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Michele A Shermak - One of the best experts on this subject based on the ideXlab platform.
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barbed suture impact on wound closure in Body Contouring surgery
Plastic and Reconstructive Surgery, 2010Co-Authors: Michele A Shermak, Jessie Mallalieu, David W ChangAbstract:Background: As artistry has been refined in Body Contouring surgery, streamlining wound closure is the next advance on the horizon. Absorbable barbed suture is one potential solution. The authors present their experience with this suture in wound closure for different Body regions. Methods: A review of operative and clinic notes of 496 patients who had Body Contouring procedures from March of 1998 to September of 2008 was performed. Variables studied included age, gender, Body mass index, medical history, and operative data. Use of barbed suture was noted, and complications were tabulated. Multilevel analysis was performed using generalized estimate equation method. Results: The records of 910 operations in 496 patients were analyzed. Procedures were performed on multiple Body regions: abdomen (n = 493), chest (n = 124), back (n = 104), thigh (n = 104), and arm (n = 88). Barbed suture was used in 114 cases. There were 115 wound-healing problems, with barbed suture present in 17 cases. On unadjusted analysis, the wound complication rate with barbed suture was 17.5 percent, compared with 12.0 percent when barbed suture was not used (p = 0.093). On multilevel multivariable analysis, age (odds ratio, 1.04) and Body mass index at contour (odds ratio, 1.05) were significant in impairing wound healing (p < 0.01), and barbed suture was not associated with the wound complication rate. In subset analysis, barbed suture was associated with significantly higher wound complication rate in the arm (odds ratio, 8.4; p = 0.046). Conclusions: Barbed suture presents problems with wound healing, particularly in the arm. The authors look forward to seeing the evolution in technologies designed to improve the speed and outcome of wound closure for lengthy Body Contouring procedures.
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seroma development following Body Contouring surgery for massive weight loss patient risk factors and treatment strategies
Plastic and Reconstructive Surgery, 2008Co-Authors: Michele A Shermak, Lisa Rotellinicoltvet, David C ChangAbstract:Background:The most common complications following Body Contouring surgery for massive weight loss include delayed wound healing and seroma. The authors investigated risk factors for seroma in this patient population and describe treatment strategies.Methods:A retrospective review of 222 patients wh
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an outcomes analysis of patients undergoing Body Contouring surgery after massive weight loss
Plastic and Reconstructive Surgery, 2006Co-Authors: Michele A Shermak, David C Chang, Thomas Magnuson, Michael SchweitzerAbstract:Background: Although published reports about technical management of massive weight loss patients are beginning to appear, risk factors for complications following Body Contouring operations are not known. Methods: A retrospective analysis of massive weight loss patients who had Body Contouring operations between March of 1998 and October of 2004 was performed. Demographic and surgical factors were analyzed. Outcome measures included seroma, wound dehiscence, thromboembolic complications, blood transfusion after surgery, and extended lengths of stay (>2 days). Results: A total of 139 patients were analyzed; 82.7 percent of them were female; mean age was 41 years. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (odds ratio, 6.4; p = 0.01). There were also trends toward increased risk for wound dehiscence with hypothyroidism (odds ratio, 4.3; p = 0.06) and Ehlers-Danlos syndrome (odds ratio, 18.7; p = 0.05). In terms of risk of blood transfusion, asthma and having three or more procedures were the two variables that emerged with significant association (odds ratio, 16.8 and 13.7, respectively; both p < 0.01). Increased length of stay to greater than 2 days was also significantly associated with having three or more procedures (odds ratio, 4.72; p < 0.01). Conclusions: Male gender, hypothyroidism, and Ehlers-Danlos syndrome may be risk factors for wound dehiscence following Body contour operations for massive weight loss. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Having three or more procedures is associated with an increased risk of blood transfusion and increased length of stay.
