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Arkoubi AY. Effect of Compression Garments on Post-Abdominoplasty Outcomes: A systematic Review of the current Evidence. JPRAS Open 2024; 41:128-137. [PMID: 39021663 PMCID: PMC11253148 DOI: 10.1016/j.jpra.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/25/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction It is commonly believed that using abdominal binders or compression garments (CGs) after an abdominoplasty could encourage fluid to drain, which would prevent fluid from building up at the surgical site and reduce the risk of seroma and other similar problems. Objective To evaluate the effect of the use of abdominal binders or CG on the post-operative outcomes following abdominoplasty. Design Systematic review. Method Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to select relevant studies from 2004 to 2024. Data from the included studies were extracted to assess the quality and risk of bias using a modified Jadaad score. Main outcome Post-operative seroma formation. Secondary outcome Ventilatory function, intra-abdominal pressure (IAP), and subcutaneous edema were the outcomes of interest. Results Only 5 trials totaling 130 patients were included in this review. Utilizing post-operative CG following abdominoplasty showed a non-significant tendency to decrease seroma development, ventilatory function, and subcutaneous edema. The limited evidence available also suggested that using post-operative CG increases IAP. Conclusion Weak evidence supports the beneficial use of abdominal binders following abdominoplasty. Limitations Low-quality scientific evidence available from the scant data and low caliber of the literature support the use of CG post-abdominoplasty. Therefore, unified outcome reporting and rigid randomized clinical trials are necessary to obtain valid data.
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Affiliation(s)
- Amr Youssef Arkoubi
- Department of Anesthesia and Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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2
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Ormseth BH, Schoenbrunner AR, Janis JE. Letter to the editor regarding: "Effect of compression garments on post-abdominoplasty outcomes: A systematic review of the current evidence". J Plast Reconstr Aesthet Surg 2024:S1748-6815(24)00425-X. [PMID: 39089985 DOI: 10.1016/j.bjps.2024.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Benjamin H Ormseth
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern, Dallas, TX, United States
| | - Anna R Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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de Abranches Oliveira Santos Filho ID, Rodrigues MA, Ferreira LM, Nahas FX. Is There a Direct Effect Between the Plication of the Myoaponeurotic Layer and the Force of Inspiratory and Expiratory Muscles After Abdominoplasty? Ann Plast Surg 2024; 93:14-21. [PMID: 38885160 DOI: 10.1097/sap.0000000000003940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Abdominoplasty may generate an increase in the intra-abdominal pressure (IAP) and consequently an alteration in the pulmonary ventilation. The purpose of this study was to evaluate the potential alterations in the maximal static inspiratory pressure (MIP) and maximal static expiratory pressure (MEP) after abdominoplasty. METHODS Thirty-three female patients, aged between 18 and 60, with type III/B Nahas abdominal deformity that underwent abdominoplasty with plication of the anterior rectus and external oblique aponeurosis were selected. The MIP and MEP were measured using a mouthpiece. This is a simple way to indirectly gauge inspiratory and expiratory muscle strength. Measurements were performed before surgery and on the 2nd, 7th, 15th, and 180th postoperative day. In addition, IAP was measured before abdominoplasty and after the placement of compression garment. The MIP and MEP were compared using analysis of variance, followed by the Bonferroni multiple comparison test pairing the different points in time. Paired Student's t test was used for comparing IAP measurements. Pearson's correlation test was used to compare MIP and MEP variations with IAP variation. Results were considered statistically significant when P ≤ 0.05. RESULTS A decrease was observed in MEP on the 2nd day, with a return close to normal values on the 15th day. In opposition MIP had a surprisingly increase on the 15th postoperative day (129 cmH2O), normalizing 180 days after the operation. A leap in IAP values was revealed at the end of the surgical procedure. It was not possible to establish a positive correlation between the increase of IAP and the alterations of MIP and MEP. CONCLUSIONS There is a decrease in maximum expiratory pressure on the very early postoperative day (2nd postoperative day) and an increase in maximum inspiratory pressure on the 15th postoperative day in patients who underwent abdominoplasty. There was no correlation between the IAP and maximum respiratory pressure variations, both inspiratory and expiratory.
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Borille G, Giannini R, Zancanaro M, Ribeiro V, Filho GP, Valente DS. Redefining Abdominal Contours: An Analysis of Medium Definition Liposuction Abdominoplasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-04058-2. [PMID: 38902340 DOI: 10.1007/s00266-024-04058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/09/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION This study elucidates the application of Medium Definition Liposuction Abdominoplasty, a novel technique for achieving well-defined abdominal contours. The technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. METHODS Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. Digital image measurements facilitated by an image software constituted the basis for these assessments. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites, with two measurements taken at each site and subsequently averaged. RESULTS Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. However, complications such as partial diminution of tension in the muscular wall (2%), distal flap necrosis (0.6%), and minor muscular hernia (0.3%) were observed. CONCLUSION The employment of combined muscle plication emerges as an efficacious methodology in meticulously rectifying alterations inherent within the muscular aponeurotic abdominal wall. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. BULLET POINTS The study introduces a novel technique, Medium Definition Liposuction Abdominoplasty, for achieving well-defined abdominal contours. This technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites. Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | | | | | | | | | - Denis Souto Valente
- Federal University of Medical Sciences of Porto Alegre, Rua Antonio Carlos Berta 475-7th floor, Porto Alegre, RS, 91340-020, Brazil.
