Antoine De Runz

The Lipo–body Lift: A New Circumferential Body-contouring Technique Useful after Bariatric Surgery

Background: After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo–body lift method. The authors describe their experience with this novel, safe procedure. Methods: Twenty-five abdominal body-contouring reconstructions following massive weight loss were treated by means of circumferential lipo–body lift. The authors describe the indications for the procedure and their perioperative and postoperative management. Results: The mean patient age was 39.4 years. The mean pre–body lift body mass index was 26.71 kg/m2; the average weight loss before surgery was 56.6 kg, with a mean delta body mass index loss of 20.82 kg/m2. The average hospital stay was 3.52 days and the drainage duration 3.56 days. No patient experienced any major complication (e.g., hematoma, thromboembolism, bleeding, skin necrosis, or a need for revision surgery to treat complications). Minor complications including wound dehiscence, wound infection, and fat necrosis were reported in 40 percent of patients. The occurrence of complications was associated with smoking status (p = 0.0280), the volume of liposuction (p = 0.0399), and the liposuction volume per unit of body mass index (p = 0.0071). Conclusions: The authors’ novel technique is less invasive than the traditional lower body-lifting method, as shown by the absence of major complications, and allows excellent conservation of connective tissue and vessels; undermining is minimal. As obesity becomes a major problem worldwide, lifting procedures that are safe and effective are important components of reconstructive strategies and should be widely offered to patients who experience massive weight loss. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Background:After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo–body lift method. The authors describe their experience with t

Circumferential Contouring of the Lower Trunk: Indications, Operative Techniques, and Outcomes—A Systematic Review

BackgroundIncreasing obesity prevalence and development of bariatric surgery have led to the development of skin re-draping techniques. Several contouring techniques have been described for treating the circumferential excess of the lower trunk.Materials and MethodsWe performed a systematic review to summarize surgical indications, operative techniques, peri-operative management (nutritional supplementation, antibiotic prophylaxis, thrombo-prophylaxis), outcomes, complications, patient satisfaction, and impact on quality of life of circumferential contouring of the lower trunk procedures. A systematic review, based on the PRISMA criteria, was conducted using the Pubmed and Cochrane databases.ResultsThe review included 42 articles and 1748 operated patients. Two studies only were graded as level of evidence II; the others were graded as levels III to V. The most frequently reported indication was massive weight loss. All the described techniques derived either from belt lipectomy or lower bodylift. Belt lipectomy resulted in a posterior scar situated at the waistline and allowed a better correction of hip back rolls, whereas lower bodylift was more effective on buttock and lateral thigh ptosis. The most reported complication was wound dehiscence. Patient satisfaction and quality of life scores were high in all studies.ConclusionsThis review included a majority of low-level evidence studies that limit extrapolability of the results. Future randomized prospective studies may generate stronger evidence, with a standardization of surgical indications and operative techniques.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Eyelid fat grafting: Indications, operative technique and complications; a systematic review

INTRODUCTION Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no study on the overall complication or satisfaction rate associated with the various grafting techniques exists. We performed a comprehensive literature review to determine the outcomes and complications of eyelid fat grafting, as well as patient satisfaction. METHODS A systematic review of the literature using the PRISMA criteria was conducted. This protocol was registered at the Prospective Register of Systematic Reviews at the National Institute for Health Research. RESULTS Sixteen studies, representing 1,159 patients and published between June 2004 and December 2014, were included. Satisfactory results, judged by clinical examination, were observed in all studies. Few postoperative complications were reported. CONCLUSIONS We demonstrated that the procedures were easy to perform, and achieved satisfactory and sustainable results with few complications in both reconstructive and cosmetic surgery. However, a wide disparity exists in the various fat harvesting, fat purification, and reinjection techniques. Further studies are required to assess the long-term outcomes. Our conclusions should be accepted cautiously due to the small number of articles and the lack of evidence in published studies.

Particular catastrophic antiphospholipid syndrome, on the sole surgical site after breast reduction

A 20-year-old woman treated with vitamin K antagonist for antiphospholipid syndrome (APS) (pulmonary embolisms at age 15) was admitted for breast reduction after bridging therapy. At 2 days post-surgery haematomas appeared on the surgical site and anticoagulant therapy was withheld. She developed a skin and breast necrosis leading to the diagnosis of catastrophic APS. Despite medical treatment (anticoagulant therapy, corticosteroids and intravenous immunoglobulins) and surgery, necrosis continued. After 2 weeks of negative-pressure wound therapy (V.A.C.(®) Therapy™) the patient improved, mammary tissues were alive, well vascularised and budding. Breast reconstruction was then initiated. Artificial dermis graft (MatriDerm(®) 2 mm) was applied, and 3 weeks later the apposition of split-thickness skin graft on it. Six months later, results of the surgery were good and the patient was satisfied.

New techniques for wound management: A systematic review of their role in the management of chronic wounds

Debridement is a crucial component of wound management. Recent technologies such as hydrosurgery (Versajet), ultrasound therapy (the MIST therapy device), or plasma-mediated bipolar radio-frequency ablation therapy (Coblation) seem to represent interesting alternatives for wound debridement. The purpose of this systematic review was to describe, evaluate, and compare these three recently developed methods for the management of chronic wounds. In January 2016, an electronic database search was conducted of MEDLINE, PubMed Central, and Embase for articles concerning these three innovative methods for the management of chronic wounds. A total of 389 references were identified by our search strategy, and 15 articles were included. We extracted data regarding the number and age of patients, indications, operating time, number of procedures, costs, wound healing time, decrease in exudation, perioperative blood loss, bacterial load, and the occurrence of complications. The 15 articles included studies that involved 563 patients who underwent hydrosurgery (7 studies), ultrasound therapy (6 studies), or Coblation (2 studies). Six randomized controlled trials were included that compared the use of a scalpel or curette to hydrosurgery (2 studies) or ultrasound therapy (6 studies). Hydrosurgery, in addition to being a very precise and selective tool, allows significantly faster debridement. Ultrasound therapy provides a significant reduction of exudation, and improves the wound healing time. No comparative study dedicated to Coblation was identified. Despite the obvious clinical interest of the topic, our review of the current literature revealed a lack of prospective randomized studies comparing these devices with each other or with standard techniques, particularly for Coblation and hydrosurgery.

