Kneser, Ulrich

AbstractIntroductionClosed incision negative‐pressure therapy (CINPT) has been shown to shorten the time to heal in post‐bariatric abdominoplasty and to lower seroma rates in cosmetic abdominoplasty. The objective of this study was to assess the effect of CINPT on donor‐site morbidity following abdominal‐based free‐flap breast reconstruction.Patients and MethodsWe reviewed medical records from 225 women who had undergone 300 microsurgical free‐flap breast reconstructions from the abdomen from November 1, 2007 to March 31, 2019. Patients were grouped according to wound therapy, including 127 patients in the standard of care group and 98 patients in the CINPT group. Primary outcomes were minor (non‐operative) and major (operative) surgical site complications. Secondary outcomes were time to drain removal, in‐hospital length, and scar quality.ResultsAnalysis of patient demographics showed an equal distribution with regard to the age, smoking status, prevalence of diabetes mellitus, preoperative chemotherapy, and previous abdominal surgery in both groups. Significantly more patients with obesity (29.6 vs. 15.8%; p = .01) and bilateral breast reconstruction (40.8 vs. 27.6%; p = .04) were included in the CINPT group. Compared to standard of care, the CINPT group had a lower incidence of major surgical site complications (26.0 vs. 11.2%; p = .001). There was no difference in minor surgical site complications and secondary outcomes between groups.ConclusionThe CINPT represents a reliable tool to reduce surgical site complications on the abdominal donor‐site in abdominal‐based free‐flap breast reconstruction.

BackgroundMicrosurgical free flaps for reconstruction of soft tissue defects in lower extremity have evolved into a reliable procedure over last decades; however, there lacked high level of evidence.MethodsA systematic literature research was performed including studies between 2000 and 2014 in English, German, and Chinese (PubMed, EMBASE). Publications were selected applying inclusion/exclusion criteria. Postoperative complications were statistically analyzed with metaprop command of R GUI 3.0.1.ResultsAlltogether 30 articles overlooking 1,397 free flaps were included. The rate of total flap loss was 6.0% (95% confidence interval [CI] = 4.0%–8.0%, PQ (P values of Q statistics) = 0.03); the thrombosis rate was 6.0% (95% CI = 4.0%–9.0%, PQ = 0.01); the hematoma rate was 4.0% (95% CI = 3.0%–5.0%, PQ = 0.79); the partial necrosis rate was 6.0% (95% CI = 4.0%–10.0%, PQ < 0.01); the early infection rate was 4.0% (95% CI = 2.0%–6.0%, PQ = 0.03), and the dehiscence rate was 3.0% (95% CI = 2.0%–5.0%, PQ = 0.12). Reconstruction for diabetic foot may be not associated with a significant increase of procedural risk (Total flap loss rate = 6%, 95% CI = 3.0%–9.0%, PQ = 0.44).ConclusionsMicrosurgical reconstruction of soft tissue defects in the lower extremity reconstruction could be regarded safe and reliable. A standardization of report of perioperative parameters and clinical outcomes is needed. © 2016 Wiley Periodicals, Inc. Microsurgery 36:511–524, 2016.