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Is Ehlers Danlos Syndrome a Contraindication to Elective Plastic Surgery?
R'ay Fodor, B.A.&Sc., Ying Ku, BS, Mazen Al-Malak, MD, Jacob Lammers, MD, Brian Figueroa, MD, Lianne Mulvihill, BA, Diane Jo, MA, Jose Reyes, BS, Ryan Khalaf, BS, Antonio Rampazzo, MD, PhD, Bahar Bassiri Gharb, MD, PhD.
Cleveland Clinic Department of Plastic Surgery
2023-02-10
Presenter: R'ay Fodor, B.A.&Sc.
Affidavit:
R'ay Fodor was the primary researcher for this project. He designed the study, coordinated data collection, conducted all the analysis, and wrote the abstract.
Director Name: Frank Papay
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND: Ehlers Danlos Syndrome (EDS) is considered a relative contraindication to elective plastic surgery, but data regarding risks are inconsistent. This study aimed to evaluate the safety of plastic surgery in EDS patients.
METHODS: A retrospective study of all EDS patients who underwent elective plastic surgery at a single institution between 2003-2022 was conducted. Demographics, comorbidities, outcomes, and secondary procedures were recorded. Logistic regression was used to identify drivers of complication risk.
RESULTS: One-hundred-fourteen patients (97 female, 17 male) underwent 120 procedures. The mean age at surgery was 40.45±16.05years. Fifty-seven percent of patients had at least one preoperative comorbidity, the most common being obesity (31.56%), cancer (16.66%), and medications affecting wound-healing (14.91%). Complications were reported in 30% of patients (n=34); these included infection (8.77%), hypertrophic/atrophic scarring (8.77%), wound dehiscence (7.89%), seroma (4.39%), hematoma (4.39%), implant failure (4.39%), soft tissue necrosis (3.51%), and reconstructive failure (2.63%). Nine patients required reoperations due to seroma (n=2), hematoma (n=3), wound dehiscence (n=3), reconstructive failure (n=3), and soft tissue necrosis (n=3). The median number of reoperations required for complete complication resolution was 3[IQR:3.5]. Documentation of a patient's diagnosis of EDS during preoperative consultation was associated with significantly decreased risk of major complications (p=0.014). No other predictors were identified for reoperation. Cancer was the only significant predictor of minor complications (p=0.0062).
CONCLUSIONS: Patients with EDS had complication rates similar to those reported in patients without EDS. This prompts reconsideration of EDS' as a relative contraindication and suggests that awareness of an EDS diagnosis may reduce risk.
