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Ehlers-Danlos syndrome:prevalence and outcomes in gender affirming surgery-a single institution experience

Plastic and Aesthetic Research 2022年第1期9卷 605-613页

作者： Alireza Najafian Isabel Cylinder breanna jedrzejewski Craig Sineath Zbigniew Sikora Leigh H.Martin Daniel Dugi Geolani W.Dy Jens Urs Berli Division of Plastic Surgery Department of General SurgeryOregon Health&Science UniversityPortlandOR 97239USA Department of Urology Oregon Health&Science UniversityPortlandOR 97239USA

Aim:Patients with Ehlers-Danlos Syndrome(EDS)are considered to have an increased risk for wound healing complications.Surgeons may therefore be hesitant to offer elective surgeries,including gender-affirming surgeries(GAS),to EDS patients.At our center,we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS.This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods:This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020.Data include EDS diagnosis,demographics,operation,and complications(including minor wound healing issues).Results:Of 1363 patients presenting for GAS,36(2.6%)had EDS diagnoses and were matched with 108 control patients.Major complications requiring surgical intervention in the OR occurred in 6 patients(4.2%),(2.8% EDS vs.5.4%controls;P=0.63),while 8.3% of EDS and 14% of controls required minor interventions(P=0.38).The rate of wound healing issues of any severity was 28% in EDS vs.47% in control groups(P=0.04).Conclusion:The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population.Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group.Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS.Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis.

关键词： Ehlers-Danlos gender transgender gender affirmation surgery outcomes

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Abdominal wall procedures: the beneifts of prehabilitation

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Plastic and Aesthetic Research 2020年第2期7卷 37-50页

作者： Nathan Knapp breanna jedrzejewski Robert Martindale Division of Gastrointestinal and General Surgery Department of Surgery Oregon Health and Science UniversityPortlandOR 97239USA Division of Plastic and Reconstructive Surgery Department of SurgeryOregon Health and Science UniversityPortlandOR 97239USA

Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications.It includes interventions that optimize nutrition,glycemic control,functional status,and utilization of the patient's microbiome pre-,intra-,and postoperatively.Through a multidisciplinary and anticipatory approach to patients'existing co-morbidities,the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting.With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay,it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction.Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.

关键词： Prehabilitation perioperative optimization abdominal wall reconstruction minimize co-morbidities

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