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Kosloski FR, Barbosa MVJ, Rodrigues MA, Martins MRC, Ferreira LM, Nahas FX. Effect of Compression Garments on the Ventilatory Function After Abdominoplasty. Aesthet Surg J 2024; 44:174-182. [PMID: 37477908 DOI: 10.1093/asj/sjad231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function. OBJECTIVES The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty. METHODS Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods. RESULTS Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group. CONCLUSIONS The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications. LEVEL OF EVIDENCE: 3
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Nahas FX, Ferreira LM. Management of the Musculoaponeurotic Layer in Abdominoplasty. Clin Plast Surg 2024; 51:59-69. [PMID: 37945076 DOI: 10.1016/j.cps.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour, should be understood and treated according to the individual deformity. Many types of deformities have been recognized and treatment respects the local anatomy in most cases. Scientific basis that consolidate these treatments are discussed as well as possible recurrences and pitfalls of these techniques. The histological composition of muscles and fascia are also discussed and anatomical details help to enrich the knowledge of the correction of this layer. Specific types of sutures are suggested for both plications and muscle advancement.
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Affiliation(s)
- Fabio Xerfan Nahas
- Adjunct Professor of Plastic Surgery, Federal University of São Paulo, UNIFESP, EPM, Av. Brasil 275, São Paulo, São Paulo 01431-000, Brazil.
| | - Lydia Masako Ferreira
- Head and Full Professor, Federal University of São Paulo, UNIFESP, EPM, R. Napoleão de Barros, 715 - 4o. andar, São Paulo, São Paulo 04024-002, Brazil
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Brown T, Murphy K, Murphy T. The Effect of Drains and Compressive Garments Versus Progressive Tensioning Sutures on Seroma Formation in Abdominoplasty. Aesthetic Plast Surg 2023; 47:1905-1910. [PMID: 36596923 DOI: 10.1007/s00266-022-03244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
Seroma is a common problem following abdominoplasty surgery. Both compressive garments with drains and progressive tension sutures have their advocates to minimise seroma formation. This is a retrospective study in which patients underwent an identical surgical procedure, except for use of drains and garments in comparison to progressive tension sutures between 2005 and 2020. Two hundred thirty-two patients were included in the study 61 in the drains and garment group (DG group), and 171 with progressive tension sutures (PTS group) alone. There was a lower incidence of seroma formation in the PTS group (X2 (1, N = 232) = 6.35, P = .012). The weight of tissue excised in the PTS group was greater than the DG group (P < .001). There was there a significantly higher tissue excision weights for patients who developed a seroma, compared with those who did not (P=.02). Patients, who developed a seroma in the PTS group, had significantly greater excision weights than the DG group. Liposuction did not change the incidence of seroma in each group (X2 (4, N = 232) = 6.701, P = .08 n/s). This study demonstrates the effectiveness of progressive tension sutures in reducing the incidence of seroma formation following abdominoplasty, particularly when large excision weights are involved. The addition of small volume liposuction distant to the abdominal flap does not increase the incidence of seroma formation.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Tim Brown
- , Suite 2, 40 Clyde Road, Berwick, VIC, 3806, Australia.
| | - Kayla Murphy
- , Suite 2, 40 Clyde Road, Berwick, VIC, 3806, Australia
| | - Tracey Murphy
- , Suite 2, 40 Clyde Road, Berwick, VIC, 3806, Australia
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Ormseth BH, Livermore NR, Schoenbrunner AR, Janis JE. The Use of Postoperative Compression Garments in Plastic Surgery-Necessary or Not? A Practical Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5293. [PMID: 37753333 PMCID: PMC10519563 DOI: 10.1097/gox.0000000000005293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Abstract
This practical review critically evaluates the evidence behind the widespread use of postoperative compression therapy intended to improve surgical outcomes, such as reduced edema, ecchymosis, pain, and seroma formation. A literature search of PubMed was conducted to identify relevant studies concerning the use of compression garments after aesthetic surgery, including rhinoplasty, facelift, neck lift, mammoplasty, abdominoplasty, limb contouring, and others. Additionally, reconstructive and therapeutic procedures closely related in anatomy or technique to these cosmetic operations, such as breast reconstruction, mastectomy, and hernia repair, were also considered to provide further perspective. After study extraction, the volume, quality, and agreement of the evidence found was highly heterogenous depending on the context of specific operations and outcomes evaluated. The most well-supported indications for the use of postoperative compression garments are to mitigate edema and ecchymosis after rhinoplasty and to reduce postoperative pain after breast and abdominal procedures, although no effect on seroma rate was demonstrated. Any potential benefit must be balanced against the associated costs and possible complications of compression, including patient discomfort, increased venous stasis, and skin defects. Thus, we encourage surgeons to critically reassess their use of compression garments. In many settings, such as brachioplasty, there is limited high-quality evidence to inform best practice, and we urge the community to continue researching this important topic so that more definitive and comprehensive guidelines may be established.
