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Weissler JM, Kuruoglu D, Salinas C, Tran NV, Nguyen MDT, Martinez-Jorge J, Bite U, Harless CA, Vijayasekaran A, Sharaf B. Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery. Aesthet Surg J Open Forum 2022; 4:ojac033. [PMID: 35692487 PMCID: PMC9174740 DOI: 10.1093/asjof/ojac033] [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] [Indexed: 11/17/2022] Open
Abstract
Background Abdominal panniculectomy after weight loss is a commonly performed procedure with high patient satisfaction yet continues to have a high post-operative complication profile. Several risk-reducing surgical approaches, such as preservation of Scarpa’s fascia, use of tissue adhesives, and progressive tension suture techniques have been described. However, the use of tranexamic acid (TXA) has not been previously reported in panniculectomy surgery. Objectives To improve the safety and predictability of this procedure, the authors investigate whether the use of topically administered TXA during panniculectomy surgery reduces seroma, hematoma, and drain duration. Methods Consecutive patients who underwent panniculectomy (January 2010 to January 2022) were retrospectively reviewed. Outcome measures included hematoma requiring surgical evacuation, seroma requiring percutaneous aspiration, and drain duration. Patients with thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared with a historical control group who had not received TXA. Results A total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months (3.7 years). The median (range) resection weight was 2.6 kg (0.15-19.96 kg). Regarding seroma and hematoma formation, the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio [OR] = 1.7, 95% CI [0.56- 4.8], P = 0.38 and OR = 2.1, 95% CI [0.4-11.8], P = 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group (18.1 [12.1] days vs 19.8 [13.9] days); however, this difference was not statistically significant, albeit clinically significant. Conclusions As the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although previous studies report hematoma and seroma risk reduction, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in body contouring are needed. Level of Evidence: 3
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Affiliation(s)
- Jason M Weissler
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cristina Salinas
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nho V Tran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Minh-Doan T Nguyen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Uldis Bite
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christin A Harless
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aparna Vijayasekaran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Basel Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abdominal Panniculectomy: An Analysis of Outcomes in 238 Consecutive Patients over 10 Years. Plast Reconstr Surg Glob Open 2021; 9:e3955. [PMID: 34840922 PMCID: PMC8613336 DOI: 10.1097/gox.0000000000003955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 01/09/2023]
Abstract
Panniculectomy is a commonly performed body contouring procedure to address skin laxity and its related complications. This study aimed to assess clinical outcomes of abdominal panniculectomy and identify predictors of complications at a tertiary academic healthcare center. Methods A retrospective review of patients who underwent panniculectomy between January 2010 and January 2020 at our institution was performed. Exclusion criteria were a history of prior panniculectomy or abdominoplasty. Patient characteristics and clinical outcomes were collected. Univariate and multivariable analyses were performed to assess the risk factors of complications. Results The mean age in the included 238 patients was 51.7 ± 12.7 years, and the mean body mass index (BMI) at the time of panniculectomy was 33 ± 7.5 kg/m2. Median resection weight was 2.7 kg (range: 0.15-14.6) and median length of hospital stay was 2 days (range: 0-24). Mean follow-up time was 50 ± 37 months. The rate of major complications was 22.3%. Revision surgery was performed in 3.4% of the cases. Multivariable analyses demonstrated that increase in BMI (P = 0.007) and active smoking (P = 0.026) were significantly associated with increased odds of major complication, and increase in BMI (P = 0.0004), history of venous thromboembolism (P = 0.034) and having a concomitant ventral hernia repair (P = 0.0044) were significantly associated with having a length of hospital stay of 3 days or more. Conclusions Panniculectomy is generally safe to perform, with major postoperative complication rate of 22.3% in our series. Increase in BMI and active smoking were significantly associated with having a major complication. Higher BMI, concomitant hernia repair, and a history of venous thromboembolism were associated with length of hospital stay of 3 days or more.
