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Pouramin P, Dow T, Williams J. Exploring Complication Rates: A Comparative Study of Breast Reduction and Combined Breast Reduction with Abdominoplasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-04040-y. [PMID: 38684537 DOI: 10.1007/s00266-024-04040-y] [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: 11/28/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Despite a trend towards combining abdominoplasty with breast reduction surgery, so called "mommy makeovers", the safety of this combined approach has been the subject of debate, with previous research yielding conflicting results. We evaluated the risk for complications and revision associated with adding abdominoplasty to bilateral breast reduction surgery. METHODS We conducted a 10-year single-center retrospective chart review of bilateral breast reduction patients in Nova Scotia. Univariate and multivariate analyses were performed to compare the risk for complication and revision in patients with bilateral breast reduction to those with a concomitant abdominoplasty. RESULTS Of the 1871 patients initially screened, 738 were included. 44 underwent a concomitant abdominoplasty procedure. Compared to the breast reduction alone group, patients with concomitant abdominoplasty were significantly older (47.5±9.9 vs. 42.8±13.2, p=0.004), had a higher BMI (28.1±4.4 vs. 25.8±3.1, p<0.001), and experienced longer operating room times (226±6 vs. 115±3 mins, p<0.001). In multivariate analysis, concomitant abdominoplasty did not increase the risk for breast-related (OR: 0.86 95%CI 0.43-1.7, p=0.668) or total complications (OR: 1.63, 95%CI 0.83-3.19, p=0.154). However, there was a trend towards an increased risk of breast revision (OR: 2.684, 95%CI 0.95-7.6, p=0.062) and a significantly increased risk of total revision (OR: 6.624, 95%CI 2.7-16.1, p<0.001). Moreover, patients with concomitant abdominoplasty experienced more follow-up visits (median: 4 vs. 3 visits, p=0.042). CONCLUSION In our single-center retrospective analysis, combining abdominoplasty with bilateral breast reduction did not increase the risk for breast, or total complications; however, it did increase the risk for total revisions. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Panthea Pouramin
- Faculty of Medicine, Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Todd Dow
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Shah V, Soh CL, Chhatwal K, Kucharczak J, Airapetyan AA, Avavde D, Torabi S, Mackenzie A, Miller G, Vardanyan R, Arjomandi Rad A, Malawana J. Autologous breast reconstruction in low- and middle-income countries (LMICs): a systematic review of current practices and challenges. Minerva Surg 2024; 79:73-81. [PMID: 38381032 DOI: 10.23736/s2724-5691.23.10111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Efforts to improve global healthcare persist, yet LMICs face challenges accessing surgical care, especially breast reconstruction amidst rising breast cancer cases. This review evaluates the present state and challenges of autologous breast reconstruction in low- and middle-income countries (LMICs). EVIDENCE ACQUISITION Utilizing the PRISMA guidelines and the Cochrane Collaboration's standards, databases such as EMBASE, MEDLINE, Cochrane, PubMed, and Google Scholar were examined for studies on breast reconstruction in LMICs (based on the World Bank's 2022-2023 definitions) up to August 2022. Articles and case reports focusing on autologous reconstruction following breast cancer surgery in these regions were incorporated. EVIDENCE SYNTHESIS From an initial 288 articles, 19 met the criteria after thorough assessment. These articles documented 4899 patient cases from LMICs, with the breakdown being: 11 on LD flaps, nine on TRAM flaps, eight on DIEP flaps, two on TDAP flaps, and one on TMG flap. Flap necrosis emerged as the prevalent complication in four studies. CONCLUSIONS While autologous breast reconstruction presents superior aesthetic benefits without notable long-term economic setbacks, its adoption in LMICs is limited. This is partly due to the domination of implant-based methods among patients and surgeons, selected due to convenience. The scarcity of concrete evidence and standardized metrics in LMICs clouds the understanding of this procedure. Despite its advantages, awareness is low, necessitating more training and awareness campaigns. Uniform reporting, quality data, and financial analysis can provide a comprehensive LMIC understanding, aiding future research.
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Affiliation(s)
- Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Chien L Soh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Karanjot Chhatwal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Arkady A Airapetyan
- Department of Research and Academia, National Institute of Health, Yerevan, Armenia
| | - Dani Avavde
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Saeed Torabi
- Department of Anesthesia, University Hospital Cologne, Cologne, Germany
| | - Alexandra Mackenzie
- Department of Emergency Surgery, Chelsea and Westminster Hospital NHS Trust, London, UK
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK -
| | - Arian Arjomandi Rad
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
- Clinical Academic Graduate School, The University of Oxford, Oxford, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
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Tettamanzi M, Sanna C, Liperi C, Manconi A, Trignano C, Rubino C, Trignano E. Outcomes of Abdominoplasty in Tumescent Local Anesthesia Combined with Subdural Anesthesia. Aesthetic Plast Surg 2024; 48:361-368. [PMID: 38129353 DOI: 10.1007/s00266-023-03795-0] [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: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Abdominoplasty is a common surgical procedure performed under general anesthesia, and although the use of TLA combined with subdural anesthesia has never been reported in abdominoplasty, it offers several benefits such as safe and effective local anesthesia and vasoconstriction. We outline our experience with the TLA technique for primary abdominoplasty over the last 7 years. METHODS From 2014 to 2021, TLA and subdural anesthesia have been used in primary abdominoplasty surgeries for 106 patients. The TLA solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) diluted in 1000 mL of 0.9% saline solution. The solution was then injected with a 2-mm cannula into the subcutaneous adipose tissue in the suprafascial plane. The subdural anesthesia was performed at intervertebral level L1-L2 using Ropivacaine 15/18 mg in 4 ml. RESULTS Patients aged from 32 to 75 years. The amount of tumescent solution infiltrated ranged between 500 and 1000 mL. Mean surgery time was 70 minutes, and recovery room time averaged at 240 minutes. Major complications related to the surgery were observed in 12.26% of patients, including eight hematomas and five seromas. Two patients experienced wound dehiscence, and no dystrophic scar formation was observed. Eventually, there was no need for a conversion to general anesthesia. CONCLUSIONS Tumescent local anesthesia combined with subdural anesthesia is a highly effective and safe method for performing abdominoplasty. This technique has proven to be an excellent choice for primary abdominoplasty, providing significant benefits to patients and surgeons alike due to its safe administration, precise pain management during and after surgery, and minimal postoperative side effects. 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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Affiliation(s)
- Matilde Tettamanzi
- Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
| | - Claudia Sanna
- Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Corrado Liperi
- Intensive Care Unit, Emergency Department, AOU Sassari, Sassari, Italy
| | - Anna Manconi
- Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Claudia Trignano
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Emilio Trignano
- Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
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Beaton AC, Solanki D, Salazar H, Folkerth S, Singla N, Minkowitz HS, Leiman D, Vaughn B, Skuban N, Niebler G. A randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a bupivacaine hydrochloride implant in patients undergoing abdominoplasty. Reg Anesth Pain Med 2023; 48:601-607. [PMID: 37076252 PMCID: PMC10646917 DOI: 10.1136/rapm-2022-104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Surgical site infiltration with bupivacaine hydrochloride (HCl) is a standard element of postoperative analgesia for soft tissue surgeries, but results in short-lived analgesia. A novel bupivacaine implant, XARACOLL (bupivacaine HCl), is Food and Drug Administration approved for treatment of acute postsurgical pain following adult inguinal herniorrhaphy. This study examined the efficacy and safety of the bupivacaine implant (300 mg) compared with placebo for postsurgical pain after abdominoplasty. METHODS In this double-blind, placebo-controlled study, patients undergoing abdominoplasty were randomized to three 100 mg bupivacaine implants or three placebo collagen implants, in a 1:1 ratio, implanted intraoperatively. No other analgesics were administered into the surgical site. Patients were allowed opioids and acetaminophen for postoperative pain. Patients were followed for up to 30 days after treatment. PRIMARY OUTCOME the analgesic effect of the bupivacaine implants through 24 hours postsurgery, measured by the sum of time-weighted pain intensity (SPI24). Prespecified key secondary outcomes included SPI48 and SPI72, percentage of opioid-free patients through 24, 48, and 72 hours, and adverse events, which were tested sequentially to control for multiplicity (ie, if the first variable failed to reach significance, no subsequent variables were declared statistically significant). RESULTS The bupivacaine implant patients (n=181) reported statistically significant lower SPI24 (mean (SD) SPI24=102 (43), 95% CI 95 to 109) compared with placebo patients (n=184; SPI24=117 (45), 95% CI 111 to 123, p=0.002). SPI48 was 190 (88, 95% CI 177 to 204) for INL-001 and 206 (96, 95% CI 192 to 219) for placebo, and not significantly different between groups. The subsequent secondary variables were therefore declared not statistically significant. SPI72 was 265 (131, 95% CI 244 to 285) for INL-001 and 281 (146, 95% CI 261 to 301) for placebo. The opioid-free percentage of patients at 24, 48, and 72 hours was 19%, 17%, and 17% for INL-001 and 6.5% for placebo patients (at all timepoints). The only adverse event occurring in ≥5% of patients and for which proportion INL-001 >placebo was back pain (7.7% vs 7.6%). CONCLUSION The study design was limited by not containing an active comparator. Compared with placebo, INL-001 provides postoperative analgesia that is temporally aligned with the period of maximal postsurgical pain in abdominoplasty and offers a favorable safety profile. TRIAL REGISTRATION NUMBER NCT04785625.
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Affiliation(s)
| | | | | | | | - Neil Singla
- Lotus Clinical Research, LLC, Pasadena, California, USA
| | | | - David Leiman
- HD Research/First Surgical Hospital, Bellaire, Texas, USA
| | | | - Nina Skuban
- Innocoll Pharmaceuticals Limited, Innocoll Biotherapeutics, Princeton, New Jersey, USA
| | - Gwendolyn Niebler
- Innocoll Pharmaceuticals Limited, Innocoll Biotherapeutics, Princeton, New Jersey, USA
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Taha N, Hodson L, Tong K, Zahari F, Hoo ZL, Wong YW, Rahman S. The Efficacy of the Transversus Abdominis Plane Block in Abdominoplasty: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e48992. [PMID: 38111414 PMCID: PMC10726299 DOI: 10.7759/cureus.48992] [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] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. Its use in cosmetic abdominoplasty procedures is less frequently documented. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery. The authors aimed to conduct the first meta-analysis within the literature to evaluate this technique's effectiveness in abdominoplasties. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay. Random effect modelling was used for the analysis. The time taken to the first analgesic was significantly lower in the TAP cohort (p <0.05). In addition, there was a lower incidence of postoperative nausea/vomiting(OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group. The authors report the first meta-analysis within the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.
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Affiliation(s)
- Nadia Taha
- Plastic Surgery, Leeds General Infirmary, Leeds, GBR
| | - Lara Hodson
- Plastic Surgery, Leeds General Infirmary, Leeds, GBR
| | - Kinseng Tong
- Plastic Surgery, Queen Victoria Hospital, East Grinstead, GBR
| | | | - Zhi Liang Hoo
- Urology, Harrogate District Hospital, Harrogate, GBR
| | - Yi Wah Wong
- Elderly Medicine, St James University Hospital, Leeds, GBR
| | - Shafiq Rahman
- Plastic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
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Gallo L, Gallo M, Chin B, Copeland A, Avram R, McRae M, McRae M, Thoma A, Coroneos CJ, Voineskos SH. Closed Incision Negative Pressure Therapy Versus Traditional Dressings for Low Transverse Abdominal Incisions Healing by Primary Closure: A Systematic Review and Meta-Analysis. Plast Surg (Oakv) 2023; 31:390-400. [PMID: 37915346 PMCID: PMC10617458 DOI: 10.1177/22925503211073840] [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: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2023] Open
Abstract
Background: Closed incision negative pressure therapy (ciNPT) devices may reduce wound healing complications when applied to closed surgical incisions. The aim of this review was to assess the effects of ciNPT versus standard dressings in patients undergoing primary closure of high tension, lower transverse abdominal incisions. Methods: This review was registered a priori on PROSPERO (CRD42021252048). A search of the following databases was performed in February 2021: Medline, EMBASE, and CENTRAL. Unpublished trials were searched using clinicaltrials.gov. All randomized and nonrandomized studies comparing ciNPT to standard dressings were included. Two independent reviewers performed screening and data extraction. Outcomes evaluated the incidence of wound dehiscence, surgical site infection, total abdominal complications, time to drain removal, and seroma formation. Main Results: Ten studies were included in quantitative and narrative synthesis. Observational study evidence suggests ciNPT likely reduces the incidence of wound dehiscence (odds ratio [OR] 0.57 [0.44-0.96], P = .03) and total abdominal complications (OR 0.34 [0.21-0.54], P < .01). Decreased incidence of seroma formation favored ciNPT (OR 0.65 [0.24-1.76], P = .40); however, this did not achieve significance. Randomized and non-randomized study evidence was very uncertain about the effect of ciNPT on the remaining outcomes. Conclusions: The current best randomized study evidence is very uncertain about the effect of ciNPT on these outcomes. Observational study evidence suggests ciNPT likely results in a statistically significant reduction in abdominal wound dehiscence and total abdominal complications. Additional randomized trials are warranted to limit the impact of bias on the overall certainty of the evidence.