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Affiliation(s)
- Benjamin H. Ormseth
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nina R. Livermore
- Division of Plastic & Reconstructive Surgery, Spectrum Health/Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anna R. Schoenbrunner
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Fontes de Moraes BZ, Ferreira LM, Martins MRC, Rostom L, Castro HASD, Nahas FX. Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty? Aesthet Surg J 2023; 43:329-336. [PMID: 36282895 DOI: 10.1093/asj/sjac273] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main disadvantages of wearing a compression garment following abdominoplasty are the increase in intra-abdominal pressure and risk of venous stasis. On the one hand, the wearing of garments may increase the risk of venous thromboembolism. On the other hand, it may be beneficial in decreasing edema formation after surgery. OBJECTIVES The authors sought to evaluate the effectiveness of compression garments in reducing subcutaneous edema after abdominoplasty. METHODS Thirty-two women aged 19 to 50 years were selected and randomly allocated to either the garment (n = 16) or no-garment (n = 16) group. All patients underwent abdominoplasty and received 10 sessions of manual lymphatic drainage during the postoperative period. Postoperative edema formation was assessed by perimetry and bioimpedance, and seroma formation was assessed by ultrasound. Statistical tests included t test, mixed linear models, analysis of variance with repeated measures, and the Kolmogorov-Smirnov test, which were performed at a significance level α of .05 (P ≤ .05). RESULTS The no-garment group showed a trend toward lower mean waist circumference at 29 days following abdominoplasty and significantly lower waist circumference after postoperative day 35 compared with the garment group (P < .001). The mean total body water was slightly lower in the no-garment group than in the garment group 7 days after surgery (P = .05). CONCLUSIONS Patients who did not wear a compression garment after abdominoplasty showed less subcutaneous edema formation after 24 days of surgery than those who wore the garment.
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Affiliation(s)
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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10
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Keane AM, Keane GC, Tenenbaum MM. Commentary on: Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty? Aesthet Surg J 2023; 43:337-339. [PMID: 36380465 DOI: 10.1093/asj/sjac298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexandra M Keane
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Grace C Keane
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
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Sorotos M, Firmani G, Schiavone L, Ricci A, Santanelli di Pompeo F. EFFECTS OF DIEP FLAP-BASED BREAST RECONSTRUCTION ON RESPIRATORY FUNCTION. J Plast Reconstr Aesthet Surg 2023; 81:99-104. [PMID: 37130446 DOI: 10.1016/j.bjps.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Breast reconstruction (BR) is an essential part of breast cancer treatment, and the DIEP flap is considered the gold standard reconstruction technique, which uses a free abdominal flap. Concerns have been raised regarding the effects of abdominoplasty on respiratory functions. This topic has not been addressed regarding donor-site closure of DIEP flaps. Our aim is to prospectively compare preoperative and postoperative spirometry in patients undergoing DIEP flap-based BR, investigating its impact on respiratory function. MATERIALS AND METHODS We enrolled 21 patients who received BR with DIEP flap in our institution, who underwent pulmonary function assessment by spirometry 1 month preoperatively and 1 year postoperatively. We assessed Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC ratio, and Peak Expiratory Flow (PEF). Statistical analysis was performed using the paired samples test. RESULTS An improvement in the mean values of all 4 variables was found at 1 year from surgery. Namely, FEV1 improved by 0.1 L with a standard deviation (SD) of 0.39 L, FVC by 0.04 L with SD of 0.627, FEV1/FVC by 2.11 L with SD of 7.85 L, and PEF by 1.2 L with SD of 1.45 L. Only PEF was statistically significant [P = 0.001]. CONCLUSION Our results suggest that DIEP flap BR does not negatively impact respiratory function. Although further knowledge is required, we confirm the possibility of considering the indication for abdominoplasty and DIEP flap reconstruction in patients with altered and reduced pulmonary function.
