Lipoabdominoplasty: Comparing UAL Versus UAL/PAL Techniques on Complication Profile and Patient Safety

PURPOSE

This study intends to assess the complications and outcomes related to the use of UAL (LIPO SAVER, LHbiomed Co, Gangnam-gu, Korea) versus a combination of UAL and PAL (Microaire, Charlottesville, VA, USA) within the abdominoplasty procedure.

MATERIAL AND METHOD

A retrospective study used patient data and chart reviews in a single surgeon's private cosmetic practice. The study involved patients who underwent the lipoabdominoplasty technique with UAL and a combination of UAL and PAL (UAL/PAL) over 4 years from October 2017 through December 2022. A total of 280 patients (272 female, eight male) who underwent standard (n:258) or fleur-de-lis abdominoplasty (n:22) due to skin excess, musculofascial laxity, and lipodystrophy were included in the study. Patients with illnesses affecting microcirculation, such as diabetes mellitus type I and II, cardiopulmonary diseases, oral contraceptive usage, hereditary bleeding and thrombotic disorders, and those who had undergone revision abdominoplasties were excluded.

RESULTS

BMI above 30 kg/m2 was associated with an increased risk of both minor and major complications in the UAL abdominoplasty group (P = 0.005 and 0.001, respectively). On the other hand, BMI over 30 kg/m2 was associated with an increased risk of major complications in the UAL/PAL abdominoplasty group (P = 0.011). BMI over 30 kg/m2 was associated with an overall increased rate of minor and major complications in both the UAL and UAL/PAL groups (P = 0.001 and 0.001, respectively). There was no statistical difference between the UAL and UAL/PAL groups regarding complications, but a slight increase in the overall complication rate was observed in the UAL group (P = 0.061). Additionally, the study unveiled that there was no correlation found between age, gender, duration of surgery, lipoaspirate volumes and combined surgeries with an increased risk of complications between groups.

CONCLUSION

BMI over 30 kg/m2 has been shown to have an adverse effect on the profile of complications in both groups, resulting in an increased risk, especially for major and minor complications such as seroma in the UAL group.

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 .

Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction

PURPOSE

Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages.

METHODS

A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)-GIR and non-definitive herniorrhaphy and Stage 2 (S2)-definitive sublay mesh herniorrhaphy.

RESULTS

Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05).

CONCLUSION

Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.

Effect of Compression Garments on the Ventilatory Function After Abdominoplasty

BACKGROUND

The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function.

OBJECTIVES

The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty.

METHODS

Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods.

RESULTS

Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group.

CONCLUSIONS

The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications.

LEVEL OF EVIDENCE: 3

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

BACKGROUND

As the obesity crisis in the United States continues, some renal transplantation centers have liberalized their BMI criteria necessary for transplant eligibility. More individuals with larger body-habitus related comorbidities with End-Stage Renal Disease (ESRD) now qualify for renal transplantation (RT). Surgical modalities from other fields also interact with this patient population.

METHODS

In order to assess surgical outcomes of panniculectomy in the context of renal transplantation and ESRD, the authors performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines. Due to a paucity of existing primary studies, we retrospectively collected data on patients with ESRD undergoing panniculectomy from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) to evaluate outcomes of body contouring in this patient population.

RESULTS

From the systematic review, a total of 783 ESRD patients underwent panniculectomy among the studies identified. Of these, 91 patients underwent panniculectomy simultaneously to RT while 692 had their pannus resected prior to kidney transplant. The most common complication was hematoma followed by wound dehiscence. From the NSQIP database, 24 868 patients met the inclusion criteria for analysis. In the setting of renal transplant status, patients with diabetes, hypertension requiring medication, and requiring dialysis were more likely to suffer postoperative complications (OR 1.31, 1.15, and 2.2, respectively). However, upon sub-analysis of specific types of complications, the only retained association was between diabetes and wound complication.

CONCLUSION

Preliminary data show that panniculectomy in ESRD patients appears to be safe, though with a nominal increased risk for complications. Pannus resection does not appear to impact post-transplantation outcomes, including long-term allograft survival. Larger, higher powered, randomized studies are needed to confirm the safety, utility, and medical benefit of panniculectomy in the context of renal transplantation.

Clinical Practice Patterns in Abdominoplasty: 16-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery

BACKGROUND

The authors evaluated trends in practice patterns for abdominoplasty based on a 16-year review of tracer data collected by the American Board of Plastic Surgery as part of the continuous certification process.

METHODS

To facilitate comparison of an equal number of patients over time, tracer data from 2005 to 2021 were split into an early cohort (EC) (from 2005 to 2014) and a recent cohort (RC) (from 2015 to 2021). Fisher exact tests and two-sample t tests were used to compare patient demographics, surgical techniques, and complication rates.

RESULTS

Data from 8990 abdominoplasties (EC, n = 4740; RC, n = 4250) were analyzed. RC abdominoplasties report a lower rate of complications (RC, 19%; EC, 22%; P < 0.001) and a lower rate of revision surgery (RC 8%; EC, 10%; P < 0.001). This has occurred despite the increased use of abdominal flap liposuction (RC, 25%; EC, 18%; P < 0.001). There has been a decline in the use of wide undermining (81% versus 75%; P < 0.001), vertical plication of the abdomen (89% versus 86%; P < 0.001), and surgical drains (93% versus 89%; P < 0.001). Abdominoplasty surgery is increasingly performed in an outpatient setting, with increased use of chemoprophylaxis for thrombosis prevention.

CONCLUSIONS

Analysis of these American Board of Plastic Surgery tracer data highlights important trends in clinical practice over the past 16 years. Abdominoplasty continues to be a safe and effective procedure with similar complication and revision rates over the 16-year period.

A randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a bupivacaine hydrochloride implant in patients undergoing abdominoplasty

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.

