High-Volume Liposuction in Lipedema Patients: Effects on Serum Vitamin D.

Background: Lipedema is a subcutaneous adipose tissue disorder characterized by increased pathological adipocytes mainly in the extremities. Vitamin D is stored in adipocytes, and serum levels inversely correlate with BMI. As adipocytes are removed during liposuction, lipedema patients might be prone to further substantial vitamin D loss while their levels are already decreased. Therefore, we examined the effect of liposuction on perioperative serum 25-hydroxyvitamin D levels. Methods: In patients undergoing lipedema liposuction, blood samples were obtained pre- and postoperatively. Statistical analyses were performed to correlate the volume of lipoaspirate, patients' BMI and number of sessions to vitamin D levels. Results: Overall, 213 patients were analyzed. Mean liposuction volume was 6615.33 ± 3884.25 mL, mean BMI was 32.18 ± 7.26 kg/m2. mean preoperative vitamin D levels were 30.1 ± 14.45 ng/mL (borderline deficient according to the endocrine society) and mean postoperative vitamin D levels were 21.91 ± 9.18 ng/mL (deficient). A significant decrease in serum vitamin D was seen in our patients (p < 0.001) of mean 7.83 ng/mL. The amount of vitamin D loss was not associated with BMI or aspiration volume in our patients (p > 0.05). Interestingly, vitamin D dynamics showed a steady drop regardless of volume aspirated or preoperative levels. Conclusions: Many lipedema patients have low vitamin D levels preoperatively. Liposuction significantly reduced these levels additionally, regardless of aspirated volume or BMI. However, vitamin D loss was constant and predictable; thus, patients at risk are easily identified. Overall, lipedema patients undergoing liposuction are prone to vitamin D deficiency, and the long-term effects in this population are currently unknown.

Gram-Positive Bacteria Increase Breast Implant-Related Complications: Prospective Analysis of 100 Revised Implants.

BACKGROUND: Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. The authors prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases. METHODS: The authors analyzed a total of 100 breast implant revisions in 66 patients between August of 2018 and January of 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses on the occurrence of bacteria and the occurrence of implant-related complications were performed. In addition, correlations between bacteria-contaminated breast implant surfaces and implant-related complications were performed. RESULTS: Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites: eight unilateral and 34 bilateral cases. In total, 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (χ 2 = x, y, and z; P = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant. CONCLUSIONS: The authors identified a correlation between implant complications and Gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of the authors' cases. No capsular contraction or other complications were seen. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Evaluation of the External Jugular Vein Overlying the Sternocleidomastoid Muscle as Venous Lymph-Node Flap.

BACKGROUND: Until recently, vascularized lymph-node flaps were based on arterial and venous donor vessels. Now, venous lymph-node flaps form a novel promising concept in the treatment of advanced-stage lymphedema. In preliminary studies, the external jugular vein has shown promising results as a venous lymph-node flap. However, nothing is known about the number of lymph nodes adjacent to the external jugular vein. METHODS: Standardized specimens of the external jugular vein and surrounding fatty tissue directly overlying the sternocleidomastoid muscle were obtained during routine neck dissection. Histologic evaluation was performed in order to evaluate for the presence of lymph nodes within the tissue. RESULTS: A total of 20 specimens were evaluated. There was no vein in 4 of the samples. We found lymph nodes in 9 of the remaining 16 samples. In 7 samples, lymph nodes were absent. CONCLUSION: Our results suggest that the vein directly overlying the sternocleidomastoid muscle may not be the ideal candidate for a venous lymph-node flap.

Median Nerve Traction Caused by Palmaris Profundus Muscle: A Case Report.

