American Association of Plastic Surgeons

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Revisiting Ehlers Danlos Syndrome As A Relative Contraindication To Elective Plastic Surgery: A Retrospective Matched Cohort Study
R'ay Fodor, BASc, Riley Marlar, DO, Ying Ku, BS, Mazen Al-Malak, MD, Jacob Lammers, DO, Lianne Mulvihill, BA, Diane Jo, MA, Ryan Khalaf, BS, Jose Reyes, BA, Fuad Abbas, BS, Antonio Rampazzo, MD, PhD, Bahar Bassiri Gharb, MD, PhD;
Cleveland Clinic, Cleveland, OH, USA

PURPOSE: Ehlers Danlos Syndrome (EDS) is considered a relative contraindication to elective plastic surgery, but data regarding surgical risks are inconsistent. We hypothesized that the plastic surgical complication rate of EDS patients would not be significantly different compared to matched controls.
METHODS: A retrospective matched cohort study of EDS patients who underwent plastic surgery at a tertiary healthcare system from 2003-2022 was performed. Controls were based on procedure, sex, age, comorbidities, and medications affecting wound healing.
RESULTS: Seventy-three patients with EDS (62 female, 5 male; 44.5318.17 years) underwent 91 surgeries; for each, a matched control was identified (79 female, 9 male; 44.4118.02 years). The most common procedures were blepharoplasty (13.19%), hand surgery (12.09%), breast reconstruction (10.99%), and breast augmentation (10.99%). Wound healing comorbidities included obesity (25.27%), cancer (14.29%), clotting/coagulation disorders (4.40%), diabetes (3.30%), and uremia (1.09%). Approximately 14% of patients took medications affecting wound healing (immunosuppressants:8.79%, corticosteroids:4.40%, chemotherapy:2.20%). Common complications included infection (EDS:6.59%, Control:5.49%; p=0.76), wound dehiscence (EDS:4.40%, Control:6.59%; p=0.48), and scar hypertrophy (EDS:4.40%, Control:7.70%; p=0.32). Early complications requiring return to the operating room included hematoma (EDS:1.10%, Control:3.30%; p=0.32), wound dehiscence (EDS:1.10%, Control:1.10%; p=1.00), and implant removal (EDS:1.10%, Control: 0%; p=1.00). Intermediate complications requiring reoperation included would dehiscence (EDS:0%, Control:1.10%; p=1.00) and implant removal (EDS:0%, Control:1.10%; p=1.00). Late complications requiring reoperation included scar hypertrophy (EDS:2.20%, Control:3.30%; p=0.65), hyperpigmentation (EDS:1.10%, Control:0%; p=1.00), and implant removal (EDS:1.10%, Control:1.10%; p=1.00).
CONCLUSION: EDS patients did not experience significantly higher complication rates compared to controls, prompting reconsideration of EDS as a relative plastic surgical contraindication.
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