THE EVALUATION OF THE RISK OF COMPLICATIONS DURING MULTIMODAL AND OPIOID ANESTHESIA IN BARIATRIC SURGERY AND ABDOMINOPLASTY

The use of opioids for anesthesia during surgery is associated with side effects. The aim of our study is to assess the risk of postoperative pain during multimodal and opioid anesthesia in bariatric surgery and abdominoplasty. The study observed 127 patients (93 women, 34 men) aged 20-70 who underwent bariatric surgery and abdominoplasty. Two groups were formed: Group I received standard anesthesia with opioids, while Group II underwent multimodal anesthesia without opioids. Standard anesthesia with opioids was administered to 49 patients - group I, multimodal anesthesia without opioids - 78 - group II. During the operation the use of opioids reduces the risk of non-opioid necessity and increases the risk of opioid usage. During the anesthesia using multimodal anesthesia and in the postoperative period, in the in-hospital stage, there is an increased risk of non-opioid necessity, whereas in the ambulatory stage, there is an increased risk of medical care necessity. There is positive significant correlation between Anesthesia using multimodal anesthesia during surgery with: Phase 1,PACU 1 - r=0.608**, p<0.001; Phase 1, PACU 2 - r=0.287**, p=0.001 and negative significant correlation with I Phase 1, PACU 3 - r=-0.779**, p<0.001;There is positive significant correlation between Anesthesia using multimodal anesthesia during surgery with: Phase 2, PACU 1 - r=0.950**, p<0.001and negative significant correlation with Phase 2, PACU 2 - r=-0.234**, p=0.008; Phase 2,PACU 3 - r=-0.871**, p<0.001. Anesthesia using opioids during surgery, compared to multimodal anesthesia, increases the relative risk of needing both non-opioid RR=0.35 (95% CI:0.17-0.71),and opioid treatment -RR=3.86 (95% CI:2.68-5.56), in the postoperative period in the hospital stage- Requires non-opioid medical treatment - RR=13.06 (95% CI:.03-28.29), Needs opioids- RR=7.50 (95% CI:4.43-12.70). The relative risk of needing medical treatment in the ambulatory stage - RR=3.11 (95% CI:2.23-4.32). Multimodal anesthesia in bariatric surgery and abdominoplasty reduces the duration of postoperative care and the use of opioids after surgery.

Combined Surgery (Mommy-Makeover) Compared to Single Procedure (Abdominoplasty) in After-Pregnancy Women: A Prospective Study on Risks and Benefits

BACKGROUND

Mommy-makeover is becoming very popular to help them reshaping their own bodies and restoring self-perception, hardly stressed by childbearing-related changes. However, debate exists in the literature concerning safety and aesthetic outcome in patients undergoing combined procedures. The study aims to shed a light on advantages and disadvantages in mommy-makeover technique compared to conventional abdominoplasty with a particular attention to psychological aspects.

MATERIALS AND METHODS

In total, 37 women were enrolled at Campus Bio-Medico Hospital in Rome between October 2019 and January 2022. All of the patients were eligible for both abdominoplasty only and mommy-makeover. We proposed to the patients both procedures explaining risks and benefits; then, based on the preference of the single patient, we performed either mommy-makeover (Group A) or abdominoplasty alone (Group B). In order to evaluate patients' satisfaction and safety, multiple questionnaires were administered 9-month postoperatively (BUT, POSAS, visual perception, etc.).

RESULTS

The sample analyzed was composed of 37 patients (treatment group = 18, control group = 19). In the pre-post comparisons of BUT-A performed, there were statistically significant differences recorded in both groups and for all observed variables. The significance values were all less than 1% (p < 0.01).

CONCLUSIONS

Combined surgery proved not to be inferior in terms of patient safety. At the same time, the effectiveness in improving diastasis-related symptoms is fully comparable with single surgery. Treatment group showcases a considerable superiority in terms of body-image perception improvement and overall patient satisfaction.

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 .

The Effect of Drains and Compressive Garments Versus Progressive Tensioning Sutures on Seroma Formation in Abdominoplasty

Seroma is a common problem following abdominoplasty surgery. Both compressive garments with drains and progressive tension sutures have their advocates to minimise seroma formation. This is a retrospective study in which patients underwent an identical surgical procedure, except for use of drains and garments in comparison to progressive tension sutures between 2005 and 2020. Two hundred thirty-two patients were included in the study 61 in the drains and garment group (DG group), and 171 with progressive tension sutures (PTS group) alone. There was a lower incidence of seroma formation in the PTS group (X2 (1, N = 232) = 6.35, P = .012). The weight of tissue excised in the PTS group was greater than the DG group (P < .001). There was there a significantly higher tissue excision weights for patients who developed a seroma, compared with those who did not (P=.02). Patients, who developed a seroma in the PTS group, had significantly greater excision weights than the DG group. Liposuction did not change the incidence of seroma in each group (X2 (4, N = 232) = 6.701, P = .08 n/s). This study demonstrates the effectiveness of progressive tension sutures in reducing the incidence of seroma formation following abdominoplasty, particularly when large excision weights are involved. The addition of small volume liposuction distant to the abdominal flap does not increase the incidence of seroma formation.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 .

Does Concomitant Umbilical Hernia Repair Increase the Risk of Complications in Abdominoplasty? A Propensity Score Matched Analysis

BACKGROUND

Patients seeking cosmetic abdominoplasty often have umbilical hernias. Optimal management and safety of concomitant umbilical hernia repair with abdominoplasty is not well described.

OBJECTIVES

The goal of this study was to compare complication rates following abdominoplasty with or without umbilical hernia repair.

METHODS

A retrospective propensity score matched cohort study of patients who underwent an abdominoplasty at Massachusetts General Hospital was performed. Direct umbilical hernia repair was performed by making a fascial slit inferior or superior to the umbilical stalk. The fascial edges were approximated with up to three 0-Ethibond sutures (Ethicon, Raritan, NJ) from the preperitoneal or peritoneal space. Propensity score matching was used to adjust for confounding variables.