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Affiliation(s)
- Lucas Gallo
- McMaster University, Hamilton, Ontario, Canada
| | | | - Brian Chin
- McMaster University, Hamilton, Ontario, Canada
| | | | - Ronen Avram
- McMaster University, Hamilton, Ontario, Canada
| | - Mark McRae
- McMaster University, Hamilton, Ontario, Canada
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Buurke P, Bleeker WA, Kemler MA. Combined abdominoplasty and stoma repositioning: A successful approach for addressing stomal retraction and problematic stoma care: A case study. Int J Surg Case Rep 2023; 110:108763. [PMID: 37651804 PMCID: PMC10510081 DOI: 10.1016/j.ijscr.2023.108763] [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: 07/02/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION This case report discusses the management of challenging stoma care in an overweight patient, focusing on the successful application of abdominoplasty combined with stoma repositioning. The increasing abdominal mass in overweight patients often leads to stoma retraction and mechanical stress, necessitating innovative and less invasive interventions. CASE PRESENTATION The subject is a 40-year-old female with a body mass index of 28.41 kg/m2, who was experiencing complications in stoma care due to recent weight gain. Through a collaborative effort between a plastic and a general surgeon, the patient underwent abdominoplasty combined with stoma repositioning, leading to significant improvements in stoma care and cosmetic results. DISCUSSION Despite the limited amount of literature on abdominoplasty combined with stoma revision, this case report contributes to the evidence supporting it as an effective alternative for persistent stoma dysfunction in overweight patients. This innovative surgical approach represents a viable solution to address stomal retraction and leakage. CONCLUSION The case report underscores the potential benefits of abdominoplasty combined with stoma repositioning in overweight patients with persistent stoma care problems. Although the risk of wound contamination must be taken into account, this combined procedure can enhance patient outcomes. The study provides valuable insights for healthcare professionals managing stoma care in overweight patients.
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Affiliation(s)
- P Buurke
- Department of Plastic Surgery Martini Hospital, van Swietenplein 1, Groningen, Groningen 9728NT, the Netherlands.
| | - W A Bleeker
- Department of General Surgery, Wilhelmina Hospital, Europaweg-zuid 1, Assen, Drenthe 9401 RK, the Netherlands
| | - M A Kemler
- Department of Plastic Surgery Martini Hospital, van Swietenplein 1, Groningen, Groningen 9728NT, the Netherlands
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Postabdominoplasty Scar Improvement after a Single Session with an Automated 1210-nm Laser. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4866. [PMID: 36910728 PMCID: PMC10005831 DOI: 10.1097/gox.0000000000004866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/24/2023] [Indexed: 03/12/2023]
Abstract
Abdominoplasty, one of the most commonly performed aesthetic procedures, aims at correcting excess abdominal skin and fat, but generates a long abdominal scar. The efficacy of an automated portative 1210-nm laser in improving the appearance of surgical scars has been previously demonstrated in a double-blind randomized controlled trial. The purpose of this work was to document the use of this laser in real-life practice. Methods Eighteen patients undergoing abdominoplasty and treated with the evaluated laser (UrgoTouch, Laboratoires Urgo; one single session immediately after the surgery) were included in this prospective, mono-center, observational study. Change in scar characteristics was assessed using the validated Observer Scar Assessment Scale, and the patients' and surgeon's satisfaction was rated using a four-point scale. Results The aesthetic outcome of the scars was very positive with a mean Observer Scar Assessment Scale score of 17.0 (SD 4.6) and 14.4 (SD 3.8) on the 6-60 point scale (60: the worst possible outcome) at 6 and 12 months, respectively. A high degree of satisfaction was also expressed by both surgeon and patients at 6 weeks, 6 months, and 12 months. No laser-related incident was reported during the study, including in patients with darker phototypes. Conclusions These findings seem to be consistent with previous clinical evidence on the use of this laser on fresh incisions. The high degree of satisfaction reported by both surgeon and patients seems to comfort the benefits of this procedure at short- and long-term and support the use of this laser in daily practice of plastic surgery.
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Fiorentini F, Fusco I. Synergistic Sequential Emission of Fractional 1540 nm and 10 600 Lasers for Abdominal Postsurgical Scar Management: A Clinical Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e938607. [PMID: 36639861 PMCID: PMC9847310 DOI: 10.12659/ajcr.938607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Abdominal scars can develop following abdominoplasty interventions and can cause severe functional and aesthetic disabilities. Surgery is almost no longer necessary thanks to the accessibility of more recent and sophisticated technology like lasers. Many ablative and non-ablative photothermolysis technologies and equipment have been developed, giving patients and medical professionals more alternatives but also complicating the system to be utilized and the methods to maximize the outcomes. The aim of the current study was to evaluate the volumetric action of 1540 wavelength and the efficacy and safety of the synergic sequential application of a new fractional ablative 10 600 nm CO2 and non-ablative 1540 nm lasers on abdominal postsurgical scar management. CASE REPORT We treated a female patient with an abdominal suprapubic scar following abdominoplasty. The patient underwent 3 treatment sessions (with a frequency of 1 session every 50 days) with 1 pass over the entire suprapubic area using 10 600 nm CO₂ fractional laser emission and 1540 fractional laser emission in simultaneous modality. A photographic evaluation was made to monitor the effect of the treatment on the aesthetic appearance of the patient's suprapubic scar. After 6 months, the photographic assessment showed a significant improvement in scar texture and color. No patient pain or adverse effects were detected. CONCLUSIONS This case report describes the possibility of effectively treating abdominal suprapubic scars following abdominoplasty surgery with simultaneous and combined irradiation of 10 600 nm and 1540 nm wavelengths.
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Affiliation(s)
- Federica Fiorentini
- Department of Dermatology and Aesthetic Medicine, Studio Medico Basoccu, Rome, Italy
| | - Irene Fusco
- Department of Clinical Research and Practice, El.En. Group, Calenzano, Italy,Corresponding Author: Irene Fusco, e-mail:
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10
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Vitagliano T, Garieri P, Lascala L, Ferro Y, Doldo P, Pujia R, Pujia A, Montalcini T, Greco M, Mazza E. Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results. Nutrients 2023; 15:nu15020352. [PMID: 36678221 PMCID: PMC9867292 DOI: 10.3390/nu15020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Aesthetic and cosmetic medical practices have attracted considerable consumer attention globally. However, possible complications vary and range from mild, self-resolving ecchymoses or edema to more persistent complications. The aim of this review is to identify the nutritional deficits or excesses associated with the major complications of reconstructive surgery, aesthetic surgery, and mini-invasive aesthetic procedures. An additional goal is to provide a bundle of actions for professionals working in the industry in order to reduce the risks of aesthetic procedures and improve the clinical outcomes. Granulomas, hypertrophic scars and keloids, seromas, infections and xerosis, hyperpigmentation, petechiae, livedo reticularis, slower wound healing, and other poor outcomes are frequently associated with nutritional deficiencies. Nutritional status can markedly affect wound healing and tissue repair following surgical interventions, as well as the outcomes of aesthetic and cosmetic medical practices. Professionals working in this industry, therefore, need to consider the nutritional aspects of their patients to obtain the best results.