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Restifo RJ. Abdominoplasty in the Massive Weight Loss Patient: Are Aesthetic Goals and Safety Mutually Exclusive? Aesthet Surg J Open Forum 2021; 3:ojab013. [PMID: 34212144 PMCID: PMC8240744 DOI: 10.1093/asjof/ojab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background The goals of abdominoplasty in massive weight loss (MWL) patients are often functional, with a greater emphasis on safety than on aesthetic rejuvenation. As important as functional improvements and safety are, however, there may be room for increasing the aesthetic potential of abdominoplasties in these patients. Objectives To determine the safety of the pursuit of aesthetic goals for abdominoplasty in MWL patients. Methods This is a retrospective study examining 910 consecutive female patients consisting of 3 groups: postpartum (n = 718), dietary MWL (n = 65), and bariatric MWL (n = 127). All patients were approached with a well-defined set of aesthetic goals which were pursued as needed and as feasible. Results The utilization of aesthetic abdominoplasty components was similar in all groups, supporting the assertion that the groups were subjected to a similar aesthetic emphasis. Logistic regression showed that a history of bariatric MWL was an independent risk factor for multiple complications (odds ratio 2.738, P = 0.014) and that elevated body mass index (BMI), smoking, diabetes, and age were likewise independent risk factors for complications. Propensity score-matched case-control pairs showed that bariatric MWL patients were more likely than dietary MWL patients to experience multiple complications (9.52% vs 0%, P = 0.031). Conclusions Bariatric MWL patients but not dietary weight loss patients seem to have a higher risk than postpartum patients. Other comorbidities (elevated BMI, smoking, diabetes, and age) seem to be more important predictors of complications than MWL status. Select MWL patients can likely be approached with an emphasis on aesthetic goals, without increasing risks as compared with the postpartum population. Level of Evidence: 2
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Affiliation(s)
- Richard J Restifo
- Corresponding Author: Dr Restifo, 620 Racebrook Road, Orange, CT 06477, USA. E-mail: ; Instagram: @DrRestifo
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Schlosshauer T, Kiehlmann M, Jung D, Sader R, Rieger UM. Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications. Aesthet Surg J 2021; 41:59-71. [PMID: 32162655 DOI: 10.1093/asj/sjaa067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. OBJECTIVES The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. METHODS A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. RESULTS A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. CONCLUSIONS This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4.
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Affiliation(s)
- Torsten Schlosshauer
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Marcus Kiehlmann
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Diana Jung
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Robert Sader
- Dr Sader is the Head of the Department, Oral, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich M Rieger
- Dr Schlosshauer is a Consultant Plastic Surgeon, Dr Kiehlmann is a plastic surgery resident, Ms Jung is a postgraduate student, and Dr Rieger is the Head of the Department, Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt am Main, Germany
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Rocha RI, Junior WC, Modolin MLA, Takahashi GG, Caldini ETEG, Gemperli R. Skin Changes Due to Massive Weight Loss: Histological Changes and the Causes of the Limited Results of Contouring Surgeries. Obes Surg 2020; 31:1505-1513. [PMID: 33145720 DOI: 10.1007/s11695-020-05100-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Outcomes of body contouring surgeries in patients who previously had obesity are limited because of the loss of skin quality. This study aimed to evaluate the morphometric characteristics of collagen and elastic fibers of the skin in the abdominal epigastric region of patients who had massive weight loss following bariatric surgery and compared such with the skin characteristics of patients with morbid obesity. METHODS This observational study compared skin fragments from the epigastric region of 20 patients who had massive weight loss due to bariatric surgery and 20 patients with morbid obesity. The morphometric analysis was performed on the collagen system using the Picrosirius/polarized light method and on the elastic system using the Weigert's resorcin-fuchsin method. RESULTS Reduction of thick collagen fibers (p = 0.048), increased thin collagen fibers (p = 0.0085), and increased elastic fiber density (p < 0.001) were observed in the massive weight loss group. No differences were found between the groups regarding mean age (p = 0.917) and total amount of collagen fibers (p = 0.3619). Structural dermis alterations in the massive weight loss group demonstrated collagenous remodeling, with consequent reduction of thick, organized, structured, and directed fibers in favor of thin, misaligned, and loosely arranged fibers. Weight loss was also associated with increased skin elasticity. CONCLUSION The morphometric changes in the collagen and elastic system scientifically explained the already established clinical perception of cutaneous alterations in patients who had massive weight loss following bariatric surgeries.
