Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. Once the compartment pressure has been relieved and stabilized, the wound should be closed as quickly and early as possible to avoid later complications. Skin grafting can lead to morbidity and scarring at both the donor and fasciotomy site. Primary closure results in a more functional and esthetic outcome with less morbidity for the patient, but can often be difficult to achieve secondary to edema, skin retraction, and skin edge necrosis. Our objective was to examine fasciotomy wound outcomes, including time to definitive closure, comparing traditional wet-to-dry dressings, and the vacuum-assisted closure (VAC) device. This retrospective chart review included a consecutive series of patients over a 10-year period. This series included 458 patients who underwent 804 fasciotomies. Of these fasciotomy wounds, 438 received exclusively VAC. dressings, 270 received only normal saline wet-to-dry dressings, and 96 were treated with a combination of both. Of the sample, 408 patients were treated with exclusively VAC therapy or wet-to-dry dressings and 50 patients were treated with a combination of both. In comparing all wounds, there was a statistically significant higher rate of primary closure using the VAC versus traditional wet-to-dry dressings (P < 0.05 for lower extremities and P < 0.03 for upper extremities). The time to primary closure of wounds was shorter in the VAC. group in comparison with the non-VAC group. This study has shown that the use of the VAC for fasciotomy wound closure results in a higher rate of primary closure versus traditional wet-to-dry dressings. In addition, the time to primary closure of wounds or time to skin grafting is shorter when the VAC was employed. The VAC used in the described settings decreases hospitalization time, allows for earlier rehabilitation, and ultimately leads to increased patient satisfaction.

Patients with panniculus morbidus have an abdominal panniculus that becomes a pathologic entity, associated with the development of candidal intertrigo, dermatitis, lymphedema, and ischemic panniculitis. Panniculectomy is a standard treatment for this problem. The objective of this study was to determine risk factors for complications associated with panniculectomy surgery to lower the complication rate. We performed a retrospective chart review of patients who underwent panniculectomy between 1999 and 2007 by looking at data related to surgical complications, comorbidities, age, and gender. In 563 patients, we recorded the incidence of the following complications: wound-related (infection, dehiscence, and/or necrosis), hematoma/seroma, respiratory distress, blood transfusions, deep venous thrombosis or pulmonary embolism, and death. Overall, 34.3% of patients suffered at least 1 complication. In patients with wound complications specifically, there was a significantly higher body mass index versus those with no wound complications (43.7% vs. 30.7%, P < 0.0001). Smokers also had a higher rate of wound complications (40.5% vs. 19.5%, P < 0.0001).

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bACKGROUND: Lower abdominal tissue remains the gold standard for autologous tissue breast reconstruction. Lower abdominal flaps have evolved to reduce donor site morbidity, and have progressed from harvesting the entire rectus abdominis muscle (pedicled TRAM flap), to excising only a portion of muscle (free ms-TRAM flap), to only incising the muscle and fascia (DIEP flap), to using an alternative blood supply so that the rectus abdominis muscle and fascia are neither excised nor incised (SIEA flap).PURPOSe: This is a comparative study of the donor site function and outcomes of patients who have undergone SIEA flap, DIEP flap, or free ms-TRAM flap breast reconstruction. We investigate the postoperative morbidity, and examine patient perceptions, of abdominal donor site aesthetics, pain, and function. MeTHODS:A 2 item questionnaire was sent to elicit patient perceptions regarding abdominal donor site contour, pain, and function. A retrospective chart review was used to obtain demographic data and outcomes with regard to donor site and flap complications. ReSULTS: 79 patients from a 5 year period were included in the study. There were 26 unilateral breast reconstruction patients (24 SIEA, 23 DIEP, 79 ms-TRAM), and 53 bilateral reconstruction patients (6 SIEA/SIEA, 5 SIEA/DIEP, 7 SIEA/ms-TRAM, 8 DIEP/DIEP, 4 DIEP/ms-TRAM, 23 ms-TRAM/ms-TRAM). The survey response rate was 63% (2 respondents). There was no difference between responders and non-responders with regard to flap types, follow-up time, timing of surgery (immediate or delayed), BMI, smoking history, or diabetes. Unilateral SIEA flap patients had statistically significantly better postoperative lifting function compared to unilateral ms-TRAM flap patients (p=0.02), and a nearly significantly shorter duration of abdominal pain (p=0.06). Furthermore, unilateral SIEA flap patients showed a trend toward less pain, and higher functioning in 7 of 8 survey items. There was no difference in patient perceptions of abdominal contour between these two groups.In the bilateral reconstructions, patients with at least one SIEA flap had statistically better ability to get out of bed (sit-up motion) when compared to patients with bilateral ms-TRAM flap and/or DIEP flaps (p=0.02). Moreover, in all remaining 11 survey items, bilateral breast reconstruction patients with at least one SIEA flap trended to having better postoperative abdominal contour, less pain, and higher functioning than patients who had bilateral breast reconstruction with any combination of DIEP and/or ms-TRAM flaps.There was no detectable difference between the unilateral SIEA flap and unilateral DIEP flap patients with regard to postoperative abdominal contour, pain, or abdominal function. CONCLUSiONS:We conclude patients who have unilateral breast reconstruction with SIEA flaps have less donor site morbidity than similar patients who have reconstruction with a ms-TRAM flap. In addition, patients who undergo bilateral breast reconstruction with at least one SIEA flap have less donor site morbidity than patie...