RESULTS

The authors identified 231 patients with a mean [standard deviation] age of 46.7 [9.7] years and a mean BMI of 25.9 [4.4] kg/m2. Nine (3.9%) had diabetes, 8 (3.5%) were active smokers, and the median number of previous pregnancies was 2. In total, 223 (96%) had a traditional abdominoplasty, whereas 8 (3.5%) underwent a fleur-de-lys approach. Liposuction was performed on 90%, and 45.4% underwent simultaneous breast or body contouring surgery. The overall complication rate was 6.9%. Propensity scores matched 61 pairs in each group (n = 122) with closely aligned covariates. There was no significant difference in total complication rates between abdominoplasty alone vs abdominoplasty with hernia repair. There were no cases of skin necrosis or umbilical necrosis in either group.

CONCLUSIONS

Performing umbilical hernia repair with abdominoplasty is safe when utilizing the technique reported in this series.

LEVEL OF EVIDENCE: 3

Alternative Abdominal Wall Plication Techniques: A Review of Current Literature

Abdominoplasty is one of the most common procedures performed in plastic surgery. By removing redundant skin and fat tissue, body contouring narrows the waist and achieves a naturally flattened appearance. To achieve this, one technique frequently utilized is plication of the abdominal rectus sheath. Although abdominal wall plication is commonly performed during abdominoplasty, there is a lack of consensus regarding which plication method provides the best outcomes. Each variation addresses some of the common intraoperative and postoperative complications of abdominoplasty. These include extended operating time, rupture of the plication, epigastric bulging, and patient postoperative dissatisfaction. Many plication techniques have been described in the literature, but no single technique has been adopted by plastic surgeons as the gold standard. Here we present a narrative comparison of current published literature reporting novel or modified abdominoplasty plication techniques. This includes diagrams of each procedure, sutures utilized, and key concepts of each plication technique. Discussion regarding how these modifications change operating time, alter epigastric bulging, and improve the ability to narrow the waist is provided. The purpose of this paper is to provide a concise source document for plastic surgeons to reference when choosing a plication method to use during abdominoplasty.

LEVEL OF EVIDENCE: 4

Umbilicus Necrosis During Mesh Repair of Rectus Diastasis for Abdominoplasty: Practical Tips for Prevention and Treatment

Rectus muscles widened by pregnancy are handled in dramatically different ways in standard abdominoplasty and mesh abdominoplasty. Patients with significant abdominal wall laxity and/or umbilical hernia repair are treated with the use of retrorectus mesh placement. In these conditions the risk of damaging the blood supply to the umbilicus might be greater. Despite the fact that it is of no functional significance in adults, the umbilicus is a key esthetic landmark of the anterior abdominal wall. For both patients and surgeons alike, its absence, distortion, or misplacement after surgery can be distressing and can be a source of frequent patient complaint. Umbilical stalk necrosis represents an underreported yet important complication for patients following mesh abdominoplasty. We advance some recommendations for patients undergoing abdominoplasty with mesh repair of rectus diastasis and/or concomitant umbilical hernia mesh repair via the open approach. This information should help influence intraoperative decision-making to prevent the development of this undesirable complication.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 .

Abdominal wall reconstruction for extensive necrosis following abdominoplasty in a patient with subcostal scars - case report

Abdominal wall defects encompass a broad spectrum of musculo-fasciocutaneous anomalies. We present case of a 42-year-old woman with a history of multimorbidity and bilateral subcostal scars. The patient underwent incisional ventral hernia repair and abdominoplasty performed by a general surgeon at another institution. However, she developed extensive necrosis of the cutaneous-fatty panniculus between the bilateral subcostal incisions and the abdominoplasty incision. The patient presented with a medial area of 50 × 60 cm with loss of soft tissue vitality and necrotic plaques. Tangential escharotomies were performed to remove devitalized tissue, and management of the open wound included hydrocolloid and alginate dressings. Finally, a defect of 45 × 40 cm was achieved. Three tissue expanders were used to reconstruct the abdominal wall, allowing sufficient adjacent autologous tissue to be harvested for definitive correction of the abdominal defect. An acceptable aesthetic result was observed 5 years after surgery. This report highlights the importance of adequate evaluation of the previously scarred abdominal wall prior to abdominoplasty.

[Treatment of ventral hernias in patients with morbid obesity]

The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.

Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study

PURPOSE

This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods.

METHODS

This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone.

RESULTS

A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05).

CONCLUSION

Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.

Efficacy of Topical Losartan in Management of Mammoplasty and Abdominoplasty Scars: A Randomized, Double-Blind Clinical Trial

BACKGROUND

Annually, millions of people suffer from skin scars' psychological and physical disadvantages. Pathologic scars prevention is challenging and requires developing feasible and effective therapeutic strategies. Regarding promising results of losartan (an angiotensin 1 receptor inhibitor) on skin scar in preclinical studies, we aimed to assess the losartan ointment's impact on surgical scars in a clinical setting.

MATERIAL AND METHOD

Twenty-four patients with surgical wounds were enrolled from Razi hospital's plastic and reconstructive surgery department. The patients were trained to apply ointments 14-18 days post-surgery on the determined scar side, twice a day for 6 months. Two dermatologists independently evaluated scar formation at 3 and 6-month follow-ups using the Vancouver Scar Scale (VSS) score.

RESULT

Twenty-four female patients with cosmetic surgeries were included. The mean VSS score of losartan-treated sides was 7.1 ± 2.06 (at month 3) and 5.21 ± 1.71 (at month 6) that significantly were different from placebo-treated sides (9.77 ± 1.55 and 8.31 ± 1.88 at 3 and 6 months, respectively) (P value < 0.001 and < 0.001, respectively, for months 3 and 6). The subset analysis demonstrated a significant improvement in height (P value < 0.001 at 3 and 6 months), pliability (P value  < 0.001 at 3 and 6 months), and vascularity (P value < 0.001 at 3 and 6 months) subsets at losartan compared to placebo-treated side. Losartan ointment was well tolerated with no complication.

CONCLUSION

Losartan ointment successfully improved scar formation in mammoplasty and abdominoplasty patients. The losartan preventive effect should be confirmed in future large-scale studies with long-term follow-ups.

LEVEL OF EVIDENCE II

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 .

