Body Contouring Surgery After Bariatric Surgery Improves Long-Term Health-Related Quality of Life and Satisfaction With Appearance: An International Longitudinal Cohort Study Using the BODY-Q.

OBJECTIVE: To examine health-related quality of life (HRQL) and satisfaction with appearance in patients who have undergone bariatric surgery (BS) with or without subsequent body contouring surgery (BCS) in relation to the general population normative for the BODY-Q. BACKGROUND: The long-term impact of BS with or without BCS has not been established using rigorously developed and validated patient-reported outcome measures. The BODY-Q is a patient-reported outcome measure developed to measure changes in HRQL and satisfaction with appearance in patients with BS and BCS. METHODS: Prospective BODY-Q data were collected from 6 European countries (Denmark, the Netherlands, Finland, Germany, Italy, and Poland) from June 2015 to February 2022 in a cohort of patients who underwent BS. Mixed-effects regression models were used to analyze changes in HRQL and appearance over time between patients who did and did not receive BCS and to examine the impact of patient-level covariates on outcomes. RESULTS: This study included 24,604 assessments from 5620 patients. BS initially led to improved HRQL and appearance scores throughout the first postbariatric year, followed by a gradual decrease. Patients who underwent subsequent BCS after BS experienced a sustained improvement in HRQL and appearance or remained relatively stable for up to 10 years postoperatively. CONCLUSIONS: Patients who underwent BCS maintained an improvement in HRQL and satisfaction with appearance in contrast to patients who only underwent BS, who reported a decline in scores 1 to 2 years postoperatively. Our results emphasize the pivotal role that BCS plays in the completion of the weight loss trajectory.

Improving the Impact of BODY-Q Scores Through Minimal Important Differences in Body Contouring Surgery: An International Prospective Cohort Study.

BACKGROUND: The BODY-Q is a widely used patient-reported outcome measure for comprehensive assessment of treatment outcomes specific to patients undergoing body contouring surgery (BCS). However, for BODY-Q to be meaningfully interpreted and used in clinical practice, minimal important difference (MID) scores are needed. A MID is defined as the smallest change in outcome measure score that patients perceive important. OBJECTIVES: The aim of this study was to determine BODY-Q MID estimates for patients undergoing BCS to enhance the interpretability of the BODY-Q. METHODS: Data from an international, prospective cohort from Denmark, Finland, Germany, Italy, the Netherlands, and Poland were included. Two distribution-based methods were used to estimate MID: 0.2 standard deviations of mean baseline scores and the mean standardized response change of BODY-Q scores from baseline to 3 years postoperatively. RESULTS: A total of 12,554 assessments from 3,237 participants (mean age; 42.5±9.3 years; body mass index; 28.9±4.9 kg/m2) were included. Baseline MID scores ranged from 1 to 5 in the health-related quality of life (HRQL) scales and 3 to 6 in the appearance scales. The estimated MID scores from baseline to 3 years follow-up ranged from 4 to 5 in HRQL and from 4 to 8 in the appearance scales. CONCLUSIONS: The BODY-Q MID estimates from before BCS to 3 years postoperatively ranged from 4 to 8 and are recommended for use to interpret patients' BODY-Q scores, evaluate treatment effects of different BCS procedures, and for calculating sample size for future studies.

[Treatment of Sternal Osteomyelitis after Median Sternotomy in 130 Patients with Pedicled Myocutaneous Latissimus Flap]. / Therapie der Sternumosteomyelitis nach medianer Sternotomie bei 130 Patienten mittels gestielter myokutaner Latissimuslappenplastik.

BACKGROUND: After median sternotomy in cardiac surgery, deep sternal wound infections develop in 0.8 - 8% of patients, resulting in prolonged hospital stay and increased morbidity and mortality. Our treatment strategy combines radical surgical debridement, removal of extraneous material and reconstruction of large and deep defects by a pedicled M. latissimus dorsi flap. With retrospective analysis of patient characteristics and pre- und perioperative data we could identify risk factors in regard to proper wound healing and bleeding complications. MATERIAL AND METHODS: Patient characteristics (age, BMI, gender), medical history (diabetes mellitus, chronic obstructive lung disease, renal insufficiency and pre- and perioperative data (anticoagulation, bacterial colonization during reconstruction) were collected for 130 patients treated by latissimus flap to cover sternal wounds between 2009 and 2015. RESULTS: The mean age was 68.72 ± 9.53 years; 37% of patients were female. The in-hospital mortality was 3.8%. Reoperation rate because of wound healing problems was 21.5%; bleeding complications leading to reoperation occurred in 10.8% of all patients. At the point of reconstruction, Staphylococcus (S.) aureus and S. epidermidis were detected most frequently. Age over 80 (p = 0.04), female sex (p = 0.002), detection of fecal bacteria (p = 0.006), or multiresistant bacteria (p = 0.007) and Klebsiellae were regarded as significant risk factors for wound healing problems leading to reoperation after flap surgery. High dose therapy with danaparoid/fondaparinux was a significant risk factor for bleeding complications needing reoperation. CONCLUSION: The pedicled latissimus flap has to be considered as the preferred method in large sternal wounds to achieve sufficient defect filling. The risk of wound healing disruption is significantly influenced by bacteria detected in the sternal wound at the point of reconstructive surgery.

