INTRODUCTION: The incidence of hematoma following male rhytidectomy reported at our institution and by other groups ranges from 7.9 to 12.9%.1-4 In 1976, Berner et al 5 demonstrated that post-operative hypertension is a key etiological factor in hematoma formation, and recommended the use of thorazine post-operatively for blood pressure (BP) control. The objective of this study was to determine if the incidence of hematoma after male rhytidectomy had decreased at our institution since initiating a strict and aggressive perioperative BP control regimen.
MATERIAL & METHODS: A retrospective chart review was performed in 36 male patients who required surgical evacuation of hematoma after rhytidectomy over a twenty year period. Operative procedures were performed by over 100 different plastic surgery attendings, residents, and fellows. Age, medical history, medications, anesthesia, rhytidectomy technique ± combination of procedures, and length of operation were reviewed as well as pre-, intra-, and postoperative BP.
RESULTS: From 1982 to 2002, 848 male patients with a mean age of 61 (age range, 49 to 72), underwent rhytidectomies. The overall incidence of hematoma during this study period was 4.24 %. Age, medical history, medications, type of anesthesia, rhytidectomy technique ± combination of procedures, and length of operation were not independent risk factors for determining who was more likely to develop a hematoma after rhytidectomy. 33% of the patients with hematoma requiring surgical evacuation had systolic BP > 150 and diastolic BP > 90 mm Hg pre-, intra-, and post-operatively.
CONCLUSION: This is the largest single study reported on male rhytidectomy. Over a 30 year period, the incidence of hematoma requiring surgical evacuation at our institution has decreased from 8.7% to 3.97% after initiating a strict perioperative BP control regimen. Despite the lower incidence of hematoma following male rhytidectomy today as compared to 30 years ago, the incidence in men (3.97%) remains higher than in women (< 1-2%).
REFERENCES:
1. Pitanguy, I. et al: Ritidoplastia em homens Rev. Bras. Cir. 63: 209, 1973.
2. Baker, D.C., Aston, S. J., Guy, C.L., Rees, T.D. The male rhytidectomy. Plast. Reconstr. Surg. 60: 514, 1977.
3. Lawson, W. Naidu, R.K. The male facelift. An analysis of 115 cases. Arch. Otolaryngol. Head. Neck Surg. May; 119 (5): 535, 1993.
4. Grover, R., Jones, B.M., Waterhouse, N. The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts Br. J. Plast. Surg. Sep; 54(6): 481-6, 2001
5. Berner, RE, Morain, WD, Noe, JM. Postoperative hypertension as an etiological factor in hematoma after rhytidectomy. Prevention with chlorpromazine. Plast. Reconstr. Surg. 57(3): 314, 1976.
Incidence of hematoma requiring surgical evacuation following male rhytidectomy at the same institution (1966 - 2002).
|
Years |
Male Rhytidectomies |
Hematoma (Surgical) |
Hematoma Rate |
|
1966 - 1976 |
137 |
12 |
8.70% |
|
Implementation of strict perioperative BP control regimen |
|||
|
1982 - 1994 |
370 |
17 |
4.59% |
|
1995 - 2002 |
478 |
19 |
3.97% |