Parálisis aislada del nervio axilar tras liposucción, una complicación excepcional / Isolated axillary nerve palsy after liposuction, an exceptional complication

La lesión aislada del nervio axilar asociada a la posición quirúrgica del paciente es una complicación muy poco frecuente, y en la mayoría de los casos está asociada al prono durante una cirugía de columna. La presentación de esta patología en relación con cirugías de otra índole es excepcional, existiendo solo unos pocos casos en la literatura científica.Presentamos el caso de una paciente que desarrolló clínica de parálisis aislada del nervio axilar izquierdo tras someterse a una lipoabdominoplastia y reducción mamaria, en la que se alternaron la posición en prono y en supino. La utilización de una solución de infiltración con lidocaína y adrenalina pudo contribuir a la aparición de la lesión en este caso único. Finalmente, el cuadro clínico se resolvió en su totalidad gracias al tratamiento conservador (AU)

Isolated injury to the axillary nerve associated with the patient́s surgical position is a very rare complication, and in most cases it is associated with the prone during spinal surgery. The presentation of this pathology in relation to surgeries of another nature is exceptional, with only a few cases in the scientific literature.We present the case of a patient who developed symptoms of isolated left axillary nerve palsy after undergoing lipoabdominoplasty and breast reduction, in which the prone and supine positions were alternated. The use of an infiltration solution with lidocaine and epinephrine could have contributed to the appearance of the lesion in this unique case. Finally, the clinical picture was fully resolved thanks to conservative treatment (AU)

[Lipoabdominoplasty in post-bariatric Surgery: a relevant Alternative to Fleur-de-Lis abdominoplasty?] / Lipoabdominoplastik in der postbariatrischen Chirurgie: eine relevante Alternative zur Fleur-de-Lis-Abdominoplastik?

BACKGROUND: The number of bariatric procedures, and thus also the number of post-bariatric operations, has increased dramatically in recent years. Although long scars are common in post-bariatric surgery and accepted in favour of body shape reconstruction, we increasingly notice the wish for aesthetically pleasing results in addition to the desire for body contouring. In particular, Fleur-de-Lis abdominoplasty (FdL) is viewed critically by younger patients after massive weight loss due to the visible vertical scar. Surgeons are also often bothered by the unsatisfying aesthetic outcome as well as the higher rate of complications. METHODS: Retrospective analysis of 20 female patients with massive weight loss following bariatric surgery, who received lipoabdominoplasty instead of Fleur-de-Lis abdominoplasty in the period from January 2019 to June 2020. Data analysis was based on measurements of preoperative vertical and horizontal excess skin and fat (Pittsburgh Rating Scale), Body Mass Index, surgical technique and final result. RESULTS: Twenty female patients with an indication for FdL abdominoplasty underwent radical liposuction of the abdomen combined with abdominoplasty. The original weight before massive weight reduction ranged between 100 and 168 kg. Average weight reduction was 56.5 kg. The mean BMI was 27.3 kg/m². The average age of our cohort was 40 years. One patient (5 %) had a major complication. This was an infected seroma which could be treated conservatively. Two other patients (10 %) developed an uninfected seroma as a minor complication. CONCLUSION: Our work shows that lipoabdominoplasty can be performed safely and well even in patients after massive weight loss. It is possible to achieve good body contours without vertical incisions and with a high degree of patient satisfaction. The number of patients who have to undergo FdL abdominoplasty can be successfully reduced by this technique.

TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

BACKGROUND: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience. METHODS: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics. RESULTS: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded. CONCLUSION: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Feasibility Study of Electromagnetic Muscle Stimulation and Cryolipolysis for Abdominal Contouring.

