Birgit Karle

After massive weight loss: patients' expectations of body contouring surgery.

BackgroundMassive weight loss following bariatric surgery leads to excess skin with functional and aesthetic impairments. Surplus skin can then contribute to problems with additional weight loss or gain. The aims of the current study were to evaluate the frequency of massive soft tissue development in gastric bypass patients, to determine whether males and females experience similar post-bypass body changes, and to learn about the expectations and impairments related to body contouring surgery.MethodsA questionnaire addressing information on the satisfaction of body image, quality of life, and expectation of body contouring surgery following massive weight loss was mailed to 425 patients who had undergone gastric bypass surgery between 2003 and 2009. Of these 425 individuals, 252 (59%) patients completed the survey.ResultsNinety percent of women and 88% of men surveyed rated their appearance following massive weight loss as satisfactory, good, or very good. However, 96% of all patients developed surplus skin, which caused intertriginous dermatitis and itching. In addition, patients reported problems with physical activity (playing sports) and finding clothing that fit appropriately. Moreover, 75% of female and 68% of male patients reported desiring body contouring surgery. The most important expectation of body contouring surgery was improved appearance, followed by improved self-confidence and quality of life.ConclusionsSurplus skin resulting from gastric bypass surgery is a common issue that causes functional and aesthetic impairments in patients. Consequently, this increases the desire for body contouring surgery with high expectations for the aesthetic outcome as well as improved life satisfaction.

The Prevalence of Body Contouring Surgery After Gastric Bypass Surgery

BackgroundAs bariatric surgery has become more popular, more patients are undergoing body contouring surgery after massive weight loss. Many of the surgical procedures performed on the massive weight loss patient are complex and labor-intensive. Therefore, the plastic surgery unit needs to be prepared for a patients demand. Little literature is available on how frequently patients who have undergone gastric bypass surgery receive body contouring surgery.MethodsTwo hundred fifty-two subjects (out of 425 who were mailed the questionnaire) who had undergone gastric bypass surgery between 2003 and 2009 completed the questionnaire, which obtained information on body image satisfaction and frequency of body contouring surgery after massive weight loss.ResultsOf all patients, 74% desire a body contouring surgery after gastric bypass surgery. Fifty-three patients (21%) have undergone a total of 61 body contouring procedures. The most common were abdominoplasties (59%), followed by lower body lifts (20%). In contrast to a positive judgment of the general aspect of the body image satisfaction after massive weight loss, both genders are unsatisfied with body areas like abdomen/waist, breast, and thighs.ConclusionsParalleling the increasing use of bariatric surgery, there is a high demand for body contouring surgery. A huge disparity exists between the number of subjects who desire a body contouring surgery and those who actually received it.

The treatment of hand burns

In more than 80% of all burns, the hand is involved. Even if a burned hand does not play a major role for the survival of a patient, its function and aesthetic appearance are of utmost importance for the re-integration into society and professional life. Adequate treatment demands a number of major decisions: necessity of an escharotomy in the early post-traumatic phase, the timing of surgery and the type of wound coverage, as well as immobilization and rehabilitation. Rapid wound closure is of utmost importance, but infection control and the preservation of active and passive motion are also essential for optimal recovery of the injured hand. The treatment of hand burns requires the interdisciplinary teamwork of surgeons, physio- and occupational therapists, psychologists, motivated health care personnel and consequent treatment strategies.

Ulnar Shortening Osteotomy With a Premounted Sliding-hole Plate

Background:Ulnar shortening osteotomy represents a common procedure for various ulnar-sided wrist disorders but is still associated with complications like malrotation, angulation, or nonunion because of incomplete closure of the osteotomy gap. We describe the use of a newly developed palmarly placed sliding-hole dynamic compression plate that allows fixation of the ulna before the oblique osteotomy is carried out. Methods:We performed ulnar shortening osteotomy on 27 consecutive patients. The indication was ulnar impaction syndrome in 25 patients and symptomatic ulnar plus variance secondary to malunited distal radial fracture in 2 patients. The mean preoperative ulnar variance was +2.1 mm (range, +1 mm to +8 mm). All patients were evaluated before and after surgery and graded with the Disability of Arm-Shoulder-Hand (DASH) scoring system. Results:All 27 osteotomies healed uneventfully over an average of 9.2 ± 2.1 weeks. The mean postoperative ulnar variance was −2.1 mm (range, −3.1 mm to 0 mm). There were significant improvements in DASH score, pain, and grip strength at an average follow-up of 8.1 months. Six patients complained of plate irritation. Conclusion:Favorable results suggest that ulnar shortening osteotomy using an oblique osteotomy and a premounted sliding-hole compression plate avoids malrotation and angulation and is associated with satisfactory outcomes. This device does not require an assisting device, which minimizes the surgical exposure of the ulna. Palmar placement of the plate seems to reduce hardware irritation.

