RESUMO
BACKGROUND: Complication rates after spinal surgery are high, in part because of surgical advancements that have made procedures available to a broader range of medically complicated patients. The high rates of infection, hematoma, and dehiscence resulting in open wounds after spinal surgery often warrant plastic surgery involvement. In this study, we aim to examine the effects of preoperative and operative risk factors on complication rates, reoperation rates, and hospital length of stay after flap reconstruction of spinal defects. METHODS: A retrospective review was performed of 373 patients who required flap reconstruction for spinal wound closure at our institution between 2003 and 2013. Data regarding demographics, comorbidities, operative variables, and postreconstructive course were collected. RESULTS: Of the 373 patients, 97.3% had at least 1 comorbid condition associated with poor wound healing, 91.2% had a significant wound condition at the time of reconstruction, and 81.8% had a history of 2 or more spinal surgeries. After reconstruction, average hospital stay was 14 days, with 35% of patients developing complications and 30% requiring reoperation. Risk factors including elevated body mass index, diabetes, tobacco use, steroid use, low prealbumin level, therapeutic anticoagulation, infection, history of spine surgery, multilevel spinal reconstruction, and spinal hardware were associated with complications, reoperations, and prolonged length of stay. CONCLUSIONS: Local muscle flap coverage is an effective strategy for the reconstruction of spinal defects in medically complex patients. To reduce the inherently high risks associated with paraspinous reconstruction in this challenging population, special consideration should be given to preoperative and operative variables associated with poor outcomes. Early coordination between spine and plastic surgeons should be considered in patients at high-risk of wound complications.
Assuntos
Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Humanos , Reoperação , Estudos Retrospectivos , Coluna Vertebral , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologiaRESUMO
OBJECTIVE: This study aimed to prospectively assess outcomes for surgical autologous fat transfer (AFT) applied for traumatic and postsurgical craniofacial deformities. The minimally invasive nature of AFT has potential for reduced risk and superior outcomes compared with current reconstructive options. BACKGROUND: Craniofacial deformities have functional and psychosocial sequelae and can profoundly affect quality of life. Traditional reconstructive options are invasive, invasive, complex, and often lack precision in outcomes. Although AFT is safe, effective, and minimally invasive, only anecdotal evidence exists for reconstruction of craniofacial deformities. METHODS: In this Institutional Review Board-approved prospective cohort study, 20 subjects underwent AFT (average volume: 23.9â±â13.2âmL). Volume retention over time was determined using high-resolution computed tomography. Flow cytometry was used to assess cellular subpopulations and viability in the stromal vascular fraction. Quality of life assessments were performed. After the completion of 9-month follow-up, 5 subjects were enrolled for a second treatment. RESULTS: No serious adverse events occurred. Volume retention averaged 63â±â17% at 9 months. Three-month retention strongly predicted 9-month retention (r=0.996, P < 0.0001). There was no correlation between the total volume injected and retention. Patients undergoing a second procedure had similar volume retention as the first (P = 0.05). Age, sex, body mass index, and stromal vascular fraction cellular composition did not impact retention. Surprisingly, former smokers had greater volume retention at 9 months compared with nonsmokers (74.4% vs 56.2%, P = 0.009). Satisfaction with physical appearance (P = 0.002), social relationships (P = 0.02), and social functioning quality of life (P = 0.05) improved from baseline to 9 months. CONCLUSIONS: For craniofacial defects, AFT is less invasive and safer than traditional reconstructive options. It is effective, predictable, and reaches volume stability at 3 months. Patient-reported outcomes demonstrate a positive life-changing impact.
Assuntos
Tecido Adiposo/transplante , Anormalidades Craniofaciais/cirurgia , Medidas de Resultados Relatados pelo Paciente , Procedimentos de Cirurgia Plástica/métodos , Qualidade de Vida , Adulto , Anormalidades Craniofaciais/diagnóstico , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Transplante Autólogo , Adulto JovemRESUMO
PURPOSE: To date, no studies have analyzed the national demographics of mandibular fractures in the United States. This report is part 1 of a 2-part series characterizing the modern demographics, epidemiology, and outcomes of mandibular fractures in the United States. The purpose of this study was to characterize mandibular fractures in relation to age, gender, mechanism of injury, and anatomic location of fracture. MATERIAL AND METHODS: A retrospective cohort study was conducted using the National Trauma Data Bank (NTDB). The sample was derived from the population of hospitalized patients enrolled in the NTDB from 2001 to 2005 using mandibular fracture (International Classification of Diseases, Ninth Revision codes 802.21 through 802.39) as an inclusion criterion. Patient- and injury-related variables, including age, gender, anatomic location of fracture, and mechanism of injury, were analyzed by Fisher exact and χ(2) testing. RESULTS: A total of 13,142 patients with mandibular fractures from participating trauma centers were included in the study. Eighty percent of patients were male. Fracture distribution by age was roughly bell-shaped, with fractures occurring most frequently at 18 to 54 years of age. Mechanism of injury differed by gender, with men most often sustaining mandibular fracture from assault (49.1%), followed by motor vehicle accidents (MVAs; 25.4%) and falls (12.8%). Women most commonly sustained mandibular fracture from MVAs (53.7%), followed by assault (14.5%) and falls (23.7%). Falls were a significantly more common mechanism in patients who were at least 65 years old (P < .001). CONCLUSION: This study sought to characterize the largest, modern, population-based sample of mandibular fractures in the United States. Overall, men had a 4-fold higher incidence, but this distribution varied by age. Similarly, mechanism of injury varied across gender and age range. A better understanding of the influence of age and gender on mechanism of injury and anatomic site is of great clinical importance in the assessment, diagnosis, and treatment of traumatic mandibular fractures.