Postoperative Seroma Formation Research Articles

The use of OK-432 to prevent seroma in extended latissimus dorsi flap donor site after breast reconstruction

BackgroundThe extended latissimus dorsi (LD) flap has become a preferred method of breast reconstruction. However, donor site seroma is the most common complication of LD flap reconstruction. The purpose of this study was to investigate the effectiveness of OK-432 on postoperative drainage and seroma formation in the site of the LD myocutaneous flap donor site. MethodsA retrospective study was conducted on 49 patients who underwent immediate breast reconstruction with extended LD flaps between July 2008 and September 2013. The patients received either OK-432 (OK-432 group, n = 24) or not (control group, n = 25) in the extended LD donor site. Outcome measures were obtained from the incidence and volume of postoperative seroma, total volume of back drains, the total drainage, indwelling period of drainage, and frequency of aspiration. ResultsThere were no statistically significant differences between the two groups in terms of age, body mass index, and flap size. The incidence of seroma was 41.7% in the OK-432 group and 72% in the control group (P = 0.032). There were also significant reductions in volume of postoperative seroma (P = 0.021), total drainage volume (P < 0.001), total volume of back drains (P < 0.001), indwelling period of drainage (P = 0.004), and frequency of aspiration (P = 0.008). ConclusionsThe use of OK-432 is a feasible option for the reduction or prevention of seroma formation at the donor site in patients undergoing immediate breast reconstruction using a LD myocutaneous flap for breast cancer.

A novel reconstruction method for giant incisional hernia: Hybrid laparoscopic technic.

Laparoscopic reconstruction of ventral hernia is a popular technic today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technic that combines laparoscopic and open approach in giant incisional hernias. Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm were included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas Group 2 (n = 16) labels laparoscopic technic combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. There were 12 patients in Group 1 and 16 patients in Group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in 6 patients for Group 1 and in only 1 patient for Group 2. Group 1 had 1 patient who suffered from recurrence where as Group 2 had no recurrence. Laparoscopic technic combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias.

Common Postoperative Findings Unique to Laparoscopic Surgery

The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls.

Radioterapia intraoperatória como protocolo de tratamento do câncer de mama inicial

ABSTRACTObjective:To report on preliminary outcomes of single-dose intraoperative radiotherapy for early-stage breast cancer based on local recurrence rates and complications.Methods:Fifty postmenopausal women with ≤2.5cm breast tumors and clinically normal axillary lymph nodes were submitted to quadrantectomy, sentinel lymph node biopsy and intraoperative radiotherapy and studied. Mean follow-up time was 52.1 months.Results:Mean patient age was 65.5 years; mean tumor diameter was 1.41cm 82% of nodules were hormonal receptor positive and HER-2negative. All patients received a 21 Gy radiation dose for a mean time of 8.97 minutes. Distant metastases were not observed. Local recurrence was documented in three cases, with identical histological diagnosis as the primary tumors. Thirty-five (70%) patients had local fibrosis, with gradual improvement and complete resolution over 18 months. Postoperative infection and seroma formation were not observed.Conclusion:Partial radiotherapy is a potentially feasible and promising technique. Careful patient selection is recommended before a longer follow-up period has elapsed to confirm intraoperative radiotherapy safety and efficacy.

Bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells: Case series of 14 patients

ObjectiveTo investigate the effect of bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells.MethodsIn 14 patients with chronic paraplegia caused by spinal cord injury, cord defects were grafted and stem cells injected into the whole construct and contained using a chitosan-laminin paste. Patients were evaluated using the International Standards for Classification of Spinal Cord Injuries.ResultsChitosan disintegration leading to post-operative seroma formation was a complication. Motor level improved four levels in 2 cases and two levels in 12 cases. Sensory-level improved six levels in two cases, five levels in five cases, four levels in three cases, and three levels in four cases. A four-level neurological improvement was recorded in 2 cases and a two-level neurological improvement occurred in 12 cases. The American Spinal Impairment Association (ASIA) impairment scale improved from A to C in 12 cases and from A to B in 2 cases. Although motor power improvement was recorded in the abdominal muscles (2 grades), hip flexors (3 grades), hip adductors (3 grades), knee extensors (2–3 grades), ankle dorsiflexors (1–2 grades), long toe extensors (1–2 grades), and plantar flexors (0–2 grades), this improvement was too low to enable them to stand erect and hold their knees extended while walking unaided.ConclusionMesenchymal stem cell-derived neural stem cell-like cell transplantation enhances recovery in chronic spinal cord injuries with defects bridged by sural nerve grafts combined with a chitosan-laminin scaffold.