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Affiliation(s)
- Tiziana Vitagliano
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Pietro Garieri
- Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo, 20900 Monza, Italy
| | - Lidia Lascala
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Yvelise Ferro
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Roberta Pujia
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Grecia, 88100 Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Grecia, 88100 Catanzaro, Italy
| | - Manfredi Greco
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
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11
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Karamchandani MM, De La Cruz Ku G, Sokol BL, Chatterjee A, Homsy C. Management of Gynecomastia and Male Benign Diseases. Surg Clin North Am 2022; 102:989-1005. [DOI: 10.1016/j.suc.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: 11/06/2022]
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12
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Xi T, Guo R, Wu X, Jiang H, Xiong J. A bibliometric and visualized research on global trends of abdominoplasty, 2011-2021. J Cosmet Dermatol 2022; 21:6893-6901. [PMID: 36047672 DOI: 10.1111/jocd.15342] [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: 06/13/2022] [Revised: 08/18/2022] [Accepted: 08/28/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with multiple pregnancies, multiple pregnancies, and a history of severe obesity, the abdominal wall muscles, and skin exhibit rectus abdominis separation and skin laxity due to prolonged overstretching, which causes damage to both the patient's appearance and health. Abdominoplasty is a surgical solution to the problems of separation of the rectus abdominis muscle and laxity of the skin of the abdominal wall under direct vision, which is important for patients with the above problems. Currently, many studies have been reported on abdominoplasty, however, no reverent bibliometric analyses of abdominoplasty have been published. METHODS In this study, we screened 1,119 studies on abdominoplasty between 2011 and 2021 based on the Web of Science Core Collection (WOSCC) database and performed a bibliometric analysis. RESULTS We found that high-quality research related to abdominoplasty has increased in the last decade, and the United States was the leading country in the field of abdominoplasty. Stanford university ranked first in number of publications and citations. Aesthetic surgery journal was the most productive journal, followed by the Plastic and reconstructive surgery and Aesthetic plastic surgery. In addition, bariatric surgery, venous thromboembolism, rectus diastasis, breast reconstruction and umbilicoplasty are the keywords of recent publications that are the focus of current research. CONCLUSION This study provides a comprehensive analysis and visualization of global research trends on abdominoplasty from 2011 to 2021, and improvements in abdominoplasty to reduce the incidence of postoperative complications will remain a focus of future research.
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Affiliation(s)
- Tingting Xi
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Guo
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuemei Wu
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiachao Xiong
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Mba UC, Ogbonnaya IS, Uduezue AO, Okoye CP, Okoli CM, Eze BU. Experience with Abdominoplasty at National Orthopedic Hospital, Enugu, South-East, Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:31-38. [PMID: 36590784 PMCID: PMC9802592 DOI: 10.4103/jwas.jwas_173_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/22/2022] [Indexed: 06/17/2023]
Abstract
Background Abdominoplasty is a body contouring surgical procedure designed to improve the contour of the lower trunk. It is one the most commonly performed cosmetic procedures in developed countries. In developing nations such as ours, it constitutes a small percentage of aesthetic procedures performed. In our hospital, a number of cases have been done in the past 12 years. However, some studies from developed countries suggest that cosmetic surgeries in developing countries in associated with higher risk of complications. The aim of this study was to evaluate the outcome of abdominoplasties performed in a specialist hospital of a developing country. Patients and Methods The study was a 12-year retrospective study. The folders of all the patients that had abdominoplasty were retrieved and reviewed. Data was subjected to statistical analysis using PSPP4Windows®17 computer software version 1.4.1, 2019. The results are presented in prose, tables, charts, and figures. Results A total of 30 women aged between 26 and 59 years had abdominoplasty. All were multiparous. About 76% of the patients had previous abdominal surgeries and 74% of this were caesarean section. No mortality was recorded but some patients had minor complications. The most common was respiratory distress which resolved on supportive treatment. Outcome was satisfactory in 95.5% and good in 4.5% of patients. Conclusion Abdominoplasty in our environment is safe in trained hands.
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Affiliation(s)
- Uwakwe Cosmas Mba
- Department of Plastic Surgery, National Orthopedic Hospital, Enugu, Nigeria
- Department of Surgery, ESUT College of Medicine and ESUT Teaching Hospital, Enugu, Nigeria
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Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring. J Clin Med 2022; 11:jcm11154315. [PMID: 35893406 PMCID: PMC9330885 DOI: 10.3390/jcm11154315] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Due to the increased prevalence of obesity in the last decades, bariatric surgery has been on the rise in recent years. Bariatric surgery is a compelling option for weight loss in obese patients with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. Redundant skin following significant weight loss is a common occurrence affecting up to 96% of patients who undergo bariatric surgery, negatively impacting physical and psychosocial health and detracting from activities of daily living. Statistics of the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report. Abdominoplasty, a well-established cosmetic surgery procedure for improving body contour, is performed by removing excess skin and fat from the abdominal wall and thereby restoring musculofascial integrity and skin elasticity, resulting in a more ideal body shape and increasing quality of life. Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. Technologic advances over the past decade have been developed as non-invasive alternatives or adjunctive tools to surgery to enhance cosmetic results and minimize complications. New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity and/or diminish the extent of surgery and resulting scars. Plastic surgeons play a significant role in improving the quality of life of patients who suffer from obesity and underwent bariatric surgery. We are deeply convinced, however, that the advancement of knowledge and research in this field will determine the introduction of new technologies and custom-made techniques. This advancement will reduce the complication rate with a rapid reintegration of the patient into the world of work and resumption of daily activities.
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Vinnik YS, Pakhomova RA, Kochetova LV, Babadzhanyan AM, Fedotov IA, Sindeeva LV. CURRENT PRINCIPLES OF TREATING ABDOMINAL COMPLICATIONS. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-1-27-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abdominal plastic is one of the most common operations in the field of plastic surgery. The main goal of abdominal plastic is to improve the body contours in the area of the anterior abdominal wall, by excising excessive skin and fat tissues, suturing diastasis of the direct abdominal muscles. Although abdominal plastic is considered a safe surgery with a high level of positive outcomes, there are still various kinds of complications, the treatment of which requires the use of modern methods. The work is based on the analysis of literature data on abdominal plastic and analysis of the postoperative period of 172 patients operated on in plastic surgery clinics in Krasnoyarsk from 2017 to 2020. Statistical data on abdominal plastic prevalence among aesthetic procedures were analyzed. Based on the identified data, it is shown that various types of abdominal plastic are quite in demand, which dictates the need to study possible complications after surgery, and modern methods of treating complications. The article analyzes common types of complications after abdominal plastics and describes the algorithms for treating these complications. A comparative analysis of the incidence of complications in plastic surgery clinics in Krasnoyarsk was carried out with data from European plastic surgery clinics. Complications after abdominal plastic vary in severity and in the effect they have on aesthetic outcomes. Most complications can be treated in an outpatient setting, following modern standards, with satisfactory results.