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Affiliation(s)
- Rodrigo I Rocha
- Division of Plastic Surgery, Hospital das Clínicas, Medical School, University of São Paulo (USP), 255 Dr Enéas de Carvalho Aguiar Avenue, São Paulo, SP, 05403-000, Brazil. .,Office, University of São Paulo (USP), 352 Teodoro Sampaio Street, Suit 101, SP, 05406-900, São Paulo, Brazil.
| | - Wilson Cintra Junior
- Division of Plastic Surgery, Hospital das Clínicas, Medical School, University of São Paulo (USP), 255 Dr Enéas de Carvalho Aguiar Avenue, São Paulo, SP, 05403-000, Brazil
| | - Miguel L A Modolin
- Division of Plastic Surgery, Hospital das Clínicas, Medical School, University of São Paulo (USP), 255 Dr Enéas de Carvalho Aguiar Avenue, São Paulo, SP, 05403-000, Brazil
| | - Giulia G Takahashi
- Division of Plastic Surgery, Hospital das Clínicas, Medical School, University of São Paulo (USP), 255 Dr Enéas de Carvalho Aguiar Avenue, São Paulo, SP, 05403-000, Brazil
| | - Elia T E G Caldini
- Laboratory of Cellular Biology, Department of Pathology, Medical School, University of São Paulo (USP), 455 Dr Arnaldo Avenue, São Paulo, SP, 01246-903, Brazil
| | - Rolf Gemperli
- Division of Plastic Surgery, Hospital das Clínicas, Medical School, University of São Paulo (USP), 255 Dr Enéas de Carvalho Aguiar Avenue, São Paulo, SP, 05403-000, Brazil
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Low Complication Rates Using Closed-Incision Negative-Pressure Therapy for Panniculectomies: A Single-Surgeon, Retrospective, Uncontrolled Case Series. Plast Reconstr Surg 2020; 146:390-397. [PMID: 32740593 DOI: 10.1097/prs.0000000000007026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Panniculectomies are associated with high complication rates (43 to 70 percent), particularly in patients with obesity, smoking, and diabetes mellitus. Closed-incision negative-pressure therapy can be used postoperatively to support healing by promoting angiogenesis and decreasing tension. The authors hypothesized that using it with panniculectomies would minimize complications, and that a longer duration of therapy would not increase the incidence of complications. The authors also evaluated whether closed-incision negative-pressure therapy malfunction was associated with complications. METHODS This retrospective, uncontrolled case series analyzed 91 patients who underwent panniculectomies managed with closed-incision negative-pressure therapy performed by a single surgeon from 2014 to 2018. Patients were followed for 6 months; therapy duration and malfunction were recorded. Patients were placed into therapy duration groups (2 to 7, 8 to 10, or >10 days). Complications managed conservatively were minor and major if they required intervention. Odds ratios were performed with 95 percent confidence intervals and p values. RESULTS Mean follow-up was 225.1 days and mean closed-incision negative-pressure therapy duration was 10.5 days. Major complications were reported in five patients (5.5 percent), infections in four (4.4 percent), dehiscence in two (2.2 percent), and seroma in four (4.4 percent). Patients with malfunction [n = 16 (17.6 percent)] were more likely to experience complications (OR, 3.3; p = 0.043). No significant increase in complications was found with therapy duration longer than 10 days, but potentially there is an increased risk of infection (OR, 4.0; p = 0.067). CONCLUSIONS Although high complication rates have been associated with panniculectomies, the authors' results show that low complication rates can be achieved with closed-incision negative-pressure therapy. Randomized controlled trials need to be conducted evaluating different therapy systems and the optimal duration of therapy with panniculectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2987. [PMID: 32802676 PMCID: PMC7413797 DOI: 10.1097/gox.0000000000002987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022]
Abstract
Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in the elderly following panniculectomy.
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8
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Cammarata MJ, Kantar RS, Rifkin WJ, Greenfield JA, Levine JP, Ceradini DJ. Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy. Obes Surg 2019; 29:426-433. [PMID: 30238217 DOI: 10.1007/s11695-018-3492-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Widespread adoption of bariatric surgery in the treatment of obesity has led to greater numbers of patients seeking panniculectomy, including aged patients, who represent a rapidly growing proportion of the U.S population. Although the quality of life and functional benefits of abdominal panniculectomy have been established, its safety in patients 65 years and older has not been evaluated. METHODS The American College of Surgeons National Surgical Quality Improvements (ACS-NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015. Age 65 years and older was the risk factor of interest, and primary outcomes included 30-day wound complications, overall complications, reoperation, readmission, and mortality. Multivariate regression was performed to control for confounders. RESULTS Review of the database identified 7030 patients who underwent abdominal panniculectomy. When stratified by age, 6455 (91.8%) of patients were younger than 65, and 575 (8.2%) were 65 or older. Multivariate regression analysis demonstrated that age over 65 was a significant independent risk factor for wound complications (OR = 1.81; 95% CI 1.35-2.42; p < 0.001) and all complications (OR = 1.46; 95% CI 1.15-1.87; p = 0.002). BMI, smoking, diabetes, and partial or total dependence were also identified as significant independent risk factors for wound and all complications. CONCLUSION Our analysis demonstrates that advanced age is an independent risk factor for wound and overall complications following abdominal panniculectomy. These results highlight the importance of preoperative evaluation and optimization of modifiable preoperative risk factors as well as close postoperative follow-up for safe outcomes in patients 65 and older.
