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Johnson C, Vollstedt A, Nakatsuka H, Orzel J, Takacs EB. Cosmetic and functional impact of fascia lata harvest for use in surgery for stress urinary incontinence. Neurourol Urodyn 2024; 43:1185-1191. [PMID: 38587244 DOI: 10.1002/nau.25462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION There has been increased interest in using autologous tissues since the Food and Drug Administration banned transvaginal mesh for pelvic organ prolapse in 2019. Our study aims to assess patients' perspective of functional and cosmetic impact on the fascia lata harvest site in patients undergoing fascia lata harvest for the treatment of stress urinary incontinence (SUI). METHODS This is a prospective survey study of a retrospective cohort of patients who underwent a fascia lata pubovaginal sling between 2017 and 2022. Participants completed a survey regarding the functional and cosmetic outcomes of the harvest site. RESULTS Seventy-two patients met the inclusion criteria. Twenty-nine patients completed the survey for a completion rate of 40.3%. For functional symptoms, 24.1% (7/29) of patients reported leg discomfort, 10.3% (3/29) reported leg weakness, 10.3% (3/29) reported a bulge, 17.2% (5/29) reported scar pain, 14.8% (4/27) reported scar numbness, and 17.2% (5/29) reported paresthesia at the scar. For cosmetic outcomes, 72.4% (21/29) reported an excellent or good scar appearance. On the PGI-I, 75.9% (22/29) reported their condition as very much better (48.3%, 14/29) or much better (27.6%, 8/29). CONCLUSIONS The majority of patients reported being satisfied with the functional and cosmetic outcomes of their harvest site as well as satisfied with the improvement in their SUI. Less than 25% of patients report harvest site symptoms, including leg weakness, scar bulging, scar pain, scar numbness, or paresthesia in the scar. This is important in the context of appropriate preoperative discussion and counseling regarding fascia lata harvest.
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Affiliation(s)
- Colin Johnson
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Annah Vollstedt
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Hannah Nakatsuka
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Joanna Orzel
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Elizabeth B Takacs
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Chen Q, Li P, Zhao Q, Tu T, Lu H, Zhang W. Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries. Front Neurol 2023; 14:1258759. [PMID: 38020669 PMCID: PMC10659089 DOI: 10.3389/fneur.2023.1258759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.
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Affiliation(s)
- Qiang Chen
- Department of Hand & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - QingFang Zhao
- Department of Plastic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tian Tu
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Babarinsa IA, Bashir M, AbdelRahman Ahmed H, Ahmed B, Konje JC. Bariatric surgery and reproduction-implications for gynecology and obstetrics. Best Pract Res Clin Obstet Gynaecol 2023; 90:102382. [PMID: 37506498 DOI: 10.1016/j.bpobgyn.2023.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
As the rates of obesity continue to rise across the world, there has been an increasing resort to bariatric surgery amongst the options for treatment. Through the reproductive lifespan, between menarche and menopause, women might benefit from this surgical intervention, which may have a bearing on other aspects of their health. The consequences of bariatric surgery have been reported and evaluated from various perspectives in obstetrics and gynecology. Fertility and sexuality are enhanced, but not all gynecological diseases are ameliorated. There are also psychological and behavioral sequelae to be cognizant of. With multi-disciplinary and responsive care, most post-bariatric pregnancies have satisfactory outcomes. The effects of bariatric surgery on the babies conceived thereafter remains a subject of interest, whereas the possible effect on the climacteric is speculative.
