1
|
Reischies FMJ, Tiefenbacher F, Holzer-Geissler JCJ, Wolfsberger C, Eylert G, Mischitz M, Pregartner G, Meikl T, Winter R, Kamolz LP, Lumenta DB. BMI and Revision Surgery for Abdominoplasties: Complication Definitions Revisited Using the Clavien-Dindo Classification. Plast Reconstr Surg Glob Open 2023; 11:e4411. [PMID: 36798721 PMCID: PMC9925103 DOI: 10.1097/gox.0000000000004411] [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: 01/30/2022] [Accepted: 04/12/2022] [Indexed: 02/15/2023]
Abstract
After body contouring surgery of the lower trunk (CSLT), the definition, rate (4%-70%), and documentation of complications vary. Objectives We analyzed the effect of risk factors on the outcome based on the Clavien-Dindo classification (CDC) after CSLT surgery and polled postoperative satisfaction among patients. Methods All patients undergoing CSLT from 2001 to 2016 were included and were classified according to the CDC for postoperative events. Statistical analysis included proportional odds logistic regression analysis. We polled patients to grade their satisfaction with the postoperative result and whether they would have the operation performed again. Results A total of 265 patients were included: 60 (22.6%), 25 (9.4%), 28 (10.6%), and 21 (7.9%) were in CDC grades I, II, IIIa, and IIIb, respectively. A high preoperative body mass index significantly increased the odds for a postoperative event requiring revision surgery under general anesthesia (CDC grade IIIb, odds ratio 0.93, 95% confidence interval 0.89-0.97, P = 0.001). One-hundred twenty-eight patients (48.3%) participated in the poll: 101 (78.9%) were either happy or content with the postoperative results, and 117 (91.4%) would have the procedure performed again, including all nine patients with CDC grade IIIb. Conclusions Our results confirm that a high body mass index is a statistically significant risk factor for requiring major revision surgery after CSLT. Despite being a complication prone intervention, postoperative satisfaction after CSLT was ranked favorably in our sample. We recommend that the CDC be used in all surgical specialties to evaluate complications and permit future comparability of pooled data.
Collapse
Affiliation(s)
- Frederike M. J. Reischies
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Fabian Tiefenbacher
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Judith C. J. Holzer-Geissler
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Christina Wolfsberger
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,Division of Neonatology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gertraud Eylert
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Madeleine Mischitz
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, Austriaand
| | - Tobias Meikl
- Department of Surgery, St John of God Hospital, Graz, Austria
| | - Raimund Winter
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria,COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - David B. Lumenta
- From the Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
2
|
Wilson A, Raafat S. One key to fit all locks? Routine internal drainage to minimize seromas during thigh lift surgeries. ANN CHIR PLAST ESTH 2022; 67:153-161. [DOI: 10.1016/j.anplas.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
|
3
|
Marouf A, Mortada H. Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2810-2820. [PMID: 34018015 DOI: 10.1007/s00266-021-02315-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is a major global health problem. With an increasing number of bariatric surgeries, the need for body-contouring procedures has grown. These procedures are associated with multiple complications because of various patient characteristics and risk factors. OBJECTIVES In this study, we performed a systematic literature review of all the complications of postbariatric body contouring surgeries, as well as a meta-analysis to estimate the effects of body mass index (BMI) and the weight of the tissue resected during body contouring on the development of complications. METHODS We conducted a literature search of the PubMed and Cochrane databases in September 2020, using the MeSH terms plastic surgery, weight loss, and complications. Studies were included if they involved more than 35 postbariatric patients and reported postoperative complication rates and types. RESULTS In total, 561 articles were initially identified, and 25 studies were included after the final review. The overall weighted rate of postbariatric body contouring surgical complications in all studies was 31.5%. The most frequent complication from all regions of body contouring was seroma (weighted rate 12.7-13.9%). Regarding risk factors, analysis indicated that a BMI < 30 kg/m2 and low mean weight of resected tissue were associated with fewer complications. CONCLUSION Body contouring procedures are relatively safe. Although complications after contouring are common, most either resolve spontaneously or require minimal intervention. In body contouring after bariatric surgery, there is a 37% increased risk of developing complications if the BMI is ≥ 30 kg/[Formula: see text] before body contouring. A higher weight of resected tissue appears to be linked to a greater risk of complications. 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 .