BACKGROUND: In addition to reducing subcutaneous fat for body contouring, some patients are interested in toning the underlying muscle layer. OBJECTIVE: This feasibility study evaluated the safety and efficacy of electromagnetic muscle stimulation (EMMS) alone, cryolipolysis alone, and cryolipolysis with EMMS for noninvasive contouring of abdomen. METHODS: Abdomens of 50 subjects were treated in a study with 3 cohorts: EMMS alone, Cryolipolysis alone, and Cryolipolysis + EMMS in combination. Electromagnetic muscle stimulation treatments were delivered in 4 sessions over 2 weeks. Cryolipolysis treatments were delivered in one session. Combination treatments consisted of one cryolipolysis and 4 EMMS visits. Efficacy was assessed by independent physician Global Aesthetic Improvement Scale (GAIS), circumferential measurement, Subject GAIS (SGAIS), and Body Satisfaction Questionnaire (BSQ). RESULTS: Safety was demonstrated for all study cohorts with no device- or procedure-related adverse events. Independent photo review showed greatest mean GAIS score for the Cryolipolysis + EMMS cohort followed by Cryolipolysis only, then EMMS only cohort. BSQ showed greatest average score increase for Cryolipolysis + EMMS cohort followed by Cryolipolysis only cohort, then EMMS only cohort. Mean circumferential reduction measurements were greatest for Cryolipolysis + EMMS cohort followed by Cryolipolysis only, and then EMMS only cohort. The mean SGAIS improvement score was equal for the Cryolipolysis only and Cryolipolysis + EMMS cohorts, followed by the EMMS only cohort. CONCLUSION: A multimodal approach using cryolipolysis and EMMS was safe and demonstrated enhanced body contouring efficacy for this feasibility study.

Comparison of Different Surgical Procedures with Local Infiltration Analgesia in Day Surgery.

Purpose of this study was assessing of local infiltration analgesia (LIA) with levobupivacaine on the trend of acute postoperative pain and outcome in individuals who underwent rhinoplasty procedure and abdominoplasty performed in general anaesthesia. The research was conducted on 60 patients, of which 30 patients underwent rhinoplasty procedure and the other 30 patients underwent abdominoplasty procedure in general anaesthesia with LIA in "Bagatin" Polyclinic in the time period between 01.01.2014. and 01.01.2017. Postoperative analgesics doses on the same day of surgery were noted in 85% of participants who underwent an abdominoplasty procedure and in 45% of participants underwent rhinoplasty procedure. Patients who underwent abdominoplasty were discharged from the facility within 48 hours, while all patients who underwent rhinoplasty procedure were discharged on the same day of the surgery. During the first postoperative day patients who underwent a rhinoplasty procedure did not require analgesics, while only 3% of patients who underwent an abdominal liposuction procedure required an additional dose of analgesics. The research results had shown, when LIA was performed, the manifestation of acute postoperative pain and vomiting did not lead to prolonged stay in day surgery.

Hip Asymmetry: Implications in Body Contouring Surgery.

BACKGROUND: Asymmetry of the hips and its implication in body contouring procedures has not yet been reported. Hip asymmetry is common in the general population and may account for uneven abdominoplasty scar and the apparent discrepancies in volume following liposuction of the hips and flanks. The goal of this study was to determine the presence of hip asymmetry in women presenting for abdominal contouring surgery. METHODS: Analysis of preoperative photographs of 100 female patients was performed by three independent plastic surgeons. They were asked to evaluate for hip asymmetry and, when present, determine which side was higher. Adobe Photoshop was also used to objectively measure hip asymmetry. Patients were women with no known history of hip abnormalities; age ranged from 17 to 64 years and the body mass index ranged from 16 to 47 kg/m(2). RESULTS: All three plastic surgeon reviewers found that the majority of patients had hip asymmetry, with raters 1, 2, and 3 documenting discrepancies in hip height in 88, 60, and 76 percent of patients, respectively. The interrater reliability was 0.713. Chi-square statistical analysis suggested that the raters were not statistically different from one another (p = 0.086). The objective analysis found asymmetry in 82 percent of patients. CONCLUSIONS: The results showed that the majority of patients who present for abdominal contouring surgery have asymmetric hips. Patients are usually unaware of the unevenness of their own hips; however, they often notice postoperative discrepancies in scar height after abdominoplasty or volume differences after liposuction.

Getting the Best Results in Abdominoplasty: Current Advanced Concepts.