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Affiliation(s)
- Isaac A Babarinsa
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha.
| | | | | | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Department of Health Sciences University of Leicester, UK
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Measurement of Postoperative Quality of Pain in Abdominoplasty Patients-An Outcome Oriented Prospective Study. J Clin Med 2023; 12:jcm12051745. [PMID: 36902531 PMCID: PMC10002866 DOI: 10.3390/jcm12051745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
(1) Background: Postoperative pain is a frequently underestimated complication significantly influencing surgical outcome and patient satisfaction. While abdominoplasty is one of the most commonly performed plastic surgery procedures, studies investigating postoperative pain are limited in current literature. (2) Methods: In this prospective study, 55 subjects who underwent horizontal abdominoplasty were included. Pain assessment was performed by using the standardized questionnaire of the Benchmark Quality Assurance in Postoperative Pain Management (QUIPS). Surgical, process and outcome parameters were then used for subgroup analysis. (3) Results: We found a significantly decreased minimal pain level in patients with high resection weight compared to the low resection weight group (p = 0.01 *). Additionally, Spearman correlation shows significant negative correlation between resection weight and the parameter "Minimal pain since surgery" (rs = -0.332; p = 0.013). Furthermore, average mood is impaired in the low weight resection group, indicating a statistical tendency (p = 0.06 and a Χ2 = 3.56). We found statistically significant higher maximum reported pain scores (rs = 0.271; p = 0.045) in elderly patients. Patients with shorter surgery showed a statistically significant (Χ2 = 4.61, p = 0.03) increased claim for painkillers. Moreover, "mood impairment after surgery" shows a dramatic trend to be enhanced in the group with shorter OP duration (Χ2 = 3.56, p = 0.06). (4) Conclusions: While QUIPS has proven to be a useful tool for the evaluation of postoperative pain therapy after abdominoplasty, only continuous re-evaluation of pain therapy is a prerequisite for constant improvement of postoperative pain management and may be the first approach to develop a procedure-specific pain guideline for abdominoplasty. Despite a high satisfaction score, we detected a subpopulation with inadequate pain management in elderly patients, patients with low resection weight and a short duration of surgery.
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Bachleitner K, Mahrhofer M, Knam F, Schoeller T, Weitgasser L. Corset trunkoplasty is able to preserve postoperative abdominal skin sensation in massive weight loss patients. J Plast Surg Hand Surg 2023; 57:438-444. [PMID: 36519716 DOI: 10.1080/2000656x.2022.2152822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Conventional abdominoplasty techniques commonly cause postoperative peri- and infraumbilical skin hypesthesia due to abdominal skin flap undermining. The aim of this study was to evaluate abdominal skin sensation after corset trunkoplasty in massive weight loss patients. Forty-nine massive weight loss patients suffering from excess skin underwent corset trunkoplasty between April 2017 and July 2021. Patient demographics and perioperative complications were recorded. Sensibility of the abdominal skin was measured in three qualities postoperatively using a Semmes-Weinstein monofilament, Tip-Therm® device for thermal sensation and a cotton wooden stick for sharp/blunt discrimination. Results were compared with a control group of healthy individuals to create a baseline. Revision surgery for major complications was necessary in five cases (10%) including hematoma and major wound healing disturbances. Minor complications that did not require surgical intervention were observed in eight cases (16%). Postoperative abdominal sensibility did not show any significant difference between the patient and the control group in all 16 measured areas. Sharp/blunt and thermal discrimination was positive in all patients for the whole abdominal surface area. The corset trunkoplasty technique is able to address both horizontal and vertical soft tissue excess in massive weight loss patients and at the same time limits loss of sensibility of the abdominal skin. Compared to conventional abdominoplasty techniques the abdominal sensation can mainly be preserved due to absence of undermining abdominal skin flaps.
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Affiliation(s)
- Kathrin Bachleitner
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, Tübingen, Germany
| | - Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, Tübingen, Germany
| | - Friedrich Knam
- Clinic for Plastic and Aesthetic Surgery/Hand Surgery, Pforzheim, Germany
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, Tübingen, Germany
| | - Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, Tübingen, Germany
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Rasulić L, Lepić M, Savić A, Novaković N, Kovačević V, Vitošević F, Samardžić M. Managing Complications Related to Peripheral Nerve Surgery: Selected Illustrative Cases. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:191-196. [PMID: 37548739 DOI: 10.1007/978-3-030-12887-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Peripheral nerve surgery mostly involves elective procedures; thus, the associated complications are of great clinical, social, and medicolegal importance. Apart from the general perioperative morbidity, complications during interventions on peripheral nerves are extremely rare. However, iatrogenic peripheral nerve injuries during unrelated surgical procedures performed by those not specialised in peripheral nerve surgery remain the most significant group of complications, accounting for up to approximately 17% of all cases. The aims of this review are to provide better insight into the multifaceted nature of complications related to peripheral nerve surgery-from the perspective of their causes, treatment, and outcome-and to raise surgeons' awareness of the risks of such morbidity. It should be emphasized that intraoperative complications in peripheral nerve surgery are largely "surgeon-related" rather than "surgery-related"; therefore, they have great potential to be avoided.
