Coupled Plasma Filtration Adsorption in Patients with a History of Kidney Transplantation: Report of Two Cases.

Coupled plasma filtration adsorption (CPFA) is an extracorporeal treatment based on plasma filtration associated with an adsorbent cartridge and hemofiltration. CPFA is able to remove inflammatory mediators and it has been used to treat severe sepsis, septic shock and multiple organ dysfunction syndrome. Limited experience exists on the use of CPFA after solid organ transplantation. We report our experience with CPFA in 2 kidney transplant recipients with post-nephrolithotomy septic shock and severe unexplained rhabdomyolysis. In both the cases, excellent results were observed. In selected cases, CPFA can be safely and effectively used in patients with a solid organ transplant. However, additional studies are needed in this particular setting, to further investigate the potential role of CPFA for the treatment of other conditions associated with excessive inflammation, such as in rheumatologic disorders and delayed graft function.

Medial Thigh Contouring After Massive Weight Loss: The Liposuction-Assisted Medial Thigh Lift (LAMeT).

INTRODUCTION: Following massive weight loss (MWL), medial contouring of the thigh is frequently requested to improve the appearance and function. Thigh lifting can be associated with significant complications if the medial thigh excess is removed en bloc. In this article, we describe the Liposuction-Assisted Medial Thigh Lift (LAMeT) and evaluate the outcomes and complications in a retrospective cohort study. MATERIALS AND METHODS: A total of 54 females aged between 25 and 61 years with Grade 2 or 3 of thigh deformity on Pittsburgh Rating Scale (PRS) underwent medial thigh reduction. Vertical thigh lift with fascia suspension was performed in 25 patients with third degree of ptosis on PRS, horizontal thigh lift with fascia suspension was performed in 3 patients with second degree on PRS, LAMeT was performed in 26 patients with second and third degree on PRS. RESULTS: Complications were observed in 35.7% of the patients that underwent the standard technique and in 3.8% patients that underwent the LAMeT. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT group. CONCLUSIONS: Medial thigh 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 because the resection of the excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus, the incidence of postoperative complications is lower and the patients heal faster.

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.

Mastoplasty after Massive Weight Loss: Redefinition and Stabilization of the Breast Mound with Submuscular Autoprosthesis.

CONTEXT: After massive weight loss, breast changes dramatically becoming ptotic, flat in the upper pole, with significant skin excess. After mastoplasty, often ptosis can recur and the upper pole can lose its fullness again. The technique described in this study treats breast deformities ensuring stable results and avoiding ptosis recurrence. AIM: To analyze a new modality of breast reshaping after massive weight loss, evaluating outcomes and complications as well as patient satisfaction. SETTINGS AND DESIGN: This was a case series. MATERIALS AND METHODS: Fifteen patients (all women, average age, 43.1 years) with bilateral breast ptosis after massive weight loss underwent mastoplasty: the technique included the creation of an inferior pedicle flap that was placed as a prosthesis under the pectoralis muscle and a superomedial pedicle flap containing the nipple-areola complex (NAC). Patients were followed up for at least 6 months, reporting any complications, and measuring the jugulum-NAC distance. Patients' satisfaction was also reported. STATISTICAL ANALYSIS USED: Nil. RESULTS: All patients were extremely satisfied with the breast volume, shape, symmetry, and ptosis correction. The new mammary contour and the distance between the jugular fossa and the nipple were stable during the follow-up and the upper pole maintained its fullness. No major complications were reported. CONCLUSION: Mastoplasty with submuscular autoprosthesis proved to be a safe and effective technique to treat breast deformities after massive weight loss because removed redundant tissue repositioned the NAC and filled the upper pole with stable results over time. A similar technique has not been described yet.

Arm Contouring After Massive Weight Loss: Liposuction-Assisted Brachioplasty Versus Standard Technique.

Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.

Gentle Is Better: The Original "Gentle Technique" for Fat Placement in Breast Lipofilling.

CONTEXT: Breast lipofilling usually involves three different stages (harvesting, processing, and placement), and in each of these phases, adipocyte cells can be damaged. Our technique of fat placement is quite different from the others as we focus our attention on the last stage of fat graft procedure, which could explain the better results in graft survival. AIMS: Our method is focused on eliminating any unnecessary manipulation of the graft so as to optimize graft retention and clinical outcomes: Controlled movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes. SETTINGS AND DESIGN: This was a retrospective cohort study. MATERIALS AND METHODS: Of 120 patients (average age 41,5 years) affected by breast soft tissue defects, 60 were managed with the lipofilling procedure using fat graft injected by "Gentle technique." To establish the effects of the injection's procedure, we compared the results obtained in fat graft maintenance with a control group made up of 60 patients, treated with fat graft injection according to Coleman procedure. STATISTICAL ANALYSIS USED: Values are expressed as mean plus standard error and analyzed using Student's t test. RESULTS: In patients treated with Gentle technique, we observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year (P < 0.0001 vs. control group); we compared the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to Coleman. CONCLUSIONS: Controlled 26 movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater 27 survival rate of adipocytes.