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Affiliation(s)
- Yu. S. Vinnik
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
| | - R. A. Pakhomova
- Private Institution – educational Organization of higher Education University REAVIZ
| | - L. V. Kochetova
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
| | | | - I. A. Fedotov
- Clinical Hospital «Russian Railways-Medicine» in Krasnoyarsk
| | - L. V. Sindeeva
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
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Biplanar Lipoabdominoplasty: Introducing the Subscarpal Lipo Aponeurotic System. Plast Reconstr Surg Glob Open 2022; 10:e4000. [PMID: 35186612 PMCID: PMC8849338 DOI: 10.1097/gox.0000000000004000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Preservation of Scarpa’s fascia in abdominoplasty has been previously presented. Herein we introduce the subscarpal lipo aponeurotic system (SLAS) and the technique of preserving the SLAS and its tightening in lipoabdominoplasty.
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General Surgery: Management of Postoperative Complications Following Ventral Hernia Repair and Inguinal Hernia Repair. Surg Clin North Am 2021; 101:755-766. [PMID: 34537141 DOI: 10.1016/j.suc.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ventral and inguinal hernia repairs are some of the most commonly performed general surgery operations worldwide. This review focuses on the management of postoperative complications, which include surgical site infection, hernia recurrence, postoperative pain, and mesh-related issues. In each section, we aim to discuss classifications, risk factors, diagnostic modalities, and treatment options for common complications following hernia repair.
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18
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Abdelhalim NM, Samhan AF. Influences of Intermittent Pneumatic Compression Therapy on Edema and Postoperative Patient's Satisfaction After Lipoabdominoplasty. Aesthetic Plast Surg 2021; 45:1667-1674. [PMID: 33837458 DOI: 10.1007/s00266-021-02272-w] [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: 09/20/2020] [Accepted: 03/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lipoabdominoplasty (LABP) is a frequently performed surgical procedure in the field of plastic surgery that often requires physical therapy in order to minimize postoperative complications, augment the postoperative outcomes, and enhance recovery. Intermittent pneumatic compression therapy (IPCT) is a physical therapy modality that may be used in the management of LABP population. This study aimed to assess the influences of intermittent pneumatic compression therapy on the resolution of edema and improvement in postoperative patient satisfaction following LABP. METHODS Forty-three females, aged 35-55 years, who underwent LABP, were involved in this prospective randomized study. They were divided into two groups: group A wherein 22 patients wore a compression garment (CG) for 24 h, through 4 weeks; group B wherein 21 patients wore CG besides the application of IPCT for 45 min, 3 times a week, for 4 weeks. The abdominal circumferences were measured at three positions: 3 cm above the umbilicus, at the umbilicus, and 3 cm below the umbilicus. Additionally, patient satisfaction rate was assessed by visual analog scale (VAS; in mm). All patients were assessed three times (Initial Assessment, During Assessment, and Final Assessment). RESULTS With reference to the abdominal circumferences at three levels and VAS satisfactory scores, there were statistically significant differences between both groups in Final Assessment (p < .04) in favor of group B. CONCLUSION Application of IPCT while wearing CG was superior as compared to CG alone in reducing the abdominal edema and improving postoperative patient satisfaction following LABP. 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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Affiliation(s)
- Nermeen Mohamed Abdelhalim
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Ahmed Fathy Samhan
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Following ISAPS Recommendations, Does it Really Help? Aesthetic Plast Surg 2021; 45:1888-1894. [PMID: 33598743 DOI: 10.1007/s00266-021-02174-x] [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: 11/26/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The demand for abdominoplasty procedures has increased in surgical centres as a result of patient preference and economic concerns. The International Society of Aesthetic Plastic Surgery (ISAPS) published the Facility Accreditation Guideline on 22 October 2018. It is a list of recommendations that aim to reduce the incidence of complications and increase safety standards. OBJECTIVES The objective of this work was to detect the effects of the ISAPS guidelines on the morbidity associated with abdominoplasty procedures in day care surgical centres. METHODS The authors performed a retrospective study. Data regarding complications of abdominoplasty were collected from medical records of the last 350 cases of abdominoplasty performed in December 2018. The complications and their incidences were compared with similar previously published data of abdominoplasty operations performed by other authors and in surgical centres before initiation of the ISAPS Facility Accreditation Guideline. RESULTS In all cases, we achieved a significant reduction in skin and adipose tissue with improvement in body shape. The incidence of major and minor post-operative complications was lower than that reported in other literature. CONCLUSIONS This report shows that abdominoplasty is a safe procedure with low complication rates, which are even lower when the ISAPS Facility Accreditation Guideline is followed together with national, regional, state and other legal requirements. 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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20
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Horta R, Domingues CS, Dias CC, Barreiro D. A Ruler for Abdominoplasty Preoperative Markings: The Potential of Best Scar Symmetry. Surg Innov 2021; 29:225-233. [PMID: 34266340 DOI: 10.1177/15533506211033145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Scar appearance is an important outcome in abdominoplasty surgery, and its asymmetry can have a significant impact on patient and surgeon satisfaction. Here, we compared the scar symmetry reached with a ruler specially designed for the preoperative marking in abdominoplasty to the classic preoperative incision marking. Methods. In this randomized, uni-blind study, 42 patients were allocated to 2 different groups. Group 1 patients had their preoperative marking made by a group of surgeons that used the classic technique as described by Baroudi (n = 21), and Group 2 patients received their preoperative marking by another group of surgeons, using a ruler specially designed to fit the abdominal contour (n = 21). Patients were evaluated using a standard questionnaire that collected information about general patient's characteristics. On the follow-up period, we evaluated the presence of late surgical complications, need for revision surgery, patient's satisfaction concerning the postoperative scar, and 4 distances were measured in both groups to assess symmetry. Statistical analysis was made. Results. A total of 42 patients underwent abdominoplasty and were evaluated on the follow-up period (mean time: 4 months). The mean difference of corresponding measures on each side (A-B vs. A-B' and A-C vs. A-C') was higher in Group 1 comparing to Group 2. The level of correlation between corresponding measurements was higher in Group 2. Better satisfaction regarding the scar symmetry was achieved in Group 2, being this result statistically significant (P = .004). Conclusions. The use of the specialized ruler may help surgeons achieve a better scar symmetry with higher patient satisfaction.