Analgesic Effect of Ropivacaine Pumped in the Sub Rectus Abdominis Muscle Sheath after Abdominoplasty

BACKGROUND

Abdominoplasty is a major surgical procedure in plastic surgery. It removes excess skin and fat, tightens abdominal muscles and fascia, restores normal abdominal anatomy and reshapes the distorted abdominal contour. According to the statistics released annually by International Society of Aesthetic Plastic Surgery (ISAPS) in 2020, there are more than 900, 000 abdominal wall plastic surgeries performed every year worldwide. However, the most commonly used analgesic methods, such as oral administration, intravenous analgesia and local infiltration anesthesia, do not provide the satisfactory analgesic results. We found that intra-sheath injection of ropivacaine of the rectus abdomen was effective in reducing postoperative pain.

OBJECTIVES

To retrospectively study the analgesic effect of continuous pumping ropivacaine into the intra-sheath space of rectus abdominis after abdominoplasty.

METHODS

A retrospective study was conducted on 67 patients with total abdominal wall plastic surgery admitted to Plastic Surgery Hospital of Chinese Academy of Medical Sciences from February 2020 to August 2021. The patients were from 25 to 56 years old, with a mean age of 38.5, ASA grade 1-2, BMI 27-33kg/m2, and rectus abdominis muscle separation range of 4-8cm. Based on the methods of postoperative analgesia, we divided patients into the following two groups: 29 patients in the conventional intravenous analgesic group (group A) and 38 patients in the rectus abdominis intrathecal analgesic group (group B). Group A received PCA with sufentanil 1.0μg/kg+ normal saline diluted to 100ml. Group B received continuous pumping of ropivacaine (0.2625%) through the rectus sheath internal tube in 100mL of normal saline and continued pumping at a rate of 2mL /h. Visual analog pain score (VAS score), analgesic pump pressure times and the degree of postoperative satisfaction were recorded at T1 (24h) and T2 (48h). The incidence of adverse drug reactions and complications related to nerve block within one week after operation were also recorded.

RESULTS

The clinical data of patients with total abdominal wall plastic surgery in two groups were collected and analyzed. The patients in group B overall had lower postoperative VAS score, less analgesic pump usage, less nausea, vomiting, drowsiness and restlessness and a higher degree of postoperative satisfaction than those in group A.

CONCLUSION

Continuous pumping of ropivacaine through rectus sheath can effectively relieve postoperative pain, reduce postoperative adverse reactions and improve postoperative satisfaction.

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 . Body Contouring LOE IV.

Functional panniculectomy vs cosmetic abdominoplasty: Multicenter analysis of risk factors and complications

BACKGROUND

Amidst the rising trend of bariatric surgical procedures being performed across the country and around the world, patients seeking functional panniculectomy after massive weight loss represent a different population than those seeking cosmetic abdominoplasty. The purpose of this study was to determine whether certain complications are more likely to occur in patients undergoing functional panniculectomy, as well as identify risk factors that are implicated in the occurrence of adverse events.

METHODS

Retrospective cohort study was conducted of patients undergoing cosmetic abdominoplasty and functional panniculectomy in North America between 2015 and 2019 using the National Surgical Quality Improvement Program database sponsored by the American College of Surgeons. Comorbidities and postoperative complications between these two cohorts were analyzed with appropriate statistics.

RESULTS

During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n = 6397) patients undergoing functional panniculectomy and 42.6% (n = 4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty (p < .001). Overall adverse events (p < .001), medical complications (p = .047), surgical complications (p < .001), related readmission (p < .001), and related reoperation (p < .001) were significantly higher in patients undergoing functional panniculectomy. Surgical complications significantly higher in functional panniculectomy included superficial incisional infection (p < .001), deep incisional infection (p < .001), organ/space infection (p < .001), dehiscence (p = .003), and bleeding requiring transfusion (p = .003).

CONCLUSIONS

Patients undergoing functional panniculectomy are significantly more likely to have comorbidities and experience postoperative wound infection, dehiscence, sepsis, bleeding, related readmission, and related reoperation.

Closed-Incision Negative Pressure Therapy Decreases Wound Morbidity in Open Abdominal Wall Reconstruction With Concomitant Panniculectomy

INTRODUCTION

Patients undergoing abdominal wall reconstruction (AWR) with concomitant panniculectomy (CP) may be at higher risk for wound complications due to the need for large incisions and tissue undermining. The aim of this study was to evaluate whether the use of closed-incision negative pressure therapy (ciNPT) decreases wound complications in AWR patients undergoing CP.

METHODS

Beginning in February 2018, all patients at this institution who underwent AWR with CP received ciNPT. These patients were identified from a prospectively maintained institutional database. A standard dressing (non-NPT) group was then created in a 1:1 fashion by identifying patients who had AWR with CP immediately before the beginning of ciNPT use (2016-2018). A univariate comparison was made between the ciNPT and non-NPT groups. The primary outcome was wound complication rate; however, other perioperative outcomes, such as requirement for reoperation, were also tracked. Standard statistical methods and logistic regression were used.

RESULTS

In total, 134 patients met criteria, with 67 patients each in the ciNPT and non-NPT groups. When comparing patients in the ciNPT and non-NPT groups, they were demographically similar, including body mass index, smoking, and diabetes (P < 0.05). Hernias was large on average (289.5 ± 158.2 vs 315.3 ± 197.3 cm2, P = 0.92) and predominantly recurrent (58.5% vs 72.6%, P = 0.14). Wound complications were much lower in the ciNPT group (15.6% vs 35.5%, P = 0.01), which was mainly driven by a decrease in superficial wound breakdown (3.1% vs 19.7%, P < 0.01). Patients in the ciNPT group were less likely to require a return trip to the operating room for wound complications (0.0% vs 13.3%, P < 0.01). In logistic regression, the use of ciNPT continued to correlate with reduced wound complication rates (P = 0.02).

CONCLUSIONS

In AWR with CP, the use of ciNPT significantly decreased the risk of postoperative wound complications, particularly superficial wound breakdown, and lessened the need for wound-related reoperation.