Wound drainage after axillary dissection for carcinoma of the breast.

Axillary dissection is commonly performed for breast carcinoma. It is uncertain whether insertion of a drain reduces complication rates. To assess the effects of wound drainage after axillary dissection for breast carcinoma on the incidence of postoperative seroma formation. Secondary outcome measures include the incidence of infection and length of hospital stay. We searched the Cochrane Wound and Breast Cancer Group's Specialised Registers (22 February 2013), MEDLINE (1950 to 22 February 2013), EMBASE (1966 to 22 February 2013), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (22 February 2013) for all prospectively registered and ongoing trials (22 February 2013). Reference lists of included studies were handsearched by two independent review authors to look for additional eligible trials. All randomised controlled trials (RCTs) comparing wound drainage versus no wound drainage in individuals after axillary dissection for the treatment of breast carcinoma were included. All disease stages were considered. Breast-conserving surgery and mastectomy were considered. Patients undergoing sentinel node biopsy without axillary dissection were not included. No limits were applied to language or study location. Two review authors independently determined the eligibility of each study. Two review authors independently extracted data for each included study using a predesigned data extraction proforma and assessed risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. Discrepancies were resolved by consensus discussion with a third review author. Dichotomous variables were analysed using a Mantel-Haenszel model to produce odds ratios (ORs). Continuous variables were analysed using an inverse variance model to produce a mean difference (MD). Seven RCTs including 960 participants were identified. The quality of trials was generally low, with several studies at risk of selection bias, and no studies used blinding during treatment or outcome assessment. There was a high level of statistical variation between the studies, which therefore reduces the reliability of the evidence. The OR for seroma formation was 0.46 (95% confidence interval (CI) 0.23 to 0.91, P = 0.03) in favour of a reduced incidence of seroma in participants with drains inserted. There was no significant difference in infection rates between drainage and no drainage groups (OR = 0.70; 95% CI 0.44 to 1.12, P = 0.14). The mean difference in length of hospital stay, reported in four trials consisting of 600 participants, was 1.47 days greater in the drained population (95% CI 0.67 to 2.28, P = 0.0003). A mean difference of 0.79 fewer postoperative seroma aspirations was found in the drained population (95% CI 1.23 to 0.35 fewer, P = 0.0004) in two trials including 212 participants. No significant difference in volume of seroma aspirations was reported (MD -19.44, 95% CI -59.45 to 20.57, P = 0.34) in three trials including 519 participants. No significant difference in the incidence of lymphoedema was noted (OR 2.31 favouring no drainage, 95% CI 0.47 to 11.37, P = 0.30), with only six instances reported in three trials of 360 participants, nor was any significant difference in the incidence of haematoma observed (OR 1.68, 95% CI 0.33 to 8.51, P = 0.53), with only five instances reported in two trials of 314 participants. There is limited quality evidence that insertion of a drain following axillary lymphadenectomy reduced the odds of developing a seroma and reduced the number of post-operative seroma aspirations. These benefits should be balanced against an increased length of hospital stay in the drained population.