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Affiliation(s)
- Michail Sorotos
- Chair of Plastic Surgery, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Guido Firmani
- Chair of Plastic Surgery, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Laurenza Schiavone
- Chair of Plastic Surgery, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Division of Respiratory Diseases, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Chair of Plastic Surgery, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
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Wang F, Chemakin K, Shamamian P, Punn I, Campbell T, Ricci JA. Rectus Plication Does Not Increase Risk of Thromboembolic Events Following Abdominal Body Contouring: A Matched Case-Control Analysis. Aesthet Surg J 2022; 42:1435-1444. [PMID: 36074733 DOI: 10.1093/asj/sjac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rectus abdominis plication increases intra-abdominal pressure and lower-extremity venous stasis, which may increase the incidence of venous thromboembolism (VTE) events. OBJECTIVES The aim of this study was to investigate the potential association between VTE and rectus abdominis muscle plication during surgery. METHODS A retrospective review of all patients who underwent abdominal body contouring at the authors' institution between 2010 and 2020 was completed. Cases were those with postoperative VTEs and were matched to controls (1:4) via potential confounders. Variables collected include demographic data, operative details, comorbidities, and postoperative complications. Statistical analysis was performed with parametric, nonparametric, and multivariable regression modeling. RESULTS Overall, 1198 patients were included; 19 (1.59%) experienced a postoperative VTE and were matched to 76 controls. The overall cohort was 92.7% female with an average age of 44 years, an average Charlson Comorbidity Index of 1 point, and an average BMI of 30.1 kg/m2. History of cerebrovascular events (14.5% vs 36.8%, P = 0.026) differed significantly between cohorts, but no significant associations were noted in all other baseline demographics. Additionally, VTE cases were more likely to have received intraoperative blood transfusions (odds ratio = 8.4, P = 0.04). Bivariate analysis demonstrated cases were significantly more likely to experience concurrent complications, including delayed wound healing (0% vs 5.3%, P = 0.044), seroma formation (5.3% vs 21.1%, P = 0.027), and fat necrosis (0% vs 5.3%, P = 0.044). However, these findings were not significant in a multivariable regression model. Plication was not associated with VTE outcomes. CONCLUSIONS Rectus plication does not increase the risk of VTE. However, the odds of VTE are significantly increased in patients who received intraoperative blood products compared with those who did not. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Fei Wang
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Katherine Chemakin
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Peter Shamamian
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Isha Punn
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Tessa Campbell
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Joseph A Ricci
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
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13
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Martins MRC, Moraes BZFD, Fabri DC, Castro HASD, Rostom L, Ferreira LM, Nahas FX. Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty? Aesthet Surg J 2022; 42:1294-1302. [PMID: 35830484 DOI: 10.1093/asj/sjac194] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For decades, the postoperative wearing of abdominal binders has been suggested to reduce dead space and prevent mobilization of the musculoaponeurotic layer in an attempt to decrease the risk of seroma formation and recurrent diastasis. OBJECTIVES This study sought to evaluate whether the postoperative wearing of an abdominal binder provides any additional contribution to the reduction of either seroma formation or recurrent diastasis recti when abdominoplasty is performed with quilting sutures. METHODS Thirty-four women undergoing abdominoplasty were randomized into 2 groups: the binder group (n = 16) wore abdominal binders during the postoperative period, whereas the control group (n = 18) did not. Ultrasound examination was performed on postoperative days 7 and 14 to assess seroma formation and at 6 months postoperatively to assess recurrence of diastasis recti. A t test for independent samples was applied to compare means between 2 numeric variables. Generalized estimation equation models were used to evaluate seroma volume at different time points for the 2 groups. RESULTS No significant differences in seroma volume were found between groups on postoperative days 7 (P = 0.830) and 14 (P = 0.882). Seven cases of subclinical recurrent diastasis were observed by ultrasound examination in the supraumbilical (4 cases) and infraumbilical regions (3 cases), but without significant differences (P = 1.000) between the 2 groups. Recurrent diastasis was not detected during physical examinations. CONCLUSIONS The postoperative wearing of abdominal binders was not effective in preventing either seroma formation or recurrent diastasis following abdominoplasty with quilting sutures. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Daniel Capucci Fabri
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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A case of severe acute respiratory failure after elective abdominoplasty. Respir Med Case Rep 2022; 38:101683. [PMID: 35711721 PMCID: PMC9194840 DOI: 10.1016/j.rmcr.2022.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Abstract
Surgical correction of abdominal muscle diastasis may decrease intra-abdominal volume and increase intra-abdominal pressure. The induced changes may ultimately lead to respiratory compromise. In abdominoplasty, one of the most frequently performed esthetic procedures, those changes are believed to be transient and clinically insignificant. We describe a case where acute change in respiratory physiology after abdominoplasty led to severe respiratory failure with significantly decreased pulmonary compliance in a young and otherwise healthy patient. In this case mechanical ventilation failed to improve compliance, and reversal of abdominoplasty was required to restitute pulmonary function.