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Affiliation(s)
- Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
- Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Milan Lepić
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Andrija Savić
- Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nenad Novaković
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Vojin Kovačević
- Department of Neurosurgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Filip Vitošević
- Neuroradiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Miroslav Samardžić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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Martins MRC, Moraes BZFD, Fabri DC, Castro HASD, Rostom L, Ferreira LM, Nahas FX. Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty? Aesthet Surg J 2022; 42:1294-1302. [PMID: 35830484 DOI: 10.1093/asj/sjac194] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For decades, the postoperative wearing of abdominal binders has been suggested to reduce dead space and prevent mobilization of the musculoaponeurotic layer in an attempt to decrease the risk of seroma formation and recurrent diastasis. OBJECTIVES This study sought to evaluate whether the postoperative wearing of an abdominal binder provides any additional contribution to the reduction of either seroma formation or recurrent diastasis recti when abdominoplasty is performed with quilting sutures. METHODS Thirty-four women undergoing abdominoplasty were randomized into 2 groups: the binder group (n = 16) wore abdominal binders during the postoperative period, whereas the control group (n = 18) did not. Ultrasound examination was performed on postoperative days 7 and 14 to assess seroma formation and at 6 months postoperatively to assess recurrence of diastasis recti. A t test for independent samples was applied to compare means between 2 numeric variables. Generalized estimation equation models were used to evaluate seroma volume at different time points for the 2 groups. RESULTS No significant differences in seroma volume were found between groups on postoperative days 7 (P = 0.830) and 14 (P = 0.882). Seven cases of subclinical recurrent diastasis were observed by ultrasound examination in the supraumbilical (4 cases) and infraumbilical regions (3 cases), but without significant differences (P = 1.000) between the 2 groups. Recurrent diastasis was not detected during physical examinations. CONCLUSIONS The postoperative wearing of abdominal binders was not effective in preventing either seroma formation or recurrent diastasis following abdominoplasty with quilting sutures. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Daniel Capucci Fabri
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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8
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Saheb-Al-Zamani M. Mons Pubis Lift (Monsplasty). Clin Plast Surg 2022; 49:479-487. [DOI: 10.1016/j.cps.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Martins MRC, Moraes BZFD, Fabri DC, Castro HASD, Rostom L, Ferreira LM, Nahas FX. The Effect of Quilting Sutures on the Tension Required to Advance the Abdominal Flap in Abdominoplasty. Aesthet Surg J 2022; 42:628-634. [PMID: 34791039 DOI: 10.1093/asj/sjab395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Quilting sutures attaching the abdominal flap to the aponeurosis contribute to the prevention of seroma formation following abdominoplasty. The sutures distribute the tension over the subcutaneous tissue along the flap length, theoretically decreasing tension at the distal (cutaneous) end of the flap. This is expected to reduce the risks of necrosis, dehiscence, and enlarged or hypertrophic scars. OBJECTIVES This study sought to verify whether quilting sutures decrease the tension required to advance the dermal-fat flap in abdominoplasty. METHODS Thirty-four women undergoing abdominoplasty with quilting sutures participated in the study. The tensile force required for flap advancement was measured with a digital force gauge before and after placement of quilting sutures and then compared. Differences in tensile force were tested for correlations with BMI, age, weight of flap tissue removed, number of previous pregnancies, and postoperative complications, including seroma formation, hematoma, necrosis, dehiscence, and enlarged or hypertrophic scars. RESULTS A mean reduction in tension of 27.7% was observed at the skin suture after the placement of quilting sutures (P < 0.001). No significant correlation was found between reduced flap tension and BMI, age, weight of tissue removed, or number of births. One case of seroma formation and 2 cases of enlarged scars were observed, but no case of hematoma, necrosis, or wound dehiscence was detected. CONCLUSIONS The use of quilting sutures to attach the abdominal flap to the aponeurosis of the anterior abdominal wall reduced tension at the advancing edge of the flap in abdominoplasty.