Use of Surgisis for Abdominal Wall Reconstruction in Children with Abdominal Wall Defects

Abdominal wall defects in children can present a challenge to the pediatric surgeon. Despite the development of new materials and modifications of surgical technique, no single approach has been established. The purpose of this study was to evaluate the authors experience using porcine small intestine submucosa for abdominal closure. A retrospective review of all patients with abdominal wall defects who underwent reconstruction with Surgisis at the authors' institution from 2004 to 2011 was performed. Patient demographics, cause of defect, recurrence, rate of infection, and length of follow-up were reviewed. A total of 24 patients were identified as having Surgisis implanted for abdominal wall defects. The most common etiology of abdominal defect was omphalocele. All patients went on to heal wounds. Four patients developed postoperative seroma formation and another two had wound infection. Two recurrences in the form of incisional hernia were observed. Both resolved spontaneously without intervention during the follow-up. The median follow-up period was 5 years (range 2-9 y). No significant predictors of complications were identified. Surgisis is an effective adjunct in the repair of abdominal wall defects in children. Complication rates remain low. In addition, recurrence may disappear spontaneously as the patch absorbed and replaced by scar tissues. Further studies are warranted.

English

INTRODUCTION: Seroma formation in immediate postoperative period is known complication after endoscopic direct inguinal hernia repair. AIM: To study effect of catgut endoloop applied at neck of pseudo sac in preventing occurrence of seroma in laparoscopic direct inguinal hernia repair. MATERIALS & METHOD: 150 patients who underwent endoscopic direct hernia repair were included in this study. They were followed for 1 month for development of seroma. In all the patients' pseudo sac dead space was obliterated by using catgut endoloop. RESULT: In all 150 patients it was possible to prevent clinically visible seroma. CONCLUSION: The primary closure of direct inguinal hernia defects with a pre-lied suture loop during endoscopic repair is safe, efficient, and very reliable for the prevention of post-operative seroma formation, without increasing the risk of developing chronic groin pain or hernia recurrence. This technique should be the preferred method over stapling of the transversalis fascia or the insertion of a closed suction drainage device in such a situation. KEYWORD: Direct inguinal hernia, seroma, catgut endoloop, pseudo sac INTRODUCTION: Post-operative seroma formation after endoscopic management of direct inguinal hernia either by total extra-peritoneal (TEP) or transabdominal pre-peritoneal (TAPP) is a known complication. Because it mimics a postoperative recurrence of hernia, seroma has been a concern to patients. It is suggested that fluid remains trapped between the prosthetic mesh and the transversalis fascia (TF) causing, on a few occasions, a tension seroma that may require repeated follow-up visits and needle aspiration, with a potential risk of iatrogenic infection. Incidence reported in the literature is around 4-5 %. Although techniques such as tacking the pseudo sac to Cooper Ligament or closed suction drain are described, few seem to practice any, probably because the majority of them resolve spontaneously or with repeated aspirations. Therefore, it was proposed to adopt simple measure for seroma prevention by obliterating the pseudo sac with Catgut endoloop and reduce risk of iatrogenic injury and chronic post-operative pain at its minimum. MATERIALS & METHODS: The study was prospective type conducted from Jan 2011 to Dec 2012. 150 patients, who underwent laparoscopic direct inguinal hernia repair, were included. Patients were reviewed in the clinic 2 and 6 weeks after the operation. A single surgeon performed all operations. Each of the M2 or M3 direct defects, according to the European Hernia Society (EHS), was included in this study, while small direct hernias were excluded. After reduction of direct hernia, pseudo sac becomes evident. (FIGURE 1) All meshes were unfolded and under vision cavity were deflated without fixing mesh.

Prevention of Seroma Formation after Axillary Dissection-A Comparative Randomized Clinical Trial of Three Methods

Seroma is a frequent complication after breast cancer surgery. Closed suction drainage for several days is the standard procedure to reduce seroma formation. The aim of this study was to compare the efficacy of external compression dressing, suture flap fixation, and the conventional method of closed suction drains in the prevention of seroma formation. A total of 161 patients were prospectively randomized in a three groups × two subgroups design into control (n = 48), compression dressing (n = 53) and suturing groups (n = 49), and two subgroups, conventional drain removal (n = 75) and early drain removal (n = 75). All patients underwent ALND as part of MRM or BCT. The primary end point was the incidence of seroma. Suture flap fixation significantly reduced the incidence of seroma (p = 0.003), total drain output (p = 0.005), and duration of drainage (p = 0.001) without increase in wound complications. Compression dressing reduced duration of drainage significantly (p = 0.03), but not the total drain output (p = 0.15) or seromas (p = 0.58). Early drain removal on postoperative day 7 irrespective of drain output does not significantly increase seroma formation (p = 0.34) or wound complications. On multivariate analysis, BMI ≥ 30 (p = 0.02) and longer duration of drainage (p = 0.04) were identified as independent predictors for seroma formation. Obliteration of the dead space after breast cancer surgery by suture flap fixation is a safe and easy procedure, which significantly reduces postoperative seroma formation and duration of drainage. Compression dressing offers no advantage over normal dressing. Drains can be removed safely on postoperative day 7 irrespective of output without significant increase in complications.