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Body Contouring following massive weight loss
Obesity Surgery, 2004Co-Authors: Jesse A Taylor, Michele A ShermakAbstract:Background: Obesity and its associated medical morbidities carry substantial health risk. While massive weight loss allows improvement in health status and lifestyle, physical sequelae due to symptomatic skin redundancy still require treatment. Areas affected include the arms, breasts, abdomen, back, and thighs. After open gastric bypass, patients often have poor abdominal support and incisional hernias. To completely address the treatment of patients following massive weight loss, Body Contouring procedures are performed, often in one stage and tailored to each patient, to rid the functional and esthetic impairment from skin redundancy. Methods: This retrospective study includes 30 patients treated from March 1998 to August 2002 by a single surgeon at an academic hospital. Average weight loss had been 71 kg, and average weight and BMI at the time of Contouring surgery were 98.6 kg and 33 kg/m2 respectively. Procedures included abdominal panniculectomy, thighlift, backlift, brachioplasty, mastopexy and incisional hernia repair, performed either alone or in combination. Results: Average weight of resected tissue was 5.9 kg. Average length of stay was 3 days. Complications included seroma, wound breakdown, hematoma requiring surgical drainage, and lymphocele after brachioplasty. One patient died of a pulmonary embolus within weeks after surgery. Conclusion: Patients requiring surgical skin excision after massive weight loss for functional and/or esthetic reasons are challenging, and require individualized approaches with intensive follow-up.
M Frey - One of the best experts on this subject based on the ideXlab platform.
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after massive weight loss patients expectations of Body Contouring surgery
Obesity Surgery, 2012Co-Authors: Hugo B Kitzinger, Felix B. Langer, Sara Abayev, Anna Pittermann, Birgit Karle, Arthur Bohdjalian, Gerhard Prager, M FreyAbstract:Background Massive weight loss following bariatric surgery leads to excess skin with functional and aesthetic impairments. Surplus skin can then contribute to problems with additional weight loss or gain. The aims of the current study were to evaluate the frequency of massive soft tissue development in gastric bypass patients, to determine whether males and females experience similar post-bypass Body changes, and to learn about the expectations and impairments related to Body Contouring surgery.
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the prevalence of Body Contouring surgery after gastric bypass surgery
Obesity Surgery, 2012Co-Authors: Hugo B Kitzinger, Felix B. Langer, Sara Abayev, Anna Pittermann, Birgit Karle, Harald Kubiena, Arthur Bohdjalian, Gerhard Prager, M FreyAbstract:Background As bariatric surgery has become more popular, more patients are undergoing Body Contouring surgery after massive weight loss. Many of the surgical procedures performed on the massive weight loss patient are complex and labor-intensive. Therefore, the plastic surgery unit needs to be prepared for a patient's demand. Little literature is available on how frequently patients who have undergone gastric bypass surgery receive Body Contouring surgery.
Jeffrey A Gusenoff - One of the best experts on this subject based on the ideXlab platform.
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heterogeneity in Body Contouring outcomes based research the pittsburgh Body Contouring complication reporting system
Aesthetic Surgery Journal, 2018Co-Authors: Rachel Guest, Dalit Amar, Sharona Czerniak, Stephanie E Dreifuss, Mark A Schusterman, Elizabeth M Kenny, Eva F Chernoff, Joshua M Barnett, Kathleen Koesarie, Jeffrey A GusenoffAbstract:Background Body Contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. Objectives We aim to provide a guideline for complication reporting in the Body Contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of Body Contouring procedures and will decrease under-, over-, and nonreporting of complications. Methods The authors reviewed the literature for the terms "Body Contouring," "MWL," and "complications." Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal Contouring and extremity Contouring. Results Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal Contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance. Conclusions Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss Body Contouring surgery.
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the influence of preexisting lower extremity edema and venous stasis disease on Body Contouring outcomes
Annals of Plastic Surgery, 2014Co-Authors: Evan B Katzel, Peter J Rubin, Harry S Nayar, Michael P Davenport, Ronald P Bossert, Jeffrey A GusenoffAbstract:BACKGROUND While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity-related lymphatic and/or venous disease and post-Body Contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are predisposed to developing this complication due to unrecognized preoperative lymphovascular disease. METHODS Fifty-five patients who had undergone Body Contouring surgery were identified from our prospective registry. Twenty-eight patients completed the Venous Clinical Severity Score (VCSS), a validated outcome measure of venous disease. Three time points were assessed: pre-weight loss (T1), post-weight loss but pre-Body Contouring (T2), and post-Body Contouring (T3). Based on T3 VCSS, patients were divided into 2 groups-a T3 VCSS ≤3 (group 1; N = 13) and a T3 VCSS ≥4 (group 2; N = 15). RESULTS VCSS for group 1 at T1, T2, and T3 were 3.31 ± 0.55, 1.85 ± 0.27, and 1.54 ± 0.35 (mean ± SEM), respectively, versus 6.3 ± 1.10, 4.33 ± 0.8, and 6.8 ± 0.63 for group 2 (P < 0.05, P < 0.05, and P < 0.0001). Pain scores at T1 was 0.46 ± 0.21 for group 1 versus 1.1 ± 0.24 for group 2 (P < 0.05). Edema scores for group 1 at T1, T2, and T3 were 0.69 ± 0.29, 0.08 ± 0.08, and 0.15 ± 0.10 versus 1.87 ± 0.35, 1.13 ± 0.31, and 2.13 ± 0.24 for group 2 (P < 0.05, P < 0.001, and P < 0.0001, respectively). CONCLUSIONS Using VCSS, post-bariatric patients with prolonged lower extremity edema experienced clinically identifiable signs of disease prior to weight loss and Body Contouring surgery. Thus, careful preoperative evaluation may help identify at-risk patients and aid in managing postoperative expectations.