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Keramidas E, Rodopoulou S, Gavala MI. A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study. Aesthetic Plast Surg 2022; 46:2323-2332. [PMID: 35043248 PMCID: PMC9592666 DOI: 10.1007/s00266-021-02739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
Background This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty. Materials and methods One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result. Results No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results. Conclusions In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02739-w.
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Affiliation(s)
- Evangelos Keramidas
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece.
| | - Stavroula Rodopoulou
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
| | - Maria-Ioanna Gavala
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
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16
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Olsson A, Kiwanuka O, Sandblom G, Stackelberg O. Evaluation of functional outcomes following rectus diastasis repair-an up-to-date literature review. Hernia 2021; 25:905-914. [PMID: 34302558 PMCID: PMC8370918 DOI: 10.1007/s10029-021-02462-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. METHOD A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. RESULT Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. CONCLUSION The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.
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Affiliation(s)
- A Olsson
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - O Kiwanuka
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
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17
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Nahas FX. Commentary on: TULUA Lipoabdominoplasty: No Supraumbilical Elevation Combined With Transverse Infraumbilical Plication, Video Description, and Experience With 164 Patients. Aesthet Surg J 2021; 41:595-597. [PMID: 33277905 DOI: 10.1093/asj/sjaa283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fábio Xerfan Nahas
- Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil
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18
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Jessen ML, Öberg S, Rosenberg J. Surgical techniques for repair of abdominal rectus diastasis: a scoping review. J Plast Surg Hand Surg 2021; 55:195-201. [PMID: 33502282 DOI: 10.1080/2000656x.2021.1873794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rectus diastasis is characterized by widening and laxity of the linea alba, causing the abdominal content to bulge. Rectus diastasis is treated either conservatively with physiotherapy, or surgically, surgical treatment showing especially convincing results. The primary aim of this study was to describe surgical techniques used to correct abdominal rectus diastasis. Secondary, we wished to assess postoperative complications in relation to the various techniques. A systematic scoping review was conducted and reported according to the PRISMA-ScR statement. PubMed, Embase, and Cochrane Library were searched systematically. Studies were included if they described a surgical technique used to repair abdominal rectus diastasis, with or without concomitant ventral hernia. Secondary outcomes were recurrence rate and other complications. A total of 61 studies were included: 46 used an open approach and 15 used a laparoscopic approach for repair of the abdominal rectus diastasis. All the included studies used some sort of plication, but various technical modifications were used. The most common surgical technique was classic low abdominoplasty. The plication was done as either a single or a double layer, most commonly with permanent sutures. There were overall low recurrence rates and other complication rates after both the open and the laparoscopic techniques. We identified many techniques for repair of abdominal rectus diastasis. Recurrence rate and other complication rates were in general low. However, there is a lack of high-level evidence and it is not possible to recommend one method over another. Thus, further randomized controlled trials are needed in this area.
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Affiliation(s)
- Majken Lyhne Jessen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
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19
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Nahas FX. Commentary on: Improvement in Back Pain Following Abdominoplasty: Results of a 10-Year, Single-Surgeon Series. Aesthet Surg J 2020; 40:1316-1318. [PMID: 32281616 DOI: 10.1093/asj/sjaa063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fábio Xerfan Nahas
- Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil
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20
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Invited Discussion on: Abdominoplasty and Patient Safety: The Impact of Body Mass Index and Bariatric Surgery on Complications Profile. Aesthetic Plast Surg 2020; 44:1625-1627. [PMID: 32410197 DOI: 10.1007/s00266-020-01748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
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21
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Fluhr S, Andrade ADD, Oliveira EJB, Rocha T, Medeiros AIC, Couto A, Maia JN, Brandão DC. Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women. ACTA ACUST UNITED AC 2019; 45:e20170395. [PMID: 31166554 PMCID: PMC6715028 DOI: 10.1590/1806-3713/e20170395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/12/2018] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. Methods: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. Results: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. Conclusions: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])
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Affiliation(s)
- Sandra Fluhr
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | | | | - Taciano Rocha
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | | - Amanda Couto
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | - Juliana Netto Maia
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
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22
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Nahas FX, Faustino LD, Ferreira LM. Abdominal Wall Plication and Correction of Deformities of the Myoaponeurotic Layer: Focusing on Materials and Techniques Used for Synthesis. Aesthet Surg J 2019; 39:S78-S84. [PMID: 30869750 DOI: 10.1093/asj/sjy333] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The different types of sutures utilized in plications and for correction of diastasis during abdominoplasty are reviewed and discussed. Because correction of abdominal deformities also involves fascia and muscle advancement, this review also covers the suture materials used in muscle advancement. The selection of specific techniques to treat different types of abdominal wall deformity is also considered. This is important, because the outcome when correcting these deformities depends not only on suture materials but also on employing the optimum technique. A PubMed/Medline search was performed with the following search terms: rectus diastasis, diastasis recti, diastasis recti abdominis, correction of rectus diastasis, abdominoplasty. Relevant articles identifying the type of suture (rapidly absorbable, slowly absorbable, nonabsorbable), monofilament or multifilament sutures, antibiotic-coated sutures, and barbed sutures were evaluated. In addition, articles about surgical technique comparing continuous and interrupted sutures, in both the anterior and posterior aponeurosis, to correct rectus diastasis are discussed. Efficacy of suture materials was evaluated based on the long-term results and recurrence rates reported in these articles. The current literature provides sufficient data to recommend a single-layer continuous suture, with slowly absorbable sutures of 0 polydioxanone or 2-0 nylon, for correction of abdominal diastasis. An interrupted triangular suture is a good alternative to correct the vertical elongation of the myoaponeurotic layer that occurs after pregnancy.