Prospective, randomized trial comparing harmonic scalpel and electrocautery in breast surgery.

e12014 Background: The objective of this study was to compare the potential advantages of the harmonic scalpel with those of electrocautery for axillary lymph node dissection in breast surgery. Methods: A prospective randomized study of axillary lymph node dissection procedures performed between March 2011 and September 2012 was conducted. Primary breast cancer patients with axillary node-positive status (n = 25) were randomly assigned to the harmonic scalpel (group A, n = 13) or electrocautery (group B, n = 12) groups.The patients underwent breast-conservation surgery or mastectomy with a level I and II axillary dissection, which was performed by one surgeon. The time required for resection and the blood loss during the lymphadenectomy were recorded. The HARMONIC FOCUS (Ethicon Endo-Surgery, Inc.) was used as the ultrasonic scalpel. A low-pressure vacuum drain was placed in the axilla and removed when the drainage volume reduced to less than 50 ml over 24 hours. After the operations, the patients were assessed for the presence of seroma in an outpatient setting. Results: Resection timein group A was significantly shorter than that in group B (mean, 28.6 ± 5.1 vs. 40.3 ± 5.6 min; P = 0.0001). Similarly, blood loss in group A was significantly lower than that in group B (mean, 7.9 ± 5.3 vs. 22.9 ± 11.5 ml; P = 0.001). Duration of drain placement in group A was significantly lower than that in group B (mean, 3.5 ± 1.1 vs. 5.0 ± 0.9 days; P = 0.01), and the seroma rate in group A was lower than that in group B (23% vs. 66%; P = 0.04). Conclusions: For axillary lymph node dissection, the harmonic scalpel is more effective in terms of resection time, blood loss, duration of drain placement, and postoperative seroma formation.

Comment to: First laparoscopic totally extraperitoneal repair of Laugier’s hernia: a case report. Ates M, Dirican A, Kose E, Isik B, Yilmaz S. Hernia 2013; 17:121–123

I read with interest the recent case report of Ates et al. [1] regarding laparoscopic totally extraperitoneal (TEP) repair of Laugier’s hernia and would like to take this opportunity to add few comments. The authors made a very important remark that ‘the surgeon should be alert to the possibility of an atypical femoral hernia when examining patients with inguinal hernias’ and this statement is even more relevant in female patients who carry a significantly higher risk of having a synchronous femoral [2], or less commonly obturator hernia. In a personal prospectively maintained database on 582 patients undergoing TEP repairs for inguinal hernias, out of 540 male patients who had 763 repairs an obturator hernia was incidentally identified in only 3 explored groins (0.4 %), whereas the same combined anomaly was found in 5 out of 52 inguinal hernia repairs (9.6 %) in the remaining 42 female patients. In comparison, I only came across two patients initially consented for a TEP repair of bilateral inguinal hernias that were incidentally found to have an associated Laugier’s hernia at time of surgery. Both repairs were completed laparoscopically and a photographic representation of the first case can be seen in a recently published article [3]. This reinforces the increasing observation that a laparoscopic approach may offer further advantages over traditional inguinal herniorrhaphy as it can also allow simultaneous repair of occult contralateral inguinal [4], synchronous femoral [5] or obturator [6] hernias. It is therefore extremely important to possess a thorough anatomical knowledge of the pelvis and groin regions as viewed through the laparoscope, but also to systematically and carefully expose all potential hernial defects such as the obturator foramen and femoral canal. This only comes at the cost of quite a steep learning curve [7] that will eventually allow the surgeon to master every aspect of this challenging procedure [8]. Once a synchronous groin/pelvic hernia has been identified, it may also become quite convenient to be familiar with few extra technical tricks that could be of significant value for a successful clinical outcome. I would like to illustrate this with the presentation of my second patient, at the time 54 years of age, who was incidentally diagnosed with multiple groin defects. During a standard TEP approach and following reduction of bilateral indirect inguinal hernia sacs and right femoral hernia, a synchronous previously undiagnosed smaller left-sided femoral hernia was identified along with the presence of an additional, quite distinct and substantial defect that had formed through the lacunar ligament on the right side (Laugier’s hernia). The Laugier’s hernia was reduced (Fig. 1a, b) and remaining defect closed using the previously described Endoloop technique (Fig. 1c) [9] in order to minimize the risk of postoperative seroma formation. Similarly, the right femoral canal was plugged using a small size prosthetic mesh (Perfix Plug, Bard, Warwick, RI, USA) that was simply glued in place using fibrin sealant [TISSEEL (Fibrin Sealant), Baxter, Deerfield, IL, USA] (Fig. 1d). Finally, two anatomical meshes of polyester with lateral slit (Parietex Anatomical Mesh 15 9 10 cm, TECT 1510 ADP2, Covidien, Mansfield, MA, USA) were used to cover all defects and also fixed with fibrin sealant as This comment refers to the article available at 10.1007/s10029-011-0820-2.