The palmaris longus muscle is one of the most variant muscles in the human body. Its variations such as the palmaris profundus can cause nerve compression symptoms. Here, we present a case of severe nerve affection due to a palmaris profundus muscle. The palmaris profundus tendon was partially resected at intervention. Pain symptoms started immediately after wearing off of the local anesthetic, and revision surgery had to be performed. Severe traction on the median nerve by the palmaris profundus tendon could be observed at revision. The resection of the palmaris profundus tendon instantly eased the patient's severe pain. At preoperative examination and planning of surgery, the palmaris profundus was not detected. As there is no test for the detection of anatomic variations of the palmaris longus muscle at physical examination, discovering such anomalies is not possible without imaging tools. Ultrasonographic examinations aid in preoperative planning of carpal tunnel release, especially at revision surgeries.

Perioperative Risk Factors for Prolonged Blood Loss and Drainage Fluid Secretion after Breast Reconstruction.

BACKGROUND: Surgical breast reconstruction is an integral part of cancer treatment but must not compromise oncological safety. Patient-dependent risk factors (smoking, BMI, etc.) are said to influence perioperative outcomes and have often been investigated. Here, we analyzed independent perioperative risk factors for increased postoperative blood loss or drainage fluid volume loss and their possible impact. METHODS: Patients undergoing breast reconstructions after breast cancer with either tissue expanders, definitive breast implants, or autologous breast reconstruction were analyzed. The collected data on patients' characteristics, blood, and drainage fluid loss were correlated and statistically investigated. RESULTS: Traditional patient-dependent risk factors did not influence blood loss or drainage volumes. On the contrary, patients with preoperative anemia had significantly higher drainage outputs compared to non-anemic patients (U = 2448.5; p = 0.0012). The administration of low molecular weight heparin showed a tendency of increased drainage output. Similar correlations could be seen in prolonged procedure time, all of which contributed to prolonged hospital stay (τb = 0.371; p < 0.00001). CONCLUSIONS: Preoperative anemia is one of the most critical factors influencing postoperative drainage fluid output. Previously assumed patient-dependent risk factors did not affect drainage output. Preoperative anemia must be monitored, and if possible, treated preoperatively to reduce postoperative morbidity.

International Multi-Center Analysis of In-hospital Morbidity and Mortality of Low-Voltage Electrical Injuries.

Background : Patients with high- and low-voltage electrical injuries differ in their clinical presentation from minor symptoms to life-threatening conditions. For an adequate diagnosis and treatment strategy a multidisciplinary team is often needed, due to the heterogeneity of the clinical presentation. To minimize costs and medical resources, especially for patients with mild symptoms presenting after low-voltage electrical injuries, risk stratification for the development of further complications is needed. Methods : During 2012-2019 two independent patient cohorts admitted with electrical injuries in two maximum care university hospitals in Germany and Austria were investigated to quantify risk factors for prolonged treatment, the need of surgery and death in low-voltage injuries. High-voltage injuries were used as reference in the analysis of the low-voltage electrical injury. Results : We analyzed 239 admitted patients with low-voltage (75%; 276 ± 118 V), high-voltage (17%; 12.385 ± 28.896 V) or unclear voltage (8%). Overall mortality was 2% (N = 5) associated only with high-voltage injuries. Patients with low-voltage injuries presented with electrocution entry marks (63%), various neurological symptoms (31%), burn injuries (at least second degree) (23%), pain (27%), and cardiac symptoms (9%) including self-limiting thoracic pain and dysrhythmia without any therapeutic need. Seventy three percentage of patients with low-voltage injury were discharged within 24 h. The remaining patients stayed in the hospital (11 ± 10 days) for treatment of entry marks and burns, with an overall need for surgery of 12% in all low-voltage injuries. Conclusions : The only identified risk factors for prolonged hospital stay in patients with low-voltage electrical injuries were the treatment of burns and electric marks. In this multi-center analysis of hospitalized patients, low-voltage electrical injuries were not associated with cardiac arrhythmia or mortality. Therefore, we suggest that asymptomatic patients, without preexisting conditions, with low-voltage injury can be discharged after an initial check-up without prolonged monitoring.

Using superficial fascial system suspension for the management of the mons pubis after massive weight loss.