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Affiliation(s)
| | | | - Daniel Capucci Fabri
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Gopinath B, Alkandari SA, Aloraify MB, Abdulsalam AJ. Foot drop post body contouring surgery: The cost of a six-pack? ACTA ACUST UNITED AC 2021; 25:421-422. [PMID: 33459295 PMCID: PMC8015597 DOI: 10.17712/nsj.2020.5.20200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Biju Gopinath
- Physical Medicine and Rehabilitation Hospital, Andalous, Kuwait
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Carlstedt A, Bringman S, Egberth M, Emanuelsson P, Olsson A, Petersson U, Pålstedt J, Sandblom G, Sjödahl R, Stark B, Strigård K, Tall J, Theodorsson E. Management of Diastasis of the Rectus Abdominis Muscles: Recommendations for Swedish National Guidelines. Scand J Surg 2020; 110:452-459. [PMID: 32988320 PMCID: PMC8551433 DOI: 10.1177/1457496920961000] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. Methods: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. Results: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient’s symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. Discussion: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
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Affiliation(s)
- A Carlstedt
- Department of Surgery, Karlstad Central Hospital, Karlstad, Sweden
| | - S Bringman
- Department of Surgery, Södertälje Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Egberth
- Department of Surgery, Mora hospital, Mora, Sweden
| | - P Emanuelsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - A Olsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinic of Surgery, Capio CFTK, Stockholm, Sweden
| | - U Petersson
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - J Pålstedt
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - R Sjödahl
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - B Stark
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - J Tall
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - E Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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12
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Chen J, Jiang H. Comments on "Post-Bariatric Abdominoplasty: Analysis of 406 Cases with Focus on Risk Factors and Complications". Aesthet Surg J 2020; 40:NP578-NP579. [PMID: 32556110 DOI: 10.1093/asj/sjaa079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jianguo Chen
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Abdominoplasty with Scarpa Fascia Preservation: Randomized Controlled Trial with Assessment of Scar Quality and Cutaneous Sensibility. Plast Reconstr Surg 2020; 146:156e-164e. [PMID: 32740578 DOI: 10.1097/prs.0000000000007024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. METHODS This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. RESULTS A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. CONCLUSION Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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14
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Nascimento FCLD, Rodrigues MCS. Risk for surgical positioning injuries: scale validation in a rehabilitation hospital. Rev Lat Am Enfermagem 2020; 28:e3261. [PMID: 32401901 PMCID: PMC7217622 DOI: 10.1590/1518-8345.2912.3261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. METHOD analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. RESULTS most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. CONCLUSION the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.
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15
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Near-circumferential Lower Body Lift: A Review of 40 Outpatient Procedures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2548. [PMID: 32537298 PMCID: PMC7288879 DOI: 10.1097/gox.0000000000002548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/04/2019] [Indexed: 12/16/2022]
Abstract
Lower body lift surgery has increased in popularity. A circumferential body lift or belt lipectomy is often recommended to treat skin redundancy. A drawback for this procedure is the midline scar bridging the lower back causing elongation of the gluteal cleft. Autoaugmentation methods have not been shown to provide a net increase in buttock volume.
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16
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Chopra K, Kokosis G, Slavin B, Williams E, Dellon AL. Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury. Aesthet Surg J 2019; 39:1427-1435. [PMID: 30346489 DOI: 10.1093/asj/sjy284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. OBJECTIVES The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. METHODS A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. RESULTS Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery. CONCLUSIONS Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Karan Chopra
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Georgios Kokosis
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Benjamin Slavin
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Eric Williams
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
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Giordano S, Kangas R, Veräjänkorva E, Koskivuo I. Ligasure impact™might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study. Scand J Surg 2019; 109:151-158. [DOI: 10.1177/1457496919828237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims:The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact™vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia.Material and Methods:Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints.Results:Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien–Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference.Conclusion:LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.