[German linguistic validation of the BODY-Q: standardised PRO instrument after bariatric and bodycontouring surgery]. / Deutschsprachige Validierung des Body-Q ­ standardisiertes PRO-Messinstrument nach bariatrischen und körperformenden Eingriffen.

One of the most important parts of result evaluation in plastic surgery, especially postbariatric and body-contouring surgery, is the appraisal of changes in patients' quality of life after treatment. Standardised assessments of patient-reported outcomes (PROs) are indispensable.BODY-Q (A. Klassen et al.) is a multifaceted, valid PRO instrument comprising a total of 26 scales for the evaluation of multiple factors of everyday life in order to quantify well-being, satisfaction and functionality. Each scale contains 4-10 statements, which have to be rated by patients.The BODY-Q was created pursuant to ISPOR (International Society for Pharmacoeconomics and Outcomes Research) standards and subjected to psychometric tests with great results. It is considered a standard PRO instrument for quality of life in postbariatric and body-contouring surgery.In order to expand the applicability of standardised questionnaires, ISPOR established linguistic validation guidelines, which have been applied to the BODY-Q in Dutch, Danish, Finnish and Polish.In this study, German linguistic validation was completed applying the standardised guidelines. First the BODY-Q was translated in consensus with medical expertise. Then a certified translator produced a backwards translation, which was commented on by the author. After appropriate changes were made in due consideration of these comments, interviews with patients were conducted to remove any sources of content-related misconception. Finally, the translated version was applied on patients. All the scales were translated to an easily understandable questionnaire reliable in form and content. An international collaboration aiming to centralise the results has started. Further linguistic validation procedures in other languages have been initiated, and an international cohort structure is planned to be established for body-contouring procedures in order to systematically improve treatment quality in plastic surgery.

[Medical Needling: effect on skin tension and elasticity of hypertrophic burn scars]. / Medical Needling ­ Effekt auf hypertrophe Verbrennungsnarben hinsichtlich der Hautspannung und -elastizität.

BACKGROUND: Burn scars are a serious psychological and physiological problem for affected individuals. Clinical studies and scientific research have shown that Medical Needling improves scar quality in terms of skin elasticity, moisture, transepidermal water loss and erythema. At the same time, patients are confronted with a comparatively low-risk therapy without any postoperative complications. OBJECTIVE: The goal of our study was to examine the influence of Medical Needling on mature hypertrophic scars with regard to skin elasticity and tension. A total of 20 patients with an average age of 34.6 years and second or third-degree burn scars were treated. Scars that were at least 2 years old and had healed by secondary intention met the criteria for inclusion in the study. METHODS: Medical Needling is performed using a roller covered with needles of 3 mm length. The needling device is rolled over the scar in three directions: vertically, horizontally and diagonally. The procedure of puncture leads to multiple micro wounds and intradermal bleeding, which induces the post needling regeneration cascade. The patients were followed up for 12 months postoperatively. The results were evaluated by means of objective and subjective measurement methods. RESULTS: Objective measurements show that Medical Needling improves pathological values of skin tension and elasticity. Depending on the scarring, a reduction in tension or an increased tightness of overstrained and lax skin was recorded. Rigid scars gained vital features and profited from a physiological degree of elasticity. CONCLUSION: Medical Needling proves to be a promising approach for the treatment of mature hypertrophic scars with pathological changes of skin elasticity and tension.

Medical Needling: Effect on Skin Erythema of Hypertrophic Burn Scars.

