Incidence Of Postoperative Hematoma Research Articles

Incidence of Hematoma Following Breast Reduction in Patients Taking Selective Serotonin Reuptake Inhibitor or Serotonin-Norepinephrine Reuptake Inhibitor: A Retrospective Review.

Background Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) use is more common in the plastic surgery population compared to the general population. This study was designed to assess the theoretical effect of SSRIs and SNRIs on platelet function and the potential for increased bleeding risk. This study sought to establish the incidence of postoperative bleeding following routine bilateral breast reduction for patients on SSRIs or SNRIs. The outcomes of this study contribute to the discussion of whether these medications should be discontinued before elective surgery. Methodology A retrospective chart review of all patients who received bilateral breast reduction surgery over a 10-year period was performed. Patient charts were reviewed for postoperative hematoma formation as well as medications being used around the time of surgery. The rate of hematoma formation in patients actively taking SSRIs or SNRIs at the time of surgery was compared with the rest of the study population. Results A total of 1,022 patients met the inclusion criteria for the study. The overall incidence of postoperative hematoma was 7.7%. Of these, 1.9% of patients had clinically significant hematomas that required operative evacuation, and the remaining were treated conservatively. The only variable associated with a significantly higher risk of hematoma formation was advanced age (p = 0.005). Conclusions There was no significant difference in hematoma incidence after breast reduction in patients taking SNRIs or SSRIs compared with the general population. This contradicts some of the previously published literature and can hopefully guide clinicians in counseling their patients preoperatively.

Design and clinical application of X-shaped cross-dressing method in rhytidectomy

ObjectiveTo investigate the effect of “X"-shaped cross-compression dressing of nasal root in rhytidectomy surgery. MethodsFrom 2019.01 to 2022.02, 60 patients with high SMAS facelift in our department were selected to undergo “X"-shaped cross compression bandaging of the nasal root, and the incidence of postoperative hematoma and skin necrosis were counted. ResultsThere were two small-scale hematomas, and no flap infection and skin necrosis were observed postoperatively. ConclusionNasal “X"-shaped cross-compression bandaging method is reliable. It can effectively prevent the occurrence of postoperative hematoma and other complications and significantly improve patients' comfort. Evidence based medicine(ebm) levelIV.

Nonsteroidal anti-inflammatory drugs (NSAID) do not increase blood loss or the incidence of postoperative epidural hematomas when using minimally invasive fusion techniques in the degenerative lumbar spine.

Nonsteroidal anti-inflammatory drugs (NSAID) are essential in surgeons' armamentarium for pain relief and antiphlogistic effects. However, spine surgeons are concerned about the drugs' impact on coagulation, fearing hemodynamic instability due to blood loss and neurological complications due to postoperative hematoma. Furthermore, there are no clear guidelines for the use of these drugs. In this retrospective subgroup analysis of a prospective observational study, we investigated 181 patients who underwent minimally invasive spinal fusions in degenerative lumbar spine pathologies. 83 patients were given NSAID perioperatively, 54 of which were female and 29 male. Of these patients who took NSAID, 39 were on NSAID until at least one day before surgery or perioperatively, whilst the others discontinued their NSAID medication at least three days before surgery. Differences in perioperative blood loss, as well as complication rates between patients with and without NSAID treatment, were investigated. A significantly higher amount of blood loss during surgery and the monitoring period was encountered in patients whose spine was fused in more than one level, regardless of whether NSAID medication was taken or not and up until what point. Furthermore, it was found that taking NSAID medication had no effect on the incidence of postoperative epidural hematomas. Perioperatively taking NSAID medication does not increase blood loss or the incidence of postoperative hematoma in patients undergoing minimally invasive lumbar spinal fusion surgery.