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Affiliation(s)
- S. Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
- The University of Turku, Turku, Finland
| | - R. Kangas
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
| | - E. Veräjänkorva
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
| | - I. Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
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Safety and Utility of the Drainless Abdominoplasty in the Post-Bariatric Surgery Patient. Ann Plast Surg 2018; 80:96-99. [PMID: 29319578 DOI: 10.1097/sap.0000000000001291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgical drains are used in abdominoplasty patients to combat wound closure disruption by hematoma or seroma formation. Several recent publications have described techniques that allow abdominoplasty to be performed safely without the need for surgical drains. This has not, however, been described in the case of the bariatric patient, who is often considered to be of higher postoperative complication risk. Here, we describe our experience of the drainless abdominoplasty in patients who have undergone massive weight loss (MWL) after a bariatric procedure. METHODS A retrospective review was conducted of 172 patients who had undergone drainless abdominoplasty using the progressive tension suture technique from 2011 to 2014. Thirty-five patients who had undergone MWL after bariatric surgery were assigned to group A. One hundred thirty-seven patients who had not undergone MWL with no history of bariatric surgery were assigned to group B. Demographics, intraoperative outcomes, and postoperative outcomes were compared. RESULTS Patients in group A were older (mean age, 48.7 vs 42.7 years; P = 0.003) and had a higher body mass index (26.6 vs 24.6 kg/m, P = 0.01), a significantly larger tissue resection (2379 vs 1228 g, P = 0.0001), and a higher estimated blood loss (100 vs 120 mL, P = 0.049). There was also a significant group-to-group difference in the American Society of Anesthesiologists Physical Status Classification distribution, with a higher percentage of MWL patients having higher scores. Despite these differences, group A did not have a statistically higher incidence of complications. There was no statistically significant difference in the rate of seroma formation (11% vs 2%, P = 0.055), wound infection (2.9% vs 4.4%, P = 0.68), wound dehiscence (8.6% vs 8.0%, P = 0.91), meralgia paresthetica (2.8% vs 1.5%, P = 0.51), or rate of reoperation (11.4% vs 13.9%, P = 0.7) between the 2 groups. CONCLUSION Despite post-bariatric surgery patients being considered higher risk for postoperative complications, drainless abdominoplasty can be safely offered to this population by using a progressive tension suture technique.
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Tremp M, Wang W, Oranges CM, Schaefer DJ, Wang W, Kalbermatten DF. Evaluation of the Neo-umbilicus Cutaneous Sensitivity Following Abdominoplasty. Aesthetic Plast Surg 2017; 41:1382-1388. [PMID: 28791469 DOI: 10.1007/s00266-017-0951-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Abdominal cutaneous sensitivity loss after abdominoplasty is an undesirable outcome. However, little is known in the literature about sensitivity changes of the neo-umbilicus after abdominoplasty. The aim of this study was to evaluate post-abdominoplasty cutaneous sensitivity of the neo-umbilicus using clinical, quantitative, and reproducible methods. METHODS Patients who underwent abdominoplasty were included, whereas the control group consisted of healthy volunteers with similar demographic characteristics but who did not undergo abdominoplasty. The umbilicus was divided into five zones, and superficial tactile sensitivity and spatial orientation were assessed subjectively (score 1-4) and objectively (Semmes-Weinstein monofilament examination). RESULTS Twenty patients (45 ± 12 years) operated on consecutively between April 2012 and May 2016 and 14 healthy volunteers in the control group (39 ± 9 years) could be included. Although there were statistically significant differences (p = 0.0005) in the average cutaneous pressure thresholds between the control group (0.4 g/mm2, range 0.07-2 g/mm2) and the study group (0.4 g/mm2, range 0.07-4 g/mm2), patient satisfaction after a mean follow-up of 33 ± 16 months (range 10-62 months) was acceptable (mean satisfaction score 1.8 ± 0.7). Furthermore, spatial perceptions were precise in all patients and similar to the control group. CONCLUSION Our long-term results indicate that spontaneous reinnervation of the neo-umbilicus after abdominoplasty together with accurate spatial orientation can occur. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Managing Complications in Abdominoplasty: A Literature Review. Arch Plast Surg 2017; 44:457-468. [PMID: 28946731 PMCID: PMC5621815 DOI: 10.5999/aps.2017.44.5.457] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 11/08/2022] Open
Abstract
Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
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Iatrogenic Peripheral Nerve Injuries—Surgical Treatment and Outcome: 10 Years' Experience. World Neurosurg 2017; 103:841-851.e6. [DOI: 10.1016/j.wneu.2017.04.099] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 11/18/2022]
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Guo R, Jacobs REA. Management of Peripheral Entrapment Neuropathy Following Abdominoplasty: A Case Report. Aesthet Surg J 2016; 36:NP206-7. [PMID: 26994393 DOI: 10.1093/asj/sjw032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robin Guo
- From the Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY
| | - Ramon E A Jacobs
- From the Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY
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Chatel H, Madar Y, Leyder P, Bonneau C, Barrat C, Quilichini J. Prevalence and factors associated with persistent pain following body contouring surgery. J Plast Reconstr Aesthet Surg 2016; 69:700-5. [PMID: 26923660 DOI: 10.1016/j.bjps.2016.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/21/2015] [Accepted: 01/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Persistent postsurgical pain (PPP) has been reported by patients following various surgeries. Body contouring procedures are being performed more frequently, but no data are available regarding the effects of these procedures. Long-term disability occurring after performing "functional" procedures on healthy subjects is a particular concern. The aim of this study was to describe the risk factors, prevalence, characteristics, and effects of persistent pain after body contouring procedures. METHODS Patients who underwent body contouring surgery (e.g., abdominoplasty, lower body lift, medial thigh lift, brachioplasty, and abdominal liposuction) between January 1 2009 and December 31 2013 were included in this retrospective, monocentric cohort study. Pain evaluation was performed using a visual analog pain scale (VAS) and the Douleur Neuropathique 4 (DN4) questionnaire. Major risk factors previously identified in the literature were evaluated. RESULTS The study included 199 patients. Pain was reported by 42 patients (21%). Seventy-one percent (n = 30) of these 42 patients presented with neuropathic pain. Risk factors that were significantly associated with PPP were acute postoperative pain (p = 0.0003), medical history of bariatric surgery (p = 0.002), longer period of hospitalization (p = 0.04), depressive status during the operative period (p = 0.03), substantial stress before surgery (p = 0.03), and major complications after surgery (p = 0.03). CONCLUSION Persistent chronic pain is frequent after body contouring procedures. Preemptive approaches and early postoperative diagnosis are important measures that can be used to limit the effects of this complication on the patient's quality of life.
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Affiliation(s)
- Harold Chatel
- Department of Plastic Surgery, CH Ballanger, 93600 Aulnay-sous-Bois, France.