LEARNING OBJECTIVES: After studying this article and viewing the videos, the participant should be able to: 1. Describe the safe techniques recommended for patients undergoing a lipoabdominoplasty. 2. Demonstrate safe planning techniques for marking a patient for a lipoabdominoplasty. 3. Summarize the various techniques for performing rectus plication. 4. State the current understanding of chemoprophylaxis for outpatient surgical patients. 5. Determine the appropriate placement and shape of the ideal umbilicus. SUMMARY: Abdominoplasty and lipoabdominoplasty surgery is one of the core procedures performed by plastic surgeons in the United States. As with most plastic surgery, it is part art and part science. In this article, the authors try to summarize the science behind this procedure, and point to the generally accepted artistic aspects that are currently still under debate. As this procedure has one of the highest morbidity and mortality rates in the specialty, the authors have also reviewed safe practices.

Sub-Scarpa's Lipectomy in Abdominoplasty: An Analysis of Risks and Rewards in 723 Consecutive Patients.

BACKGROUND: During the course of performing abdominoplasties, a plastic surgeon will encounter a certain body habitus characterized by a thick, tethered, and excessively redundant upper skin flap. Often these patients also demonstrate diffuse and substantial fascial laxity. One approach to this problem involves direct thinning and release of the flap by resection of the sub-Scarpa's fat pad. In theory, this resection should be safe from a flap perfusion standpoint. However, the safety of the sub-Scarpa's resection has not been completely documented. OBJECTIVES: The author sought to assess the safety and efficacy of sub-Scarpa's lipectomy in abdominoplasty. METHODS: A total 723 patients were retrospectively examined and divided into 2 groups: those with (Group B) and those without (Group A) a sub-Scarpa's lipectomy component to the abdominoplasty. Because of differences in the baseline characteristics between the 2 groups, data analysis was performed with a logistic regression model and with propensity score matching. RESULTS: The sub-Scarpa's lipectomy technique allowed for substantial thinning of the flap: the average weight of the resected fat pad was 411 g. Wide undermining allowed for substantial fascial correction, and excellent results were obtainable even in challenging cases. The sub-Scarpa's lipectomy group did not demonstrate an increase in either minor (<5 cm2) or major (>5 cm2) flap necrosis. However, there was a statistically significant increase in fat necrosis and seroma formation in Group B compared with Group A. In both groups, an increasing body mass index was a risk factor for fat necrosis and major flap necrosis. CONCLUSIONS: The implementation of a sub-Scarpa's lipectomy during abdominoplasty is a useful technique to consider for selected abdominoplasty candidates. The risks of minor and major flap loss do not seem to be increased compared to the standard abdominoplasty, but the risks of fat necrosis and seroma formation may be greater.

Safety of Lipoabdominoplasty Versus Abdominoplasty: A Systematic Review and Meta-analysis.

BACKGROUND: Lipoabdominoplasty is a powerful operation to maintain a youthful physique for aging people, improve body contouring, and remove excess skin caused by massive weight loss. Nonetheless, it is controversial to combine abdominoplasty and liposuction because of the potential for vascular damage of the abdominal flap and increased complications. The purpose of this article was to determine the complication rates of lipoabdominoplasty compared with traditional abdominoplasty. METHODS: PubMed, EMBASE, and Cochrane databases were searched through July of 2018. Study results were analyzed utilizing a fixed random effects model. The outcomes were expressed as relative risk (RR) and 95% confidence interval. Subgroup analyses were conducted based on complications. RESULTS: Overall, 17 trials enrolling 14,061 adult patients were searched. Of these patients, 577 (4.1%) developed seroma; 113 (0.8%) experienced hematoma; 783 (5.6%) experienced wound infection, dehiscence, or fat necrosis; 35 (0.2%) developed deep venous thrombosis; and 110 (0.7%) experienced scar deformity. A forest plot revealed fewer complications in the lipoabdominoplasty group than in the traditional abdominoplasty group (RR = 0.85; 95% CI 0.74-0.97; p = 0.017). Subgroup analysis showed that the lipoabdominoplasty group had a lower incidence of hematoma (RR = 0.56; 95% CI 0.36-0.86; p = 0.009) and seroma (RR = 0.69; 95% CI 0.57-0.85; p = 0.000). CONCLUSIONS: Lipoabdominoplasty is a valuable tool to perfect body shape. This meta-analysis showed no evidence that it was associated with higher rates of complications. LEVEL OF EVIDENCE III: 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 .

Seroma Rates Are Not Increased When Combining Liposuction With Progressive Tension Suture Abdominoplasty: A Retrospective Cohort Study of 619 Patients.

