Evaluation of a Novel Absorbable Mesh in a Porcine Model of Abdominal Wall Repair.

Unlabelled: Bioabsorbable meshes have seen increasing clinical use to reinforce soft tissue, and exist on a spectrum of strength loss versus absorption: several retain their strength for months, but remain in situ for years. Others lose strength fully by 6 weeks. An intermediate profile, with some strength for 3 -4 months, but consistent absorption in less than a year, may be an optimal balance of near-term support and long-term safety.

Mesh sutured repairs of contaminated incisional hernias.

Background: We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias.

Methods: 48 patients with contaminated hernias 5 cm wide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature.

What's New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction.

Of the nearly 90,000 implant-based breast reconstructions performed in the United States, the majority use internal soft-tissue support. Aesthetically, these constructs may allow for better positioning of prosthesis, improve lower pole expansion, and increase projection. They may have particular utility in direct-to-implant, nipple-sparing mastectomies, and prepectoral reconstructions.

Combining abdominal and cosmetic breast surgery does not increase short-term complication rates: a comparison of each individual procedure and pretreatment risk stratification tool.

Background: Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures.

Objectives: This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure.

Methods: All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified.

Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score.

Background: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score.

The use of patient registries in breast surgery: a comparison of the tracking operations and outcomes for plastic surgeons and national surgical quality improvement program data sets.

Background: The National Surgical Quality Improvement Program (NSQIP) and the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) registries gather outcomes for plastic surgery procedures. The NSQIP collects hospital data using trained nurses, and the TOPS relies on self-reported data. We endeavored to compare the TOPS and NSQIP data sets with respect to cohort characteristics and outcomes to better understand the strengths and weakness of each registry as afforded by their distinct data collection methods.

Surgical duration and risk of venous thromboembolism.

Importance: There is a paucity of data assessing the effect of increased surgical duration on the incidence of venous thromboembolism (VTE).

Objective: To examine the association between surgical duration and the incidence of VTE.

Design, Settings, And Participants: Retrospective cohort of 1,432,855 patients undergoing surgery under general anesthesia at 315 US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011.

Increased anaesthesia duration increases venous thromboembolism risk in plastic surgery: A 6-year analysis of over 19,000 cases using the NSQIP dataset.

Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality, particularly in the postoperative setting. Various risk stratification schema exist in the plastic surgery literature, but do not take into account variations in procedure length. The putative risk of VTE conferred by increased length of time under anaesthesia has never been rigorously explored.

Risk factors for mastectomy flap necrosis following immediate tissue expander breast reconstruction.

Tissue expander placement is a mainstay of reconstructive surgery in the post-mastectomy patient. Necrosis of the native breast tissue is one of the most significant concerns in their post-operative care. The goal of this study is to elucidate factors that confer risk of this outcome.

Tumescent technique does not increase the risk of complication following mastectomy with immediate reconstruction.

Background: Despite the growing interest in the advantages of tumescent mastectomy technique, there remain concerns that tumescent solution may increase postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy in the setting of immediate prosthetic reconstruction.

Methods: Retrospective review of 1,491 breasts (1,030 patients) treated by 4 oncologic and 2 reconstructive surgeons between 2004 and 2012 at a single institution.

Intraoperative transfusion of packed red blood cells in microvascular free tissue transfer patients: assessment of 30-day morbidity using the NSQIP dataset.

Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent microvascular free tissue transfer between 2006 and 2010. Multivariate logistic regression models were used to determine the association between intraoperative transfusion and outcomes.

Predictors of readmission after breast reconstruction: a multi-institutional analysis of 5012 patients.

Background: Recent health care legislation institutes penalties for surgical readmissions secondary to complications. There is a paucity of evidence describing risk factors for readmission after breast reconstruction procedures.

Methods: Patients undergoing breast reconstruction in 2011 were identified in the National Surgical Quality Improvement Program database.

Anemia is not a predictor of free flap failure: a review of NSQIP data.

Background: Thrombosis is a common cause of flap failure in microvascular tissue transfer, which questions the effects of anemia on this outcome. This article seeks to contribute a large, multi-institutional data analysis to this debate.

Methods: Free tissue transfer patients were identified in the National Surgical Quality Improvement database through a specified Current Procedural Terminology algorithm.