Medical Case Reports

Introduction

Immunosuppressive medications are essential to treatment, such as in patients with autoimmune diseases or after organ transplantation. They delay wound healing by modulating the immune response against the body's own structures, putting these patients at risk for surgery. This Immunosuppressed Patients (IP) requires and elective procedures for plastic and reconstructive surgeons, but the individual risks for complications are unclear. The unfavorable impacts of corticosteroids are broadly reported. To decide the various effects of intense and constant foundational admission of corticosteroids on injury mending, Wang et al. analyzed a number of studies conducted between 1949 and 2011. They came to the conclusion that, particularly if corticosteroids were given at least 30 days prior to surgery, chronic systemic intake increased the rates of complicated wound healing. When compared to patients who do not take corticosteroids, wound complications may rise by as much as two to five times with prednisone doses of 40 mg or more per day. Wound healing is negatively impacted by calcineurin inhibitors like cyclosporine A and tacrolimus, mTOR inhibitors like sirolimus and everolimus, and antimetabolites like mycophenolate mofetil and azathioprine, among other immunosuppressive medications. Dean and co. further categorized the renal allograft recipients into two groups to compare the rates of wound healing complications; patients who received sirolimus as opposed to those who received tacrolimus. Complications with the wound occurred in 47% of the sirolimus group and 8% of the tacrolimus group. In addition, they observed a significant rise in the rates of wound complications in patients with a high Body Mass Index (BMI), particularly when sirolimus treatment was used in conjunction with it.

Various Autoimmune Diseases

Immunosuppression is currently an essential component of treatment for patients receiving solid organ transplants or those suffering from various autoimmune diseases. These patients may require plastic surgery as a result of trauma or other factors. In addition to plastic reconstructive surgery, more and more immunosuppressed patients are undergoing plastic aesthetic procedures. The number of successful organ transplants is dramatically rising. As a result, life expectancy rises, as does the need for cosmetic procedures to enhance one's physical appearance and quality of life. When compared to emergency procedures, these elective aesthetic procedures typically result in fewer complications. Transplant recipients can be risk-free candidates for aesthetic surgery if they are carefully selected and treated by a multidisciplinary team.

The patient's immunosuppressive treatment should be well controlled to prevent complications during wound healing. Cofactors like BMI and comorbidities should be taken into account individually. A delicate medical procedure method is reasonable to stay away from postoperative entanglements. However, it is still essential to provide in-depth patient counseling regarding the potential dangers posed by immunosuppression. Using a matched pair analysis and the unique perspective of plastic surgery, the purpose of this study was to compare and contrast the postoperative outcome of immunosuppressed and untreated patients. We selected 54 patients who underwent plastic and reconstructive surgery in our Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery between 2007 and 2019 using the hospital information system SAP. Due to a variety of autoimmune diseases or organ transplants, each of these patients was taking immunosuppressive medications perioperatively. The patient's clinical data was acquired through definite investigation into every individual's clinical records including clinical history, nursing reports, release letters, and activity reports and conventions. In addition to the rate of complications, revisions, and lengths of stay in the hospital, data were gathered on drug intake, etiology, and surgical indication (trauma, tumor, and other). For the matched matching cycle, the vitally German Activity and Methodology Characterization Framework Code (Operations) were distinguished for every patient out of the emergency clinic coding framework (see supplemental information). The hospital data warehouse provided cases with the same OPS-Code but without immunosuppression as comparable controls for each of the 54 main procedures. From these 2589 cases, age, sex, and procedure information were used to match 2245 different patients. The most closely related OPS code was accepted for patients for whom there was no suitable control patient with exactly the same OPS code. In order to guarantee the comparability of surgical procedures, photographic documentation of the surgery area during the procedure as well as details from the operation report, such as the duration of the procedure, was examined.

Cacineurin Inhibitors

We stop taking or reduce the dose of mTOR inhibitors, such as sirolimus and everolimus (half-lives 6 days and 30 hours), 7-14 days before planned surgery to reduce the risk of postoperative complications. On the day before surgery, mycophenolate mofetil, which has a half-life of 17 hours, is stopped or reduced in dose, while cacineurin inhibitors like tacrolimus and cyclosporine an are continued after surgery. Prednisolone 15 to 20 mg once a day is used in place of immunosuppressant if the risk of organ rejection is moderate or high. The stopped immunosuppressant ought to just be re-managed after injury mending is finished. In all cases, the following standard operating procedures were followed: Amoxicillin or clindamycin were used for allergy-related perioperative antibiotic prophylaxis. Starting with polyglactin-based resorbable deep cutaneous sutures, the skin was closed in two to three layers depending on the thickness. The shallowest layer was shut by means of running resorbable stitches (polyglecaprone) or with non-resorbable single button stitches for folds, in the palmar or plantar locale or in the face (copolymer polyamide). In areas of the hands or face, skin transplants were held in place with staples or resorbable sutures. Postoperative agony was overseen routinely as indicated by the WHO with one or the other ibuprofen, or paracetamol joined with novalgin and hydromorphone. The primary and secondary endpoints of the study were the onset of impaired wound healing and the necessity of a reoperation, respectively. The length of stay in the hospital was the secondary endpoint. In addition to the descriptive parameter analysis, inferential statistics were used to identify relevant risk factors for impaired outcome and higher injury grades. The Kolmogorov-Smirnov test was used to look at how continuous data were distributed.