1
|
Kilian K, Panayi A, Matar D, Hamwi C, Bigdeli A, Kneser U, Vollbach F. Similarity of Seroma Rate at the Medial Thigh following Free Flap Harvesting or Medial Thigh Lift: A Systematic Review and Meta-analysis. JPRAS Open 2024; 40:360-374. [PMID: 38770115 PMCID: PMC11103577 DOI: 10.1016/j.jpra.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/30/2024] [Indexed: 05/22/2024] Open
Abstract
Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
Collapse
Affiliation(s)
- K.K. Kilian
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - A.C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - D.Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C. Hamwi
- Department of Data Science, Saint Louis University, St. Louis, MO, USA
| | - A.K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - U. Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - F.H. Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| |
Collapse
|
2
|
Caretto AA, Servillo M, Tagliaferri L, Lancellotta V, Fragomeni SM, Garganese G, Scambia G, Gentileschi S. Secondary post-oncologic vulvar reconstruction - a simplified algorithm. Front Oncol 2023; 13:1195580. [PMID: 37409264 PMCID: PMC10318400 DOI: 10.3389/fonc.2023.1195580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Surgical treatment is the gold standard of care for vulvar cancer and is burdened by a high risk of wound complications due to the poor healing typical of the female genital area. Moreover, this malignancy has a high risk of local relapse even after wide excision. For these reasons, secondary reconstruction of the vulvoperineal area is a relevant and challenging scenario for gynecologists and plastic surgeons. The presence of tissue already operated on and undermined, scars, incisions, the possibility of previous radiation therapy, contamination of urinary and fecal pathogens in the dehiscent wound or ulcerated tumor, and the unavailability of some flaps employed during the primary procedure are typical complexities of this surgery. Due to the rarity of this tumor, a rational approach to secondary reconstruction has never been proposed in the literature. Methods In this observational retrospective study, we reviewed the clinical data of patients affected by vulvar cancer who underwent secondary reconstruction of the vulvoperineal area in our hospital between 2013 and 2023. Oncological, reconstructive, demographic, and complication data were recorded. The primary outcome measure was the incidence of wound complications. The secondary outcome measure was the indication of the different flaps, according to the defect, to establish an algorithm for decision-making. Results Sixty-six patients were included; mean age was 71.3 ± 9.4 years, and the mean BMI was 25.1 ± 4.9. The mean size of the defect repaired by secondary vulvar reconstruction was 178 cm2 ± 163 cm2. Vertical rectus abdominis myocutaneous (VRAM), anterolateral thigh (ALT), fasciocutaneous V-Y (VY), and deep inferior epigastric perforator (DIEP) were the flaps more frequently employed. We observed five cases of wound breakdown, one case of marginal necrosis of an ALT flap, and three cases of wound infection. The algorithm we developed considered the geometry and size of the defect and the flaps still available after previous surgery. Discussion A systematic approach to secondary vulvar reconstruction can provide good surgical results with a low rate of complications. The geometry of the defect and the use of both traditional and perforator flaps should guide the choice of the reconstructive technique.
Collapse
Affiliation(s)
- Anna Amelia Caretto
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
| | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Simona Maria Fragomeni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Rome, Italy
| | - Giorgia Garganese
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Rome, Italy
| | - Stefano Gentileschi
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Rome, Italy
| |
Collapse
|
3
|
Özkaya Ö, Yasak T. Vertical Medial Thigh Lift with the 'Anchor L Liposculpture' Technique in Massive Weight Loss Patients: Preliminary results. Aesthetic Plast Surg 2022; 46:276-286. [PMID: 34173029 DOI: 10.1007/s00266-021-02394-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among all post bariatric surgical procedures, vertical thigh lift has the highest complication rates. Many modifications have been described to achieve better aesthetic results and decrease complication rates. The study aimed to present ''Anchor L Liposculpture Technique'' and discuss the results in the light of current literature. METHOD Between 2016 and 2020, 33 patients were operated with the Anchor L Liposculpture technique. In this technique, liposuction is performed similarly with the other techniques, but the liposuction area is not extended to posterior or anterior compartments to prevent complications. The technique also used a deepithelized flap to anchor the superficial fascial system to the pubic arch periosteum. The patients' characteristics (age, sex, body mass index, smoking history, amount of weight loss, comorbidities) volume of liposuction and postoperative complications were recorded. Results were compared between uncomplicated (group A) and complicated patients (group B). RESULT Six (n=6, %18.2) out of 33 patients experienced complications (Group B). There were no major complication. The most common complications are wound dehiscence (n = 2) and lymphocele (n = 2). All complication cases managed conservatively. Age and amount of liposuction were found to be statistically associated with increased complications. Other comparisons between group A and B did not show any significant difference. Scar migration was not observed in any patient during follow-up. CONCLUSION Anchor L Liposculpture technique is an easy-to-apply and reliable technique aimed better surgical results and lower complication rates. Surgeons especially at beginning of the learning curve or who experienced high complication rates can utilize this technique. 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 .
