[Show abstract][Hide abstract] ABSTRACT: A técnica de anastomose microcirúrgica é desafiadora e requer treinamento extenso, dedicação e tempo. Os autores descrevem um modelo de treinamento acessível, prático e fácil, que utiliza retalho abdominal proveniente de abdominoplastias. O calibre dos vasos epigástricos superficiais encontrados nos retalhos abdominais excisados variou de 1,2 mm a 2 mm, dependendo do índice de massa corporal da paciente no pré-operatório. Esse retalho permitiu o treinamento de anastomoses microcirúrgicas em vasos de diferentes calibres. Esses vasos permaneciam com pequena quantidade de sangue em seu lúmen, o que permitia testar a qualidade e a patência das anastomoses. Esse modelo de treinamento em vasos abdominais humanos, quando comparado aos modelos animais ou inanimados, permite transição mais rápida e real aos pacientes. A prática de dissecção e de anastomoses terminoterminais e terminolaterais de uma maneira efetiva e prática aperfeiçoa a destreza cirúrgica.
[Show abstract][Hide abstract] ABSTRACT: The volume-outcome relationship has not been specifically measured for U.S. autologous breast reconstruction. The authors studied whether there is a relationship between hospital procedural volume and perioperative complication rates.
The authors identified (1) patients who underwent total mastectomy with immediate autologous reconstruction from 1998 to 2010 and (2) a subset of microsurgical cases from 2008 to 2010. Hospitals were categorized into quartiles based on number of yearly procedures. Outcomes included surgery-specific and systemic complications. A multivariable model was used to analyze the volume-outcome relationship after adjusting for other variables.
Over the 13-year study period, 21,016 immediate autologous reconstructions were recorded. Surgery-specific and systemic complication rates were 13.0 and 7.5 percent, respectively. Ninety-two percent of centers perform a very low (fewer than nine cases per year) or low (nine to 20 cases per year) number of procedures. The highest-volume centers (>44 cases per year) are located in metropolitan areas. An inverse relationship between reconstructive volume and surgery-specific and systemic complications was identified (p < 0.01). In the multivariable analysis, centers with very low, low, and medium case volumes were more likely to have surgery-specific complications than high-volume centers (p < 0.01). Very-low-volume compared with high-volume centers were more likely to have systemic complications (p < 0.01).
Higher volume autologous breast reconstruction centers have lower complication rates. The volume-outcome relationship is stronger for surgery-specific than for systemic complications. Geographic disparities are present in the distribution of high-volume centers. Such information can be used to inform best practices and improve access to care.
Plastic and Reconstructive Surgery 08/2013; 132(2):192e-200e. DOI:10.1097/PRS.0b013e31829586c1 · 2.99 Impact Factor
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