Here - EWMA 2013

FREE PAPER SESSION: MISCELLANEOUS
Free Paper Session: Miscellaneous
138
Adjuvant chemotherapy reduces the incidence of abdominal
hypertrophic scarring following immediate TRAM breast
reconstruction
Eun Key Kim 1 , Woo Shik Jeong 1 , Jin Sup Eom 1 , Taik Jong Lee 1
1 Asan Medical Center (Seoul, Korea).
Aim: Among the many factors that affect the degree of completion and satisfaction of
breast reconstruction, the scarring is one issue that a surgeon cannot completely
control. We hypothesized that the administration of cytotoxic drugs following the
immediate breast reconstruction using transverse rectus abdominis musculocutaneous
(TRAM) flap might affect the process of scarring, thus resulting in reduced incidence of
hypertrophic scarring at the donor site.
Methods: Data have been collected from 1,000 consecutive patients between July 2001
and December 2009. The relationship between the adjuvant chemotherapy and the
incidence of hypertrophic scarring was studied and the influence of other presumed risk
factors was analyzed.
Results: The incidence of hypertrophic scarring was 18.6% (75 of 404) in the non-CTX
group and 3.8% (20 of 530) in the CTX group. Univariate analysis using logistic
regression modeling confirmed the statistical significance of the reducing effect of
chemotherapy on the incidence of hypertrophic scarring (p < 0.001; OR: 0.172).
Conclusions: The incidence of donor site hypertrophic scarring following immediate
TRAM breast reconstruction was found in nearly 20% of the patients without
chemotherapy, showing a significant difference from the patients with chemotherapy. We
believe that Asian patients who undergo immediate TRAM breast reconstruction without
chemotherapy are a high-risk group that is prone to hypertrophic scarring, requiring
active preventive measures.
139
Free Paper Session: Miscellaneous
QUALITY OF CARE OF PATIENTS WITH CHRONIC LYMPHOEDEMA BASED ON
GUIDELINES AND PATIENT-REPORTED OUTCOMES.
Matthias Augustin 1 , Christine Blome 1 , Katharina Herberger 1 , Kristina Heyer 1 ,
Angelika Sandner 1 , Friederich Altheide 2 , Karl Christian Münter 3 , Wolf Rüdiger Gottlieb 3 ,
Sebastian Debus 4
1 Institute for Health Services Research in Dermatology and Nursing, University Clinics of
Hamburg (Hamburg, Germany);
2 Dermatology practice (Hamburg, Germany);
3 Phlebology practice (Hamburg, Germany);
4 Clinic for Vascular Surgery, University Clinics of Hamburg (Hamburg, Germany).
Aim: Management of lymphoedema is complex and should be conducted according to
evidence-based guidelines. To date, no data assessing quality-of-care in lymphoedema
in Germany are available. Thus, the aim of this study was the evaluation of quality-ofcare
of lymphoedema in the metropolitan area of Hamburg using guideline-based
indicators.
Methods: Cross-sectional, community-based study including patients with chronic
lymphoedema or lipoedema of any origin. Patients were approached in all sectors of
ambulant and inpatient care of the region within the study period. Assessment included a
structured interview, clinical examination and patient-reported outcomes. 12 quality
indicators were derived from guidelines by a national Delphi consensus. Furthermore,
health care quality was reflected by the patients’ health-related quality of life, as
measured by the validated Freiburg life quality assessment (FLQA) for lymphedema.
Results: 348 patients (median age 60.5 years) with lymph- (66.4%), lip- (9.5%) or
combined oedema (24.1%) were included. 86.4% performed compression therapy,
85.6% received lymphatic drainage. On average, 55% of the quality-of-care criteria were
met, 64.8% of patients were satisfied with care. The distribution curve of the health care
index was almost normal. Treatment by specialists was associated with a significantly
higher quality-of-care index.
Conclusion: Although overall quality-of-care in lymphoedema in the Metropolitan area of
Hamburg is adequate, many patients are not treated properly according to guidelines.
Accordingly, the early detection of patients with lymphedema and subsequent
presentation to a specialist in lymphology is essential.
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
89