Chad A. Purnell

Multiple Procedures and Staging in the Massive Weight Loss Population

Background: Unlike traditional plastic surgery patients who present with a specific anatomical complaint, massive weight loss patients often have multiple regions of concern. No single procedure can address the whole-body deformities associated with massive weight loss. The authors sought to quantify their clinical experience to provide evidence-based analysis of procedural combination in body contouring. Methods: Patients were enrolled in an institutional review board–approved prospective clinical database over a 5-year period. Procedure categories included breast, medial thigh lift, buttock and lateral thigh lift, upper back lift, brachioplasty, and abdomen. Analysis of variance was used to analyze differences between procedure combinations. Results: Six hundred nine massive weight loss patients underwent 661 cases involving 1070 procedures. Length of hospital stay increased with the number of procedures performed (p < 0.001). Second-stage cases (n = 60) had similar complication rates and length of hospital stay. Seroma and dehiscence were strongly correlated with the number of procedures (p < 0.001), as were tissue necrosis and infection (p = 0.02), whereas hematoma was unrelated (p = 0.25). Major complications did not increase in multiple-procedure cases. Conclusions: In a large experience at a high-volume center, concomitant procedures were performed safely in carefully selected patients with low major complication rates. Although aggregate minor complication rates were predictably higher than in single-procedure cases, there was no significant increase on a per-procedure basis. Multiple procedures can be combined safely in the body contouring patient, with surgical staging offering a viable alternative for patients who are unable to undergo combined procedures.

Fleur-de-Lis abdominoplasty: a safe alternative to traditional abdominoplasty for the massive weight loss patient.

BACKGROUND Traditional abdominoplasty techniques often fail to adequately correct the complex contour deformities in the massive weight loss patient. To address these deformities, addition of a vertical skin resection to the traditional horizontal excision has become a popular procedure. The authors analyzed the impact of vertical (fleur-de-lis) excision on complications when compared with traditional transverse excision. METHODS A review of massive weight loss patients enrolled in an institutional review board-approved prospective registry was performed on consecutive patients undergoing abdominoplasty by a single surgeon. Patients were included if they underwent at least 50 pounds of weight loss. Demographic information, procedural data, and outcome measures were studied. Logistic regression and t tests were performed to analyze differences in complication rates for both procedures and identify risk factors for complications. RESULTS Four hundred ninety-nine patients met inclusion criteria, of whom 154 (31 percent) had a fleur-de-lis vertical component. The overall abdominal complication rate for all patients was 26.3 percent, with a 5.0 percent rate of major complications. Transverse-only and fleur-de-lis abdominoplasty had similar rates of complications with the exception of a higher rate of wound infection in the fleur-de-lis group on multivariate analysis. Risk factors for abdominal wound complications with either procedure included male sex, high body mass index, concurrent component separation, and previous subcostal scars. CONCLUSIONS Fleur-de-lis abdominoplasty can be safely performed with complication rates comparable to those of traditional abdominoplasty techniques. Ideal candidates are patients with upper abdominal skin laxity who may not achieve an adequate aesthetic result with transverse-only excision.

Donor-site Morbidity of Medial and Lateral Thigh-based Flaps: A Comparative Study

Background: Free and pedicled medial and lateral thigh-based flaps are common reconstructive procedures. However, there have been no comparative studies of morbidity between medial and lateral donor sites. Methods: We conducted an Enterprise Data Warehouse-based review of all the senior authors’ (R.D.G., G.A.D., and M.S.A.) thigh-based free and pedicled flaps. Patient demographic data, donor-site complications, drain duration, and number of postoperative visits were collected and compared. Complications were also compared between fasciocutaneous flaps and muscle or myocutaneous flaps, and skin grafted donor sites. Results: We analyzed 352 flap donor sites, with 155 medial and 197 lateral. Two hundred seventeen (217) flaps were pedicled. Flap types included 127 gracilis, 27 rectus femoris, 134 anterolateral thigh, and 36 vastus lateralis-only flaps. There were no significant differences in complications between medial (17.4%) and lateral thigh (21.3%) donor sites, although lateral thigh flaps had a mean of 1 additional postoperative visit. Rates of wound dehiscence/healing issues were significantly higher in both gracilis myocutaneous flaps (25.9%) and flaps requiring a skin grafted donor site (31.2%). Postoperative therapeutic anticoagulation was the only significant risk factor for a donor-site complication. Flap complications resulted in increased drain duration and postoperative office visits. Conclusions: Donor-site morbidity is similar in both lateral and medial thigh-based flaps. The inclusion of muscle in the flap from either donor site does not seem to increase complications, but the inclusion of a skin paddle with gracilis muscle, or a skin grafted lateral thigh donor site, results in increased wound healing complications.

Abstract 08: Risk Factors for Airway-Related Complications Following Primary Palatoplasty

CONCLUSIONS: Here we provide evidence, for the first time, that controlled mechanical advancement of the lower jaw activates FAK signaling events which unlock gene regulatory programs normally active in cranial neural crest cells during facial morphogenesis, leading to an enhanced regenerative potential of tissue-resident SSCs in the adult mandible. Mechanotransduction via FAK in skeletal stem cells during distraction activates regulatory elements normally active in primitive neural crest cells. This reversion to a more developmental chromatin state underlies the robust tissue growth that facilitates stem cell-based regeneration of this adult tissue.

Resolution of Cosmetic Buttock Injection-induced Inflammatory Reaction and Heart Failure after Excision of Filler Material

We present a case of a 66-year-old woman who developed heart failure and severe inflammatory reaction after the illicit cosmetic injections of polymethyl-methacrylate or polyacrylamide hydrogel from a primary care provider. After medical optimization, an en bloc excision of all injectable materials and gluteus muscle was performed, which resulted in exposure of bilateral sciatic nerves. Within 10 days, the patients heart failure resolved and inflammatory state improved. This is the first known report of heart failure due to buttock injections and subsequent improvement after surgery.