PSEUDOCYST FORMATION AFTER ABDOMINOPLASTY: A CASE REPORT

Abdominoplasty is one of the most popular aesthetic body contouring procedures. Seroma formation is the most common early complication after abdominoplasty. Usually, it resolves with punctions and seroma evacuation. Chronic seroma and pseudocyst formation is a rare complication and it demands surgical intervention. Based on our experience from the described case, the pseudocyst needs to be radically extirpated and a combination of quilting sutures, fibrin glue, three weeks of suction drainage, and compressive garments should be used to prevent recurrence.

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

Background

This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty.

Materials and methods

One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result.

Results

No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results.

Conclusions

In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results.

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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00266-021-02739-w.

Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity is a major global health problem. With an increasing number of bariatric surgeries, the need for body-contouring procedures has grown. These procedures are associated with multiple complications because of various patient characteristics and risk factors.

OBJECTIVES

In this study, we performed a systematic literature review of all the complications of postbariatric body contouring surgeries, as well as a meta-analysis to estimate the effects of body mass index (BMI) and the weight of the tissue resected during body contouring on the development of complications.

METHODS

We conducted a literature search of the PubMed and Cochrane databases in September 2020, using the MeSH terms plastic surgery, weight loss, and complications. Studies were included if they involved more than 35 postbariatric patients and reported postoperative complication rates and types.

RESULTS

In total, 561 articles were initially identified, and 25 studies were included after the final review. The overall weighted rate of postbariatric body contouring surgical complications in all studies was 31.5%. The most frequent complication from all regions of body contouring was seroma (weighted rate 12.7-13.9%). Regarding risk factors, analysis indicated that a BMI < 30 kg/m² and low mean weight of resected tissue were associated with fewer complications.

CONCLUSION

Body contouring procedures are relatively safe. Although complications after contouring are common, most either resolve spontaneously or require minimal intervention. In body contouring after bariatric surgery, there is a 37% increased risk of developing complications if the BMI is ≥ 30 kg/[Formula: see text] before body contouring. A higher weight of resected tissue appears to be linked to a greater risk of complications.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis.

METHODS

In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I² index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2).

RESULTS

In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05).

CONCLUSIONS

This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously.

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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Expanding the Progressive Tension Suture Concept: A Study of Its Utility in Body Contouring Procedures

BACKGROUND

Seroma is one of the most common complications following body contouring. Progressive tension sutures (PTSs) have been shown to decrease the seroma rate following abdominoplasty, component separation, and facelifts and following latissimus flap and deep inferior epigastric artery perforator flap harvest.

OBJECTIVES

The aim of this study was to investigate the effects of PTS techniques and their impact on the seroma rate in body contouring flap procedures.

METHODS

A retrospective review was performed of all patients undergoing a flap procedure (defined as any procedure that produces a dead space and subsequent susceptibility to seroma) by a single surgeon at a single institution over 3 years. All patients/procedures utilized PTS techniques, as is routine in the surgeon's practice. No drains were used. Patient demographics and complications, including seroma, were tracked.

RESULTS

A total of 441 flap procedures were performed in 351 patients over the 3-year study period. These procedures comprised 305 abdominoplasties, 68 lower body lifts, 17 medial thigh lifts, 36 brachioplasties, and 15 torsoplasties. PTSs were used in all procedures. No drains were utilized. Complications occurred in 72 procedures (16.3%), with the most common complication being minor wound dehiscence without infection. There were no cases of seroma.

CONCLUSIONS

PTSs represent an effective technique for reducing the seroma rate, eliminating the potential space and promoting tissue adherence in flap procedures for body contouring. This is the first study of its kind demonstrating the use and role of this technique in body contouring procedures beyond the scope of abdominoplasty.

LEVEL OF EVIDENCE: 4

The Edmonton Obesity Staging System Predicts Postoperative Complications After Abdominoplasty

BACKGROUND

This study investigates the relationship between Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after abdominoplasty in massive weight loss patients.

METHODS

A single-institution retrospective review of patients undergoing abdominoplasty between 2009 and 2019 after massive weight loss. Demographic data, laboratory findings, known risk factors for postoperative complications, as well as data on major and minor complications were extracted from the patient charts. Logistic regression models were used to investigate the relationship between the variables.

RESULTS

Four hundred and five patients were included in the study. The prevalence of EOSS stages was: 0 (no comorbidities, N = 151, 37%), 1 (mild conditions, N = 40, 10%), 2 (moderate conditions, N = 149, 36%) and 3 (severe conditions, N = 70, 17%). Regression analysis showed that, controlling for body mass index (BMI), BMI Δ (maximal BMI - BMI at presentation), bariatric surgery, volume of resected tissue, and duration of surgery, EOSS stage significantly associated with the occurrence of postoperative complications. Compared with EOSS stage 0, EOSS stages 2 and 3 patients were associated with significantly more minor and major complications, respectively. The volume of resected tissue, BMI Δ, and age were associated with the occurrence of major complications. A regression model of comorbidities comprising the EOSS revealed a significant association of variables diabetes mellitus and hypertension with the occurrence of postoperative complications.

CONCLUSIONS

Edmonton Obesity Staging System is a robust predictor of postoperative complications in abdominoplasty.

Is simultaneous panniculectomy an ideal approach to repair a ventral hernia: a general surgeon's experience

BACKGROUND

The number of Australian patients undergoing ventral hernia repair has seen a significant increase in the last twenty years. With the obesity epidemic, the general surgeon is frequently seeing patients with hernias and significant abdominal aprons and is being asked to address this at the time of the hernia repair. This can be performed utilising a general surgery and plastic surgery team, but there may be some advantages to general surgeon being able incorporate this into their practice. We present our approach to patients undergoing ventral hernia repair and simultaneous panniculectomy (VHR + PAN) by a single general surgeon.

METHODS

Data were analysed from a single surgeon's experience performing VHR + PAN at the same operation. Data were collected prospectively from 2009 to 2020. 146 cases of patients undergoing VHR + PAN were identified and included in this study.