Background Burn scars frequently tend to have pathological discolorations, which is manifested in the development of persistent erythema. Affected people suffer from psychological and physiological issues when they are restricted or rejected in their daily life. In this context, medical needling seems to be an efficient therapy for erythematous scars with a relatively low-risk rate of postoperative complications. Study research has already shown significant improvements in the scar quality with reference to the parameters "moisture and transepidermal water loss." Clinical data is up-to-date and provides an innovative therapy outcome of scar treatment with medical needling. Objective The aim of our study was to examine the influence of medical needling on the pathological and persistent erythema of hypertrophic burn scars. By means of reliable measurement methods, we were able to prove positive and sustainable outcomes for normal and healthy skin. The patient cohort included 20 patients with an average age of 34.63 years. Our examinations involved scars that were at least two years old and had healed by secondary intent. Every scar showed the pathological values of persistent erythema according to the participation requirements. Methods For the practical implementation of medical needling or percutaneous collagen induction (PCI), we used a roller covered with needles of 3 mm length. The needling device is rolled over the scar alternatively in a vertical, horizontal, and diagonal orientation. Multiple micro-wounds at a close distance cause intradermal bleeding, which evokes modified skin regeneration provoked by the effects of medical needling. Every patient has been followed up for 12 months postoperatively. Further on, valid results have been evaluated objectively as well as subjectively by the patient and observer. Results Our study has shown that persistent erythema of hypertrophic scars can be considered as an indication of PCI. The needling procedure influences vascularization by stimulating angiogenesis in the post-needling wound healing cascade. As the method is based on percutaneous collagen induction, the synthesis of collagen improves the vital thickness of the epidermis, which is directly associated with less transparency. Examined scars showed a significant reduction of erythema and were less reddened after treatment. Based on the outcomes of objective measurements, medical needling achieves a normalization of the skin color and an adjustment to healthy skin after repetitive treatments. Conclusion Medical needling seems to be a suitable therapy approach for treating erythematous, hypertrophic burn scars.

Platelet-rich Plasma for Skin Rejuvenation and Treatment of Actinic Elastosis in the Lower Eyelid Area.

Background Treatment of the lower eyelid region to rejuvenate the skin or treat actinic elastosis often proves difficult. Established treatment options, such as hyaluronic acid injections, botulinum toxin injections, microneedling, skin resurfacing (microdermabrasion, chemical peel (exfoliation), laser treatment), as well as blepharoplasties and autologous fat transfers, can be associated with significant risks and increased patient burden. Furthermore, they may not be effective for treating the signs of skin aging or actinic elastosis, including dark rings under the eyes, a lack of volume and cutis laxa. A minimally invasive treatment approach which visibly improves the above-mentioned conditions and which involves minimal risk and patient burden would be a desirable alternative. Materials & methods Twenty patients were treated a total of three times at monthly intervals with PRP (platelet-rich plasma). The patients were examined on the days of treatment and one month after the third injection. The PRP was obtained directly prior to treatment using the Arthrex ACP double syringe at the point of care. The injections (2 ml PRP per side) were administered laterally using 27 G 38 mm cannulas. Accurate photographic documentation and skin elasticity measurements using a cutometer were performed to objectify the subjective assessments from the patient and practitioner questionnaires. Results A progressive improvement in the esthetic outcome and a high level of patient satisfaction were determined. The cutometer measurements showed a statistically significant higher level of skin firmness (due to increased collagen production) and a statistically significant increase in skin elasticity (thanks to increased elastin production). Other than the anticipated visible swelling directly after the PRP injection, no other undesirable side effects or complications occurred. The typical burning sensation during the injection had not been reported. Conclusion The results indicate that a series of PRP injections in the lower eyelid region is a safe, efficient, virtually pain-free, simple and rapid treatment option for an area with otherwise limited treatment alternatives.

Medical Needling: Effect on Moisture and Transepidermal Water Loss of Mature Hypertrophic Burn Scars.

BACKGROUND: Burn scars remain a serious psychological and physiological problem for affected people. Clinical studies and scientific research have already shown that medical needling improves the scar quality in terms of skin elasticity and erythema. At the same time, patients are confronted with a low-risk therapy and face comparatively less postoperative complications. OBJECTIVE: The goal of our study was to examine the influence of medical needling on the skin moisture and transepidermal water loss (TEWL) of hypertrophic dry scars. Therefore, 20 patients, of an average age of 34.63 years, with deep second- and third-degree burn scars have been treated. METHODS: Medical needling is performed using a roller covered with needles of 3-mm length. The needling device is rolled over the scar in three directions: vertically, horizontally, and diagonally in order to create as many puncture channels as possible. The puncturing leads to multiple micro-wounds and intradermal bleeding, which evokes the post-needling regeneration cascade. The patients were followed up for 12 months postoperatively. The results have been evaluated by means of objective as well as subjective measurement methods. RESULTS: The objective measures show that medical needling influences epidermal thickness and improves the epidermal barrier function at a molecular level. Outcomes are marked by a measurable increase in skin moisture and a reduction in TEWL. CONCLUSION: Medical needling seems to be a promising approach for the treatment of mature hypertrophic burn scars with a focus on skin moisture and TEWL.