Increased intraabdominal pressure in abdominoplasty: delineation of risk factors.
*Pressure; Abdominal Cavity/*physiopathology; Abdominal Wall/physiopathology/*surgery; Adult; Body Mass Index; Female; Humans; Linear Models; Lipectomy/*adverse effects; Middle Aged; Morbid/*surgery; Nonparametric; Obesity; Pilot Projects; Postoperative Complications; Probability; Prognosis; Prospective Studies; Rectus Abdominis/surgery; Risk Assessment; Statistics; Treatment Outcome
BACKGROUND: Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which components of the abdominoplasty procedure (i.e., general anesthesia, flexion of the bed, plication, and/or binder placement) may elevate intraabdominal pressures and whether this was clinically relevant. METHODS: Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position. RESULTS: All intraabdominal pressures measured were clinically insignificant (\textless20 mm Hg). A statistically significant increase was found from flexion of the bed (mean difference, 3.80 +/- 2.0, p \textless 0.001, in the control group; and 4.39 +/- 1.68, p \textless 0.001, in the study group); rectus plication (mean difference, 2.78 +/- 2.11, p = 0.001, in the supine position; and 2.03 +/- 2.48, p = 0.016, in the flexed position); and binder placement (2.63 mm Hg for no binder versus 4.5 mm Hg with binder, p = 0.004). Both groups also showed an increase from preoperative to skin closure (mean difference, 2.03 +/- 6.7, p = 0.035, for the control group; and 2.83 +/- 3.97, p = 0.031, for the study group), suggesting general anesthesia as a risk factor. CONCLUSIONS: This study confirms the effect of rectus plication on increasing intraabdominal pressures but also implicates bed position, binder placement, and general anesthetic as risk factors. A larger study is needed to clarify the role of these variables in elevating intraabdominal pressure during abdominoplasty.
Huang Georgeanna J; Bajaj Anureet K; Gupta Subhas; Petersen Floyd; Miles Duncan A G
Plastic and reconstructive surgery
2007
2007-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.prs.0000254529.51696.43" target="_blank" rel="noreferrer noopener">10.1097/01.prs.0000254529.51696.43</a>
Analysis of the Pressure Distribution Qualities of a Silicone Border Foam Dressing.
*Bandages; *Pressure; *Silicones; Adult; Body Mass Index; Comparative Studies; Convenience Sample; Data Analysis Software; Descriptive Statistics; Female; Foam Dressings; Heel; Heel – Pathology; Human; Humans; Interface Pressure; Male; Middle Age; Models; Ohio; P-Value; Pearson's Correlation Coefficient; Pressure Ulcer – Prevention and Control; Pressure Ulcer/prevention & control; Prospective Studies; Regression; Silicones; Statistical; Supine Position; Surveys; T-Tests
PURPOSE: To determine whether application of a silicone foam dressing is associated with decreased interface pressures when applied to the heel. DESIGN: Prospective, within-subjects design. SUBJECTS AND SETTING: The study was conducted in a community-based hospital using a convenience sample of 50 healthy volunteers with a mean age of 39.6 years and mean body mass index of 26.6; 70% were female. METHODS: Application of the silicone border foam dressing was randomized between the left and right heels. Participants were asked to lie down in the supine position on a viscoelastic foam mattress. Interface pressure measurements were captured using a pressure mapping system; measurements were taken once with the dressing applied to the heel (intervention map) and once without (control map). Data were captured after a 4-minute time period allowing stabilization. Analysis was based on mean interface pressure; data points were collected for both heels in each of the 2 frames, yielding 4 observations per subject. RESULTS: Application of the dressing was associated with a significant decrease in average pressure measurements as compared to the heel with no dressing applied (P \textless .001). Application of the dressing did not impact pressure readings for the heel to which no dressing was applied (P = .53), and application of the dressing to either the left or right heel did not impact pressure readings (ie, the random effect was insignificant; P = .9). CONCLUSIONS: Application of a silicone border foam dressing is associated with significant reduction in interface pressure and may be considered as part of a pressure ulcer prevention program.
Miller Stephannie K; Sharma Neal; Aberegg Lauren C; Blasiole Kimberly N; Fulton Judith A
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/WON.0000000000000130" target="_blank" rel="noreferrer noopener">10.1097/WON.0000000000000130</a>