BACKGROUND: Several studies have demonstrated that progressive tension sutures (PTS) reduce seroma. Many fear that adding liposuction to abdominoplasty will increase seroma rates and avoid drainless abdominoplasty when performing concomitant liposuction. OBJECTIVES: We sought to identify whether liposuction increases seroma in PTS and non-PTS abdominoplasty. METHODS: In this retrospective study, 619 patients underwent abdominoplasty between 2009 and 2017, of which 299 patients had drainless abdominoplasty with PTS and 320 had drain-based abdominoplasty. We compared complications among PTS patients with and without liposuction and among drain-based abdominoplasty patients with and without liposuction. RESULTS: Demographics were similar between PTS and drain patients and between liposuction and nonliposuction PTS. Mean liposuction volume with PTS was 1592 ± 1048 mL. Seroma in the PTS group was found to be 2.6%, which is consistent with previous data. PTS without liposuction had a rate of seroma of 6.67% compared to a rate of 2.2% with liposuction; these rates were not significantly different (P = 0.20). A total of 207 patients had drain-based abdominoplasty with liposuction, and 113 had it without liposuction. Seroma with liposuction was 9.17% and without liposuction was 6.19%, although these differences were not significant (P = 0.52). PTS lipoabdominoplasty had less seroma compared with drain-based lipoabdominoplasty (P = 0.01). CONCLUSIONS: Liposuction was performed in 80% of the patients, and patients with lipoabdominoplasty were not at a higher risk of seroma, in the drain group or the PTS group. More patients may allow validation that liposuction may actually be protective with PTS. Regardless, there is no increase in seroma with the addition of liposuction to PTS drainless abdominoplasty.

Lipoabdominoplastia. Sistematização para minimizar complicações / Lipoabdominoplasty. Systematization to minimize complications

Introdução: A abdominoplastia e a lipoaspiração estão entre as cirurgias plásticas estéticas mais realizadas em nosso país, inúmeros cirurgiões plásticos brasileiros contribuíram para o seu aperfeiçoamento, sempre visando um melhor resultado ao paciente. Devemos sempre estar atentos aos fenômenos tromboembólicos que podem ter um desfecho dramático. Métodos: Foram operadas 20 pacientes, com idade variando de 29 a 63 anos, idade média de 43 anos, todas do sexo feminino. As pacientes passaram por consulta pré-anestésica, onde foram classificadas segundo o risco cirúrgico utilizando tabela da ASA (American Society of Anesthesiologists), realizaram os exames de rotina, Ultrassonografia de parede abdominal, avaliação cardiológica e avaliação psicológica. Resultados: Em nossa casuística de 20 pacientes, tivemos um caso de seroma persistente, um caso de "dog ear" e um caso de deiscência de cicatriz umbilical, as complicações encontradas não influenciaram o resultado final da cirurgia e 15 pacientes se disseram muito satisfeitos após 6 meses de operados. Conclusão: A lipoabdominoplastia demonstrou ser uma técnica segura e que traz bons resultados ao paciente, aspectos psicológicos devem ser avaliados e uma rotina criteriosa desde o pré-operatório visa diminuir possíveis intercorrências.

Introduction: Abdominoplasty and liposuction are two of the most frequently performed plastic surgeries in Brazil. Many Brazilian plastic surgeons have contributed to their improvement and constantly seek the best result for their patients. Surgeons also must always be attentive to thromboembolic events that may have a tragic outcome. Methods: Twenty (20) female patients, aged 29 to 63 years, with a mean age of 43 years, underwent surgery. The patients attended a pre-anesthetic visit, where they were classified according to surgical risk using the American Society of Anesthesiologists classification, underwent routine testing, abdominal wall ultrasonography, cardiovascular assessment, and psychological assessment. Results: Among the 20 cases, there was one case of persistent seroma, one case of "dog-ear," and one case of umbilical wound dehiscence. The complications that occurred did not influence the final surgical outcome and 15 patients were very satisfied 6 months post-surgery. Conclusion: Lipoabdominoplasty proved to be a safe technique with good results. Psychological factors must be assessed and a necessarily rigorous routine starting from the preoperative period allows a reduction in the risk of complications.