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Affiliation(s)
- Michael J Cammarata
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - William J Rifkin
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Jason A Greenfield
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA.
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Lymphostasis and Hemostasis in Body-Contouring Surgery Using a Polysaccharide Based Hemostat (4DryField PH). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2128. [PMID: 31044110 PMCID: PMC6467625 DOI: 10.1097/gox.0000000000002128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
Background: Following liposuction, abdominoplasty is the most frequent body-contouring intervention in the world. The transection of small blood vessels in large areas and subsequent bleeding is a viable risk during this procedure. The resulting microvascular bleedings should be stopped thoroughly to reduce the probability of related complications. In this prospective, monocentric, randomized study, the efficacy of the polysaccharide-based hemostat 4DryField PH (4DF) (PlanTec Medical, Lueneburg, Germany) is examined in classic abdominoplasty and lower body lift after Lockwood. Methods: For this prospective, monocentric, randomized study, 40 patients underwent surgery for both interventions. Twenty patients received an abdominoplasty, and 20 patients underwent a body lift. In each group, 10 patients have been treated with 4DF, whereas 10 have been served as the untreated control group. Results: 4DF had neither a beneficial nor a negative effect on necessity of drainages, drainage volume and duration, length of hospital stay or frequency of postoperative seromas, wound healing disturbances, and infections, independent of surgical intervention. Patients in the 4DF group, however, had more individual risk factors, and required extended surgical interventions that might mask primary outcome results. Conclusions: This is the first prospective, monocentric, randomized study on 4DF in body-contouring surgery. The use of 4DF did not lead to a better postoperative outcome regarding hemostasis and lymphostasis. Potential benefits need further evaluation in high-volume studies.
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Zavlin D, Jubbal KT, Balinger CL, Dinh TA, Friedman JD, Echo A. Impact of Metabolic Syndrome on the Morbidity and Mortality of Patients Undergoing Panniculectomy. Aesthetic Plast Surg 2017; 41:1400-1407. [PMID: 28779409 DOI: 10.1007/s00266-017-0952-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is defined as the concomitant disease process of obesity and at least two of the following variables: diabetes, hypertension, hypertriglyceridemia, or reduced high-density lipoprotein. These entities are well established as risk factors for complications following surgery. Obese patients are particularly prone to the development of MetS. The authors therefore aimed at elucidating the impact of MetS on the perioperative panniculectomy outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was analyzed for all primary procedures of panniculectomy from 2010 through 2015. The cases were stratified based on the presence or absence of MetS and evaluated for demographic data, intraoperative details, and their morbidity and mortality within 30 days after surgery. RESULTS A total of 7030 cases were included in this study. Patients with MetS (6.2%) were of significantly worse health, required more emergency admissions (p = 0.022), longer hospitalization (p < 0.001), and more frequently inpatient procedures (p < 0.001) compared to the control group without MetS (3.8%). Plastic surgery was the predominant specialty operating on 79.5% of all cases. Surgical (23.3 vs. 8.7%) complications, readmission (8.7 vs. 3.0%), and reoperations (6.9 vs. 3.1%) rates were all significantly higher in patients with MetS that those without (p < 0.001). One fatality occurred in each cohort (0.23 vs. 0.02%, p = 0.010). CONCLUSION Comorbidities are not uncommon in patients undergoing panniculectomy, especially in those diagnosed with MetS. Health-care providers need to be aware of the increased morbidity and mortality in this high-risk subgroup and need to consider preoperative optimization and management before proceeding with surgery. 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)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA.