Although an abundance of literature exists regarding frequently lifted body areas, there are few reports about body contouring of the mons pubis. Therefore, this paper describes the first clinical results from a new technique, which surgically lifts the mons pubis using superficial fascial system suspension. Fifty patients underwent a lower body lift, including a superficial fascial system suspension of the mons pubis. After a mean follow-up period of 16.9 months (range, 6-31 months), patients were evaluated by standardized preoperative and postoperative photographs using the Pittsburgh Rating Scale. In addition, all patients completed a Likert-type scale questionnaire pertaining to body satisfaction and other bodily changes. Scores from the Pittsburgh Rating Scale improved significantly (P=0.03) from 2.76 (0.43) [range, 1-3] preoperative to 0.5 (0.59) [range, 0-2] postoperative. Fifteen (30%) of the patients assessed the new contour as very good, 26 (52%) patients as good. Eight patients developed a temporary edema in the mons pubis and 1 patient developed an infected fascia suture granuloma, which had to be removed. A mons pubis lift with the aid of the superficial fascial system is a safe surgical technique, which can easily be integrated in body contouring surgeries of the torso.

Human but not mouse adipogenesis is critically dependent on LMO3.

Increased visceral fat is associated with a high risk of diabetes and metabolic syndrome and is in part caused by excessive glucocorticoids (GCs). However, the molecular mechanisms remain undefined. We now identify the GC-dependent gene LIM domain only 3 (LMO3) as being selectively upregulated in a depot-specific manner in human obese visceral adipose tissue, localizing primarily in the adipocyte fraction. Visceral LMO3 levels were tightly correlated with expression of 11ß-hydroxysteroid dehydrogenase type-1 (HSD11B1), the enzyme responsible for local activation of GCs. In early human adipose stromal cell differentiation, GCs induced LMO3 via the GC receptor and a positive feedback mechanism involving 11ßHSD1. No such induction was observed in murine adipogenesis. LMO3 overexpression promoted, while silencing of LMO3 suppressed, adipogenesis via regulation of the proadipogenic PPARγ axis. These results establish LMO3 as a regulator of human adipogenesis and could contribute a mechanism resulting in visceral-fat accumulation in obesity due to excess glucocorticoids.

Prospective evaluation of a single-sided innervated gluteal artery perforator flap for reconstruction for extensive and recurrent pilonidal sinus disease: functional, aesthetic, and patient-reported long-term outcomes.

BACKGROUND: Treating large and extensive pilonidal sinus disease is a challenging task. Long-term reports on flaps suitable for coverage of large, wide, local-excision defects are sparse. We prospectively evaluated data with a minimum 1-year follow-up of the use of a single-sided, innervated, superior gluteal artery perforator flap. METHODS: Twenty-one patients (1 woman, 20 men) with a median age of 26 years (min - max = 18 - 46) were included in the study period from September 2005 to April 2010. We recorded flap size, major and minor complications, hospital length of stay, impairment in activities of daily living, pain, aesthetic outcomes, and sensibility in the gluteal region (PSSD, pressure-specified sensory device) at 6 and 12 months postoperatively. RESULTS: The mean defect size (±SD) was 13.0 ± 1.9 × 8.6 ± 1.3 × 5.5 ± 1.2 cm (height × width × depth), and median length of hospital stay was 9 days (range = 7-11). Only two patients developed minor wound-healing complications. Visual analog pain scales significantly improved, with no pain detectable at 12 months postoperatively (p < 0.0001). The aesthetic appearance of the results was good in the majority of patients (61.9-85.7 %). PSSD showed gradual normalization, with retained sensibility in the flap area over 12 months postoperatively (p = 0.0232). During the median 36-month (range = 20-60) follow-up, we have not observed any recurrence in the operated area. CONCLUSIONS: The innervated superior gluteal artery perforator flap is a useful technique for covering large and recurrent pilonidal sinus defects following wide local excision and represents an excellent tool in the surgical armamentarium for achieving long-lasting outcomes in this young group of patients.