RESULTS

The mean age of patients undergoing VHR + PAN was 58 years. The mean BMI was 35, with 59% of patients losing weight loss prior to surgery. 66% of patients had a hernia repair with biosynthetic mesh and 91% of patients had retro-rectus or pre-peritoneal mesh approach to the repair. 42% of patients had a post-operative complication with 80.6% of these being related to surgical-site occurrences. Other complications included gastrointestinal (14%), respiratory (13%) and venous thromboembolism, such as a deep vein thrombus or pulmonary embolism (6%). There were 2 deaths in the series (1.3%). The hernia recurrence rate was 6%.

CONCLUSION

Simultaneous PAN is possible in patients with an abdominal apron who are undergoing VHR, with an acceptable risk of SSOs and other complications. This technique provides excellent exposure and with appropriate training is well within the remit of the general surgeon. This may save further operative management in the future and can offer patients improved self-esteem, mobility, and independence. Patient optimisation is key, paying careful attention to pre-operative weight loss, diabetic control, smoking cessation and respiratory function. VHR + PAN is an important technique that should be in the repertoire of all abdominal wall reconstruction units.

The Ever-Present Costs of Cosmetic Surgery Tourism: A 5-Year Observational Study

BACKGROUND

Cosmetic surgery tourism is an ever-growing industry. Despite its associated risks, an increasing number of patients are presenting to NHS services with resulting complications. This study aims to evaluate the current presentation patterns for complications in cosmetic surgery tourism, and the financial burden to the NHS reported by a single UK level one trauma centre in Birmingham, UK.

METHODS

From 2015 to 2020, all patients presenting to the department of plastic surgery with complications of cosmetic surgery performed outside of the UK were included. Data were collected for patients' characteristics including demographics, performed procedures, complications and treatment. A cost analysis was performed for each patient using published "National Schedule of NHS Costs."

RESULTS

A total of 26 patients presented to our hospital within the study period. All patients were female, with the mean age being 35.1 years (range 22-55years). A total of 32 cosmetic procedures were undertaken, with the majority performed in Turkey (n = 14). Abdominoplasty was the most common procedure, followed by gluteal enhancement surgery. The total financial cost to the NHS from all cosmetic surgery-related complications was £152,946, with an average cost per patient of £5,882.54 (range £362-£26,585).

CONCLUSION

Patients seek out medical tourism for multiple reasons including cost savings, shorter waiting times and surgical expertise. The costs displayed should predominantly be viewed as a reflection of the detrimental effect these complications can have on patients' lives. Global governing bodies should focus efforts on educating patients and raising awareness on this ever-prevalent issue.

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 .

The Effect of Obesity, Bariatric Surgery, and Operative Time on Abdominal Body Contouring Outcomes

BACKGROUND

Abdominal body contouring procedures are associated with the highest rates of complications among all aesthetic procedures. Patient selection and optimization of surgical variables are crucial in reducing morbidity and complications.

OBJECTIVES

The purpose of this single-institution study was to assess complication rates, and to evaluate BMI, operative time, and history of bariatric surgery as individual risk factors in abdominal body contouring surgery.

METHODS

A retrospective chart review was performed of all patients who underwent abdominoplasty, circumferential lower body lift, fleur-de-lis panniculectomy (FDL), and circumferential FDL between August 2014 and February 2020. Endpoints were the incidence of venous thromboembolism, bleeding events, seroma, infection, wound complications, and reoperations. Univariate statistical analysis and multivariate logistic regressions were performed. Covariates in the multivariate logistic regression were BMI, procedure time, and history of bariatric surgery.

RESULTS

A total of 632 patients were included in the study. Univariate analysis revealed that longer procedure time was associated with infection (P = 0.0008), seroma (P = 0.002), necrosis/dehiscence (P = 0.01), and reoperation (P = 0.002). These associations persisted following multivariate analyses. There was a trend toward history of bariatric surgery being associated with minor reoperation (P = 0.054). No significant increase in the incidence of major reoperation was found in association with overweight or obese patient habitus, history of bariatric surgery, or prolonged procedure time. BMI was not found to be an individual risk factor for morbidity in this patient population.

CONCLUSIONS

In abdominal body contouring surgery, surgery lasting longer than 6 hours is associated with higher incidence of seroma and infectious complications, as well as higher rates of minor reoperation.

LEVEL OF EVIDENCE: 4

The Impact of Perioperative Blood Pressure on Hematoma Development After Panniculectomy

PURPOSE

Hematoma affects 10% to 13% of patients undergoing panniculectomy. Although elevated perioperative blood pressure has been associated with hematoma after rhytidectomy, this has not been established for panniculectomy. We sought to determine the impact of perioperative blood pressure on hematoma development in patients undergoing panniculectomy.

METHODS

A retrospective review was performed on patients undergoing isolated panniculectomy procedures. Blood pressure parameters recorded included systolic blood pressures (SBPs), diastolic blood pressures (DBPs), and mean arterial pressure. The mean, peak, and trough blood pressure values were recorded. Preoperative, intraoperative, and postoperative blood pressures were recorded, and differences between phases were calculated. Univariate and multivariate logistic regressions were performed.

RESULTS

One hundred forty-three patients were identified, which included 84% (n = 120) women and 17% (n = 23) men. A history of hypertension was present in 55% (n = 79) of patients, of which 91% (n = 72) were medically controlled. Preoperative antiplatelet or anticoagulation was used in 21% (n = 31) of patients. Seven patients (5%) developed a hematoma, of which 5 required operative drainage. Development of hematoma was not associated with patient, surgical, or postoperative pain variables. There was an association between hematoma and elevated postoperative blood pressures on univariate and multivariate analyses. The mean peak SBP in the hematoma group was 160 mm Hg in comparison to 141 mm Hg in the nonhematoma group. For each 10-mm Hg increase in postoperative peak SBP, the odds of a hematoma increased by 2.8 times. When comparing phases of care, hematoma patients had similar intraoperative and postoperative peak SBP, but their postoperative SBP was 19 mm Hg higher than preoperative baseline. Conversely, nonhematoma patients had a postoperative blood pressure that was similar to their preoperative baseline and 20 mm Hg lower than their intraoperative values.