| | - Kevin T Jubbal
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Christopher L Balinger
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Tue A Dinh
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
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12
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Akita S, Yamaji Y, Tokumoto H, Adachi N, Sasahara Y, Kubota Y, Kuriyama M, Mitsukawa N. Abdominoplasty with Lymphatic Microsurgery for Patients with Secondary Lower Extremity Lymphedema. Plast Reconstr Surg 2017; 140:719e-723e. [PMID: 28746237 DOI: 10.1097/prs.0000000000003755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with secondary lower extremity lymphedema often develop suprapubic lymphedema. The authors developed a novel surgical method of shaping the lower abdomen and debulking suprapubic lymphedema with simultaneous reconstruction of lymphatic flow in case of lower extremity lymphedema. METHODS A fleur-de-lis skin incision pattern was performed for horizontal and vertical abdominal skin and fat resection. A caudally based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions. After resection and debulking of the suprapubic region, a lymphaticovenular anastomosis between the efferent lymphatic vessel of the groin node and the superficial inferior epigastric vein was created or vascularized lymph node transfer to the groin region was performed to restore lymphatic flow. Lymphaticovenular anastomosis and lymph node transfer were also performed at the lower extremities to improve lower extremity lymphedema. Perioperative change in limb volume was evaluated using the lower extremity lymphedema index, and lymphatic function was evaluated by lymphoscintigraphy. RESULTS Simultaneous abdominoplasty and reconstructive lymphatic microsurgery were performed in 11 patients. The lower extremity lymphedema index improved perioperatively, with a significant difference (p < 0.01). In eight patients who underwent lymphoscintigraphy before and after surgery, the lymphatic function was found to have not deteriorated in any limb. CONCLUSIONS When simultaneous lymphatic microsurgical procedures and careful observation for complications were performed, abdominoplasty resulted in good outcomes in patients with lower extremity lymphedema and suprapubic lymphedema without worsening of lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Shinsuke Akita
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Yoshihisa Yamaji
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Hideki Tokumoto
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Naoki Adachi
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Yoshitaro Sasahara
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Yoshitaka Kubota
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Motone Kuriyama
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
| | - Nobuyuki Mitsukawa
- Chiba, Ibaragi-cho, and Nankoku, Japan.,From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine; the Division of Plastic and Reconstructive Surgery, Chiba Cancer Center; the Department of Surgery, Mito Medical Center; and the Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital
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Abstract
BACKGROUND In addition to the already-known postoperative complications in patients formerly obese, for medial thigh lift, there are many more problematic issues. The main ones are represented as follows: by the frequent downward displacement of the scars that become, in this way, extremely visible; by the distortion of the vulva or scrotal region; by serious and disabling disorders of the lymphatic system; and by the early recurrence of ptosis in this anatomical site. MATERIALS AND METHODS From 2004 to 2010, 16 patients with moderate to severe laxity of the medial area of the thighs were treated by an L-shaped medial thigh lift after selective liposuction. Ten have been previously treated with biliopancreatic diversion and 6 have been previously treated with gastric bypass. Mean (standard deviation [SD]) height before bariatric surgery was 1.62 (0.08) m, mean (SD) weight was 141.53 (23.12) kg, and mean (SD) body mass index was 57.13 (8.21) kg/m. After the intervention, mean (SD) weight decreased to 81.12 (16.43) kg, whereas mean (SD) body mass index decreased to 31.83 (8.51) kg/m. RESULTS After L-shaped lipothighplasty, 13 patients (81%) had no complications in the postoperative period. No skin necrosis, hematoma, seroma, or thromboembolic events were reported. Two patients experienced hypertophic scarring and 1 patient had a wound infection because of poor hygienic care. CONCLUSIONS The medial lifting technique defined as L-shaped lipothighplasty is a valid, fast, and safe technique and can reduce early and late postoperative complications in a critical and troublesome area for the surgeon who is going to correct the deformity.