Collapse
Affiliation(s)
| | - Tuğçe Yasak
- Prof. Dr. Cemil Taşçıoğlu State Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Piyalepaşa Street, Istanbul, Turkey.
| |
Collapse
|
4
|
Feasibility, indications and complications of SCIP flap for reconstruction after extirpative surgery for vulvar cancer. J Plast Reconstr Aesthet Surg 2021; 75:1150-1157. [PMID: 34866009 DOI: 10.1016/j.bjps.2021.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 09/24/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Surgical therapy for vulvar cancer involves wide defects that often require flap-based reconstruction. The goal of the reconstruction is fast wound healing with low donor site morbidity. MATERIALS AND METHODS This is a retrospective observational cohort study in which we reviewed all patients who underwent surgery for vulvar cancer followed by reconstruction using the Superficial Circumflex Iliac Artery Perforator (SCIP) flap between 2015 and 2020. The primary outcome measure of this investigation was the incidence of wound complications. The secondary outcomes were the surgical indications in terms of establishing the anatomical subunits involved in the resection that made us choose this flap for reconstruction. This study adheres to the STROBE guidelines. RESULTS Thirty-two patients were included; in two cases, the flap was performed bilaterally for a total of 34 SCIP flaps. The mean age of patients was 70.6 ± 8.6 years, and the mean BMI was 26.8 ± 4.7. The SCIP flap was always feasible. The mean flap size was 128.8 ± 74.3cm2. Three patients showed wound complications. In every patient, the defect involved the vulva, perineum and inguinal area; in 18 patients, the mons pubis was also involved. The mean follow-up was 30 months. During the follow-up, six patients died, and four showed local or nodal cancer relapse. CONCLUSION Our results suggest that the advantages of SCIP flap for the reconstruction of vulvoperineal defects secondary to vulvar cancer surgery include low complication rate, minimal donor site morbidity, quick dissection, proximity of donor and recipient sites, possibility to harvest large skin islands of variable thickness and chimeric flaps.
Collapse
|
5
|
Risk Factors for Complications after J Medial Thighplasty following Massive Weight Loss: A Multivariate Analysis of 94 Consecutive Patients. Plast Reconstr Surg 2021; 148:540e-547e. [PMID: 34550932 DOI: 10.1097/prs.0000000000008386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bariatric surgery has increased the number of patients requiring medial thighplasty after massive weight loss. However, despite the various complications, the procedure improves quality of life. The authors report postoperative complications of vertical J-shaped medial thigh lift in a series of patients and identify preoperative risk factors. METHODS For almost 5 years, the details of all J medial thighplasties performed by a single surgeon were recorded; detailed medical records were also available. Complications can be major (e.g., need for early surgical revision or readmission) or minor (delayed wound healing). RESULTS During the study period, 94 patients were treated and only minor complications were recorded (42.5 percent). On multivariate analysis, older age (OR, 1.05; 95 percent CI, 1.01 to 1.10) and a body mass index greater than or equal to 30 kg/m2 (OR, 2.82; 95 percent CI, 1.10 to 7.22) were independent risk factors for postoperative complications. CONCLUSIONS As with other postbariatric operations, medial thighplasty is associated with significant morbidity, but the risk thereof can be easily established and managed. Specific algorithms for determining the risk of postoperative complications based on age and body mass index are needed to guide preoperative discussions with patients and perform patient selection. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
6
|
Losco L, Roxo AC, Roxo CW, de Sire A, Bolletta A, Cuomo R, Grimaldi L, Cigna E, Roxo CDP. Helix Thigh Lift. A Novel Approach to Severe Deformities in Massive Weight Loss Patients. J INVEST SURG 2021; 35:620-626. [PMID: 34027784 DOI: 10.1080/08941939.2021.1912220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND After massive weight loss, the severe gynoid body contour deformities are not always faceable with optimal results. The thigh is one of the most demanding area to address; therefore, the approach should be virtually individualized. The authors describe the helix thigh lift: A novel technique that combines vertical with horizontal axis of pull. The goal of this ultimate customization is to dramatically impact physical functioning and esthetics of this patient population. METHODS Thigh lift patients from 2016 to 2019 were assessed retrospectively; fourteen patients were selected for helix thigh lift procedure. Preoperative markings, surgical technique and outcomes were described. The mean follow-up time was 14.8 ± 3.2 months. A questionnaire was administered to evaluate the results. RESULTS Fourteen female patients (mean age, 42 ± 4.8 years) underwent helix thigh lift after massive weight loss. The overall complication rate was 36 percent. They were all minor complications and were treated in an outpatient setting. Seroma formation was the most frequent, at 29 percent. No skin necrosis was reported. Complication development was straight related to the age of the patient (p = 0.0455). The patients were very satisfied with the overall outcome. CONCLUSIONS Helix thigh lift effectively addresses the severe gynoid body contour deformities. The high satisfaction and the reasonable complication rate suggest that this is a safe and effective technique. The age of the patient was significantly associated to complication development. A dramatic improvement of ease in performing activities of daily living along with reduction of the skin problems leads to significant improvement of the quality of life.