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Affiliation(s)
- Fábio Xerfan Nahas
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Leandro Dario Faustino
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
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23
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Rodrigues MA, Ferreira LM, de Carvalho Calvi EN, Nahas FX. Preoperative Respiratory Physiotherapy in Abdominoplasty Patients. Aesthet Surg J 2018; 38:291-299. [PMID: 29040352 DOI: 10.1093/asj/sjx121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND After abdominoplasty, patients experience decreased ventilatory function and increased intra-abdominal pressure (IAP). Breathing exercises are used during the pre- and postoperative periods of several abdominal surgeries to prevent or minimize postoperative complications. OBJECTIVES The aim of this study was to assess the effect of preoperative respiratory physiotherapy on the outcome of abdominoplasty patients. METHODS Thirty-three patients were divided into 2 groups. The control group (n = 18) received no preoperative intervention. The intervention group (n = 15) performed breathing exercises during the preoperative period, including incentive spirometry, diaphragmatic breathing, shortened expiration, and sustained maximal inspiration. Respiratory physiotherapy started one week before surgery. Breathing exercises were performed daily. They were performed 3 times weekly in the presence of a physiotherapist and patients were instructed to carry on the exercises at home on days without physiotherapy sessions for three sets of 20 repetitions each. Patients were assessed by spirometry and IAP measurements. RESULTS No significant difference in spirometry was found between groups. However, patients in the intervention group had lower IAP at the start of surgery and at all time points (P = 0.010) compared with controls. CONCLUSIONS Preoperative respiratory physiotherapy had no impact on spirometry, but may have contributed to reduce IAP intraoperatively. LEVEL OF EVIDENCE 2
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24
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Rosenfield LK. Commentary on: Preoperative Respiratory Physiotherapy in Abdominoplasty Patients. Aesthet Surg J 2018; 38:300-301. [PMID: 29040354 DOI: 10.1093/asj/sjx148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorne K Rosenfield
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco (UCSF), San Francisco, CA
- Adjunct Clinical Professor, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
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25
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Doubkova L, Andel R, Palascakova-Springrova I, Kolar P, Kriz J, Kobesova A. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil 2018; 31:107-112. [PMID: 28946525 DOI: 10.3233/bmr-169687] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal muscles are important spinal stabilizers and its poor coordination, as seen in diastasis of rectus abdominis (DRA), may contribute to chronic low back pain (LBP). However, this has not yet been studied directly. OBJECTIVES To conduct a pilot study to examine the association between DRA and LBP. METHODS Using a digital caliper, standard clinical DRA measurement was performed in 55 participants with and 54 without chronic LBP. RESULTS Participants were on average 55 years old, 69 (63%) were women. Among the 16 participants with DRA, 11 (69%) had chronic LBP; among the 93 participants without DRA, 44 (47%) had LBP. Among men, 7 of 9 (77%) with DRA had LBP and 14 of 31 (45%) without DRA had LBP. Among women, 4 of 7 (57%) with DRA had LBP and 30 of 62 (48%) without DRA had LBP. BMI was the strongest correlate of DRA and may explain the relation between DRA and chronic LBP. CONCLUSIONS DRA and LBP may be interrelated, especially among men. This may be a function of greater BMI in individuals with chronic LBP. Understanding the association between DRA, LBP, and BMI may have important implications for treatment of LBP and for intervention.
