The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform
Fiona C. Denison - One of the best experts on this subject based on the ideXlab platform.
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Predictors of surgical site skin infection and clinical outcome at caesarean section in the very severely obese: A retrospective cohort study
PloS one, 2019Co-Authors: Michael Dias, Allyn Dick, Rebecca M. Reynolds, Marius Lahti-pulkkinen, Fiona C. DenisonAbstract:INTRODUCTION The optimal surgical approach for caesarean section is uncertain in women with very severe obesity (body mass index (BMI) >40kg/m2). We aimed to assess maternal and surgical predictors of surgical site skin infection (SSSI) in very severely obese women and to undertake an exploratory evaluation of clinical outcomes in women with a supra-Panniculus transverse compared to an infra-Panniculus transverse skin incision. MATERIAL AND METHODS Using a retrospective cohort design, case-records were reviewed of very severely obese women with a singleton pregnancy delivered by caesarean between August 2011 and December 2015 (n = 453) in two maternity hospitals in Scotland. Logistic regression analysis was used to determine predictors for SSSI. Outcomes were compared between women who had a supra-Panniculus transverse compared to infra-Panniculus transverse skin incision. RESULTS Lower maternal age was predictive of SSSI, with current smoking status and longer wound open times being marginally significant. Maternal BMI, suture method and material demonstrated univariate associations with SSSI but were not independent predictors. Women with a supra-Panniculus transverse skin incision were older (32.9 (4.4), vs. 30.6 (5.7), p = 0.002), had higher BMI (49.2 (7.1), vs. 43.3 (3.3), p
Michael S. Wong - One of the best experts on this subject based on the ideXlab platform.
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Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal Panniculus: A pilot study
Surgery, 2016Co-Authors: Christoph Troppmann, Jennifer H. Kuo, Richard V. Perez, Chandrasekar Santhanakrishnan, Chad M. Bailey, Michael S. WongAbstract:Background Obese patients can develop a large lower abdominal Panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious wound-healing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods In a pilot study, adult patients with CKD who had a high-risk Panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008–06/2014). Results Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62%) patients were transplanted; (2) 7 (19%) remain listed; and (3) 7 (19%) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95% vs 35%, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5% (1 minor subcutaneous hematoma). Conclusion For obese CKD patients with a high-risk abdominal Panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation.
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Panniculectomy in Preparation for Renal Transplantation: A New Indication for an Old Procedure to Reduce Renal Transplantation–Associated Wound Complications
Plastic and reconstructive surgery, 2011Co-Authors: Jennifer H. Kuo, Christoph Troppmann, Richard V. Perez, Michael S. WongAbstract:End-stage renal disease patients who have lost a significant amount of weight are increasingly being evaluated for kidney transplantation. An abdominal Panniculus, almost uniformly observed, creates an area predisposed to wound complications. Consequently, a Panniculus may limit a patient's candidacy for transplantation. The authors describe their preliminary experience utilizing panniculectomy as a prophylactic procedure to reduce wound complications following kidney transplantation in patients whose Panniculus would exclude them from renal transplantion. A single-institution chart review was conducted of nine patients with end-stage renal disease who underwent a panniculectomy in preparation for transplantation. Clinical outcomes and complications were reviewed. The nine patients included three men and six women with a mean age of 54.5 years and a mean body mass index of 28.3 kg/m. Four patients had diabetes. All patients underwent an uncomplicated panniculectomy, with a mean resected weight of 3.0 kg, and a mean length of hospital stay of 1.75 days. No one required blood transfusions. All patients were followed postoperatively for 3 months. Complications included an abscess and a skin dehiscence treated with local wound care. After recovery, patients were referred to the transplant center for re-evaluation for kidney transplantation. Thus far, four of these nine patients have undergone transplantation. This case series suggests that panniculectomy can be performed safely in patients with end-stage renal disease. Furthermore, panniculectomy gives these otherwise unsuitable kidney transplant candidates access to a life-saving operation.
Michael Moretti - One of the best experts on this subject based on the ideXlab platform.
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An Original Suprapannicular Incision Technique for Cesarean Delivery in the Morbidly Obese Parturient
Obstetrics and gynecology, 2018Co-Authors: Nisha Lakhi, Katherine Williamson, Michael MorettiAbstract:BACKGROUND:Obese patients are at an increased risk of cesarean delivery and its associated wound complications. We present an alternative incision technique for obese parturients that avoids making a Pfannenstiel incision under the Panniculus while still providing access to the lower uterine segment
Juarez M. Avelar - One of the best experts on this subject based on the ideXlab platform.