Collapse
Affiliation(s)
- Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
| | - Ana Claudia Roxo
- Plastic Surgery Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Carlos Weck Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Italy
| | - Alberto Bolletta
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | |
Collapse
|
7
|
Bracaglia R, Servillo M, Fortunato R, Gentileschi S. The Triple Plane, the Bra-Flap, and the Inverted Bra-Flap Modified Dual Plane Techniques for Breast Augmentation. Aesthet Surg J 2020; 40:NP141-NP151. [PMID: 31150054 DOI: 10.1093/asj/sjz160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast augmentation (BA) is a very common procedure performed for a wide range of indications. The short-term and long-term outcomes are strongly correlated with the choice of the correct implant pocket, which should be tailored to the anatomic features of the breast. OBJECTIVES The aim of this study was to report the safety and efficacy of the triple-plane technique and Bra-flap modified dual-plane techniques for BA. METHODS From January 1995 to January 2016, 605 patients underwent BA procedures that utilized the triple-plane technique or Bra-flap modified dual-plane techniques. Patient evaluation was performed preoperatively and postoperatively at 6 and 12 months and every 5 years thereafter. The occurrence of ptosis and implant malposition, as well as breast animation deformity, were assessed. Patient satisfaction was evaluated with the BREAST-Q Augmentation Module. RESULTS The average patient age was 39.3 years. The follow-up period ranged from 24 months to 20 years. The triple-plane technique was performed in 450 patients, the Bra-flap modified dual-plane technique in 97, and the inverted Bra-flap modified dual-plane technique in 58. No cases of double-bubble deformity or implant bottoming-out were observed. Regarding animation deformity, 209 patients presented with mild to moderate distortion, whereas no patients presented with severe distortion. The BREAST-Q questionnaire reported significant postoperative improvements in all scales. CONCLUSIONS In over 20 years of experience, the triple-plane technique has proven to be a reliable procedure that offers natural and long-lasting results. The Bra-flap and inverted Bra-flap modified dual-plane techniques are efficient options to expand the range of breast conditions treated. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
| | | | | | - Stefano Gentileschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
8
|
Di Pietro V, Gianfranco MC, Cervelli V, Gentile P. Medial Thigh Contouring in Massive Weight Loss: A Liposuction-Assisted Medial Thigh Lift. World J Plast Surg 2019; 8:171-180. [PMID: 31309053 PMCID: PMC6620815 DOI: 10.29252/wjps.8.2.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Thigh’s lifting can be associated with significant complications, if the medial thigh excess is removed en bloc. In this study, the liposuction-assisted medial thigh’s lift (LAMeT) procedure, outcomes and complications were assessed. METHODS Twenty four females between 25 and 61 years with grade 2 or 3 on Pittsburgh Rating Scale (PRS) treated with medial thigh’s reduction were enrolled. Medial thigh’s reduction was performed in three different procedures of vertical, horizontal and LAMeT. Vertical thigh’s lift with fascia suspension was conducted in 13 patients with grade 3 of ptosis on PRS; horizontal thigh’s lift with fascia suspension was undertaken in 3 patients with grade 2 on PRS; vertical and horizontal thigh’s lift considered as control group was described as excision-only group; and LAMeT was performed in 8 patients with grade 2 and 3 on PRS. RESULTS Complications were observed in 62.5% of patients who underwent vertical or horizontal thigh’s lift with fascia suspension and in 16.7% who experienced the LAMeT without fascia suspension. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT. CONCLUSION Medial thigh’s lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc, as the resection of excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus postoperative complications incidence is lower and the patient heals faster.