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Affiliation(s)
- Lucie Doubkova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | | | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jiri Kriz
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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26
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Messeha MM. Effect of Switching between Pressure-controlled and Volume-controlled Ventilation on Respiratory Mechanics and Hemodynamics in Obese Patients during Abdominoplasty. Anesth Essays Res 2017; 11:88-93. [PMID: 28298763 PMCID: PMC5341628 DOI: 10.4103/0259-1162.186594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: The ideal intraoperative ventilation strategy in obese patients remains obscure. This prospective, randomized study was designed to evaluate the effect of pressure-controlled ventilation (PCV) before or after volume-controlled ventilation (VCV) on lung mechanics and hemodynamics variables in obese patients subjected to abdominoplasty operation. Patients and Methods: The study included forty patients with body mass index 30–45 kg/m2 subjected to abdominoplasty. All patients were randomly allocated in two groups after the induction of general anesthesia (twenty patients each), according to intraoperative ventilatory strategy. Group I (P-V): started with PCV until the plication of rectus muscle changes into VCV till the end of surgery. Group II (V-P): started with VCV until the plication of rectus muscle changes into PCV till the end of surgery. Lung mechanics, hemodynamics variables (heart rate and mean blood pressure), and arterial blood gases (ABGs) were recorded. Results: No significant difference in the hemodynamics and ABGs were recorded between the studied groups. The use of PCV after VCV induced the improvement of lung mechanics. Conclusion: Switching from VCV to PCV is preferred to improve intraoperative oxygenation and lung compliance without adverse hemodynamic effects in obese patients.
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Affiliation(s)
- Medhat Mikhail Messeha
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
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27
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Wilhelmsson S, Fagevik Olsén M, Staalesen T, Elander A, Nygren-Bonnier M. Abdominal plasty with and without plication-effects on trunk muscles, lung function, and self-rated physical function. J Plast Surg Hand Surg 2016; 51:199-204. [DOI: 10.1080/2000656x.2016.1222293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sofia Wilhelmsson
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Trude Staalesen
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Malin Nygren-Bonnier
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Pereira N, Sciaraffia C, Danilla S, Parada F, Asfora C, Moral C. Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function. Aesthet Surg J 2016; 36:697-702. [PMID: 26895955 DOI: 10.1093/asj/sjv273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Abdominal wall weakness is a consequence of rectus abdominis diastasis and flaccidity of the myofascial component. A degree of plicature of the rectus abdominis generates an increase of intra-abdominal pressure (IAP), which may result in an increase of intrathoracic pressure, thus affecting thoracic hemodynamics and leading to inadequate ventilation. OBJECTIVES To assess changes generated by plicature of the rectus abdominis on IAP and pulmonary function in patients undergoing abdominoplasty. METHODS A total of 10 female patients with abdominal ptosis were included. Chronic smokers and patients with respiratory co-morbidities were excluded. The IAP was measured using a modified Kron's trans-bladder technique. Pulmonary function was assessed by pulmonary compliance (P-Comp) and was calculated with parameters provided by the mechanical ventilator. Both were calculated before and after plicature. RESULTS The mean values for IAP before and after plicature were 6.6 and 9.3 mmHg respectively. Before plicature, the mean P-Comp value was 38.97 mL/cm of water, and after it was 36.54 mL/cm. Both differences were statistically significant. CONCLUSIONS Based on the results obtained, it is possible to conclude that plicature of the rectus abdominis generates significant physiological changes, such as an increase in IAP and a decrease of P-Comp, which do not have a clinically relevant impact on healthy individuals. Measuring IAP with the modified technique and the assessment of pulmonary function using P-Comp are both reliable and provide a more accurate correlation with such physiologic changes. LEVEL OF EVIDENCE 3: Therapeutic.
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Affiliation(s)
- Nicolas Pereira
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carlos Sciaraffia
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Stefan Danilla
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Francisco Parada
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Constanza Asfora
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - César Moral
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
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Nahas FX. Commentary on: Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty with Rectus Plication. Aesthet Surg J 2016; 36:588-90. [PMID: 26931307 DOI: 10.1093/asj/sjw028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Fabio Xerfan Nahas
- Dr Nahas is an Adjunct Professor, Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil
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Ceber M, Yuksek A, Mutlu LC, Bali I, Topcu B. Reduction Mammaplasty Effect on Pulmonary Function and Arterial Blood Gas in the Overweight Female. Aesthetic Plast Surg 2015; 39:540-6. [PMID: 26085228 DOI: 10.1007/s00266-015-0522-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/10/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study sought to prospectively determine whether reduction mammaplasty improves the results of pulmonary function tests (PFTs) and arterial blood gas (ABG) measurements among overweight or obese women with macromastia and assess whether these changes are correlated with participant weight and body mass index (BMI) changes. METHODS Thirty women who were overweight or obese and underwent bilateral reduction mammaplasty were included in this study. PFT and ABG measurements were performed within a 4-week period before reduction mammaplasty and 3 months after reduction mammaplasty. The following selected PFT parameters were used to diagnose the restrictive patterns of ventilatory defects: forced vital capacity (FVC), forced expiratory volume at one second (FEV1), the ratio of FEV1 to FVC expressed as a percentage (FEV1/FVC%), and the average FVC flow rate of 25-75 % (FEF 25-75 %). The ABG measurements included PaO2, PaCO2, HCO3, oxygen saturation, and pH. RESULTS A significant difference was found between certain preoperative and postoperative PFTs (i.e., predicted FVC%, predicted FEV1% and predicted FEF 25-75 %) and between all of the preoperative and postoperative ABG measurements (pH, PaO2, PaCO2, HCO3, and Sat O2). A significant positive correlation was found between specimen weight and improvements in FEF 25-75 % and Sat O2. A significant positive correlation was found between the percentage reduction in BMI and the improvements in FEF 25-75 % and FVC. CONCLUSIONS Overweight or obese women who underwent reduction mammaplasty showed significant improvements in certain PFT and all of the ABG measurements at 3 months after surgery. The more resected breast tissue predicts greater improvements in FEF 25-75 % and Sat O2, and greater reductions in BMI predicted increased improvements in FEF 25-75 % and FVC.