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prospective assessment of nutrition and exercise parameters before Body Contouring surgery optimizing attainability in the massive weight loss population
Plastic and Reconstructive Surgery, 2010Co-Authors: Peter F Koltz, Rui Chen, Susan Messing, Jeffrey A GusenoffAbstract:Background:A lower Body mass index at the time of Body Contouring surgery can optimize surgical options and, ultimately, aesthetic results. With increased emphasis on preoperative evaluation of the massive weight loss patient, the interrelationships between nutrition and exercise on Body mass indice
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implications of weight loss method in Body Contouring outcomes
Plastic and Reconstructive Surgery, 2009Co-Authors: Jeffrey A Gusenoff, Devin Coon, Peter J RubinAbstract:Background:Patients frequently present for Body Contouring after massive weight loss resulting from bariatric procedures or diet and exercise. The authors investigated whether Body Contouring complications vary by weight loss method.Methods:Four hundred forty-nine patients (511 cases) were entered i
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temporal and demographic factors influencing the desire for plastic surgery after gastric bypass surgery
Plastic and Reconstructive Surgery, 2008Co-Authors: Jeffrey A Gusenoff, Susan Messing, William Omalley, Howard N LangsteinAbstract:Background:An increasing number of gastric bypass patients desire plastic surgery after massive weight loss. However, the timing of interest and factors influencing the desire for Body Contouring have not been studied.Methods:Two thousand five hundred one gastric bypass patients were surveyed. Outco
Hugo B Kitzinger - One of the best experts on this subject based on the ideXlab platform.
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after massive weight loss patients expectations of Body Contouring surgery
Obesity Surgery, 2012Co-Authors: Hugo B Kitzinger, Felix B. Langer, Sara Abayev, Anna Pittermann, Birgit Karle, Arthur Bohdjalian, Gerhard Prager, M FreyAbstract:Background Massive weight loss following bariatric surgery leads to excess skin with functional and aesthetic impairments. Surplus skin can then contribute to problems with additional weight loss or gain. The aims of the current study were to evaluate the frequency of massive soft tissue development in gastric bypass patients, to determine whether males and females experience similar post-bypass Body changes, and to learn about the expectations and impairments related to Body Contouring surgery.
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the prevalence of Body Contouring surgery after gastric bypass surgery
Obesity Surgery, 2012Co-Authors: Hugo B Kitzinger, Felix B. Langer, Sara Abayev, Anna Pittermann, Birgit Karle, Harald Kubiena, Arthur Bohdjalian, Gerhard Prager, M FreyAbstract:Background As bariatric surgery has become more popular, more patients are undergoing Body Contouring surgery after massive weight loss. Many of the surgical procedures performed on the massive weight loss patient are complex and labor-intensive. Therefore, the plastic surgery unit needs to be prepared for a patient's demand. Little literature is available on how frequently patients who have undergone gastric bypass surgery receive Body Contouring surgery.
Peter J Rubin - One of the best experts on this subject based on the ideXlab platform.
