Similarity of Seroma Rate at the Medial Thigh following Free Flap Harvesting or Medial Thigh Lift: A Systematic Review and Meta-analysis.

Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.

An Original Approach to Massive Weight Loss Deformities in the Lower Thigh: A Retrospective Assessment of Results and Patients' Satisfaction.

INTRODUCTION: Massive weight loss (MWL) patients present skin and soft-tissue laxity and ptosis involving inner thighs. Previous efforts were focused on the upper two thirds of the thigh, while literature has never dealt specifically with lower thigh contouring. We present an original approach to the lower inner thigh, intended for patients who already had upper thigh lift, discussing outcomes, advantages, and limits of our technique. MATERIALS AND METHODS: Sixteen female MWL patients with persisting severe deformities in the lower inner thigh, following an upper thigh lift, received lower third medial thigh contouring, through concurrent liposuction and skin excision, between 2017 and 2019. The excision pattern consisted of an inferiorly-based vertical triangular component, centered on the inner midline, and a distal horizontal crescent, resulting in an inverted-T scar. Our series was retrospectively investigated, comparing preoperative and 12-month postoperative pictures and assessing the outcomes by means of a tailor-made 11-item survey. RESULTS: Three patients had minor complications (two cases of skin de-epithelization at the wound margin, one granuloma). Photographic assessment showed a 15.9% transverse diameter reduction (p<0.05). The questionnaire showed encouraging scores for all the investigated items. Mean overall satisfaction was 9.6/10. CONCLUSION: Despite the retrospective design and the limited sample size, in consideration of the applicability of this technique in selected cases, and the need for a two-step procedure, separate upper and lower thigh contouring, the results of our study showed a considerable improvement of the inner thighs by our personal combined liposuction and lower medial thigh lift approach. 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 .

Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective.

BACKGROUND: The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique. MATERIAL AND METHODS: Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated. RESULTS: Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups. CONCLUSION: LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications.

Vertical Medial Thigh Lift with the 'Anchor L Liposculpture' Technique in Massive Weight Loss Patients: Preliminary results.

BACKGROUND: Among all post bariatric surgical procedures, vertical thigh lift has the highest complication rates. Many modifications have been described to achieve better aesthetic results and decrease complication rates. The study aimed to present ''Anchor L Liposculpture Technique'' and discuss the results in the light of current literature. METHOD: Between 2016 and 2020, 33 patients were operated with the Anchor L Liposculpture technique. In this technique, liposuction is performed similarly with the other techniques, but the liposuction area is not extended to posterior or anterior compartments to prevent complications. The technique also used a deepithelized flap to anchor the superficial fascial system to the pubic arch periosteum. The patients' characteristics (age, sex, body mass index, smoking history, amount of weight loss, comorbidities) volume of liposuction and postoperative complications were recorded. Results were compared between uncomplicated (group A) and complicated patients (group B). RESULT: Six (n=6, %18.2) out of 33 patients experienced complications (Group B). There were no major complication. The most common complications are wound dehiscence (n = 2) and lymphocele (n = 2). All complication cases managed conservatively. Age and amount of liposuction were found to be statistically associated with increased complications. Other comparisons between group A and B did not show any significant difference. Scar migration was not observed in any patient during follow-up. CONCLUSION: Anchor L Liposculpture technique is an easy-to-apply and reliable technique aimed better surgical results and lower complication rates. Surgeons especially at beginning of the learning curve or who experienced high complication rates can utilize this technique. 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 .

Prolonged postoperative antibiotic administration reduces complications after medial thigh lift.

There is widespread consensus that there is no indication for postoperative antibiotic administration after elective surgery. However, medial thigh lift (MTL) remains a procedure with a notoriously high rate of wound-healing disorders and infections. This study investigates the correlation between prolonged antibiotic administration and complications after MTL in massive weight loss patients. We performed a single-institution retrospective review of 121 patients undergoing MTL between 2009 and 2020. Data on postoperative outcome, demography, surgery and comorbidities were collected. All patients received intravenous antibiotics preoperatively. One group was continued on oral antibiotics for two weeks postoperatively. Complications and surgical site infections were observed and evaluated. There was no difference between the groups regarding age, BMI, or presence of obesity-associated risk factors. We observed complications in 76 patients (71%), with 60 (56%) minor and 16 (15%) major complications. The group without prolonged antibiotic administration had a higher number of total complications (OR 3.5; p = 0.0037), major complications (OR 4; p = 0.01), and wound infections (OR 6.8; p = 0.0004). Logistical regression analysis showed that this effect was independent of type of weight loss, resection volume, and age. Reduction of major infections by prolonged antibiotics was, however, dependent on BMI Δ. No side-effects associated with antibiotics were registered in this series. This study suggests that prolonged antibiotic administration may decrease complications in MTL. We thus continue to use prolonged antibiotic administration after MTL. Further research is needed to determine the optimal duration of antibiotic treatment. Level of Evidence: Level IV: therapeutic study.