A qualitative study of life events and psychological needs underlying the decision to have cosmetic surgery

Objective A thorough psychological assessment of patients requesting cosmetic surgery can help to protect them from the risk of postoperative dissatisfaction and the onset and/or aggravation of psychiatric disorders. This study seeks to shed more light on why people desire cosmetic surgery and thus help surgeons, psychiatrists, and psychologists to conduct assessments before surgery. Methods In-depth interviews were conducted with 35 subjects who requested cosmetic surgery. The interviews were recorded and transcribed and then analyzed qualitatively with Grounded Theory. Themes and categories were identified and compared in logical order, to build a consistent theoretical model. Results In each interview, we identified one or more recent events that the subjects considered to be contributing factors in their decisions to have cosmetic surgery. We observed that 33 of 35 patients said they sought cosmetic surgery at a time when they were experiencing, or had just experienced, one or more major changes in their bodies or their relationships. Recent life events triggered or strengthened specific psychological needs in the subjects: to cope with the past and with change, attain a consistent identity, find or regain a positive self-image, alter others’ perceptions, define themselves in relation to others, or please themselves or others. Patients said that they chose plastic surgery to fulfill one or more of these needs. Conclusions This study identifies the role of recent events in inciting individuals to resort to cosmetic surgery. This factor provides new perspectives for surgeons to understand those patients and opens new avenues for research.

Management of nipple-areola complex ischemia after breast reduction: A systematic literature review and algorithm proposal

BackgroundRare and dreaded, necrosis of the nipple-areola complex (NAC) is one of the major complications of breast reduction surgery. Our objective was to establish a management algorithm summarizing the different possible treatments reported in the literature.MethodsThe data extracted from the articles selected for this literature review covered surgical techniques, frequency of NAC necrosis, type of necrosis, and management proposed for women who have had this surgery for macromastia.ResultsIn the 54 articles finally selected, the mean frequency of NAC necrosis was 5.1%. The risk factors for necrosis were the weight of the tissue resected, smoking, obesity, the surgical technique used, and stretch marks. The treatments proposed were listed according to four categories of issues: patient-specific susceptibility, type of breast, surgical technique, and its technical performance.ConclusionsNo consensus exists about the management of NAC necrosis, which remains a complication feared by surgeons. We propose a management algorithm that simplifies the therapeutic indications.Level of Evidence: Not ratable

Reply: The Lipo–Body Lift

1. Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier E. The lipo-body lift: A new circumferential body-contouring technique useful after bariatric surgery. Plast Reconstr Surg. 2017;139:38e–49e. 2. Le Louarn C, Pascal JF. High superior tension abdominoplasty. Aesthetic Plast Surg. 2000;24:375–381. 3. Dixit VV, Wagh MS. Unfavourable outcomes of liposuction and their management. Indian J Plast Surg. 2013;46:377–392. 4. Shiffman MA. Prevention and treatment of liposuction complications. In: Shiffman MA, Di Giuseppe A, eds. Liposuction: Principles and Practice. 1st ed. New York: Springer; 2006:333–341.

Safe monsplasty technique

Abstract Introduction: To improve their health and quality of life, obese patients undergo consultation after weight loss. In these patients, the sub-umbilical abdominal and pubic regions are often characterized by redundant skin, creating aesthetic and functional discomfort. Monsplasty is an important step in abdominoplasty or bodylift procedures. We report on an original technique used to correct deformity in the pubic region following weight loss. Methods: All interventions were performed by the same surgeon between April and December 2015. On stretched skin, we drew two lines 5 cm lateral to the median line on both sides and connected them with the arc of a circle placed 7 cm from the vulvar fork. Then, monsplasty marks extend to abdominal fold. During lower abdominal contouring, we performed monsplasty with three separate stitches between the camper fascia and aponeurosis of the abdominal muscle. The aim was to bring tension to the pubic region without additional surgical procedure. Results: We report on 21 consecutive cases of monsplasty following lower trunk contouring. No reoperation was performed due to complication or aesthetic demand (no under- or over-correction occurred). No complication (e.g. edema, seroma, disturbance of sensibility) was observed in the pubic area. The results were stable 1 year after surgery. Conclusions: We report on a simple, rapid, and reproducible monsplasty technique for all stages of Pittsburgh classifications, which achieved favorable results with no complication. We recommend performance of this effective technique simultaneously with abdominoplasty or bodylift procedures. Level of evidence: IV.

Primary Skin Umbilical Endometriosis: About One Case

Extremely rare (1% of the cases), cutaneous endometriosis can be located in the umbilical region. Its principal differential diagnoses are keloid scar, sebaceous cyst and melanoma which must first be discounted. Most often in a secondary location and accompanied by concomitant menstrual pain and bleeding following abdominal surgery, Villar’s nodule can also be totally asymptomatic, isolated and without a known cause. This was the distinctive feature of our 33-year-old patient whose nodule had appeared 5 years beforehand. Only histological examination could confirm a diagnosis of endometriosis - even if the bluish multinodular aspect had strongly suggested it. Extended excision is the treatment of choice.