Impact of Ultrasonically Activated Scalpel on Thyroid Surgery

Objective: This prospective study was designed to evaluate the feasibility and outcome of thyroidectomy using Ultrasonically Activated Scalpel (UAS) in comparison to the conventional thyroidectomy. Patients and Methods: This study comprised 40 patients with mean age 41.4 ± 9 years, divided into two groups: Group A comprised 25 patients underwent thyroidectomy using UAS and 15 patients underwent conventional thyroidectomy (Group B). Both groups were compared as regards operating time, operative blood loss, postoperative seroma formation and surgeons’ satisfaction regarding the ease of dissection, need of blood vessel ligation and dryness of the surgical field. Results: Mean operative time was significantly shorter in group A (77 ± 5.8 minutes) compared to group B, (105.7 ± 6.5 minutes). Intraoperative blood loss showed a significant reduction in group A, (85 ± 5.4 gm) compared to group B (125.3 ± 7.8 gm). There was a positive significant correlation between the reduction of intraoperative blood loss and operating time in both groups despite being more significant in group B. Mean total surgeons’ satisfaction scores showed a significant difference in favor of satisfaction by using UAS. Conclusion: The use of UAS for thyroidectomy is feasible and could minimize intraoperative bleeding with shorter duration of surgery and had achieved significant surgeons’ satisfaction.

Does Fibrin Sealant Reduces the Seroma after Immediate Breast Reconstruction Utilizing a Latissimus Dorsi Myocutaneous Flap?

INTRODUCTION: The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is the seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation and we have investigated where there was a statistically significant difference in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of latissimus dorsi harvested for immediate breast reconstruction after skin sparing partial mastectomy. METHODS: Total 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. 23 patients were performed without fibrin sealant and other 23 with the use of fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed as to the potential benefits of fibrin sealant. The correlation analysis and Mann/Whitney test were used for the analysis of drainage volume according to age, weight of breast specimen and body mass index. RESULTS: Although statistically not significant, the cumulative drainage fluid volume showed higher in control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage from postoperative day 3 (Figure 1). Comparing the donor site, the fibrin sealant group showed more drainage from postoperative day 3 and the drain was removed 1 day faster in the control group (Table 1).Figure 1: Volume of drain output during two weeks.Table 1: Comparison of outcome measureCONCLUSION: The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits from the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with the patients before its use, as a part of informed consent.

Does Fibrin Sealant Reduce Seroma after Immediate Breast Reconstruction Utilizing a Latissimus Dorsi Myocutaneous Flap?

BackgroundThe most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy.MethodsA total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index.ResultsAlthough not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group.ConclusionsThe use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.