KIDNEY TRANSPLANTATION – EARLY POSTOPERATIVE COMPLICATIONS

Introduction: Kidney transplantation is an established surgical method for the treatment of end-stage chronic renal failure with good long-term results. Despite the continuous progress and development of transplantology, a number of postoperative surgical and urological complications still occur today, which could compromise the success of this operative method. Purpose: All possible surgical and urological complications in the first 60 days after kidney transplantation were followed up. Materials and Methods: This study is based on a retrospective analysis of the disease history of 35 patients who underwent kidney transplantation at the Clinic of Urology at the UMHAT "Alexandrovska" for the period from 02.2018 to 12.2019. Results: Early postoperative complications were found in 46% of the observed transplant patients. Urological complications were found in 26% of them. Discussion: The incidence of urinary tract infections in transplanted patients was 26%. During the follow-up period, there were no cases of urinary retention, stricture of the ureter and urinoma in the group of patients. The incidence of surgical complications in the transplanted patients was 29%. The incidence of postoperative hematomas was 23%. Postoperative lymphocele was diagnosed in one patient, which shows a complication rate of 3% for this diagnosis. The incidence of surgical wound infection in transplanted patients during the follow-up period was 3%. Conclusions: Our results show that the frequency of the different early postoperative urological and surgical complications correspond to the literature data from other transplant centers. They show that the transplantation activities in the Clinic of Urology in UMHAT "Alexandrovska" correspond to the world standards.

Comparison of auricle reconstruction with expanded flaps and auricle reconstruction with non-expanded flaps in patients with microtia: A meta-analysis.

We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 3.2% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 2.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 3.1% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis (P > .05). The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.

269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon’s Experience

Abstract Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 months follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol (fig. 1). Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they only had excision without closure. Pre, per and post-operative management of the remaining 87 patients was according to a standardised protocol (fig. 1). Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: Secondary outcome: Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad-spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

Trunkoplasty after massive weight loss – a case series with a one-stage body contouring procedure for the NHS patient

Body contouring post massive weight loss (MWL) is a considerable task and is often a functional rather than esthetic operation. Clinicians are often encouraged to solve multiple issues in a single setting that can be difficult in the MWL patient. A simple abdominoplasty often does not provide a satisfactory outcome in such patients and may result in disharmony of the esthetic unit of the trunk. Trunkoplasty is a technique that combines a fleur-de-lis abdominoplasty and reverse abdominoplasty. This is a one-stage operation to address the extra skin of the whole trunk esthetic unit. The average operation time was 4 h with a 3-surgeon team. No blood transfusions were required. There were 3 out of 15 patients with wound-related problems and no incidence of postoperative hematomas. There were no returns to theaters. Seromas formed were not symptomatic and no interventions were required. The average inpatient stay was 6.9 days and a return to work after 4 weeks. It can improve abdominal contour, define the waist, and improve mons ptosis in one stage without any change in position. This procedure has some specific advantages (accommodates preexisting abdominal scars), but also has shortcomings as compared to "standard" circumferential body contouring.

Intravenous Tranexamic Acid in Implant-Based Breast Reconstruction Safely Reduces Hematoma without Thromboembolic Events.

Antifibrinolytic medications, such as tranexamic acid, have recently garnered increased attention. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research in breast reconstruction. The authors investigate whether intravenous tranexamic acid safely reduces the risk of hematoma following implant-based breast reconstruction. A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate two-stage implant-based breast reconstruction following mastectomy between 2015 and 2016. The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1000 mg of intravenous tranexamic acid before mastectomy incision and 1000 mg at the conclusion of the procedure. Fisher's exact test and the Mann-Whitney-Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous tranexamic acid after adjusting for possible confounders. A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous tranexamic acid, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar between the two the groups. Patients who received tranexamic acid were less likely to develop hematomas [n = 1 (0.46 percent)] than patients who did not [n = 19 (2.9 percent)] after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral) (p = 0.018). Adverse effects of intravenous tranexamic acid, including thromboembolic phenomena were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma. Intravenous tranexamic acid safely reduces risk of hematoma in implant-based breast reconstruction. Further prospective randomized studies are warranted to further corroborate these findings. Therapeutic, III.

Treatment of Carotid Restenosis Using Transcarotid Revascularization.

