ABSTRACT
Introducción y objetivo: Dentro del contexto de la pandemia COVID-19 del 2020 en nuestro país, el objetivo principal de este estudio es determinar la incidencia de contagios por SARS-CoV-2 en pacientes intervenidos por Cirugía Plástica en las Unidades o Servicios de Andalucía (España) en los tiempos pre y posoperatorios, mostrar si ha existido un incremento en la incidencia de complicaciones posquirúrgicas durante la pandemia, y si se han observado complicaciones relacionadas con el virus distintas a las ocurridas en períodos previos.Analizamos también la influencia del tipo de anestesia, tiempo quirúrgico o tipo de cirugía en los resultados y en la posibilidad de contagio.Material y método.Análisis observacional del comportamiento y evolución de los pacientes intervenidos en las Unidades de Cirugía Plástica de los hospitales de Sevilla, Málaga, Córdoba, Granada y Cádiz, entre el 9 de marzo y el 30 de abril de 2020. Recogimos datos relacionados con la infección por SARS-CoV-2 de 703 pacientes, incluyendo resultados de PCR y serología pre y posoperatorias y datos relacionados con el procedimiento quirúrgico, cuando fue posible. Todo el registro se realizó en una base de datos anonimizada común y analizados mediante el software estadístico SPSS®.Resultados.Todos los casos tuvieron un desenlace favorable, más del 96% de los pacientes no experimentaron ningún tipo de complicaciones y cuando aparecieron, se resolvieron con éxito. No se diagnosticaron entre ellos casos de SARS-CoV-2 y la duración de las intervenciones no se relacionó con mayor incidencia de contagio. Además, ninguno de los tipos de anestesia ni de las cirugías se relacionó con mayor incidencia de infección por este virus. (AU)
Background and objective: Within the context of the 2020 COVID-19 pandemic in our country, the main objective of this study is to determine the incidence of SARS-CoV-2 infections in patients operated on for Plastic Surgery in Units or Services in Andalusia (Spain) in the pre and postoperative times, show if there has been an increase in the incidence of postoperative complications during the pandemic, and if complications related to the virus other than those that occurred in previous periods have been observed. We also analyze the influence of the type of anesthesia, surgical time or type of surgery on the results and the possibility of contagion.Methods.Observational analysis of the behavior and evolution of patients operated on in the Plastic Surgery Units of the hospitals of Seville, Malaga, Córdoba, Granada and Cádiz, between March 9 and April 30, 2020. We collected data related to infection by SARS-CoV-2 of 703 patients, including pre and postoperative PCR and serology results and data related to the surgical procedure, when possible. All registration was carried out in a common anonymized database and analyzed using the SPSS® statistical software.Results.All the cases had a favorable outcome, more than 96% of the patients did not experience any type of complications and when they appeared, they were resolved successfully. No cases of SARS-CoV-2 were diagnosed among them and the duration of the surgeries was not related to a higher incidence of contagion. In addition, none of the types of anesthesia or surgeries were associated with a higher incidence of infection by this virus. (AU)
Subject(s)
Humans , Surgery, Plastic , Severe acute respiratory syndrome-related coronavirus , Coronavirus Infections/epidemiology , PandemicsABSTRACT
The aim of this paper is to identify risk factors associated with the development of osteosynthesis plates' related complications in fibula free flap reconstructions. This is a case series study of consecutive fibula free flaps. Clinical and radiological variables were recorded. Patient outcomes were evaluated with special attention to osteosynthesis plates' related complications; these included plate exposure, plate fracture, loosening of screws, non-union, bone resorption, oro-cutaneous fistulas, and bone exposure. We have done a descriptive analysis, univariate analysis, and multivariate logistic regression model to explore possible risk factors for osteosynthesis plates' related complications. Data analysis was performed using R software (version 3.5.0). 111 fibula free flaps were studied. 29 patients (26.1%) developed osteosynthesis plates' related complications. The mean time to osteosynthesis plates' related complications was 22 months; range (1-120); the median and mode were 12 months. Patients with preoperative radiotherapy (34% vs 14%, p = 0.021), and secondary reconstruction (31% vs 15%, p = 0.053) had a higher incidence of osteosynthesis plates' related complications. In the univariate analysis, "preoperative radiotherapy" (OR 3.07, 95%CI = 1.139-8.242, p = 0.025) and "extraoral soft-tissue defect" (OR 2.907, 95%CI = 1.032-8.088, p = 0.042) were risk factors for osteosynthesis plates' related complications. We have observed an interaction effect: patients with mandibular Brown's classes III + IV and "secondary reconstruction" have a higher risk for osteosynthesis plates' related complications; more than 47.30 times compared to Brown's class I and "primary reconstruction" (p = 0.026). Different factors may contribute to the development of osteosynthesis plates' related complications. Our study adds important information about these. Patients with higher risk of developing complications should be informed that a second intervention to remove the plates might be necessary.