CONCLUSIONS

Hematoma is associated with elevated postoperative blood pressures. A postoperative mean peak SBP of 160 mm Hg was associated with hematoma, and for each 10 mm Hg, the risk of hematomsa increased by 2.8 times. The risk of hematoma may be reduced by strict postoperative blood pressure control. We recommend a postoperative peak SBP goal of 140 mm Hg or less, with a value equal to or less than their preoperative baseline and 20 mm Hg lower than their intraoperative pressure.

Conceptual Paper: Abdominoplasty and Liposuction in Systemic Sclerosis

Surgical interventions in patients with systemic sclerosis (SSc), in particular plastic procedures, might cause undesired consequences. Notably, liposuction seems to possess greater risk as adipose tissue has been shown to play an important role in treating wounds and ulcers in patients with SSc. While anticentromere antibodies were found to be correlated with vasculopathy in SSc, patients with SSc and anticentromere antibodies might be more vulnerable to surgical wound complications following liposuction. A 46-year-old female patient, who had been diagnosed with SSc at the age of 31 years, had antinuclear as well as anticentromere antibodies. She underwent abdominoplasty with liposuction and developed severe skin necrosis of the abdomen following the procedure and at the site of liposuction. The correlation with anticentromere and the role of liposuction in skin necrosis in SSc are presented.

Efficacy of Progressive Tension Sutures without Drains in Reducing Seroma Rates of Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Abdominoplasty using progressive tension sutures (PTS) without drains has been reported to lower seroma risk. However, evidence regarding the reproducibility of PTS drainless abdominoplasty in lowering seroma risk is inconsistent and limited to a few studies.

OBJECTIVES

The purpose of this review and meta-analysis was to assess the efficacy of PTS without drains in reducing seroma rates associated with abdominoplasty.

METHODS

PubMed, EMBASE, and Cochrane databases were searched with no restrictions for randomized controlled trials (RCTs) and observational studies in which the number of patients who experienced postoperative seroma was indicated. The keywords included ''progressive tension sutures,'' ''quilting sutures,'' "drain," and "abdominoplasty.'' Review Manager software (RevMan, version 5.3) was utilized to compute the pooled effect estimate using a random-effects Mantel-Haenszel model. The outcomes were expressed as odds ratios (OR) and 95% confidence intervals (CI). Subgroup analysis was conducted based on whether abdominoplasty was combined with liposuction.

RESULTS

Five studies were included (one RCT and four retrospective studies) involving a total of 1255 adult patients. Patients who underwent abdominoplasty using PTS without drains experienced a significantly lower rate of postoperative seroma compared to those with drains (D) only (OR, 0.36; 95% CI, 0.19-0.70; P = 0.002; I² = 9%). There was no significant difference in postoperative seroma rates between the PTS and PTS + D groups (OR, 1.03; 95% CI, 0.30-3.54; P = 0.96; I² = 0%). The data analysis for the subgroup that included liposuction showed that compared with the use of drain only, PTS were associated with a significantly reduced number of seromas (OR, 0.24; 95% CI, 0.11-0.49; P = 0.0001; I² = 0%).

CONCLUSION

Abdominoplasty using PTS without drain and combined with liposuction was effective in reducing seroma rates. Additional RCTs with larger sample sizes and better comparability are needed to confirm the safety and effectiveness of the drainless abdominoplasty technique using progressive tension sutures.

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 .

Abdominoplasty and Patient Safety: The Impact of Body Mass Index and Bariatric Surgery on Complications Profile

BACKGROUND

Abdominoplasty is a frequent aesthetic surgical procedure. Despite its popularity, patient safety requires further attention because of an important risk of complications. Obesity and bariatric surgery are potential risk factors. This study evaluated the impact of body mass index (BMI) and bariatric surgery on complications profile.

METHODS

A retrospective review of patients undergoing abdominoplasty over a 5-year period was conducted. Patient demographics, comorbidities, BMI, bariatric surgery, complications (minor and major) and drainage outcomes were evaluated. Univariate and multivariate logistic regression analyses were performed for risk assessment.

RESULTS

The 191 study patients showed an overall complication rate of 32.5%, comprising minor (27.7%) and major complications (7.9%). Seroma was the most common complication (20.9%). Mean BMI was 27.1 kg/m². Obesity was present in 14.1%, and bariatric surgery in 53.4%. Obese patients had significant higher rates of overall complications (74.1%, p < 0.001), minor complications (66.7%, p < 0.001), seroma (51.9%, p < 0.001) and drainage outputs (p < 0.001). Bariatric patients showed an increased time (p = 0.003) and volume of drainage (p < 0.001), without significant differences in complications. Obesity and preoperative BMI were the only independent risk factors for overall complications (OR 8.3; and OR 1.3; p < 0.001), minor complications (OR 7.4; and OR 1.3; p < 0.001) and seroma (OR 4.5; and OR 1.2; p = 0.002). Diabetes was an independent risk for major complications (OR 4.6; p = 0.047).

CONCLUSION

Obesity has negatively impacted the profile and risk of complications, whereas bariatric surgery independently did not. Our study provides an accurate understanding of abdominoplasty complications, allowing better risk stratification, candidate selection refinement, morbidity reduction, fair patient counseling and overall improvement in patient safety.

EBM LEVEL 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 .

Poly-4-hydroxybutyrate (Phasix™) mesh onlay in complex abdominal wall repair

BACKGROUND

Poly-4-hydroxybutyric acid (P4HB, Phasix™) is a biosynthetic polymer that degrades by hydrolysis that can be woven into a mesh for use in soft tissue reinforcement. Herein, we describe our initial experience performing complex abdominal wall repair (CAWR) utilizing component separation and P4HB mesh as onlay reinforcement.

METHODS

All patients undergoing CAWR between June 2014 and May 2017 were followed prospectively for postoperative outcomes. Only those patients who underwent components separation with primary repair of the fascial edges followed by onlay of P4HB mesh were included in this study.