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the influence of preexisting lower extremity edema and venous stasis disease on Body Contouring outcomes
Annals of Plastic Surgery, 2014Co-Authors: Evan B Katzel, Peter J Rubin, Harry S Nayar, Michael P Davenport, Ronald P Bossert, Jeffrey A GusenoffAbstract:BACKGROUND While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity-related lymphatic and/or venous disease and post-Body Contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are predisposed to developing this complication due to unrecognized preoperative lymphovascular disease. METHODS Fifty-five patients who had undergone Body Contouring surgery were identified from our prospective registry. Twenty-eight patients completed the Venous Clinical Severity Score (VCSS), a validated outcome measure of venous disease. Three time points were assessed: pre-weight loss (T1), post-weight loss but pre-Body Contouring (T2), and post-Body Contouring (T3). Based on T3 VCSS, patients were divided into 2 groups-a T3 VCSS ≤3 (group 1; N = 13) and a T3 VCSS ≥4 (group 2; N = 15). RESULTS VCSS for group 1 at T1, T2, and T3 were 3.31 ± 0.55, 1.85 ± 0.27, and 1.54 ± 0.35 (mean ± SEM), respectively, versus 6.3 ± 1.10, 4.33 ± 0.8, and 6.8 ± 0.63 for group 2 (P < 0.05, P < 0.05, and P < 0.0001). Pain scores at T1 was 0.46 ± 0.21 for group 1 versus 1.1 ± 0.24 for group 2 (P < 0.05). Edema scores for group 1 at T1, T2, and T3 were 0.69 ± 0.29, 0.08 ± 0.08, and 0.15 ± 0.10 versus 1.87 ± 0.35, 1.13 ± 0.31, and 2.13 ± 0.24 for group 2 (P < 0.05, P < 0.001, and P < 0.0001, respectively). CONCLUSIONS Using VCSS, post-bariatric patients with prolonged lower extremity edema experienced clinically identifiable signs of disease prior to weight loss and Body Contouring surgery. Thus, careful preoperative evaluation may help identify at-risk patients and aid in managing postoperative expectations.
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hereditary coagulopathies practical diagnosis and management for the plastic surgeon
Plastic and Reconstructive Surgery, 2010Co-Authors: Tali Friedman, Devin Coon, Joseph Michaels, Franklin Bontempo, Leroy V Young, Julio Clavijo, Peter J RubinAbstract:Background:Venous thromboembolism is a devastating complication representing one of the major causes of postoperative death in plastic surgery. Within the scope of plastic surgery, Body-Contouring procedures are often considered to carry a higher risk of venous thromboembolism. Hereditary thrombophi
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implications of weight loss method in Body Contouring outcomes
Plastic and Reconstructive Surgery, 2009Co-Authors: Jeffrey A Gusenoff, Devin Coon, Peter J RubinAbstract:Background:Patients frequently present for Body Contouring after massive weight loss resulting from bariatric procedures or diet and exercise. The authors investigated whether Body Contouring complications vary by weight loss method.Methods:Four hundred forty-nine patients (511 cases) were entered i
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Body image and quality of life in post massive weight loss Body Contouring patients
Obesity, 2006Co-Authors: Angela Y Song, Peter J Rubin, Veena Thomas, Jason R Dudas, Kacey G Marra, Madelyn H FernstromAbstract:Objective: Because post-bariatric surgery patients undergo massive weight loss, the resulting skin excess can lead to both functional problems and profound dissatisfaction with appearance. Correcting skin excess could improve all these corollaries, including Body image. Presently, few data are available documenting Body image and weight-related quality of life in this population. Research Methods and Procedures: Eighteen patients who underwent both bariatric surgery and Body Contouring completed our study. Both established surveys and new surveys designed specifically for the study were used to assess Body perception and ideals, quality of life, and mood. Patients were surveyed at the following time-points: pre-Body Contouring (after massive weight loss) and both 3 and 6 month post-Body Contouring. Statistical testing was performed using Student's t test and ANOVA. Results: The mean age of the patients was 46 ± 10 years (standard deviation). Quality of life improved after obesity surgery and was significantly enhanced after Body Contouring. Three months after Body Contouring, subjects ascribed thinner silhouettes to both current appearance and ideal Body image. Body image also improved with Body Contouring surgery. Mood remained stable over 6 months. Discussion: Body Contouring after surgical weight loss improved both quality-of-life measurements and Body image. Initial Body dissatisfaction did not correlate with mood. Body Contouring improved Body image but produced dissatisfaction with other parts of the Body, suggesting that as patients become closer to their ideal, these ideals may shift. We further developed several new assessment methods that may prove useful in understanding these post-surgical weight loss patients.