Revisiting Ehlers-Danlos Syndrome as a Relative Contraindication to Elective Plastic Surgery: A Retrospective Matched Cohort Study.

Background: Ehlers-Danlos Syndromes comprise a heterogeneous group of connective tissue disorders, often associated with concerns about poor wound healing and elevated surgical complication rates. This study evaluated the safety of elective plastic surgery in EDS patients relative to matched controls. We hypothesized that EDS patients would not experience higher complication rates relative to matched controls.

Methods: An IRB approved retrospective cohort study of EDS patients and matched controls who underwent elective plastic surgery between 2003 and 2023 was conducted at a tertiary health care system. Patients were matched for comorbidities, medications, and other factors affecting wound healing. Complication rates, categorized by severity and timing, were compared between groups. Data analysis included paired t-tests and McNemar's tests. To detect a complication rate difference of 10% (α=0.05, β=0.2), a sample of 97 patients per group was required.

Results: One-hundred EDS patients (86% female, mean age 43.29±17.45 years, mean BMI 26.47±6.01) and 100 matched controls (86% female, mean age 42.98±18.12 years, mean BMI 26.82±6.61) were included. The most common EDS subtype was hypermobile EDS (41%), followed by classical (6%) and vascular EDS (2%). Complications were observed in 25% of EDS patients and 35% of controls (p=0.16). There was no significant difference in the rate of minor complications (EDS: 19% vs. Controls: 24%, p=0.39) or major complications (EDS: 6% vs. Controls: 12%, p=0.20).

Conclusions: Elective plastic surgery can be performed safely in patients with EDS, particularly those with hypermobile EDS.