Collapse
Affiliation(s)
- Azmi Marouf
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
| |
Collapse
|
4
|
Hurwitz DJ, Davila AA. Invited Discussion on: Lipo-Bodylift Reconstruction Following Massive Weight Loss-Our Experience with 100 Consecutive Cases. Aesthetic Plast Surg 2021; 45:2229-2232. [PMID: 33723646 PMCID: PMC8481171 DOI: 10.1007/s00266-021-02133-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Dennis J. Hurwitz
- Hurwitz center for Plastic Surgery, Plastic Surgery University of Pittsburgh, 3109 Forbes Avenue, Pittsburgh, Pa I5213 USA
| | - Armando A. Davila
- Hurwitz center for Plastic Surgery, UNLV School of Medicine, 3109 Forbes Avenue, Pittsburgh, Pa I5213 USA
| |
Collapse
|
5
|
Lipo-Bodylift Reconstruction Following Massive Weight Loss: Our Experience with 100 Consecutive Cases. Aesthetic Plast Surg 2021; 45:2220-2228. [PMID: 33492477 DOI: 10.1007/s00266-020-02118-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/26/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND We report our experience using the Lipo-Bodylift technique for circumferential lower trunk reconstruction following massive weight loss. METHODS The procedure combines extensive circular liposuction with circular skin resection immediately under the dermis. We classify lower trunk deformities using three parameters: (1) excess skin (in the horizontal direction, or both horizontally and vertically); (2) the body mass index (BMI); and, (3) skin quality (hyperlaxity or a normal tone). All patients can be divided into four groups, of whom groups I and II are the best candidates for the Lipo-Bodylift procedure. We also describe our perioperative management and patient outcomes, with a focus on postoperative complications. RESULTS Between January 2015 and January 2020, 100 patients underwent Lipo-Bodylift treatment. The median patient age was 41 years. The median preoperative BMI was 26.3 kg/m2. The median drainage duration and hospital stay were both 3 days. Of all patients, 30% experienced at least one complication, 2% of which were major. Of the minor complications, 27 patients evidenced wound dehiscence. Only (positive) smoking status was significantly associated with postoperative complications (p < 0.001). CONCLUSION We developed the Lipo-Bodylift technique after analyzing changes in the skin and subcutaneous fat after massive weight loss. The technique completes the arsenal of body contouring techniques, appears to be less invasive than the undermining that is usually performed during circumferential reconstruction of the lower trunk, and is associated with a lower rate of major complications. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
6
|
Bertheuil N, Mocquard C, Kerfant N, Bergeat D. The Assessment of a Predictive Risk and a Decrease Postoperative Complication Following Body-Contouring Surgery After Massive Weight Loss. Obes Surg 2019; 29:1644-1646. [PMID: 30701388 DOI: 10.1007/s11695-019-03742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France. .,INSERM U1236, University of Rennes 1, Rennes, France. .,SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France.
| | - C Mocquard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - N Kerfant
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Brest, Brest, France
| | - D Bergeat
- Department of Hepatobiliary and Digestive Surgery, University of Rennes 1, Rennes, France
| |
Collapse
|
7
|
Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
Collapse
Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | |
Collapse
|
8
|
Abstract
Massive weight loss patients and aesthetic patients can present with significant gluteal contour abnormalities. Gluteal ptosis, skeletal deformities, severe platypgia, and a paucity of donor fat for autologous transfer are common problems. Excisional procedures are used to treat massive-weight-loss contour abnormalities. These procedures present an opportunity to address severe gluteal deformities using autologous tissue augmentation. With a working knowledge of the relevant anatomy, sound surgical technique, and meticulous postoperative care, autologous gluteal autoaugmentation with circumferential body lift/excisional buttock lift using the "Moustache" flap technique will enhance massive weight loss body contouring outcomes and improve patient satisfaction.
Collapse
Affiliation(s)
- Robert F Centeno
- Department of Plastic Surgery, The Ohio State University, 915 Olentangy River Road, Suite 2100, Columbus, OH 43212, USA; Private Practice, Columbus Institute of Plastic Surgery, 6499 East Broad Street, Suite 130, Columbus, OH 43213, USA.
| |
Collapse
|
9
|
Guest RA, Amar D, Czerniak S, Dreifuss SE, Schusterman MA, Kenny EM, Chernoff EF, Barnett JM, Koesarie KR, Gusenoff JA. Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Body Contouring Complication Reporting System. Aesthet Surg J 2017; 38:60-70. [PMID: 29040346 DOI: 10.1093/asj/sjx081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. OBJECTIVES We aim to provide a guideline for complication reporting in the body contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of body contouring procedures and will decrease under-, over-, and nonreporting of complications. METHODS The authors reviewed the literature for the terms "body contouring," "MWL," and "complications." Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal contouring and extremity contouring. RESULTS Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance. CONCLUSIONS Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.