Transcarotid artery revascularization (TCAR) using the ENROUTE Neuroprotection System (Silk Road Medical) is a United States Food and Drug Administration-approved treatment modality for stroke risk reduction in the setting of carotid artery stenosis. The goal of this investigation was to define the real-world outcomes associated with the application of this technique to patients presenting with restenosis after previous carotid endarterectomy (CEA) or transfemoral carotid artery stenting (TF-CAS). Retrospective review of prospectively maintained institutional databases capturing all nontrial TCARs performed between August 2013 and July 2018 using the ENROUTE Neuroprotection System was completed at 3 unaffiliated hospital systems and unified for descriptive outcomes analysis. During the study period, 237 combined TCARs were performed at our respective institutions. Of these procedures, 55 stents were implanted for the indication of restenosis after previous carotid revascularization (47 CEA, 8 TF-CAS). Within the 30-day perioperative period, we observed no ipsilateral strokes or deaths; one patient experienced perioperative myocardial infarction (MI; 1.8%). We noted a 4.8% incidence of postoperative hematoma, but none of these events were clinically significant as no reinterventions were performed in any of the 55 patients. Additionally, we did not observe any cases of stent thrombosis or pulmonary embolus. Mean length of stay was 2.2 ± 2.8 days. Our mean follow-up duration was 15.0 ± 9.2 months. Throughout the follow-up period, we did not observe any additional stroke or MI events. Additionally, there were no cases of in-stent restenosis, thrombosis, or reinterventions. Transcarotid artery revascularization can be performed in patients with restenotic carotid arteries with acceptable rates of ipsilateral stroke, MI, and death as demonstrated in this small multi-institutional series.

Flying brevet: a technique for mastectomy in female-to-male gender reassignment

Background: Several techniques are described for chest wall contouring in female-to-male (FTM) transgender patients, each with specific applications and limitations. Factors to consider are the aesthetic requirements of the male chest, elimination of anatomical female breast features, operative technique, scar minimisation and success of outcome. We describe the ‘flying brevet’ technique, named for the pattern of excised skin that resembles pilot’s wings. This procedure is tailored to FTM patients but can also be used for large gynaecomastia patients. We present a description of the technique with a retrospective review of outcomes and case series of patients who have undergone this procedure.
 Methodology: This is a retrospective review of a single surgeon experience with 113 consecutive patients who have undergone the flying brevet technique. The approach involves a semicircular areolar incision, with superior skin resection and glandular resection. A planned second stage procedure may be performed for larger breasts if required.
 Results: Seven per cent incidence of postoperative haematoma, one case of fat necrosis, one case of partial nipple-areolar-complex (NAC) necrosis and one case of full NAC necrosis in the series. There was one postoperative infection and six per cent incidence of hypertrophic scarring.
 Conclusions: The flying brevet provides a consistent method of mastectomy for FTM chest wall reconstruction. It permits large glandular and skin resection in ptotic breasts with preservation of NAC circulation. The flying brevet is an additional technique that can be added to the current options for mastectomy in FTM chest wall reconstruction.

Clinical application of lobulated transplantation of free anterolateral thigh perforator flap in the treatment of electric burns of limbs

Clinical application of lobulated transplantation of free anterolateral thigh perforator flap in the treatment of electric burns of limbs

Intravenous Tranexamic Acid in Implant-based Breast Reconstruction Safely Reduces Hematoma Without Thromboembolic Events

PURPOSE: Antifibrinolytic medications, such as tranexamic acid (TXA), have recently garnered increased attention in plastic surgery. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research on TXA in breast reconstruction. The aim of this study was to investigate whether intravenous TXA reduces the risk of postoperative hematoma following immediate implant-based breast reconstruction. METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate 2-stage IBR following mastectomy over 2 years (2015–2016). The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1,000 mg of intravenous TXA before mastectomy incision and 1,000 mg at the conclusion of the procedure. Fisher’s exact test and the Mann-Whitney–Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous TXA after adjusting for possible confounders. RESULTS: A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous TXA, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar among the groups. Patients who received TXA were less likely to develop hematomas (n = 1; 0.46%) than patients who did not (n = 19; 2.9%) after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral; P = 0.018). Adverse effects of intravenous TXA, including thromboembolic phenomena, were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma. CONCLUSION: Intravenous TXA safely reduces risk of hematoma in IBR. Further prospective randomized studies are warranted to further corroborate these findings.

