the study was to identify a difference in the psychological and physiological patient satisfaction between DIEP- and free TRAM-flap. MATERIAL AND METHODS: To provide a homogenous group, with a stable result of the reconstruction, the collective for questioning was picked out of the years 2009 and 2010. All patients included underwent a breast reconstruction with a DIEP-flap or free TRAM-flap at our division. For evaluation we formed 2 groups: DIEP-flap group (DLG) and TRAM-flap group (TLG). After preparing the questionnaire a telephone survey was performed. For the null hypothesis we postulated that there is no difference between DLG and TLG in the patient satisfaction. RESULTS: We contacted 44 patients, 30 of them took part in our survey (15 from the DLG and 15 from the TLG). The mean BMI in the questionnaire group was 26.9 kg/m² and the mean age was 48.3 years. 2 questions (lifting heavy loads (p=0.005) and performing sit-up's (p=0.001)) show a significant difference between DLG and TLG, a benefit of the DLG could be seen. Both questions had the physiology of the rectus abdominis muscle as background. The complication rate for partial flap loss or partial necrosis was one third lower (p=0.299) in the TLG than compared to the DLG. CONCLUSION: Up to now, physicians think that the DIEP-flap seems to be the best possible procedure for breast reconstruction with belly flaps. However, numerous studies disprove the superiority in the donor site morbidity. In the literature, an advantage of the TRAM-flap is clearly visible by comparing the complication rates. Our oral interviewing also states that there is no -difference in the psychological and physiological satisfaction of the patients. We can recommend a precise patient selection if a DIEP-flap for breast reconstruction should be performed. In case of comorbidities the possibility of the safer free TRAM-flap should be considered. In the future, a comparative analysis between the DIEP-flap, free TRAM-flap and pedicled TRAM-flap should be performed, by keeping the patients satisfaction, the complication rate and the cost effectiveness in mind.

The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment.

The requirements for accurate documentation within the process of burn assessment have increased dramatically over the years. TBSA (total body surface area) and burn depth are commonly determined by visual inspection, especially in the emergency or acute care setting. However, inexperience often results in incorrect estimation of these factors. In 2001, BurnCase 3D was initiated in order to develop a tool for objective burn assessment and documentation on mobile devices (Apple iPhoneTM). The centerpiece is a 3D model representing the actual patient. At two international burn meetings, a survey containing three pictures of patients was conducted and this data was collected. A patient-specific 3D model adapted to the height and weight of the real patient was created and the digital picture was superimposed in the computer system. The burns were transferred to the model and the TBSA in % was calculated by the software BurnCase 3D. The preferred methods of the 80 respondents for burn extent estimation were: the Rule of Nines (38%), the Rule of Palm (37%) and the Lund-Browder chart (18%). Analysis showed very high deviations of TBSA within the participants, even among the group of experts. In comparison to a computer-aided method we found massive overestimation of up to 230%. The use of BurnCase 3D could have a true impact on the quality of treatment in burns. In the acute care setting for burn injuries, telemedicine has great potential to help guide decisions regarding triage and transfer based on TBSA, burn depth, patient age and injury mechanism.

Les exigences en matière de documentation précise dans le processus de l'évaluation des brûlures ont augmenté de façon spectaculaire au cours des années. La SCT (surface corporelle totale) et la profondeur de la brûlure sont généralement déterminées par inspection visuelle, en particulier dans le contexte d'urgence ou de soins aigus. Cependant, l'inexpérience se traduit souvent par une estimation incorrecte de ces facteurs. En 2001, BurnCase 3D a été lancé afin de développer un outil d'évaluation des brûlures objectif et de la documentation sur les appareils mobiles d'Apple (iPhone™). La pièce maîtresse est un modèle 3D représentant le patient réel. Sur deux réunions de brûlures internationales, une enquête contenant trois photos de patients a été réalisée. Ces données ont été collectées. Un modèle 3D spécifique au patient adapté à la taille et le poids du patient réel a été créé et l'image a été superposée dans le système informatique. Les brûlures ont été transférés dans le modèle et le % de la surface corporelle totale a été calculé par le logiciel BurnCase 3D. Les méthodes préférées des 80 répondants pour l'estimation de la taille de la brûlure étaient : la règle des neuf (38%), la règle des palm (37%) et les tables de Lund et Browder (18%). L'analyse montre des écarts très élevés de SCT dans les participants, même parmi le groupe d'experts. Par rapport à un procédé assisté par ordinateur, nous avons trouvé surestimation massive de jusqu'à 230%. L'utilisation de BurnCase 3D pourrait avoir un véritable impact sur la qualité du traitement des brûlures. Dans le cadre de soins de courte durée pour les brûlures, la télémédecine a un grand potentiel pour aider à guider les décisions concernant le triage et le transfert sur la base de la SCT et la profondeur de la brûlure, l'âge du patient et le mécanisme de blessure.