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Affiliation(s)
- Ricardo Horta
- Porto University Medical School, Porto, Portugal.,Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | | | - Cláudia C Dias
- Department of Plastic, Aesthetic and Reconstructive Surgery, São João Hospital, Porto University Medical School, Porto, Portugal
| | - Diogo Barreiro
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
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21
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Saldanha O, Saldanha C. Commentary on: The Addition of Partial or Circumferential Liposuction to Abdominoplasty Is Not Associated With a Higher Risk of Skin Necrosis. Aesthet Surg J 2021; 41:NP445-NP446. [PMID: 33724359 DOI: 10.1093/asj/sjaa275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Osvaldo Saldanha
- Division of Plastic Surgery, UNIMES—Metropolitan University of Santos, São Paulo, Brazil
| | - Cristianna Saldanha
- Division of Plastic Surgery, UNIMES—Metropolitan University of Santos, São Paulo, Brazil
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22
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Raghuram AC, Yu RP, Gould DJ. The Addition of Partial or Circumferential Liposuction to Abdominoplasty Is Not Associated With a Higher Risk of Skin Necrosis. Aesthet Surg J 2021; 41:NP433-NP444. [PMID: 32856688 DOI: 10.1093/asj/sjaa251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Combining abdominoplasty with liposuction is a common practice for optimal patient aesthetic outcomes. In the past, several practitioners have argued against liposuction due to the potential for vascular insufficiency, especially with central liposuction. Despite these concerns for flap damage with resultant necrosis, the incidence of this complication has not been comprehensively investigated. OBJECTIVES The authors therefore examined the incidence of necrotic complications, including skin and fat necrosis as well as partial/total flap loss, in patients who underwent abdominoplasty alone (AA) or abdominoplasty with partial or circumferential liposuction (APCL). METHODS Literature searches were performed in PubMed/Medline and Embase with no query limits. For the systematic review, data from the studies were extracted into a form including primary author, publication year, study design, number of AA and APCL patients, abdominal zone(s) treated with liposuction, average lipoaspirate volume, follow-up time, necrotic complications, and revision procedures. A meta-analysis was separately performed for 13 studies that included patients who underwent both AA and APCL. RESULTS The overall rate of necrotic complications was lower in the APCL group (0.39%) compared with the AA group (1.01%). The incidence of necrotic complications was low for all patients, with a pooled partial flap loss rate of 0.24% and a pooled skin necrosis rate of 0.23%. The forest plots revealed that patients who underwent APCL do not face a higher risk of skin necrosis or revision compared with those who underwent AA. CONCLUSIONS Performing APCL is a safe combined procedural approach and can confer added benefits of improved patient satisfaction and aesthetic outcomes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Anjali C Raghuram
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Roy P Yu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA
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De Paep K, Van Campenhout I, Van Cauwenberge S, Dillemans B. Post-bariatric Abdominoplasty: Identification of Risk Factors for Complications. Obes Surg 2021; 31:3203-3209. [PMID: 33796972 DOI: 10.1007/s11695-021-05383-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim was to evaluate the complication rate after abdominoplasty procedures performed in a high volume post-bariatric center and to identify predictors of complications. MATERIAL AND METHODS A retrospective analysis was performed and included all abdominoplasty procedures performed between January 2011 and December 2019. Complications classified according to the Clavien-Dindo classification were documented and potential risk factors were statistically evaluated. RESULTS A total of 898 patients were included. Overall complication rate was 29.8%. Type I complications (minor wound problems) occurred in 15.8% (n = 140). Type II complications requiring medical intervention occurred in 10% (n = 90). Five patients had deep venous thrombosis or pulmonary embolism; others received antibiotic treatment for wound infections. In total 42 type III complications occurred in 36 patients, with re-intervention for wound problems (n = 16), seroma (n = 16), umbilical necrosis (n = 4), and bleeding (n = 6). The weight of tissue resected (p < 0.001), the interval between bariatric and body contouring surgery (p < 0.05), preoperative BMI (p < 0.05), male gender (p < 0.05), diabetes mellitus type 2 (p = 0.05), and smoking (p < 0.05) were important predictors for developing complications. CONCLUSION In this large retrospective post-bariatric abdominoplasty series, the overall complication rate is low compared to other published series as a consequence of our completely standardized approach and technique. Our analysis shows a significant linear correlation between the amount of skin tissue resected and postoperative complications. Moreover, the longer the interval between bariatric surgery and abdominoplasty, the higher the complication rate. High preoperative BMI, diabetes mellitus type 2, smoking, and male gender were identified as independent significant risk factors for complications.
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Affiliation(s)
- Karen De Paep
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| | - Ilia Van Campenhout
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| | - Sebastiaan Van Cauwenberge
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium.
| | - Bruno Dillemans
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
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Gormley J, Copeland A, Augustine H, Axelrod C, McRae M. Impact of Rectus Diastasis Repair on Abdominal Strength and Function: A Systematic Review. Cureus 2020; 12:e12358. [PMID: 33520552 PMCID: PMC7839807 DOI: 10.7759/cureus.12358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rectus diastasis plication performed during abdominoplasty aims to narrow the widened linea alba and return the rectus muscle bellies to their anatomic position. It is unclear whether plication improves abdominal strength and function. This systematic review summarizes the effect of rectus plication on abdominal strength, function, and postoperative complications. A comprehensive search of CINAHL, Embase, Medline and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically. A total of 497 patients from seven articles were included. Mean age was 44.5 years (range 20.5-72) and 94.4% were female. Three articles reported abdominal strength measurements, with two showing significant improvement. Four articles used the SF-36 survey, all demonstrating improvement in physical function subscale postoperatively. An additional six instruments were used to assess functional outcomes, of which four demonstrated significant improvement. The overall complication rate was 17.0%. Rectus plication is commonly performed during abdominoplasty to improve abdominal form and function. While the literature to date is encouraging with respect to functional outcomes, improvements in abdominal strength are less consistent. Heterogeneity in patient population, outcome measures, and comparison groups limit the strength of our conclusions. Future research should include a large comparative study as well as a protocol for standardizing outcomes in this population.
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Affiliation(s)
- Jessica Gormley
- Plastic Surgery, Michael G. DeGroote School of Medicine, Hamilton, CAN
| | | | | | - Charlotte Axelrod
- Plastic Surgery, University of Toronto Faculty of Medicine, Toronto, CAN
| | - Mark McRae
- Plastic Surgery, McMaster University, Hamilton, CAN
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Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck. Case Rep Surg 2020; 2020:8819102. [PMID: 33299633 PMCID: PMC7707930 DOI: 10.1155/2020/8819102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.
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Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ. Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 2020; 21:179-189. [PMID: 33207164 PMCID: PMC7673892 DOI: 10.5811/westjem.2020.6.46415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.