Comparison the efficacy of minimally invasive surgery and traditional surgery in the treatment of multiple benign mammary lumps

Objective To compare the clinical efficacy of minimally invasive surgery and traditional surgery in the treatment of multiple benign mammary lumps. Methods A retrospective study was conducted to select 158 patients with multiple benign breast masses admitted to Yijishan Hospital of Wannan Medical College from July 2016 to February 2018, all of them were female, average age was (28.3±6.6) years old, range from 19 to 51 years old. The patients were divided into minimally invasive group (n=122) and traditional group (n=36) according to different surgical methods. The minimally invasive group was treated by minimally invasive rotary excision, while the traditional group was treated by traditional surgery. The operation time, number of incisions, average length of incisions, cumulative length of incisions and healing time of incisions were compared between the two groups. The incidence of local hematoma, local infection, breast deformity and local residual were compared after operation, and the satisfaction of the two groups was aslo compared. Normal distribution measurements were expressed by mean±standard deviation (Mean±SD), independent sample t test was used for inter-group comparison; non-normal distribution measurements were expressed by median (quartile spacing) [M(P25, P75)], Mann-Whitney U test was used for inter-group comparison. Chi-square test or Fisher exact probability test was used to compare the count data between the two groups. Results As compared to the traditional group, the minimally invasive group had shorter operation time (20.0 min vs 40.0 min, Z=-8.590, P<0.001), less number of incisions (1.0 vs 2.0, Z=-4.423, P<0.001), smaller average surgical incision length (3.8 mm vs 35.5 mm, Z=-9.211, P<0.001), smaller cumulative surgical incision length (4.0 mm vs 67.2 mm, Z=-9.130, P<0.001), quicker postoperative recovery (4.0 d vs 7.0 d, Z=-9.334, P<0.001). There were no significant differences between the two groups in incidence of postoperative hematoma (4.1% vs 2.8%, χ2=0. 000, P=1.000), incidence of infection (0 vs 2.8%, P=0.228), incidence of postoperative breast shape change (1.6% vs 2.8%, χ2=0.000, P=1.000), and incidence of residual (0.8% vs 0, P=1.000). Psychological satisfaction of patients in minimally invasive group (95.1%) was significantly higher than that in traditional group (58.3%), the difference was statistically significant (P<0.001). Conclusions Compared with traditional surgery, the application of minimally invasive surgery in the treatment of multiple benign mammary lumps has many advantages, such as shorter operation time, less number of incisions, smaller surgical incision length, quicker postoperative recovery and higher satisfaction of patients after operation. It has not significantly increased postoperative complications. It is worthy of clinical application and promotion. Key words: Breast neoplasms; Vacuum; Ultrasonography; Surgical procedures, minimally invasive

Clinical curative effect analysis of disposable circumcision suture device Versus Shang Ring circumcision and Traditional circumcision

Objective To compare the efficacy and safety of disposable circumcision suture device (DCSD), ShangRing circumcision and traditional circumcision in the treatment of patients with redundant prepuce or phimosis. Methods All the 620 patients with redundant prepuce or phimosis were randomly divided into three groups: the DCSD group(n=280) and the ShangRing group(n=210) and the traditional circumcision group(n=130). Factors concerning efficacy and safety were compared. Results DCSD showed obvious advantages of the ShangRing and the traditional circumcision in operating time(6.1±0.8), (8.5±1.7), (30.1±0.5)min, intraoperatve blood soss (1.0±0.0), (1.0±0.0), (5.0±1.0)mL, wound healing time (14.5±1.5), (18.5±2.0), (13.5±1.5)d, postoperative pain score (1.94±1.08), (3.89±0.98), (4.20±0.58). The incidence of postoperative hematoma was 2.29%, 2.25%, 1.52%, and post operation edema rate was 8.04%, 25.89%, 30.89%.There was significant difference in above results (P<0.05). Conclusions DCSD has advantages of shorter operation and incision healing time, reduced postoperative pain score, and high appearance satisfaction.It should be widely used in clinical practice. Key words: Foreskin; Phimosis; Circumcision, Male

