Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Body Contouring Complication Reporting System.

BACKGROUND: Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. OBJECTIVES: We aim to provide a guideline for complication reporting in the body contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of body contouring procedures and will decrease under-, over-, and nonreporting of complications. METHODS: The authors reviewed the literature for the terms "body contouring," "MWL," and "complications." Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal contouring and extremity contouring. RESULTS: Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance. CONCLUSIONS: Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.

Transverse dual-perforator fascia-sparing free TRAM flap: technique description.

As techniques for breast reconstruction with autologous abdominal tissue have evolved, free transverse rectus abdominis myocutaneous flaps have persevered because of their superior reliability and minimal donor-site morbidity compared with muscle-sparing techniques. Further refinements are described in this article to maximize abdominal flap perfusion and ensure primary closure of the rectus fascia. It has been well documented that incorporating both the lateral and medial perforators provides maximal perfusion to all zones of the lower abdominal transverse skin flap. However, dissection and harvest of both sets of perforators requires disruption and/or sacrifice of abdominal wall tissues. The technique presented here was designed to use both the lateral and medial row perforators, and to minimize abdominal wall disruption. Deep inferior epigastric artery medial and lateral row perforators are selected for their diameter, proximity, and transverse orientation to each other. A transverse ellipse of fascia is incised to incorporate both perforators. The fascial incision is then extended inferiorly in a T configuration to allow for adequate exposure and harvest of the vascular pedicle and/or rectus abdominis, and primary closure. Limiting perforator selection to one row of inferior epigastric arteries diminishes perfusion to the abdominal flap. Furthermore, perforator and inferior epigastric artery dissection often results in fascial defects that are not amenable to primary closure. However, maximal abdominal flap perfusion and minimal donor-site morbidity can be achieved with the transverse dual-perforator fascia-sparing free transverse rectus abdominis myocutaneous flap technique and can be performed in most patients.

Induced pulsation of a continuous-flow total artificial heart in a mock circulatory system.

BACKGROUND: We studied the hemodynamic effects of inducing an artificial pulse in a continuous-flow total artificial heart consisting of 2 axial-flow pumps in a mock circulatory system. METHODS: We varied the amplitude (maximum minus minimum speed), beat rate and systolic duration of the left pump, right pump or both. Mean left and right pump speeds were maintained at 11 and 8 krpm, respectively. Flow rates and arterial and filling pressures were measured in the systemic and pulmonary portions of the mock circulation. Pulse pressure, pulse flow, pulsatility index and surplus hemodynamic energy (SHE) were calculated. The percent change in mean left atrial pressure (LAP) during each induced pulsatility condition was compared with that observed during continuous flow. RESULTS: Systemic pulse pressures of 17 to 61 mm Hg were attained when the left pump was pulsed, regardless of right pump pulsatility settings. The pulse pressure was directly related to the systolic duration and inversely related to the left pump beat rate. SHE ranged from 0.1 to 3.0 mm Hg, and its changes were comparable to those in pulse pressure. The LAP was reduced by left pump pulsation, but a maximal reduction (

Lowering the inframammary fold.

The primary indication for lowering the inframammary fold is to recruit skin into the lower pole of a small breast to accommodate a breast implant. However, the author advises that in the ptotic breast or the constricted breast, lowering the inframammary fold may result in a double-bubble deformity if improperly executed.