ABSTRACT
PURPOSE: We aim to determine the natural history of the ACE in idiopathic constipation and factors predictive of closure. METHODS: A retrospective case-note review of all patients undergo ACE formation for idiopathic constipation Jan 2003-Mar 2016. Kaplan-Meier analysis was used to determine ACE survival and Cox's proportional hazard models to examine potential predictors of closure. RESULTS: 29/84 (35%) ACEs were closed: 21/84 due to success and 8/84 due to failure. Median age of closure was 15.5 years (3.5-23.6). Median ACE survival was 77.0 months (95% CI 58.0-96.0). An ACE survival curve was derived from which we estimate that 5-year post-ACE, one-third of patients can expect to have had their ACE closed. Younger age at ACE was predictive of earlier closure (p = 0.023) and closure for success (p < 0.001). Neither patient sex (p = 0.546) nor presence of psychological comorbidities (p = 0.769) predicted likelihood of closure. Incontinence 6-week post-ACE was also associated with increased likelihood of closure (p = 0.042). CONCLUSION: The ACE survival curve estimates the proportion of patients with idiopathic constipation who can expect closure (either due to success or failure) at certain timepoints. This may be useful for patient counseling. Younger age at ACE was associated with earlier closure (for success).
Subject(s)
Constipation/therapy , Enema/methods , Fecal Incontinence/epidemiology , Surgical Stomas , Adolescent , Child , Child, Preschool , Constipation/physiopathology , Fecal Incontinence/etiology , Female , Follow-Up Studies , Humans , Incidence , Kaplan-Meier Estimate , Male , Retrospective Studies , Time Factors , Treatment Failure , Treatment Outcome , Young AdultSubject(s)
Breast Neoplasms/drug therapy , Mammaplasty/methods , Myocutaneous Flap , Venous Thromboembolism/prevention & control , Abdomen/surgery , Anticoagulants/therapeutic use , Antineoplastic Agents, Hormonal/administration & dosage , Breast Neoplasms/surgery , Data Collection , Early Ambulation , Female , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Intermittent Pneumatic Compression Devices , Mammaplasty/adverse effects , Stockings, Compression , Tamoxifen/administration & dosage , Venous Thromboembolism/etiology , Withholding TreatmentABSTRACT
BACKGROUND: Whilst soft tissue closure is the priority to prevent infection in open fractures of the lower limb, some patients find that bulky flaps interfere with function and dislike the appearance. We report the outcomes of delayed free anterolateral thigh flap thinning with liposuction. MATERIAL AND METHODS: 38 patients treated between 2006 and 2009 were offered flap contouring. 23 chose flap thinning and 15 did not. We measured outcomes using the SF-36v2 questionnaire and cosmetic outcome scores pre and postoperatively at a mean follow up of 12 weeks (range 10-16 weeks). RESULTS: SF-36v2 physical health (PH) scores improved from a mean of 67 preoperatively to 80 postoperatively (p = 0.01) in the thinned group, while mental health (MH) scores remained unchanged (74-72). The mean SF-36v2 scores for the non-thinned group were 77 (PH) and 86 (MH). Following liposuction the median cosmetic outcome scores out of 5 improved from 1 (not at all satisfied) to 4 (very satisfied) postoperatively (p = 0.0005), which was also higher than the non-thinned group (3) [moderately satisfied], p = 0.004). There was no difference in sex, age, BMI and region on the leg of free flap reconstruction between the non-thinned and thinned groups. CONCLUSIONS: Delayed contouring of free ALT flaps used for lower limb reconstruction results in improvements in physical health measures and cosmetic outcomes. Patients not requesting thinning are generally satisfied with their reconstruction.