Evacuation of postoperative hematomas after thyroid and parathyroid surgery: An analysis of the CESQIP Database

A feared complication after thyroid and parathyroid operations is postoperative hematoma that threatens the airway. The aim of this study was to identify factors associated with postoperative hematoma. Patients undergoing thyroidectomy or parathyroidectomy were evaluated for postoperative hematoma requiring operative intervention using the database of the Collaborative Endocrine Surgery Quality Improvement Program. Associations between perioperative factors and postoperative hematoma were evaluated with bivariate methodologies and multivariable logistic regression. Among 19,356 patients, 60.4% underwent thyroidectomy ± lymph node dissection, 34.9% parathyroidectomy, and 4.7% concurrent thyroidectomy/parathyroidectomy. Postoperative hematoma occurred in 0.6% overall: 0.7% of thyroidectomies, 0.3% of parathyroidectomies, and 1.3% of combined thyroid/parathyroid operations (P < .001). The incidence of postoperative hematoma was greater among men (P < .001) and after greater operative times (P < .001) but was not influenced by body mass index, prior neck surgery, or reoperations. Multivariable logistic regression determined that operative complexity, operation >1 hour, male sex, and age were independently associated with postoperative hematoma. Postoperative hematoma were associated with greater rates of other complications as well. Large databases such as Collaborative Endocrine Surgery Quality Improvement Program are useful to evaluate rare complications. The risk of postoperative hematoma is associated with extent of operation, greater operative times, age, and male sex. These data may be beneficial in counseling patients and may serve as a benchmark for surgeons to evaluate their practices.

Postoperative Epidural Hematomas in the Lumbar Spine.

Postoperative epidural hematomas are rare complications following lumbar spine surgery, but if they are not quickly identified and treated they can lead to permanent neurological deficits. Epidural hematomas occur in approximately 0.10%-0.24% of all spine surgeries, and despite the fact that multiple large studies have been performed attempting to identify risk factors for this complication, there is still significant debate about the effect of subfascial drains, postoperative anticoagulation, and antiplatelet medication on the incidence of postoperative hematoma. The purpose of this manuscript is to review the epidemiology, etiology, diagnosis, and treatment of patients who develop a postoperative lumbar epidural hematoma.

The investigation of cosmetic surgery methods of periareolar incision treating the multiple benign breast lumps

Objective To explore the cosmetic effect of periareolar incision treating the multiple benign breast lumps in clinic. Methods A total of 406 cases with benign breast lumps from Hunan Provincial People's Hospital treated by periareolar surgical resection were collected in 2014. Forty two of all cases were treated by periareolar surgical resection combined with mammotome resection, 56 of all cases were treated by periareolar surgical resection combined with injecting methylene blue as a mark, and 29 of all cases were treated by combined therapy with three methods above. Follow-up and evaluation were performed about postoperative complications, recurrence rate and patients satisfaction scores using the statistical methods for data analysis. Results ⑴The incidence of postoperative hematoma of whom treated only by periareolar surgical resection was significantly lower than that by periareolar surgical resection combined with two or three methods (P<0.01). ⑵The patient satisfaction of whom treated only by periareolar surgical resection was significantly higher than other groups (P<0.01). ⑶The total postoperative complications and recurrence rate of the patients treated by periareolar surgical resection was low, the cosmetic effect of breast and patient satisfaction was high. Conclusions The cosmetic effect of periareolar incision which treats the multiple benign breast lumps is ideal. It can achieve the requirements of cosmetic surgery. Key words: Breast neoplasms/SU; Nipples/SU; Surgery, plastic

Evolution of hypertension management in face lifting in 1089 patients: optimizing safety and outcomes.

