The BAPRAS screening tool for reimbursement in a postbariatric population.

INTRODUCTION: Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool. METHODS: In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes. RESULTS: Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m2 versus 30.4 kg/m2, p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales. CONCLUSIONS: Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS.

Nasolabial fold augmentation with SMAS graft.

This case report shows a new technique for inserting superficial musculoaponeurotic system (SMAS) tissue as autologous filling of deep nasolabial folds during an SMAS or minimal access cranial suspension (MACS) facelift procedure with satisfying aesthetic results. The technique avoids visible scars on the cheek and does not require insertion through a potential contaminated area such as nasal mucosa.

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature.

OBJECTIVE: The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. STUDY DESIGN AND METHODS: Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. RESULTS: Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. CONCLUSIONS: Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.

[Successful breastfeeding after reduction mammaplasty]. / Succesvolle borstvoeding na borstverkleining.

OBJECTIVE: To determine if it is possible to successfully breastfeed after reduction mammaplasty with intact continuity between papilla and glandular tissue. DESIGN: Retrospective by use of a written questionnaire. METHOD: Between 1986 and 2000, 994 women under the age of 35 underwent a reduction mammaplasty at the Medical Centre in Leeuwarden, The Netherlands. They were all sent a questionnaire of which 585 were completed correctly and returned. RESULTS: Of the 585 women, 215 had had one or more children and 90 had started breastfeeding, 57 of whom were successful (63%). In non-operated women this figure is 69%. The advice to try to breastfeed was associated with a higher percentage of success than the advice not to try--78% and 42% respectively. CONCLUSION: It appears to be justified to encourage women who have had a breast reduction to attempt to breastfeed after the birth of a child.

[Recognition of malignant skin tumors of the head and neck]. / Herkenning van maligne huidtumoren in het hoofd-halsgebied.

Skin cancer is the most common malignancy in man. The sun-exposed surfaces of the head and neck are the areas most frequently involved. Since skin cancers in most instances are easily recognized, they may be diagnosed at an early stage. The dentist may play a role in the early detection of skin cancers of the head and neck.

Long-term results of arthrodesis of the carpometacarpal joint of the thumb.

We reviewed 48 arthrodeses of the carpometacarpal joint of the thumb in 39 patients being treated for osteoarthritis. The mean follow-up period was 90 months (range 14 months-17 years). In 28 (58%) hands pain relief was excellent and in 6 (12%) good. Morbility was significantly reduced (p < 0.002). Mean key pinch (52.9 N) and grip strength (219.5 N) were comparable with the unoperated hand (51.0 and 239.1 N, respectively). Hand function was near normal. In 29 hands an additional operation was needed to remove the osteosynthesis material; 14 hands failed to unite. Osteoarthritis of the scaphotrapezial joint increased significantly faster in the operated hands than in the unoperated ones (p < 0.0001). A soft tissue procedure (such as flexor carpi radialis interposition arthroplasty) is advised instead of arthrodesis, because of the large number of reoperations, based on non-union and removal of the osteosynthesis material. From a survey of published papers we conclude that arthrodesis of the carpometacarpal joint of the thumb can best be done by stapling and bone grafting.

Closure of radial forearm free flap donor site with local full-thickness skin graft.

A triangular shaped full-thickness skin graft harvested adjacent to the donor site of the radial forearm flap, as originally described by Liang et al, has successfully been used in seven consecutive patients for coverage of the donor site of the radial forearm free flap. In all patients this resulted in a robust coverage with no late wound breakdown and an aesthetic appearance far superior to split-thickness skin-graft coverage. We recommend this technique which is feasible in the majority of cases and reduces both donor site and graft site morbidity of the radial forearm flap.

[Plastic surgery treatment of a nose tip amputation in an Eleven-Cities marathon skater]. / Plastisch-chirurgische behandeling van een neuspuntamputatie bij een Elfstedentochtrijder.

A 41-year-old male participant of the 200 km Eleven Cities ice skating marathon in 1997 lost a large part of his nose tip as a result of hitting a bridge. Avascular replantation of the amputated nose tip combined with ice water cooling for three days did not result in revascularisation. Subsequently the entire nose tip was reconstructed by means of a paramedian forehead flap. This reconstruction was performed in three stages and had a good aesthetic result.

Osteosarcoma of the sternum.

Primary malignant sternal tumours are very rare. The most common malignant sternal tumour is a chondrosarcoma. Until now, controversies in the management of malignant sternal tumours were mainly caused by limited clinical experience. However, treatment of malignant sternal tumours should not differ from that of chest wall malignancies. In this paper a 74-year-old man with a kyphoscoliosis and an osteosarcoma of the sternum is described who received combined treatment modalities, consisting of surgical resection and reconstruction with a myocutaneous flap, followed by external beam radiotherapy. This treatment strategy is discussed.

Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty.

Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for bilateral trapeziometacarpal osteoarthritis yields satisfactory long-term results on both sides.

Carpometacarpal arthritis of the thumb.

Forty-five flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for the treatment of carpometacarpal osteoarthritis were reviewed. The average follow-up period was 103 months (range, 22-213 months). Pain was reduced in 42 (93%) of the cases. Mobility was equal to that of the unoperated side. Key pinch and grip strengths compared to the unoperated thumb measured 86% and 90%, respectively. The mean distance between the scaphoid and the base of the first metacarpal bone was 7 mm (range, 2-12 mm). Function was improved in 39 (87%) of the cases, and in 42 (93%) of the cases the overall results were satisfactory. The results of this study show that FCR tendon interposition arthroplasty gives satisfactory long-term results.

The 3M precise microvascular anastomotic system for implanting PTFE microvenous prostheses into the rat femoral vein.

Successful implantations of PTFE microvenous prostheses with 3M precise anastomosis systems were presented. Twelve PTFE prostheses (Gore-Tex;I.D.1.0 mm) were implanted into rat femoral veins by means of 3M precise technique to evaluated the patency rate. In the control group, PTFE prostheses (n = 12) were implanted by means of end-to-end technique. In the experimental group, patency of the PTFE prostheses was evaluated at 3 (n = 6) and 6 (n = 6) weeks after implantation by means of macroscopic inspection and scanning electron microscopy. All prostheses except one were patent at the time of removal (patency rate 91.7 percent). All the microvenous prostheses were completely covered by an endothelial layer at 3 and 6 weeks after implantation, and no stenosis was observed at the anastomotic sites. In the control group, all prostheses except one were found to be occluded 3 weeks after implantation. These results demonstrate the value of the 3M precise technique when implanting PTFE microvenous prostheses.