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Surgical Principles and Classification of Abdominolipoplasty or Lipoabdominoplasty
New Concepts on Abdominoplasty and Further Applications, 2016Co-Authors: Juarez M. AvelarAbstract:My original publications were concerning descriptions of a new technique for patients presenting abnormalities on the abdominal wall: excess skin, localized adiposity, redundant Panniculus, striae, muscular flaccidity, and diastasis of the rectus abdominalis. Therefore new surgical principles were described as follows: (1) The operation is performed as a closed vascular system, which represents new concepts for improving the body contour. Since the vascular network is not damaged, the perforator vessels supply the abdominal Panniculus. (2) Full-thickness lipoplasty is made on the areas where skin resection will be performed. (3) Deep lipoplasty is performed on all abdominal regions that present localized adiposity on the remaining Panniculus. (4) Full-thickness skin resection. (5) The cutaneous excess is resected on infraumbilical and/or submammary regions after full-thickness liposuction of the Panniculus. (6) Do not perform cutaneous or Panniculus undermining, as used to be performed on traditional abdominoplasty. (7) The connective tissue and all vessels of the skin on resected areas are also preserved. This prevents the destruction of perforator vessels and small vessels coursing perpendicularly from the communicating network vessels situated in the fascia superficialis provided by the subdermal vascularization. (8) Perforator vessels are preserved during operation which works afterward as multiple pedicles providing adequate blood supply to the remaining abdominal Panniculus. (9) As perforator vessels are a neurovascular pedicle since there is a sensitive nerve that passes together with the artery and veins which is not damaged during surgery. For this reason the sensibility of the remaining Panniculus after is preserved. (10) The lymphatics surround the arteries and veins and are preserved, since the perforator vessels are not cut. Therefore, the lymph coming from the abdominal Panniculus maintains its normal circulation after surgery, avoiding seroma formation. (11) Cauterization during surgery quite often is not necessary since there is no damage to the blood vessels. (12) Differently from the classical abdominoplasty, in which drainage is an important procedure, in this new surgical technique drainage is not necessary because there is no bleeding during or after surgery. (13) Blood transfusion used to be a necessary support until 1998 because traditional abdominoplasty operations caused so much bleeding. Nevertheless, in the use of new concepts for abdominoplasty, blood transfusion has not been necessary since there is no bleeding during or after surgery. (14) The new surgical principles are employed for treatment of localized abnormalities on several regions of the human body such as aesthetic surgery of axial, rhytidolipoplasty, ear reconstruction, lower reverse blepharoplasty, aesthetic surgery of the buttocks, medial thigh lipoplasty, torsoplasty, and flankplasty.
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Medial Thigh Lipoplasty: New Concepts (A Technique Without Skin and Panniculus Undermining)
New Concepts on Abdominoplasty and Further Applications, 2016Co-Authors: Juarez M. AvelarAbstract:Introduction My new concepts for abdominoplasty are also employed for treatment of unaesthetic deformities of localized adiposities with excess Panniculus on medial thigh. In fact, the surgical principles of the procedures on both regions are similar since the inner thigh presents the same abnormalities as may occur on the abdominal wall. Excess skin, cutaneous flaccidity, localized adiposities, and cutaneous fold on inner thigh are the most frequent abnormalities causing unaesthetic appearance. A combination of liposuction with Panniculus resection was a traumatic procedure since bleeding during and after operation used to be quite often, leaving ungraceful final scars.
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Anatomy of the Abdominal Panniculus
New Concepts on Abdominoplasty and Further Applications, 2016Co-Authors: Juarez M. AvelarAbstract:Since the time that I learned how to perform the liposuction technique, several questions have come to mind. The first one was the anatomy: where and how does the cannula work to remove the amount of fat tissue? At that moment I recognized that it was mandatory to study the subcutaneous layers and that there was little knowledge about this compartment. The anatomical study described in this chapter is limited to the Panniculus of the abdominal wall, because the new concepts of abdominolipoplasty require adequate knowledge of the sophisticated structures between the skin and the musculoaponeurotic wall. A description of the vascularization is given in detail, as this is the main reason that motivated me to search for new concepts in abdominolipoplasty, which is the combination of a liposuction procedure with traditional abdominoplasty. The vascular networks coming from the rectus abdominis are perforator vessels which communicate with each other, creating communicating vessels that are similar to multiple arches. When severe complications occurred due to combined procedures, I concluded that these were caused by direct trauma due to Panniculus undermining that occurred because the vascularization was cut during liposuction and abdominoplasty. Therefore, the anatomical descriptions are concerned with fat tissue and the vascular network, as well as with the lymphatics and nerves.