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Affiliation(s)
- Mehmet Ceber
- Department of Plastic, Reconstructive and Aesthetic Surgery, Namik Kemal University Faculty of Medicine, 59100, Tekirdag, Turkey,
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Rodrigues MA, Nahas FX, Reis RP, Ferreira LM. Does Diastasis Width Influence the Variation of the Intra-Abdominal Pressure After Correction of Rectus Diastasis? Aesthet Surg J 2015; 35:583-8. [PMID: 25922363 DOI: 10.1093/asj/sju091] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It has been demonstrated that there is an increase of intra-abdominal pressure (IAP) after correction of rectus diastasis. OBJECTIVE To evaluate the correlation between the diastasis width and IAP variation after the plication of the anterior rectus sheath. METHODS Seventeen patients met the inclusion criteria and were selected. The diastasis width was measured at three levels: 3 cm above the umbilicus, 2 cm above the umbilicus, and 2 cm below the umbilicus. Rectus sheath plication was performed in two layers: the first layer with separate stitches, and the second with continuous suture. The IAP was measured at two stages: before and after the correction of rectus diastasis. The distance between the iliac spines (IS) and that between the xiphoid process and pubic symphysis (XP) were measured. The abdominal surface index (ASI) was calculated using the formula: ASI = (IS × XP)/2. This index was used to determine the individual abdominal surface. The relative diastasis coefficient (RDC) was calculated using the formula: RDC = diastasis/ASI. These measurements were correlated to the IAP variation. The results of the IAP measurements obtained in each stage and the RDC values were compared, using the Pearson's linear correlation coefficient. RESULTS There was no statistically significant correlation between the IAP variation and the RDC values at the three levels studied. CONCLUSIONS The diastasis width does not interfere with the increase of the IAP when a plication of the anterior aponeurosis is performed. LEVEL OF EVIDENCE 3 Diagnostic.
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Does the Use of Compression Garments Increase Venous Stasis in the Common Femoral Vein? Plast Reconstr Surg 2015; 135:85e-91e. [DOI: 10.1097/prs.0000000000000770] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Villegas FJ. A novel approach to abdominoplasty: TULUA modifications (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar). Aesthetic Plast Surg 2014; 38:511-20. [PMID: 24770799 DOI: 10.1007/s00266-014-0304-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lipoabdominoplasty can be associated with complications, particularly tissue necrosis, wound dehiscence, epigastric bulging, high transverse scar, low positioning of the umbilicus, and seroma. METHODS Modified abdominoplasty characterized by (1) transverse elliptical plication of the lower abdominal wall, (2) no undermining of the flap above the navel, (3) unrestricted liposuction, (4) umbilical amputation and neoumbilicoplasty by skin graft, and (5) low transversely placed abdominal scar (TULUA) was performed for 42 patients. These procedures were elective and performed primarily to remedy epigastric skin redundancy associated with obesity or when supraumbilical undermining was considered inappropriate. RESULTS The results were objectively scored as excellent for 20 patients, good for 21 patients, and fair for 1 patient. A normal-appearing umbilicus was attained in all cases except one. The lower transverse scars were generally concealable (6.3 ± 1.4 cm from the anterior vulvar commissure), and epigastric bulging was avoided. Although four patients experienced seromas at the tail ends of incisions, no skin necrosis, wound dehiscence, or other major complications such as venothromboembolism occurred, and there were no fatalities. In four patients, postoperative magnetic resonance imaging demonstrated measurable and significant changes attributable to plicature compared with equivalent control points (p < 0.000001), which persisted over time. CONCLUSIONS The TULUA procedure offers potential advantages in terms of vascular safety, sensory recovery, position and quality of the umbilicus, and transverse scar location, with aesthetic outcomes that generally eliminate epigastric bulging. A sizeable patient population stands to benefit from this approach, especially when obesity, smoking, secondary revisions, umbilical or hypogastric hernias, and massive weight loss are clinical considerations for abdominoplasty. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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