Abdominoplasty in the Obese Patient: Risk versus Reward.

BACKGROUND: The incidence of obesity is on the rise worldwide. Many surgeons elect not to perform abdominoplasty on patients with a high body mass index, fearing an increased risk of perioperative complications. In this study, the authors compare the outcomes of obese and nonobese patients who underwent abdominoplasty. METHODS: A retrospective chart analysis was performed on all patients who underwent abdominoplasty by a single surgeon from 2009 to 2016. Complication rates were compared in obese and nonobese patients. Patients were excluded if they did not undergo a full abdominoplasty, underwent a combined surgical procedure, or underwent liposuction in an area outside of the abdomen or flanks at the time of the abdominoplasty. RESULTS: A total of 83 patients were included: 62 nonobese and 21 obese patients. The obese group had a higher average body mass index (34. 9 kg/m versus 25.1 kg/m; p < 0.001). Follow-up time was similar (310 days versus 265 days; p = 0.468). No significant differences were seen with regard to perioperative seroma formation (14.2 percent versus 22.5 percent; p = 0.419)), wound dehiscence (9.5 percent versus 11.29 percent; p = 0.822), hematoma formation (4.7 percent versus 1.6 percent; p = 0.438), or surgical-site infection (9.5 percent versus 8.0 percent; p = 0.835). No instances of venous thromboembolism were observed. CONCLUSIONS: Abdominoplasty, with or without concurrent liposuction, in obese patients, is a safe and effective procedure with similar perioperative complication rates as the nonobese patient population. No significant differences were observed in perioperative complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Incidence of Cellulitis in Lower Extremity Burns: 6-Year Analysis.

INTRODUCTION: Patients with burn wounds of the lower extremities are at increased risk of developing cellulitis. The probability of developing burn-associated cellulitis is presumed to be correlated with a medical history of diabetes, the etiology of the burn, delay in hospitalization of the patient during their initial presentation, and depth of the burn itself. This study aims to identify factors that place patients at increased risk for developing lower extremity burn wound cellulitis. MATERIALS AND METHODS: A retrospective chart review was performed of all Nassau University Medical Center Burn Center admissions from January 2010 to January 2016. All patients admitted with burns of any etiology isolated to the lower extremity were included in this study. Patients who were evaluated and followed as an outpatient were not included in this study. Pediatric patients less than or equal to 12 years of age were excluded from this study. RESULTS: Of the 218 admissions for lower extremity burns during the 6-year study period, 34% of patients developed cellulitis. Risk factors for developing lower extremity burn wound cellulitis included being male, greater depth of burn, and burn-to-admission delay. This was true in both univariate and multivariate analysis. total body surface area was a risk factor on univariate analysis but was not found to be an independent risk factor on multivariate analysis. No difference was observed in the development of cellulitis in patients discharged on oral antibiotics compared with those not given antibiotics. CONCLUSIONS: Burn wound cellulitis is the second most common complication observed in burns. Identification of patients at risk for developing cellulitis is important. Admitting these patients at increased risk and excising and grafting the burned area is a reasonable solution in preventing this costly complication.

Treatment of the Open Glenohumeral Joint with the Anterior Deltoid Muscle Flap.

Upper extremity reconstruction is most often encountered in trauma patients. Although the rate of complications from elective orthopedic procedures remains relatively low, these complications are oftentimes in the form of open joints or joint infections that can be devastating. Classically, wounds of the shoulder girdle have been treated with large muscles such as the pectoralis major, pectoralis minor, and latissimus dorsi. Flaps more local to the area including the deltoid muscle flap have been overlooked due to their small size. Despite its size, the anterior deltoid can be used for shoulder girdle reconstruction with minimal functional deficit and allows for reconstruction of the glenohumeral joint without sacrifice of the larger muscles of the upper trunk. This study reports a case of a chronic shoulder girdle wound and successful management with the use of an anterior deltoid muscle flap.

Protein complexes at the microtubule organizing center regulate bipolar spindle assembly.

Bipolar spindle assembly is essential to genomic stability in dividing cells. Centrosomes or spindle pole bodies duplicated earlier at G(1)/S remain adjacent until triggered at mitotic onset to become bipolar. Pole reorientation is stabilized by microtubule interdigitation but mechanistic details for bipolarity remain incomplete. To investigate the contribution of spindle pole microtubule organizing center (MTOC) proteins in bipolarity, we applied genetic, structural and molecular biochemical analysis along with timelapse microscopy. Spindle formation was followed by an in vivo growth assay with the conditional allele cut7-22(ts), encoding fission yeast mitotic Kinesin-5, essential for bipolarity. By analysis of double and triple mutant strains of MTOC alleles and cut7-22(ts) we found that stabilized microtubules or increased bundling can rescue cut7-22(ts) associated bipolarity defects. These changes to microtubule dynamics and organization occurred through two surface domains on gamma-tubulin, a helix 11 domain and an adjacent site for binding MTOC protein Alp4. We demonstrate that Kinesin-14 Pkl1, known to oppose bipolarity, can bind to gamma-tubulin at helix 11 and that mutation of either of two conserved residues in helix 11 can impair Kinesin-14 binding. Altering the Alp4/gamma-tubulin interaction, conserved residues in helix 11 or deletion of pkl1 each are sufficient to rescue bipolarity in our cut7-22(ts) strain. Our findings provide novel insights into regulation of the bipolar mechanism through the MTOC complex.