Abdominoplasty Seroma Prevention with Fibrin Sealant

Abdominoplasty is among the most commonly performed procedures in plastic surgery. Complications reported after abdominoplasty include pulmonary embolism and seromas. The abdominoplasty paradox is that postoperative patient and flap immobilization may diminish seroma formation but may also predispose the patient to embolism. Early mobilization may prevent the latter but increase the risk of seroma. Commercially available fibrin sealants can create flap adherence, reducing the risk of seroma formation, while at the same time allowing early ambulation. In this article we retrospectively review 55 consecutive ambulatory abdominoplasty procedures using intraoperative aerosolized commercial fibrin sealant for flap adhesion. Minimum follow-up was 24 days. No postoperative seromas occurred. Results indicate that fibrin sealants can help prevent postoperative seroma formation in abdominoplasty surgery. No complications or untoward side effects are reported. The application of sealant product requires proper in-service and technique.

Body Contouring in the Male Weight Loss Population

Growing numbers of men are presenting for consultation and potential postbariatric body contouring surgery. Due to concerns about whether men might have increased rates of complications or dissatisfaction with aesthetic surgery, the authors assessed their clinical experience with male patients. The authors examined male patients in their prospective database who had undergone body-contouring surgery. Chi-square analysis, regression analysis, and a binary logistic regression model were used to study categorical variables, surgical outcomes, continuous variables, and significant factors. Odds ratios were calculated. Of 481 patients, 48 (10 percent) were male. There were no significant differences in baseline comorbidities between the genders, except that women had a higher incidence of anxiety/depression. Men had a greater weight loss before body-contouring surgery, but this did not correlate with greater operative time or estimated blood loss. Male gender, however, was associated with a 14.6 percent incidence of postoperative hematoma and a 25 percent incidence of seroma, in contrast to female gender, with 3.5 and 13 percent, respectively. Logistic regression showed that male gender was associated with an increased incidence of hematoma, seroma, and postoperative complications. It was an independent risk factor for hematoma and seroma formation, with odds ratios of 3.76 and 2.65, respectively. Gender was not an independent predictor of wound dehiscence, flap loss, transfusion, or surgical-site infection. Men who are considering body-contouring surgery should be advised that they are at an increased risk of postoperative hematoma and seroma formation. The causal relationship between gender and postoperative complications is an area for further study. Risk, II.

Microvascular Breast Reconstruction and Lymph Node Transfer for Postmastectomy Lymphedema Patients

Postoperative lymphedema after breast cancer surgery is a challenging problem. Recently, a novel microvascular lymph node transfer technique provided a fresh hope for patients with lymphedema. We aimed to combine this new method with the standard breast reconstruction. During 2008-2010, we performed free lower abdominal flap breast reconstruction in 87 patients. For all patients with lymphedema symptoms (n = 9), we used a modified lower abdominal reconstruction flap containing lymph nodes and lymphatic vessels surrounding the superficial circumflex vessel pedicle. Operation time, donor site morbidity, and postoperative recovery between the 2 groups (lymphedema breast reconstruction and breast reconstruction) were compared. The effect on the postoperative lymphatic vessel function was examined. The average operation time was 426 minutes in the lymphedema breast reconstruction group and 391 minutes in the breast reconstruction group. The postoperative abdominal seroma formation was increased in patients with lymphedema. Postoperative lymphoscintigraphy demonstrated at least some improvement in lymphatic vessel function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased in 7 of 9 patients. Physiotherapy and compression was no longer needed in 3 of 9 patients. Importantly, we found that human lymph nodes express high levels of endogenous lymphatic vessel growth factors. Transfer of the lymph nodes and the resulting endogenous growth factor expression may thereby induce the regrowth of lymphatic network in the axilla. No edema problems were detected in the lymph node donor area. Simultaneous breast and lymphatic reconstruction is an ideal option for patients who suffer from lymphedema after mastectomy and axillary dissection.