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New Concepts in Abdominoplasty: Origin and Evolution
New Concepts on Abdominoplasty and Further Applications, 2016Co-Authors: Juarez M. AvelarAbstract:Ever since I started performing abdominoplasties with a liposuction technique, it has been evident that, quite often, cutaneous excess had to be resected as an associated procedure. Thus, the roots of the origin of new concepts in abdominoplasty arose a long time ago. Nevertheless, high rates of local disorders after combined operations (seroma formation, hematoma, sloughing of the skin, Panniculus necrosis), as well as systemic complications, used to occur with all plastic surgeons. I became so disappointed with all these complications that, in 1988, I made the radical decision of not performing such combined operations anymore. However, during 10 years of anatomical studies, and by analyzing peri- and postoperative complications, I concluded that most of these problems were caused by Panniculus undermining when perforator vessels coming from the rectus abdominalis were sectioned, causing interruption of the arterial blood supply and venous and lymphatic stasis.
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Abdominoplasty combined with lipoplasty without Panniculus undermining: abdominolipoplasty--a safe technique.
Clinics in plastic surgery, 2006Co-Authors: Juarez M. AvelarAbstract:This article discusses the author's technique of abdominoplasty that combines the excision of excess skin with lipoplasty without Panniculus undermining and resection.
George A. Vogler - One of the best experts on this subject based on the ideXlab platform.
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Implantation and expansion of split-thickness skin grafts: a new source of prefabricated pedicle flaps and grafts.
Plastic and reconstructive surgery, 1994Co-Authors: Sameer I. Shehadi, Peggy Donovan, Carmen K. Steigman, Carole Vogler, George A. VoglerAbstract:The objective of this study was to determine whether a split-thickness skin graft can be implanted deep to the skin and whether it can be expanded. We also wanted to find out whether this implanted and expanded split-thickness skin graft can be used as a new source of skin grafts and as a pedicle flap. A tissue expander mounted on a Dacron sheet backing was specially designed for this experiment. Six female Hanford minipigs weighing 20 to 25 kg were operated on in three stages. In stage one, a split-thickness skin graft 0.03 in thick was harvested from the back, placed dermal side out over the expander, and sutured to the Dacron backing. The expander with the overlying split-thickness skin graft was then implanted deep to the Panniculus carnosus muscle. Daily expansion was started 2 weeks after implantation to obtain a total volume of 1300 to 2500 cc. In the second stage, performed 4 to 6 weeks after implantation, the skin over the expander was elevated superficial to the Panniculus carnosus muscle as a ventrally based flap, and the Panniculus carnosus muscle was next elevated as a dorsally based flap lined on its deep surface with the implanted/expanded skin. Full-thickness skin grafts obtained from this implanted/expanded skin and from normal skin were transplanted to two 3 x 3 cm skin defects. The Panniculus carnosus muscle implanted/expanded skin flap was then turned 180 degrees and sutured to a dorsally created skin defect. In the third stage, 4 weeks later, we noted the quality, texture, and appearance and obtained punch biopsies from normal skin, normal skin graft, implanted/expanded skin graft, and Panniculus carnosus muscle implanted/expanded flap for histopathologic examination. All skin grafts "took" well, survived implantation, and were expanded successfully. The initial surface area of implanted split-thickness skin graft showed a net increase of 8 to 193 percent (mean percentage net increase 90 percent). This implanted/expanded skin also was retransplanted successfully to a skin defect. In all six minipigs, a skin-lined Panniculus carnosus muscle implanted/expanded skin flap was constructed and survived transfer to an adjacent skin defect. The smallest flap of Panniculus carnosus muscle implanted/expanded skin measured 10 x 12 cm and the largest 12 x 28 cm (mean surface area 228 cm2).