Four-corner arthrodesis – Does the source of graft affect bony union rate? Iliac crest versus distal radius bone graft

Four-corner arthrodesis is an accepted surgical option for treatment of scapholunate advanced collapse, scaphoid non-union advanced collapse and midcarpal instability. A preferred source of bone graft for performing four-corner arthrodesis is the iliac crest. An alternative and more convenient donor site is the distal radius. The aim of this study was to investigate whether the union rate after four-corner arthrodesis is influenced by the source of bone graft, that is, iliac crest or distal radius. In a retrospective analysis, charts and radiographs of 180 patients were identified. In 109 patients, iliac crest bone grafts were used, whereas 71 patients received distal radius bone grafts. In the iliac crest bone graft group, 101 out of 109 patients obtained a solid radiographic union of the arthrodesis at an average of 10 weeks after surgery, and non-union in eight patients (7.3%). In the distal radius bone graft group, X-rays of 66 patients showed bone union after an average of 10 weeks after surgery as well and five patients with non-union (7.0%) respectively. There was no statistical difference in bone union. Our data show that distal radius bone graft compares equally to iliac crest bone graft in performing four-corner arthrodesis. The advantages of the distal radius bone graft include a minor surgical exposure and the avoidance of using a distant anatomic site with associated donor-site morbidity.

Prospective study on harvesting autologous bone grafts from the anterior iliac crest using a new specialized reamer.

AbstractThe iliac crest remains the most frequent donor site for bone harvesting. Despite the surgical access to the iliac crest being relatively simple and the operation being carried out regularly, there are frequent complications. Therefore, a new, manual iliac crest reamer (R group) was compared to the classical harvesting of a corticocancellous bone graft by means of an oscillating saw (Con group) in a prospective study on 80 consecutive patients having hand surgery. Follow-up time was 3 months. Operation time and incidence of hematomas, seromas, and paresthesias in the R group were significantly shorter and less, respectively, than in the Con group. Pain at harvest site measured with the visual analogue scale (VAS) at 5 days, 6 weeks, and 12 weeks postoperatively was significantly less in group R as well. The utilization of the iliac crest reamer allows bone graft harvest in a relatively quick and simple operation with relatively few complications but with the limitation in that the maximum diameter of a bone cylinder that it can harvest is 20 mm.

Using superficial fascial system suspension for the management of the mons pubis after massive weight loss.

AbstractAlthough an abundance of literature exists regarding frequently lifted body areas, there are few reports about body contouring of the mons pubis. Therefore, this paper describes the first clinical results from a new technique, which surgically lifts the mons pubis using superficial fascial system suspension. Fifty patients underwent a lower body lift, including a superficial fascial system suspension of the mons pubis. After a mean follow-up period of 16.9 months (range, 6–31 months), patients were evaluated by standardized preoperative and postoperative photographs using the Pittsburgh Rating Scale. In addition, all patients completed a Likert-type scale questionnaire pertaining to body satisfaction and other bodily changes. Scores from the Pittsburgh Rating Scale improved significantly (P = 0.03) from 2.76 (0.43) [range, 1–3] preoperative to 0.5 (0.59) [range, 0–2] postoperative. Fifteen (30%) of the patients assessed the new contour as very good, 26 (52%) patients as good. Eight patients developed a temporary edema in the mons pubis and 1 patient developed an infected fascia suture granuloma, which had to be removed.A mons pubis lift with the aid of the superficial fascial system is a safe surgical technique, which can easily be integrated in body contouring surgeries of the torso.

Burn reconstruction: Hand and upper extremity

Although hand burns affect less than 3 % of the total body surface area (per hand), they are classified to be severe injuries, which will require the treatment in a specialized burn centre. In more than 80 % of severely burned patients the hand is involved [49]. Even if hand burns do not play a major role concerning mortality, they are important factors for a successful reintegration into society and professional life after discharge from hospital [26]. An adequate treatment of the hands is often neglected in the acute phase in favour of the treatment of other body parts or intensive care, but already in this acute phase the course for a successful restoration of hand function is set. At the end of the 1940 s, surgeons pointed out that failing to mobilize fingers will lead to early stiffening of the fingers and therefore to a loss of hand function [7]. Apart from functional rehabilitation, the aesthetic outcome is also essential since hands cannot, similar to the face, be hidden by clothes so easily.

Verbrennungen der Hand

Verbrennungen der Hand werden entsprechend der „American Burn Association“ (ABA) als eine schwere Verletzung definiert, obwohl sie je Hand nur weniger als 3% der gesamten Korperoberflache betreffen. Bei mehr als 80% der schwer Brandverletzten ist die Hand durch das thermische Trauma betroffen [1]. Verbrennungen der Hand haben nur selten einen Ein-fluss auf die Uberlebensrate der Brandverletzten, sind aber zum Zeitpunkt der Entlassung der wichtigste prognostische Faktor fur den erfolgreichen Wiedereintritt in die Gesellschaft und das Berufsleben [2]. Haufig wird die Hand in der posttraumatischen Phase zugunsten anderer Korperteile oder der Intensivtherapie vernachlassigt. Doch gerade in dieser Phase werden die Weichen fur das Wiedererreichen der kompletten Handfunktion gestellt. Bereits Ende der 1940er Jahre wurde auf die Tendenz einer fruhzeitigen Einsteifung der Fingergelenke mit einem Funktionsverlust der Hand hingewiesen, wenn die Mobilisierung der Finger nicht rechtzeitig erfolgt [3].