The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach

Seroma is a frequent complication of endoscopic totally extraperitoneal (TEP) mesh repair of direct inguinal hernia that may cause discomfort and anxiety. Its volume is proportional to the size of the preperitoneal dead space created after the reduction of the hernia. Attempts to reduce its incidence have included tacking the transversalis fascia (TF) to the pubic ramus or closed suction drainage of the preperitoneal space. Both of these techniques are not without problems. The aim of this study was to evaluate the efficiency of a new alternate technique that must be safe and easily reproducible, using a widely available and inexpensive pre-tied suture loop (Endoloop(®) Ligature) for plication of the weakened TF. This is a prospective study of consecutive patients diagnosed with inguinal hernia during a 33-month period and eligible for endoscopic TEP repair. A single surgeon performed all operations. Each of the M2 or M3 direct defects, according to the European Hernia Society (EHS), were systematically closed prior to the introduction of the prosthetic mesh and as follows: grasping and inversion of the attenuated TF at its apex, using a laparoscopic forceps and plication of the TF by placing a tight Endoloop of Polydioxanone (PDS) at its base. All meshes were secured with fibrin sealant only. Patients were reviewed in the clinic 2 and 6 weeks after the operation. Further follow-up was scheduled if it was deemed necessary. The primary post-operative outcome parameter was seroma formation; secondary outcome parameters included groin pain, surgical complications, and recurrence. Two hundred and fifty hernia repairs were prospectively recorded during this period. All procedures were carried out endoscopically. Seventy-nine patients with 94 direct inguinal hernias were selected in a sequential manner. There were 75 males and four females, with a median age of 57 years. Of those, 55 were combined with an indirect inguinal defect. In total, Endoloops of PDS were used to close the weakened TF in 76 cases (30 M3, 44 M2, and two M1). Only one patient (1.3%) complained of a residual seroma formation, which was still clinically present at 3 months post-operatively, but was not symptomatic. There were only two minor post-operative complications, which occurred in the same patient and were not related to the Endoloop technique. Finally, no patient complained of chronic groin pain and there was no hernia recurrence after a median follow-up of 18 months. The primary closure of direct inguinal hernia defects with a pre-tied suture loop during endoscopic TEP repair is safe, efficient, and very reliable for the prevention of post-operative seroma formation, without increasing the risk of developing chronic groin pain or hernia recurrence. This technique should be the preferred method over stapling of the TF or the insertion of a closed suction drainage device in such a situation.

Scarpa Fascia or Rectus Fascia in Abdominoplasty Flap Elevation: A Prospective Clinical Trial

Postoperative seroma formation remains the most frequent complication after full abdominoplasty. This study aimed to evaluate postoperatively the formation of a minor seroma when the superficial fascia is used for preparation. The study enrolled 50 patients who underwent a full abdominoplasty with umbilicus transposition between February 2008 and February 2010. The patients were alternated to the scarpa group or the rectus group. The two groups differed in terms of postoperative seroma formation and amount of average drain output. Scarpa fascia preservation seems to reduce postoperative seroma formation. The mechanism of the decreased fluid collection is not clear and needs further investigation.

Excision of apocrine glands and axillary superficial fascia as a single entity for the treatment of axillary bromhidrosis

Surgical excision of apocrine glands is the effective treatment for axillary bromhidrosis. Skin necrosis, the most serious adverse result observed postoperatively, results in a prolonged wound healing and leads to unsightly scars in the axillary fossae. It is mainly caused by the skin damage during the operation and postoperative seroma or haematoma formation. To investigate the effects and complications of our surgical modality for axillary bromhidrosis. Sixty-three patients with bromhidrosis were treated. An incision about two-thirds of the length of the widest transverse diameter was made on the axillary crease. The loosened layers between the dermis and axillary superficial fascia containing apocrine glands were carefully undermined with an iris scissor. The entire apocrine glands-axillary superficial fascia complex was dissected from the centre to the superior and inferior margins with an electrosurgical pencil. Of the 126 axillae, malodour was eradicated in 112 axillae and reduced sharply in 14. There were three cases of skin necroses. The Dermatology Life Quality Index score decreased significantly and the quality of life improved after the operation. Our surgical technique can achieve minimal tissue damage and maintain no hematoma postoperatively. The rate of skin necrosis was low. Quality of life improved after the procedure in this patient population.