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Affiliation(s)
- Tim Montrief
- University of Miami Miller School of Medicine, Department of Emergency Medicine, Miami, Florida
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Ramzy
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Brit J Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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Zhitny VP, Iftekhar N, Zide B, Stile F. Anatomic reconstruction for major tissue loss following abdominoplasty: A case report. Int J Surg Case Rep 2020; 72:241-244. [PMID: 32553936 PMCID: PMC7300238 DOI: 10.1016/j.ijscr.2020.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022] Open
Abstract
Abdominoplasty is a highly requested cosmetic procedure, but ultimately, as a major surgery can have unwanted complications. Autografts are a viable option for repairing skin necrosis, especially after a tight liposculpture. Large skin grafts may result in abdominal wall deformity, which requires surgical creativity for repair. Abdominal wall deformity can be corrected in a two-part procedure.
Introduction Abdominoplasty is currently one of the most widely requested cosmetic procedures in the United States. There is limited literature describing the corrective measures following skin loss from a flap necrosis due to an abdominoplasty complication. Methods A 53-year-old female presented with a large split thickness skin graft due to skin loss as a necrotic complication from an abdominoplasty performed at our center. The patient suffered from emotional stress related to the abdominal deformity, which included a lack of an umbilicus. Results Patient recovered well post-operatively. She required two procedures – the initial procedure involved excision of the skin graft and closure with the patient’s own full-thickness skin and tissue. The second procedure, which occurred six months later, involved the creation of an umbilical stalk from a small cuff of skin. Conclusion Abdominoplasty, although sought for cosmetic purposes, is indeed a major procedure and can result in complications especially from aggressive liposculpture. When complications do occur, revisions are indeed possible with aesthetically pleasing results.
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Affiliation(s)
| | - Noama Iftekhar
- School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Barry Zide
- New York University, Langone Health, New York City, NY, USA
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Chong K, Sun CK, Miao Y, Hu ZQ. Overcoming the Achilles' heel of orthostatic hypotension during interactive standing liposculpture. J Cosmet Dermatol 2020; 19:3000-3006. [PMID: 32159282 DOI: 10.1111/jocd.13336] [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: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) is a major obstacle to standing liposculpture. AIMS To investigate the feasibility of a novel "interactive standing liposculpture" procedure under local anesthesia to avoid possible general anesthesia-related complications and overcome standing-associated OH. METHODS A total of 68 subjects undergoing IsLipo were divided into three groups: Individuals with normal body weight (18 ≤ BMI < 23, n = 21, Group 1), overweight or mildly obese subjects (23 ≤ BMI < 30, n = 29, Group 2), and those with moderate-to-severe obesity (BMI ≥ 30, n = 18, Group 3). A 4-area liposculpture technique was adopted with alternate change in position from recumbent to standing for each area. Subjects with symptoms of OH (ie, dizziness or/and nausea) were allowed to rest in a supine position before resuming the procedure. Incidence of OH and duration of liposculpture for each area were recorded and analyzed. RESULTS The incidence of OH was 15 (four subjects experienced two episodes during the same procedure). All OH episodes occurred in Group 3 subjects. The total liposuction time significantly increased from Group 1 to Group 3 (all P < .001). The IsLipo time in Group 3 was also substantially longer than that in Group 1 and Group 2 (P < .001). Mean arterial blood pressure dropped and heart rate increased significantly in all subjects experiencing OH without fluctuation in arterial oxygen saturation. All subjects with OH recovered after a 10-minute rest and resumed the IsLipo procedure. Successful liposculpture were performed in all subjects. CONCLUSION Orthostatic hypotension associated with interactive standing liposculpture, which predominantly occurred in subjects with moderate-to-severe obesity, could be resolved with an intraoperative resting strategy.
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Affiliation(s)
- Kinman Chong
- Department of Plastic and Anesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China.,City Idol Aesthetic Clinic, Kaohsiung City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yong Miao
- Department of Plastic and Anesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Zhi-Qi Hu
- Department of Plastic and Anesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
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Marlino S, Cagli B, Vitale A, Boccia A, Avvedimento S, Madonna G, Santorelli A. Bleeding in Plastic-Aesthetic Surgery: A Prognostic Pathway with Clinical Application. Aesthetic Plast Surg 2020; 44:201-206. [PMID: 31822961 DOI: 10.1007/s00266-019-01557-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/23/2019] [Indexed: 11/30/2022]
Abstract
One of the potential complications of aesthetic surgery is bleeding. Given the high surgical activity carried out in our center and the variety of interventions performed, the risk of bleeding is not negligible: A clinical practice that could reduce this postsurgical complication is necessary. The goal of this article is to value effectiveness of a bleeding score obtained through the evaluation of anamnestic data. The study was divided into two steps. The preliminary data consist in the creation of a form for the evaluation of the bleeding score based on literary data. Subsequently, the first step was put on a retrospective study on 163 patients who underwent aesthetic surgery from January 2013 to July 2017. In the second step, the bleeding score was introduced in clinical practice, submitting the form to 223 patients operated on from September 2017 to September 2018. Retrospective results showed that patients with a low bleeding index had no hemorrhagic complications. One patient of three with a medium-high bleeding score showed a hemorrhagic complication in the postoperative course. The prospective study showed that in three patients with an index between 4 and 7, the level II panel analysis confirmed a medium risk of incurring bleeding episodes during or after the surgery. One patient in 223 obtained a bleeding index of 9: This patient was not operated on and he was sent to the reference center for further investigation. This routine will help to recognize, manage, and prevent hemorrhagic complications of aesthetic surgery.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Sergio Marlino
- Plastic Surgery, Health Park, Naples, Italy
- Plastic Surgery, Clinica Grimaldi, San Giorgio a Cremano, Italy
| | - Barbara Cagli
- Dipartimento di Chirurgia Plastica, Campus Biomedico, Rome, Italy
| | | | - Andrea Boccia
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Gabriele Madonna
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" di Napoli, Naples, Italy.
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.
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Louri NA, Ammar HM, Abdulkariml FA, Alkhaldi TASAE, AlHasan RN. Abdominoplasty: Pitfalls and Prospects. Obes Surg 2020; 30:1112-1117. [DOI: 10.1007/s11695-019-04367-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Maningas T, Sturm L, Mangler A, Pazdernik VK. Manual Lymphatic Drainage in Postoperative Abdominoplasty With Core Liposuction Patients. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/0748806819874941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Manual lymphatic drainage (MLD) performed by lymphatic massage, in the postoperative period after abdominoplasty with core liposuction, may promote a faster resolution of edema. The purpose of this study was to determine the benefits of MLD by assessing the amount of edema at 6 and 8 weeks after abdominoplasty with core liposuction in patients who did or did not receive MLD for 3 weeks. The study used a prospective, comparative design. A total of 20 women aged 30 to 60 years, who underwent an abdominoplasty and core liposuction, were recruited from 2 clinics. Participants were divided into 2 equal groups based on clinic location. All participants wore a standard compression garment for 8 weeks after surgery. Starting at 6 weeks after surgery, the treatment group was treated by a certified lymphedema specialist twice a week for 3 weeks (6 visits). At 6 and 8 weeks after surgery, the waist circumferences of all participants were measured in 3 locations: at the navel, 3 cm above the navel, and 3 cm below the nave. Data from the 2 groups were compared to determine the change in edema. The mean age of participants was 41.6 years (range = 32-59 years) in the treatment group and 40.8 years (range = 30-59 years) in the control group. The mean (SD) reduction in edema between weeks 6 and 8 in the treatment group was 9.8 cm; 1 participant lost 18.2 cm during that period. The mean (SD) reduction in edema between weeks 6 and 8 in the control group was 6.6 cm; a few participants lost 12.0 cm during that period. No differences in mean reductions were found between groups ( P = .11). No differences were found between groups based on clinic location ( P = .84). Our results suggested that receiving MLD after abdominoplasty and core liposuction reduced edema more than the standard compressive garments, but not by a statistically significant amount. Furthermore, differences in the study groups were not dependent on clinic location.