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Classifying severity of abdominal contour deformities after weight loss to aid in patient counseling: a review of 1006 cases. Plast Reconstr Surg 2015; 134:888e-894e. [PMID: 25415111 DOI: 10.1097/prs.0000000000000763] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal contour deformities after massive weight loss are highly variable, ranging from a mild upper protuberance to multiple rolls. Correction of these deformities is challenging and may require advanced surgical techniques. Evaluating the incidence of patients presenting with various abdominal deformities and the factors influencing these deformities could aid patients undergoing weight loss. METHODS All massive weight loss patients presenting for abdominal contouring from 2002 to 2012 were reviewed, and abdomens were graded using a modified Pittsburgh Rating Scale. Data collected for each patient included body mass indices, history of bariatric surgery, and type of abdominal contouring surgery. RESULTS One thousand six patients were evaluated, with a mean age of 44.2 ± 10.5 years. The mean maximum body mass index was 51.7 ± 9.6 kg/m2, mean current body mass index was 30.0 ± 6.4 kg/m2, and mean change in body mass index was 21.7 ± 7.0 kg/m2. Sixty-four percent had a high-grade deformity. Patients with a larger change in body mass index had higher deformity grades (p < 0.001). Patients with higher deformity grades were more likely to undergo a fleur-de-lis abdominoplasty (p < 0.001). CONCLUSIONS Most patients presenting for body contouring after massive weight loss have high-grade abdominal deformities with multiple rolls. Change in body mass index is positively correlated with deformity grade and more aggressive contouring procedures. Patients interested in massive weight loss should be counseled that, depending on desire for eventual outcomes, more complex procedures may be required to correct the resultant abdominal deformity.
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Staalesen T, Olsén MF, Elander A. Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy. J Plast Surg Hand Surg 2012; 46:416-20. [DOI: 10.3109/2000656x.2012.717898] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bracaglia R, Tambasco D, D'Ettorre M, Gentileschi S. "Inverted-Y": a modified vest-over-pants abdominoplasty pattern following bariatric surgery. Aesthetic Plast Surg 2012; 36:1179-85. [PMID: 22936375 DOI: 10.1007/s00266-012-9956-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 06/11/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The post-bariatric surgery patient presents several challenges to the surgeon. Correction of skin and subcutaneous redundancy can be difficult, particularly in massive-weight-loss patients with horizontal laxity, upper abdominal or flank laxity, and "double-roll" deformities. The aim of our study was to propose our modification of the "vest-over-pants" abdominoplasty technique to exploit all the advantages of the Planas technique in bariatric surgery patients and to solve the problem of extreme epigastric skin redundancy in difficult abdominal contour cases. METHODS Sixteen post-bariatric surgery patients (10 females and 6 males, nonsmokers) with moderate to severe epigastric skin laxity were enrolled in the study. They all had undergone a biliopancreatic diversion (BPD) by laparotomy and had undergone this body-contouring procedure from 2006 to 2010. RESULTS After the inverted-Y abdominoplasty, 12 patients (75 %) had an uneventful recovery. On the other hand, one subject (6.25 %) had a seroma and four (25 %) had wound dehiscence and delayed wound healing. No skin necrosis was reported. In one patient (6.25 %) scar revision in areas that had delayed healing was performed. The addition of a vertical incision has not led to an increased rate of postoperative complications, but the rates are in line with the satisfactory results described with the Planas technique in bariatric surgery patients. In addition, various advantages have been observed compared to traditional vertical resection patterns. CONCLUSION This case series has quantitative limitations and further investigations are needed. However, this study suggests that inverted-Y abdominoplasty could be a good compromise between the need to minimize complication rates and ensure an optimum aesthetic result and patient satisfaction rate in some abdominal defects in massive-weight-loss patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article.
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Affiliation(s)
- Roberto Bracaglia
- Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Rome, Italy
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Staalesen T, Elander A, Strandell A, Bergh C. A systematic review of outcomes of abdominoplasty. J Plast Surg Hand Surg 2012; 46:139-44. [DOI: 10.3109/2000656x.2012.683794] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Changes in Quality of Life and Functional Status following Abdominal Contouring in the Massive Weight Loss Population. Plast Reconstr Surg 2011; 128:520-526. [DOI: 10.1097/prs.0b013e31821b62f0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Discussion: Changes in quality of life and functional status following abdominal contouring in the massive weight loss population. Plast Reconstr Surg 2011; 128:527-528. [PMID: 21788845 DOI: 10.1097/prs.0b013e31821e9f76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fleur-de-Lis Abdominoplasty: A Safe Alternative to Traditional Abdominoplasty for the Massive Weight Loss Patient. Plast Reconstr Surg 2010; 125:1525-1535. [DOI: 10.1097/prs.0b013e3181d6e7e0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mercedes Panniculectomy with Simultaneous Component Separation Ventral Hernia Repair. Plast Reconstr Surg 2010; 125:94e-8e. [DOI: 10.1097/prs.0b013e3181cb641d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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