Collapse
Affiliation(s)
- Verdiana Di Pietro
- Department of Plastic, Reconstructive and Regenerative Surgery, University of Rome "Tor Vergata", Italy
| | | | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, Catholic University, "Our Lady of Good Counsel", Tirane, Albania
| | - Pietro Gentile
- Department of Plastic, Reconstructive and Regenerative Surgery, University of Rome "Tor Vergata", Italy
| |
Collapse
|
9
|
Reply: Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients. Plast Reconstr Surg 2017; 139:803e-804e. [PMID: 28234876 DOI: 10.1097/prs.0000000000003098] [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]
|
10
|
Afshari A, Gupta V, Nguyen L, Shack RB, Grotting JC, Higdon KK. Preoperative Risk Factors and Complication Rates of Thighplasty: Analysis of 1,493 Patients. Aesthet Surg J 2016; 36:897-907. [PMID: 27217587 DOI: 10.1093/asj/sjv275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite a rise in thighplasties, outcomes and risk factors have not been well described. OBJECTIVES This study investigated the incidence and risk factors of major complications following thighplasty in a large, prospective, multicenter database. It further evaluated the safety of combined procedures. METHODS Patients undergoing thighplasty between 2008 and 2013 were identified within the CosmetAssure database (Birmingham, AL). The primary outcome was the occurrence of major complication(s) requiring emergency department visit, hospital admission, or reoperation within 30 days postoperatively. Age, gender, body mass index, smoking, diabetes, type of facility, and combination procedures were evaluated as risk factors. RESULTS Among the 129,007 patients enrolled in CosmetAssure, 1493 (0.8%) underwent thighplasty. One thousand and eighty-eight (72.9%) thighplasties were combined with other procedures. Ninety-nine (6.6%) developed at least one complication. The most common complications were infection (2.7%), hematoma (2.1%), suspected venous thromboembolism (VTE) (1.1%), fluid overload (0.5%), and confirmed VTE (0.3%). Thighplasties performed in a hospital had higher complications (8.1%) than ambulatory surgical center (6.2%) and office-based surgical suite (3.1%). When thighplasty was performed alone, smoking was an independent risk factor to develop at least one complication (RR = 9.51) and hematoma (RR = 13.48). Compared to thighplasty alone, complication rate did not increase with the addition of concomitant procedures (4.7% vs 7.4%, P = .079). CONCLUSION Infection and hematoma are the most common major complications. In thighplasty alone, smoking is the only independent risk factor for overall complications and hematoma formation. The addition of concomitant cosmetic procedures does not increase complication rates. LEVEL OF EVIDENCE 2 Risk.
Collapse
Affiliation(s)
- Ashkan Afshari
- Drs Afshari and Nguyen are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Afshari and Nguyen are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Lyly Nguyen
- Drs Afshari and Nguyen are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - R Bruce Shack
- Drs Afshari and Nguyen are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Afshari and Nguyen are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Drs Afshari and Nguyen are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| |
Collapse
|
11
|
Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients. Plast Reconstr Surg 2016; 137:1748-1757. [DOI: 10.1097/prs.0000000000002194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Simone P, Carusi C, Del Buono R, Persichetti P. Medial thigh lift in post-bariatric patients: Our encouraging experience. J Plast Surg Hand Surg 2016; 50:359-366. [DOI: 10.1080/2000656x.2016.1184157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
13
|
Sisti A, Cuomo R, Zerini I, Tassinari J, Brandi C, Grimaldi L, D'Aniello C, Nisi G. Complications Associated With Medial Thigh Lift: A Comprehensive Literature Review. J Cutan Aesthet Surg 2016; 8:191-7. [PMID: 26865783 PMCID: PMC4728900 DOI: 10.4103/0974-2077.172189] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using “medial thighplasty”, “medial thigh lifting” and “technique” as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.
Collapse
Affiliation(s)
- Andrea Sisti
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Irene Zerini
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Juri Tassinari
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Cesare Brandi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| |
Collapse
|