Hematoma continues to be the most common complication after rhytidectomy. Perioperative hypertension is a known risk factor, and meticulous control of this has been shown to significantly reduce the incidence of postoperative hematoma development, thus improving outcomes and decreasing patient morbidity. Despite this, there are few well-described hypertension management regimens in the literature today. A retrospective chart review of 1089 patients undergoing rhytidectomy performed by a single surgeon was conducted. A predetermined antihypertensive protocol was used in all patients that included the routine use of transdermal clonidine. A target systolic blood pressure of 140 mmHg or less was the goal of therapy, and close hemodynamic monitoring was used throughout the entire perioperative phase. The incidence of postoperative hematoma was then assessed. The overall incidence of postoperative hematoma was 0.9 percent (10 patients). Of these patients, five were female (0.05 percent) and five were male (5.2 percent). Preoperatively, 170 patients were noted to be hypertensive, with a systolic blood pressure greater than 140 mmHg. Postoperatively, 355 patients were found to be hypertensive (p < 0.001). Of the patients who developed a postoperative hematoma, eight patients (80 percent) had documented hypertension (systolic blood pressure >140 mmHg) in the postanesthesia care unit (p = 0.045). Male sex was found to be a significant risk factor for the development of hematoma (p < 0.001). Meticulous perioperative blood pressure control significantly reduces the rate of postoperative hematoma formation. The use of a specific protocol developed by our senior author and primary anesthesia provider contributed to our very low hematoma rates.

One-stage vs. two-stage brachio-basilic arteriovenous fistula for dialysis access: a systematic review and a meta-analysis.

IntroductionA brachiobasilic arteriovenous fistula (BB-AVF) can provide access for haemodialysis in patients who are not eligible for a more superficial fistula. However, it is unclear whether one- or two-stage BB-AVF is the best option for patients.AimTo systematically assess the difference between both procedures in terms of access maturation, patency and postoperative complications.MethodsOnline search for randomised controlled trials (RCTs) and observational studies that compared the one-stage versus the two-stage technique for creating a BB-AVF.ResultsEight studies were included (849 patients with 859 fistulas), 366 created using a one-stage technique, while 493 in a two-stage approach. There was no statistically significant difference between the two groups in the rate of successful maturation (Pooled risk ratio = 0.95 [0.82, 1.11], P = 0.53). Similarly, the incidence of postoperative haematoma (Pooled risk ratio = 0.73 [0.34, 1.58], P = 0.43), wound infection (Pooled risk ratio = 0.77 [0.35, 1.68], P = 0.51) and steal syndrome (Pooled risk ratio = 0.65 [0.27, 1.53], P = 0.32) were statistically comparable.ConclusionAlthough more studies seem to favour the two-stage BVT approach, evidence in the literature is not sufficient to draw a final conclusion as the difference between the one-stage and the two-stage approaches for creation of a BB-AVF is not statistically significant in terms of the overall maturation rate and postoperative complications. Patency rates (primary, assisted primary and secondary) were comparable in the majority of studies. Large randomised properly conducted trials with superior methodology and adequate sub-group analysis are needed before making a final recommendation.

Herbal Products That May Contribute to Hypertension

The role of hypertension in the incidence of postoperative hematoma has been well documented. A large number of patients who undergo aesthetic surgery consume a variety of herbal products, some of which may cause or exacerbate hypertension. The purpose of this study was to review the herbal products that are known to cause hypertension and thus may play a role in postoperative complications. The MEDLINE and PubMed databases were searched for articles published from 1991 to 2011. Search terms included "hypertension," "herbal supplements," "herbals and hypertension," "blood pressure," and "dietary supplements." References from reviews about herbal products and hypertension were searched for additional articles and case reports. A manual search was also conducted based on citations in the published literature. Of 56 articles that were found to be related to herbal supplements that contribute to hypertension, 27 were excluded because of insufficient demonstration of the association or duplication. Twenty-nine articles, which examined the cause, pathophysiology, and risk factors of hypertension in addition to herbals, were included. In addition, four books were reviewed that contained some information regarding the association of hypertension and herbal products. The herbal products that may cause hypertension include arnica, bitter orange, blue cohosh, dong quai, ephedra, ginkgo, ginseng, guarana, licorice, pennyroyal oil, Scotch broom, senna, southern bayberry, St. John's wort, and yohimbine. This study lists the herbal products that may cause hypertension and should be considered when a patient undergoes plastic surgery to reduce perioperative morbidity related to the herbal supplements.