RESUMEN

BACKGROUND: Persistent postsurgical pain is a well-recognized problem after a number of common surgical procedures, such as amputation, thoracotomy, and inguinal hernia repair. Less is known about persistent pain after cosmetic surgical procedures. We, therefore, decided to study the incidence and characteristics of persistent pain after abdominoplasty, which is one of the most frequent cosmetic surgical procedures. METHODS: In September 2014, a link to a web-based questionnaire was mailed to 217 patients who had undergone abdominoplasty between 2006 and 2014 at the Department of Plastic Surgery, Aalborg University Hospital, Denmark. The questionnaire included questions about pain and sensory abnormalities located to the abdominal skin, and physical and psychological function; patient satisfaction with surgery was rated on a 4-point scale. RESULTS: One hundred seventy patients answered the questionnaire. Fourteen patients (8.2%) reported pain within the past 7 days related to the abdominoplasty. Abnormal abdominal skin sensation was common and reported by 138 patients (81%). Sensory hypersensitivity was associated with the presence of persistent pain. Satisfaction with the procedure was reported by 149 (88%) patients. The majority of patients reported improvement on all physical and psychological factors. Patients with pain were more often disappointed with the surgery and unwilling to recommend the surgery. CONCLUSIONS: Overall, patients were satisfied with the procedure, although abnormal abdominal skin sensation was common. However, there is a risk of developing persistent neuropathic pain after abdominoplasty, and patients should be informed about this before surgery.

RESUMEN

The risk of postoperative bleeding and wound healing complications in skin grafts among anticoagulated patients undergoing cutaneous surgery has not been firmly established. The objective was to examine the literature and assess the risk of postoperative bleeding or wound healing complications in skin grafts among anticoagulated patients, compared with patients who discontinue or patients who are not receiving antithrombotic therapy prior to cutaneous surgery requiring skin grafting. A systematic review examining the effect of antithrombotic therapy on cutaneous surgery was performed according to the PRISMA-guidelines. PubMed and Embase databases were primarily searched for relevant literature in the period from the start date of each database to 2014. A total of eight studies representing 443 patients met criteria for inclusion. No randomised controlled trials were found; the included studies were of prospective and retrospective design. Most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts. These complications are only wound threatening and not life threatening. Therefore, this is of concern mostly in terms of hemostasis by the surgeon and good pressure dressings. Care should be taken when operating on anticoagulated patients undergoing cutaneous surgery requiring skin grafting. However, graft failure is rare and, given the risk of thrombotic events, the reviewed studies recommend continuing all medically necessary antithrombotic therapy. The limitations of this study are the small sample sizes and the level of evidence; hence, more research is needed to substantiate these preliminary findings.

Asunto(s)

RESUMEN

Studies on complications related to chronic nerve injury following sentinel lymph node biopsy (SLNB) and complete lymph node dissection (CLND) for melanoma are sparse. This review summarizes the existing literature on pain and neuropathic complications in melanoma patients undergoing SLNB with or without CLND. The Cochrane Central Register of Controlled Trials and the Embase and PubMed databases were searched. Full-text English language articles published before June 2013 were included. Prospective and retrospective studies assessing persistent (>1 month) sensory nerve injury, postoperative pain, neuropathic pain, and sensory disturbances following SLNB with or without CLND in melanoma patients were eligible. Nine studies (six prospective and three retrospective) including data for 3632 patients met our inclusion criteria. Outcome parameters were too heterogeneous to conduct a quantitative analysis, and few studies systematically evaluated pain and sensory abnormalities. Persistent postoperative pain was reported in 1-14% of patients following SLNB and in 6-34% following CLND and sensory abnormalities in 0.1-32 and 2-82%, respectively. In the one study that assessed the type of pain, neuropathic pain was suggested to explain persistent pain in 31-66% of patients with SLNB and 82-89% of patients with CLND. Sensory-nerve-related complications in melanoma patients seem to be less pronounced following SLNB compared with CLND. Prospective observational studies are necessary to identify predictors of persistent pain, to evaluate the prevalence and impact of pain and sensory abnormalities, and to develop strategies for prevention of long-term complications.

Asunto(s)

RESUMEN

OBJECTIVES: Chronic pain is a well-known complication after surgery, but the prevalence of persistent pain after melanoma surgery is unknown. This study examined the prevalence and predictors of persistent pain after melanoma surgery. METHODS: Between September 2005 and June 2009, 448 patients underwent surgery for cutaneous melanoma at the Department of Plastic Surgery, Aalborg Hospital. A questionnaire was sent to all 402 survivors, and 350 (87.1%) responded. In addition, all patients with pain and a control group of sex-matched and age-matched patients without pain were invited to a clinical examination. RESULTS: Thirty-four patients (9.7%) reported pain in the scar area within the last month, and 8.6% reported chronic pain. The pain was mostly mild with little impact on daily life, but 1.7% reported moderate to severe pain, and 3.4% reported at least moderate impact of pain on daily life. Sensory changes were reported by 108 patients (31.5%); 25% of these had pain compared with 3% of patients with normal sensation [P<0.001, 10.8 (4.5 to 25.8)]. Young age was a predictor for persistent pain. A small group of patients (10 with and 22 without pain in the questionnaire) were clinically examined, suggesting that the areas of sensory disturbances were larger in patients reporting persistent pain or dysesthesia. DISCUSSION: The results support previous findings that persistent postoperative pain is a complication of almost any surgical intervention. Persistent pain was related to abnormal sensation, and neuropathic pain should be considered in these patients.