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Hunecke P, Toll M, Mann O, Izbicki JR, Blessmann M, Grupp K. Clinical outcome of patients undergoing abdominoplasty after massive weight loss. Surg Obes Relat Dis 2019; 15:1362-1366. [PMID: 31296446 DOI: 10.1016/j.soard.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/20/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Abdominoplasty is one of the most commonly performed surgical procedures to reshape the body contour in patients who have undergone massive weight loss. OBJECTIVES This study was undertaken to assess the clinical outcome, complication rates, and risk factors for complications of patients undergoing abdominoplasty after massive weight loss. SETTING University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. METHOD Clinical outcome was retrospectively analyzed in 121 patients, who underwent abdominoplasty. The retrospective analysis included demographic data of patients, such as sex, age, body mass index (BMI), and pre-existing illnesses. Moreover, postoperative complications including seroma, hematoma, wound infection, and tissue necrosis were analyzed. RESULTS In our study cohort, the median age was 43.7 years, the median weight was 94.7 kg, and the median BMI was 32.3 kg/m2. The majority of included patients were women (70.3%). Death occurred in none of the patients. Among individuals, wound infection occurred in 3.3%, tissue necrosis in 1.7%, seroma in 7.4%, and hematoma in 3.3% of patients during the postoperative course. Reoperations were necessary in 2 patients (1.7%) due to postoperative bleeding and tissue necrosis of the navel. Tissue necrosis was significantly more often seen in a subset individual with type 2 diabetes (P = .006). Moreover, the rate of reoperations was significantly higher in patients with pre-existing cardiovascular illnesses compared with cardiovascular healthy patients (P = .036). Multivariate analysis analyzing risk factors for postoperative complications, including sex, age, BMI, diabetes, pulmonary disease, and cardiovascular disease, revealed strong independent relevance for type 2 diabetes (P = .024). CONCLUSIONS We found that abdominoplasty is a safe operative procedure. In addition, the risk for complications is significantly increased in the subgroup of diabetic patients and patients with cardiovascular diseases.
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Affiliation(s)
- Pauline Hunecke
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marianne Toll
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Robert Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Blessmann
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Grupp
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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A Comparative Trial of Incisional Negative-Pressure Wound Therapy in Abdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2141. [PMID: 31333924 PMCID: PMC6571337 DOI: 10.1097/gox.0000000000002141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Abstract
The risk for minor local complications for abdominoplasty remains high despite advances in strategies in recent years. The most common complication is the formation of seroma with reported rates ranging from 15% to 40%. The use of incisional negative-pressure wound therapy (iNPWT) on closed surgical sites has been shown to decrease the infection, dehiscence, and seroma rates. Thus, this article aims to determine whether an iNPWT dressing, Prevena Plus, is able to reduce postoperative drainage and seroma formation in patients who undergo abdominoplasty. Sixteen consecutive patients who underwent abdominoplasty by a single surgeon were dressed with standard dressings and iNPWT dressings. Total drain output, day of drain removal, and adverse events were compared between cohorts with a minimum follow-up of 6 months. The iNPWT group demonstrated a significantly less amount of fluid drainage with a mean total fluid output of 370 ± 275 ml compared to 1269 ± 436 ml mean total drainage from controls (P < 0.001). Time before removal of both drains was almost halved in the iNPWT group with an average of 5.3 ± 1.6 days, which was significantly less than the average time of 10.6 ± 2.9 days seen in control patients (P < 0.001). No observed adverse events were recorded in either group. Our findings show that iNPWT for a closed abdominoplasty incision decreases the rate of postoperative fluid accumulation and results in earlier drain removal.
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Al Daoud F, Thayer A, Sachwani Daswani G, Maraqa T, Perinjelil V, Mercer L. Management of chronic abdominal wall seroma with Doxycycline sclerotherapy using a Negative Pressure Wound Therapy System KCI-V.A.C.Ulta™-A case report. Int J Surg Case Rep 2018; 51:25-28. [PMID: 30130670 PMCID: PMC6104591 DOI: 10.1016/j.ijscr.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Seroma is a common and challenging post-operative complication that surgeons are often faced with after performing procedures in which tissue dead spaces have been created. The management strategies consist of non-operative management, percutaneous drainage, or surgical drainage. Our case report discusses the use of Doxycycline sclerotherapy in the successful resolution of a chronic abdominal wall seroma. PRESENTATION OF CASE We present the case of a 50 year old patient with extensive history of multiple abdominal surgeries, including appendectomy, multiple hernia repairs with recurrent mesh replacement as a result of infection followed by post-operative formation of seroma after each repair. Recently, patient underwent panniculecotomy complicated by seroma that was successfully resolved with the use of doxycycline sclerotherapy. DISCUSSION Sclerotherapy has been used previously in the surgical field such as thoracic surgery, as a successful use of sclerosants in chronic pleural effusions has been documented. Sclerosants range from talc, tetracycline antibiotics, ethanol, polidocanol, erythromycin, OK-432, fibrin glue, and povidone-iodine, and are largely safe and easily applicable. Doxycycline in particular can be a simple and effective method for resolution of chronic seroma. This case demonstrates the successful use of doxycycline in the resolution of a chronic abdominal wall seroma. CONCLUSION Chronic and recurrent seroma after surgery can be difficult to deal with. Using sclerosants such as Doxycycline would be an effective solution to treat this chronic issue and to prevent its recurrence especially if it is used with a Negative Pressure Wound Therapy System.
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Affiliation(s)
- Fadi Al Daoud
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
| | - Angelyn Thayer
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
| | | | - Tareq Maraqa
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
| | | | - Leo Mercer
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
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Usurpation of the role of the plastic surgeon as a public health problem in Mexico: Reflections on a case. Arch Plast Surg 2018; 45:390-392. [PMID: 30037204 PMCID: PMC6062698 DOI: 10.5999/aps.2018.00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022] Open
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