| | - Yoni Madar
- Department of Plastic Surgery, CH Ballanger, 93600 Aulnay-sous-Bois, France
| | - Patrick Leyder
- Department of Plastic Surgery, CH Ballanger, 93600 Aulnay-sous-Bois, France
| | - Claire Bonneau
- Curie Institute, 35 Rue Dailly, 92220 Saint-Cloud, France
| | - Christophe Barrat
- Department of Bariatric and Metabolic Surgery, CHU Avicenne, 93000 Bobigny, France; Paris North University, 99 Avenue Jean Baptiste Clément, 93430 Villetaneuse, France
| | - Julien Quilichini
- Department of Bariatric and Metabolic Surgery, CHU Avicenne, 93000 Bobigny, France; Paris North University, 99 Avenue Jean Baptiste Clément, 93430 Villetaneuse, France
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Moreno-Egea A. Abdominoplastia y reparación de hernia incisional: lo que un cirujano general debe saber. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rehah.2015.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Persistent Pain and Sensory Abnormalities after Abdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e561. [PMID: 26893986 PMCID: PMC4727713 DOI: 10.1097/gox.0000000000000542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/17/2015] [Indexed: 11/26/2022]
Abstract
Background: Persistent postsurgical pain is a well-recognized problem after a number of common surgical procedures, such as amputation, thoracotomy, and inguinal hernia repair. Less is known about persistent pain after cosmetic surgical procedures. We, therefore, decided to study the incidence and characteristics of persistent pain after abdominoplasty, which is one of the most frequent cosmetic surgical procedures. Methods: In September 2014, a link to a web-based questionnaire was mailed to 217 patients who had undergone abdominoplasty between 2006 and 2014 at the Department of Plastic Surgery, Aalborg University Hospital, Denmark. The questionnaire included questions about pain and sensory abnormalities located to the abdominal skin, and physical and psychological function; patient satisfaction with surgery was rated on a 4-point scale. Results: One hundred seventy patients answered the questionnaire. Fourteen patients (8.2%) reported pain within the past 7 days related to the abdominoplasty. Abnormal abdominal skin sensation was common and reported by 138 patients (81%). Sensory hypersensitivity was associated with the presence of persistent pain. Satisfaction with the procedure was reported by 149 (88%) patients. The majority of patients reported improvement on all physical and psychological factors. Patients with pain were more often disappointed with the surgery and unwilling to recommend the surgery. Conclusions: Overall, patients were satisfied with the procedure, although abnormal abdominal skin sensation was common. However, there is a risk of developing persistent neuropathic pain after abdominoplasty, and patients should be informed about this before surgery.
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Löscher WN, Wanschitz J, Iglseder S, Vass A, Grinzinger S, Pöschl P, Grisold W, Ninkovic M, Antoniadis G, Pedro M, König R, Quasthoff S, Oder W, Finsterer J. Iatrogenic lesions of peripheral nerves. Acta Neurol Scand 2015; 132:291-303. [PMID: 25882317 DOI: 10.1111/ane.12407] [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] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Iatrogenic nerve lesions (INLs) are an integral part of peripheral neurology and require dedicated neurologists to manage them. INLs of peripheral nerves are most frequently caused by surgery, immobilization, injections, radiation, or drugs. Early recognition and diagnosis is important not to delay appropriate therapeutic measures and to improve the outcome. Treatment can be causative or symptomatic, conservative, or surgical. Rehabilitative measures play a key role in the conservative treatment, but the point at which an INL requires surgical intervention should not be missed or delayed. This is why INLs require close multiprofessional monitoring and continuous re-evaluation of the therapeutic effect. With increasing number of surgical interventions and increasing number of drugs applied, it is quite likely that the prevalence of INLs will further increase. To provide an optimal management, more studies about the frequency of the various INLs and studies evaluating therapies need to be conducted. Management of INLs can be particularly improved if those confronted with INLs get state-of-the-art education and advanced training about INLs. Management and outcome of INLs can be further improved if the multiprofessional interplay is optimized and adapted to the needs of the patient, the healthcare system, and those responsible for sustaining medical infrastructure.