Asunto(s)

RESUMEN

Persistent postoperative pain is a common complication of surgery, including surgical interventions for cancer. So far, there is limited information about the prevalence and clinical characteristics of pain after lymph node biopsy and dissection in patients with malignant melanoma. In this study, a questionnaire was sent out to all surviving patients (n=402) after surgery for cutaneous malignant melanoma at the Aalborg Hospital Department of Plastic Surgery, Aalborg, Denmark. Of patients responding, sentinel node biopsy (SNB) and/or lymph node dissection (LND) was performed in 175 patients. All patients with pain and a control group were invited to a clinical examination. Altered sensation and pain were significantly more common after LND (82% and 34%, respectively) than after SNB (32% and 14%, respectively). In patients with LND, 12% reported at least moderate pain and 14% impact of pain on quality of life, while in patients with SNB, 3% reported at least moderate pain and 2% pain impact on quality of life. The most important predictor of pain was sensory abnormalities. At the clinical follow-up, 10 out of 12 patients with pain both met the criteria of the recently proposed grading system for probable neuropathic pain and used descriptors on the DN4 questionnaire suggestive of neuropathic pain. Different patterns of sensory profiles were observed in single patients, suggesting heterogeneous sensory processing within single patients. This study suggested that nerve injury was the main underlying mechanism of persistent pain after lymph node excision.

Asunto(s)

RESUMEN

BACKGROUND: Persistent postsurgical pain has been reported following cosmetic breast augmentation, but little is known about the underlying mechanisms. AIMS: To describe the prevalence, character, and impact of sensory changes and chronic pain following cosmetic breast augmentation and to assess possible causes of pain. METHODS: In September 2009, a detailed questionnaire was mailed to all 142 patients who underwent cosmetic breast augmentation at Viborg Private Hospital from 2004 to 2009. RESULTS: Ninety-five patients (66.9%) returned the questionnaire; mean age was 34.2 years (SD 9.3). All patients were operated by the same surgeon. Mean time since operation was 31.8 months. Forty-two patients (44.2%) reported having pain as a consequence of the operation, 9.5% had moderate to severe pain, and 6.3% regretted the cosmetic surgery due to pain. Patients with pain were less satisfied with the surgery than those without pain. Seventy-two patients (75.8%) had sensory changes over the breast. There was an increased risk for developing pain in those with hypoesthesia (OR 4.6 (1.7-12.8)) and hyperesthesia (OR 2.6 (1.1-6.2)). Sixty-two percent had touch-evoked pain and 38% used pain descriptors that met the neuropathic pain diagnostic questionnaire (DN4) cut-off criteria for neuropathic pain. CONCLUSION: Sensory changes and persistent pain are common following cosmetic breast augmentation and may have a negative impact on daily activities and satisfaction after surgery. Findings suggest that neuropathic pain should be considered in these patients. Preoperative information about the risk of developing sensory changes and chronic pain after breast augmentation is important.

Asunto(s)

RESUMEN

Background Few studies have examined persistent pain after reduction mammaplasty, and sensory changes remain a controversial subject with studies reporting both reduced, improved, and unchanged skin sensitivity following surgery. The aim of the present study was to describe the prevalence, character, and impact of sensory changes and persistent pain following breast reduction surgery and to assess possible causes and predictors of persistent sensory changes and chronic pain. Methods In May 2010, a detailed questionnaire was mailed to all 109 patients who underwent reduction mammaplasty at the Department of Plastic Surgery, Aalborg Hospital from September 2004 to February 2010. Ninety patients (83%) returned the questionnaire; mean age was 48.7 years (SD 14.7); and mean time since surgery was 27.7 months. Results Eight patients reported that they had sensory abnormalities in the breasts before surgery, which normalized or improved in four, remained unchanged in one, and worsened in three patients following surgery. Forty-nine patients (54%) reported sensory changes in the nipple-areola complex or skin as a consequence of surgery. Sixty-nine patients reported having pain before surgery (most often in the neck/back), which was completely relieved in 42% and partially in 43%. Twenty-five patients (28%) reported having pain in the breasts as a consequence of the operation: 20% had chronic pain (defined as constant pain or pain at least once weekly for at least 3 months) and 7% had moderate to severe pain. In more than half of the patients, the pain was compatible with neuropathic pain. Patients with pain tended to be less satisfied with the surgery than those without pain (p = 0.07, Mann-Whitney U test). Young age, time since surgery, complications to surgery and sensory abnormalities before surgery were significantly related to pain. Conclusion Reduction mammaplasty relieved neck and back pain in most patients, but the surgery is associated with a risk of developing new sensory abnormalities and persistent neuropatic pain. Implications The clinical implication of this study is that reduction mammaplasty may sooth preexisting neck- and back pain, but may lead to a new condition in the patient with chronic sensory changes and pain in the breasts.