The Edmonton Obesity Staging System as a predictor for postoperative complications after medial thigh lift in massive weight loss patients.

BACKGROUND: This study investigates the correlation between the Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after medial thigh lift in formerly obese patients. PATIENTS AND METHODS: A single-institution retrospective review of patients undergoing medial thigh lift between 2009 and 2019 after massive weight loss. Data on demography, comorbidities, surgery, and postoperative outcome were extracted from patients' charts. Patients were grouped into EOSS categories. Complications were classified into minor and major. Logistic regression analysis was performed to determine the association between risk factors and complications. RESULTS: One hundred and eight patients were included in the study. Complications occurred in 76 (70%) of the patients, most of which were minor (60/108, 56%). Complications increased with increasing EOSS stage, and all EOSS 3 patients had complications. Classification as EOSS 2 or 3 significantly associated with occurrence of postoperative complications (OR 99.3, p<0.001) as well as minor and major complications individually (OR 3.1 and 6.5, p<0.05). This effect was independent of body mass index (BMI), maximum BMI loss, type of weight loss, volume of liposuction, weight of resected tissue, and type of surgery. CONCLUSION: EOSS is a robust and independent predictor for postoperative complications in medial thigh lift surgery after massive weight loss.

Medial Thigh Contouring in Massive Weight Loss: A Liposuction-Assisted Medial Thigh Lift.

BACKGROUND: Thigh's lifting can be associated with significant complications, if the medial thigh excess is removed en bloc. In this study, the liposuction-assisted medial thigh's lift (LAMeT) procedure, outcomes and complications were assessed. METHODS: Twenty four females between 25 and 61 years with grade 2 or 3 on Pittsburgh Rating Scale (PRS) treated with medial thigh's reduction were enrolled. Medial thigh's reduction was performed in three different procedures of vertical, horizontal and LAMeT. Vertical thigh's lift with fascia suspension was conducted in 13 patients with grade 3 of ptosis on PRS; horizontal thigh's lift with fascia suspension was undertaken in 3 patients with grade 2 on PRS; vertical and horizontal thigh's lift considered as control group was described as excision-only group; and LAMeT was performed in 8 patients with grade 2 and 3 on PRS. RESULTS: Complications were observed in 62.5% of patients who underwent vertical or horizontal thigh's lift with fascia suspension and in 16.7% who experienced the LAMeT without fascia suspension. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT. CONCLUSION: Medial thigh's lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc, as the resection of excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus postoperative complications incidence is lower and the patient heals faster.

Outcome, Complications, and Body Mass Index Correlation of Horizontal and Combined Horizontal and Vertical Thigh Lift: A 16-year Single-center Experience.

BACKGROUND: Thigh lift is a procedure used within the aesthetic as well as the post-bariatric field of surgery as it focuses on reducing excess lipodermal tissue within the medial thigh area. Depending on the specific area of excess tissue, common thigh lifting procedures include horizontal (H) and combined horizontal and vertical (HV) tissue reduction. AIMS AND OBJECTIVES: The aim of this study was the analysis of outcome of H and HV thigh lift procedures, including evaluation of comorbidities and complications. SUBJECTS AND METHODS: Over a 16-year period, all thigh lift procedures performed at our department were assessed for comorbidities and outcome through our hospital documentation system. RESULTS: A total of 151 thigh lifts have been performed over 16 years. Of which, 124 were performed using the HV technique and 27 thigh lifts were performed using H tissue excision only. Of all the patients, 9 of 10 were female, the overall average age was 43 years. Approximately 48% of the HV group of patients had previously undergone bariatric surgery, the mean body mass index (BMI) was 29.3 kg/m2 for this group. Around 19% of the H patient population had previously undergone bariatric surgery. This group had a mean BMI of 25.1kg/m2. Wound-associated problems occurred in 48%, for these patients, surgical revision was necessary for 12%. Remaining excess tissue was an issue for 20% of all patients, for this reason, 14% needed revision surgery. Age was found to be a significant cofactor for wound-associated complications (P = 0.02) and nicotine abuse for scar-related problems (P = 0.032). CONCLUSION: The rate of overall complication for thigh lifts is high, although surgical revision rate is low. Remaining excess tissue and wound-associated problems are most common, possibly reflecting a too restrictive and radical surgical approach, respectively. Increasing BMI increases the risk for development of complications.

Vertical Medial Thigh Contouring.

Excess thigh laxity is a problem for many patients following significant weight loss. Thigh laxity has both vertical and horizontal components that require correction to optimize the aesthetic appearance of the thigh. The vertical vector is best corrected first with a lower body lift or extended abdominoplasty. The remaining loose skin in the medial thigh can then be removed using a horizontal vector resulting in a vertical incision. Residual vertical skin excess is also removed parallel to the groin crease. This article describes the author's surgical approach and management of medial thigh deformity in the significant weight loss patient.