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Affiliation(s)
- W. N. Löscher
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - J. Wanschitz
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - S. Iglseder
- Department of Neurology; Barmherzige Brüder Linz; Linz Austria
| | - A. Vass
- Private Practice; Vienna Austria
| | - S. Grinzinger
- Department of Neurology; Paracelsus Private Medical University; Salzburg Austria
| | - P. Pöschl
- Barmherzige Brüder Regensburg; Regensburg Germany
| | - W. Grisold
- Department of Neurology; Kaiser-Franz-Josef Spital; Vienna Austria
| | - M. Ninkovic
- Department of Physical Medicine and Rehabilitation; Medical University Innsbruck; Innsbruck Austria
| | - G. Antoniadis
- Neurosurgical Clinic; University of Ulm and Province Hospital; Günzburg Germany
| | - M.T. Pedro
- Neurosurgical Clinic; University of Ulm and Province Hospital; Günzburg Germany
| | - R. König
- Neurosurgical Clinic; University of Ulm and Province Hospital; Günzburg Germany
| | - S. Quasthoff
- Department of Neurology; Graz Medical University; Graz Austria
| | - W. Oder
- AUVA Rehabilitation Center Wien Meidling; Vienna Austria
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Gutowski KA. Commentary on: Use of Quilting Sutures During Abdominoplasty to Prevent Seroma Formation: Are They Really Effective? Aesthet Surg J 2015; 35:581-2. [PMID: 26059392 DOI: 10.1093/asj/sjv003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karol A Gutowski
- Dr Gutowski is an Adjunct Associate Professor in the Department of Surgery, Division of Plastic Surgery, University of Illinois - Chicago, Chicago, IL
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Abstract
BACKGROUND Cutaneous hypesthesia is an undesirable postoperative outcome following abdominoplasty. The purpose of this study was to evaluate postabdominoplasty cutaneous sensibility using clinical, quantitative, and reproducible methods. METHODS Thirty patients who underwent abdominoplasty were divided into three groups: 0 to 12 months (short-term follow-up), 12 to 24 months (intermediate-term follow-up), and greater than 24 months (long-term follow-up) following abdominoplasty. Abdominal skin was divided into 12 areas, and superficial tactile sensibility was assessed subjectively using a patient questionnaire and objectively using Semmes-Weinstein monofilaments. Statistical analysis was performed using the t test, with significance defined as p ≤ 0.05. RESULTS Seventeen patients (56.7 percent) subjectively reported the presence of any abdominal cutaneous sensibility change postoperatively. Of those, 82.4 percent reported indifference toward this outcome. The greatest degree of objective sensibility loss was noted in area 8 (infraumbilical), followed by areas 5 (supraumbilical) and 11 (midline infraincisional). In these areas, there were statistically significant decreases in the average cutaneous pressure thresholds between the short-term and intermediate-term follow-up groups, the intermediate-term and long-term follow-up groups, and the short-term and long-term follow-up groups. CONCLUSIONS Postabdominoplasty cutaneous sensibility losses improve over time. These findings may enable plastic surgeons to better inform their patients regarding the risk of sensibility loss and the longitudinal outcome of such changes postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Fiala T. Tranversus abdominis plane block during abdominoplasty to improve postoperative patient comfort. Aesthet Surg J 2015; 35:72-80. [PMID: 25536505 DOI: 10.1093/asj/sju019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The transversus abdominis plane (TAP) block is an effective regional nerve block for the anterior abdominal wall. An anesthesiologist typically administers the TAP block preoperatively with ultrasound guidance. It is not yet commonly used during abdominoplasty, where postprocedural pain remains a major concern for patients and surgeons. OBJECTIVES The author investigated the feasibility of administering the TAP block under direct vision and compared postoperative narcotic use in patients who received analgesia by TAP block vs by a standard nerve block, both performed under direct vision during abdominoplasty with or without flank liposuction. METHODS In this pilot study, 32 consecutive patients received either a TAP block (n = 16) or a combination of pararectus injections and ilioinguinal/iliohypogastric nerve blocks (n = 16) during abdominoplasty. Patients in both groups also received an injection of bupivacaine in the rectus plication. All patients were then monitored for narcotic use patterns during the first 16 hours after surgery. Statistical significance was ascertained with the t test. RESULTS Patients in the TAP block group required a significantly smaller mean dose of postoperative hydromorphone (TAP block group: 2.63 mg; standard treatment group: 4.31 mg; P = .024) and had a significantly longer mean time to first request for as-needed pain medication (TAP block group: 3 hours 11 minutes; standard treatment group: 1 hour 27 minutes; P = .022). CONCLUSIONS The open TAP block provided more effective analgesia than a standard nerve block in the observation period after abdominoplasty with or without flank liposuction. Larger studies are needed to confirm the results.
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