[BODY-CONTOURING AFTER MASSIVE WEIGHT LOSS - THE POST-BARIATRIC SERVICE SAMSON ASSUTA ASHDOD UNIVERSITY HOSPITAL].

INTRODUCTION: Bariatric surgery is an effective tool for weight loss in the obese population, improving and often resolving related co-morbidities such as diabetes and hypertension, reducing overall morbidity and mortality. However, many patients suffer from excess and redundant skin in many areas of their body. Skin excess can cause physical, functional, psychological and aesthetic impairments such as fungal infections and skin rashes, difficulty maintaining personal hygiene, low self-esteem and self-image, social isolation, depression and low quality of life. Areas most commonly affected are the abdomen, upper arms, thighs and breasts. Body contouring surgery (post-bariatric surgery) can resolve health issues related to skin excess, improve quality of life and body image and help maintain weight loss. Since its establishment, the post-bariatric unit has performed 76 post-bariatric surgeries on 56 patients in Assuta Ashdod Hospital (67.1% abdominoplasties, 14.47% thigh-lifts, 10.52% brachioplasties, 5.26% breast surgeries, 2% gynecomastia repairs). In this article, we present the post-bariatric service in Assuta Ashdod Hospital including the pre-and post-operative treatment protocols and results.

Fat Grafting for Improved Ileostomy Ostomy Device Fit: A Case Report.

For patients with an ostomy, a poor fitting appliance may cause leakage, peristomal dermatitis, and frequent appliance changes. PURPOSE: The purpose of this case study was to report the outcome of fat grafting to augment peristomal soft tissue and improve appliance fit. CASE STUDY: A 57-year-old woman with a history of Crohn's disease presented with soft-tissue deficiency and uneven contour around her ileostomy site. She was unable to properly fit an ostomy appliance, which resulted in leakage, chronic skin irritation, and frequent appliance changes. The patient underwent 2 rounds of fat grafting using fat harvested from her medial thighs and knees infused with dilute lidocaine with epinephrine. The patient noted immediate improvement after 34 cc of processed fat was injected in the first round. Appliance change frequency decreased from daily to every 3 to 4 days. A second graft of 32 cc provided 3 months later further improved appliance fit, reducing appliance change frequency to every 5 to 7 days and obviating the need to use adjustment rings and glue. Pre- and postoperative computed tomography showed increased thickness of abdominal wall subcutaneous tissues. CONCLUSION: Fat grafting around an ostomy site presents a viable option to improve contour and appliance fit with reduced skin irritation and leakage.

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.