An Integrative Therapeutic Concept for Surgical Treatment of Severe Cases of Lymphedema of the Lower Extremity.

BACKGROUND: Lymphedema results from insufficient lymphatic drainage and typically affects the extremities. Recent studies revealed obesity as another cause of extremity lymphedema. Conservative treatment of patients with elephantiastic lymphedema of the lower extremity is limited and often inadequate. Resecting surgery plays an important role in these cases. Here, we investigated the effects of an integrated therapy concept on outcome and complication rates. METHODS: We retrospectively analyzed the clinical outcome of 26 patients with elephantiastic lymphedema of the lower limb who underwent a complex decongestive physical therapy (CDP) perioperatively and reduction surgery in our clinic between 1998 and 2011. We subsequently compared these patients (group A) with a control group of 30 patients (group B) who received medial thigh lift due to post-bariatric or aesthetic issues between 2011 and 2013. The incidence of complications, reoperations, blood transfusion, and duration of hospital stay was analyzed. All patients in group A received CDP perioperatively in a specialized lymphological clinic. RESULTS: Both groups are comparable in terms of age and sex. Patients significantly differ in terms of BMI (p < 0.001). Thirty-six reductive procedures were performed in group A and 30 in group B. We did not see any significant difference in the incidence of complications (p = 1.000) and the rate of postoperative blood transfusions (p = 0.116). CONCLUSIONS: We were able to show that an integrative concept including surgery is a good additional option for the treatment of severe cases of lymphedema in appropriate candidates. Furthermore, an adequate perioperative conservative setting helps to minimize possible complications.

Medial thighplasty: Current concepts and practices.

Medial thighplasty, also known as medial thigh lift, is a procedure that has been carried out for five decades. The original "Lewis" technique has undergone many changes, and thereby been rendered widely available to plastic surgeons. Given the increasingly high number of surgical reconstructions after massive weight loss, this technique is now an integral part of a surgeon's therapeutic arsenal as he strives to meet the evolving demands of patients. The objective of this article, which is based on a comprehensive review of the literature, is to summarize current knowledge on medial thighplasty and thereby allow plastic surgeons to adopt the operating technique best suited to the deformations presented by their patients and to the overall context. The different techniques, outcomes and complications are successively discussed.

Complications Associated With Medial Thigh Lift: A Comprehensive Literature Review.

Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using "medial thighplasty", "medial thigh lifting" and "technique" as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.

The vertical medial thigh lift.

This article discusses management of the post-weight loss thigh deformity. Beginning with an explanation of the soft tissue variables contributing to the thigh and medial thigh deformity in the postbariatric individual, the article describes the important elements of selecting and screening candidates for surgery and the ideal sequence of procedures that should be followed to optimize results in this patient population. A detailed step-by-step description of the author's technique for medial thigh lift is provided along with multiple examples of outcomes. Aftercare is reviewed along with potential complications and their management.

Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty.

BACKGROUND: Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome. METHODS: We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used. RESULTS: We report on three women aged 55-77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high. CONCLUSION: A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities.

Liposuction-assisted medial thigh lift in obese and non obese patients.

INTRODUCTION: The abdomen, thighs and buttocks are often the areas of greatest concern to patients following massive weight loss due to bariatric surgery. The typical appearance of the patient who has lost a massive amount of weight derives from a combination of factors, including gender-dependent body morphology and a change in body mass index, which lead to skin and soft-tissue excess and poor skin tone. Thigh laxity and redundancy represents a great challenge to both patients and surgeons. Not only because of the difficulty to satisfy the patients, but also due to the higher incidence of complications especially, with those obese patients who have not undergone bariatric surgery before. The problems with such patients are due to the heavy thighs that require both debulking and tight anchorage to prevent scar migration or labial distortion. AIM OF THE WORK: The aim of the present study is to improve the aesthetic outcome and avoid the complications of medial thigh lifting with simultaneous liposuction in obese and non-obese. PATIENTS AND METHODS: A total of 25 female patients presented during the period from January 2007 to July 2011 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 20 patients medial transverse thigh lift was performed, to treat medial thigh friction and laxity particularly in the upper half. Whereas, in the other five patients were suffering from upper and lower medial thigh bulkiness, vertical thigh lift was performed. RESULTS: All patients recovered well in 2 weeks and showed improvement of thigh contour. Scar downward displacement in one patient. No skin necrosis or seroma. No labial distortion or separation encountered. CONCLUSION: Simultaneous liposuction and thigh lift gave good results provided proper patients selection, appropriate technique to each patient, meticulous, cautious liposuction and handling of the tissues and most importantly is the deep tight anchorage sutures to guard against the effect of heavy skin flaps.

Body contouring following massive weight loss.

Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them.