Collapse
Affiliation(s)
- Rachel A Guest
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Dalit Amar
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Sharona Czerniak
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Stephanie E Dreifuss
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Mark A Schusterman
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Elizabeth M Kenny
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Eva F Chernoff
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Joshua M Barnett
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Kathleen R Koesarie
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
- Body Contouring Section, Aesthetic Surgery Journal
| |
Collapse
|
10
|
Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation. Plast Reconstr Surg 2017; 141:625-636. [PMID: 29135892 DOI: 10.1097/prs.0000000000004178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND An often-neglected part of the lower body lift procedure is the gluteal region. The objective of this study was to classify massive weight loss patients undergoing a body lift procedure and provide a safe, standardized approach for gluteal augmentation. METHODS A retrospective review of all body lift procedures performed between January of 2012 and January of 2017 was conducted. Patients undergoing a lower body lift with or without gluteal augmentation were included for analysis. Patients were classified as follows: type I, minimal lower and upper back fat and deflated buttock; type II, substantial lower back fat, minimal upper back fat, and deflated buttock; type III, substantial lower and upper back fat and deflated buttock; and type IV, good buttock projection. Type I patients had gluteal implants, type II patients had autologous flap augmentation, type III patients had gluteal lipofilling, and type IV patients did not have any gluteal augmentation. RESULTS Two hundred eighty patients were included for analysis. Two hundred thirty-eight underwent concomitant gluteal augmentation (85 percent): 213 had autologous flaps (76 percent), 13 had gluteal implants (5 percent), and 12 had large-volume lipofilling (4 percent). Forty-two patients underwent a body lift with no gluteal augmentation (15 percent). Gluteal augmentation did not increase the rate of complications. In both groups, no skin necrosis, venous thrombosis, or pulmonary embolism was reported. Patients who had a sleeve gastrectomy had significantly lower odds of complications compared with gastric bypass (OR, 0.45; p = 0.017). CONCLUSION A standardized algorithmic approach for gluteal augmentation may optimize the result without increasing the complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
|
11
|
Carloni R, Naudet F, Watier E, Bertheuil N. Comments on "What is Wrong With Systematic Reviews and Meta-Analyses: If You Want the Right Answer, Ask the Right Question!". Aesthet Surg J 2017; 37:NP22-NP23. [PMID: 28052907 DOI: 10.1093/asj/sjw230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raphael Carloni
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France.
| | - Florian Naudet
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Eric Watier
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Nicolas Bertheuil
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| |
Collapse
|
12
|
Thoma A, Eaves FF. What is Wrong With Systematic Reviews and Meta-Analyses: If You Want the Right Answer, Ask the Right Question! Aesthet Surg J 2016; 36:1198-1201. [PMID: 27756743 DOI: 10.1093/asj/sjw172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Achilleas Thoma
- Dr Thoma is a Clinical Professor, Division of Plastic Surgery, Department of Surgery; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; and Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal. Dr Eaves is a Professor of Surgery, Division of Plastic Surgery, Emory University; Medical Director of the Emory Aesthetic Center and Emory Ambulatory Surgery Center, Atlanta, GA, USA; and Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| | - Felmont F Eaves
- Dr Thoma is a Clinical Professor, Division of Plastic Surgery, Department of Surgery; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; and Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal. Dr Eaves is a Professor of Surgery, Division of Plastic Surgery, Emory University; Medical Director of the Emory Aesthetic Center and Emory Ambulatory Surgery Center, Atlanta, GA, USA; and Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| |
Collapse
|
13
|
Ellart J, Grolleau JL, Gangloff D, Meresse T, Garrido I, Bertheuil N, Carloni R, Chaput B. [Morbidity of bodylift. Evaluation of 111 patients over 5 years]. ANN CHIR PLAST ESTH 2016; 61:820-826. [PMID: 27666182 DOI: 10.1016/j.anplas.2016.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The management of patients with weight loss sequelae, sometimes major, is increasingly well standardized. However, this surgery is not without risk. Complications of bodylift are more frequent than those of conventional abdominoplasties. The objective of this study was to evaluate the morbidity associated with this surgery through a retrospective, single-center study. MATERIALS AND METHODS One hundred and eleven circular abdominaloplasties were conducted between June 2011 and September 2015 in the plastic surgery department of the university hospital of Toulouse. Minor and major complications were identified and analyzed. RESULTS Frequency of postoperative complications was 44.1% in our series. Major complications have involved 15.3% of patients. Blood transfusions (9%) and hematoma requiring reoperation (7.2%) were the most frequent major complications. We found significantly more major complications in patients with important fat resection with a cut off at 3200 g (P=0.02). Men experienced significantly more major complications than women (P=0.005). The average delta-BMI (before and after weight loss) was significantly higher in the group of patients with the highest percentage of minor complications (P=0.045). Indeed, a high delta-BMI (greater than 19.5) was associated with an excess risk of minor complications in our population. CONCLUSION Democratization and progress in the field of bodylift should not obscure the fact that it is, in reality, a procedure at risk. While we manage increasingly better cosmetic results and thromboembolic complications, it still persists many complications.
Collapse
Affiliation(s)
- J Ellart
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Lille, rue Émile-Laine, 59037 Lille, France
| | - J-L Grolleau
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - D Gangloff
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - T Meresse
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - N Bertheuil
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Sud, université de Rennes 1, 2, rue Henri-Le-Guillax, 35000 Rennes, France
| | - R Carloni
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
| |
Collapse
|