RESULTS

105 patients (52 male, 53 female; mean age 59.2 years, range 22-84) met inclusion criteria. Mean BMI was 29.1 (range 16-48); 52% patients had prior attempted hernia repair, most with multiple medical comorbidities (71% of patients with ASA 3 or greater). 30% of cases were not clean at the time of repair (CDC class 2 or greater). Median follow-up was 36 months (range 9-63). Eighteen patients (17%) developed a hernia recurrence ranging from 2 to 36 months postoperatively. Five (5%) patients developed a localized superficial infection treated with antibiotics, three (2.8%) required re-operation for non-healing wounds, and six (6%) patients developed seroma.

CONCLUSIONS

These data demonstrate a relatively low rate of hernia recurrence, seroma, and other common complications of CAWR in a highly morbid patient population. Importantly, the rate of mesh infection was low and no patients required complete mesh removal, even when placed into a contaminated or infected surgical field.

Ultrasound Imaging of the Superficial Fascial System Can Predict the Subcutaneous Strength of Abdominal Tissue Using Mean Gray Value Quantification

BACKGROUND

This study is the first to correlate sonographic findings of subcutaneous tissue to structural and biomechanical properties.

METHODS

Precisely sized tissue specimens (59 samples) were collected from five abdominoplasty procedures. A Philips Lumify L12-4 linear array probe, connected to an Android tablet, was used to obtain ultrasound images of the superficial fascial system. A no. 1 Vicryl suture on a CTX needle placed though a needle guide within a three-dimensionally printed template ensured equal bites of subcutaneous tissue across specimens. Suture pull-out strength was measured until failure at a displacement rate of 2.12 mm/second using an Admet MTEST Quattro. Mean gray value for the superficial fascial system in associated ultrasonographic images was quantified by CellProfiler.

RESULTS

Superficial fascial system visualization can be accomplished using high-resolution portable ultrasound. Comparing multiple specimens' imaging, interpatient and intrapatient variability of superficial fascial system quantity and structural characteristics are apparent. The superficial fascial system is highly abundant in some patients, but has limited presence in others. Individual-specimen mean gray value and whole-patient mean gray value positively correlated with tissue tensile strength (p = 0.006) and patient-average tissue tensile strength (p = 0.036), respectively. Whole-patient mean gray value accounted for 98.5 percent of the variance seen in patient-average tensile strength, making it a strong predictor for tensile strength.

CONCLUSIONS

Portable ultrasound and image-processing technology can visualize, quantify, and predict subcutaneous tissue strength of the superficial fascial system. The superficial fascial system quantity correlates with suture tensile strength. Clinically, preoperative superficial fascial system quantification may aid in outcome predictions, manage patient expectations, and potentially lower complication rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Diagnostic, V.

Reduced Seroma Risk in Drainless Abdominoplasty Using Running Barbed Sutures: A 10-Year, Multicenter Retrospective Analysis

BACKGROUND

Drains are still commonly inserted during abdominoplasties despite extensive evidence documenting the benefits of drainless procedures. Continued improvements in progressive tension suturing (PTS) techniques and suture technologies have consistently shown a reduced seroma risk profile that outperforms procedures involving surgical drains.

OBJECTIVES

The aim of this report was to assess the authors' combined patient series, which represents the largest and longest-running, retrospective, multicenter set of abdominoplasty patients treated with a PTS technique involving running barbed sutures.

METHODS

Two surgical groups, each at different surgical centers, have for the past decade performed drainless abdominoplasties in which running barbed sutures were used. The results for all 445 patients in this series are reported by surgical center and pooled across centers.

RESULTS

The majority of the 445 patients underwent drainless abdominoplasty alone (n = 368; 82.7%); most of the remaining patients did so as part of a circumferential body lift (n = 55; 12.4%). Overall, 33 (7.4%) patients experienced a postoperative complication. The overall seroma rate was 4.7% (21 of 445 patients), but this dropped to 2.3% after surgical technique modifications were made to decrease upper abdominal dead space. The seroma incidence in this series is markedly lower than the 13% seroma rate with drains reported during the same time period and comparable to those seen in drainless abdominoplasties with interrupted suture techniques.

CONCLUSIONS

Drainless abdominoplasty involving PTS with running barbed sutures shows long-term reproducibility in lowering seroma risk compared to techniques in which drains are inserted, supporting results from published series of drainless abdominoplasty procedures that use interrupted suture techniques.

LEVEL OF EVIDENCE: 4

Is Plastic Surgery Combined with Obstetrical Procedures Safe?

In the existing reports on combined procedures of abdominoplasty with Cesarean section or natural delivery, a high incidence of complications and poor aesthetic results are reported. We conducted a survey with the participation of 61 plastic surgeons who performed this procedure in 808 patients, with an average of 13.24 procedures per surgeon. In 783 procedures (96.9% of the cases), the combination was with Cesarean section and 25 procedures (3.13% of cases) were combined with vaginal delivery. The plastic surgery procedures were as follows: 242 abdominoplasty procedures (29.95%), 210 abdominoplasty plus liposuction procedures (25.99%), 18 mini abdominoplasty procedures (2.22%), 121 mini abdominoplasty and liposuction procedures (14.97%), and 217 liposuction procedures (26.85%). The following complications were reported: seroma in 255 cases (31.57%), thrombosis in 212 (26.23%), infection in 170 (21.03%), skin necrosis in 127 (15.71%), and hematoma in 42 (5.19%). There were three deaths due to thrombosis (0.4%). There were redundancy skin abdominal wall defects in 336 (41.66%) cases, unaesthetic scars in 291 (36.11%), abdominal wall defects in 134 (16.58%), unpleasant contours in 22 (2.72%), and rotational folds in 22 (2.72%). Fifty-five (90.16%) surgeons decided to stop delivering babies with these practices. The combination of abdominoplasty with Cesarean section or natural delivery has a high incidence of complications and poor aesthetic results; therefore, we make a strong recommendation to avoid this practice before the patient reaches sixth month postpartum.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 .