Raymond Isakov

Weight loss is higher among patients who undergo body contouring procedures after bariatric surgery.

BACKGROUND As the number of patients who have undergone bariatric surgery increases, it is expected that more patients will present for body contouring procedures after weight loss. It has been reported that abdominoplasty can improve mobility, reduce skin fold complications, and improve psychosocial functioning. No previous studies have evaluated weight loss in patients who pursue plastic surgery after bariatric surgery. OBJECTIVES The aim of this study is to evaluate weight loss outcomes in patients who choose to undergo body contouring procedures after bariatric surgery. SETTING Academic center, United States. METHODS Patients who underwent body contouring procedures after bariatric surgery between 2002 and 2014 were included. A comparison was made to a matched cohort based on age, gender, type of bariatric procedure, preoperative body mass index (BMI), and length of follow-up. RESULTS In total, 186 patients had documentation of a body contouring procedure after bariatric surgery. There were 158 (84.9%) female participants in the body countering group. Mean age was 48.5±12.7 years and mean BMI was 49.8±10.4 kg/m2. Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding were performed in 157 (84.4%), 17 (9.1%), and 11 (5.9%) patients, respectively. After a matched follow-up period of 61 months, total weight loss was 43.0±22.6 kg in the body contouring group versus 33.5±21.7 kg in the control group (P<.001), percentage of total weight loss was 30.8±11.4% versus 24.0±13.2% (P<.001), percentage excess weight loss was 66.4±25% versus 52.5±30.5% (P<.001), and BMI dropped by 15.7±7.8 kg/m2 versus 12.1±7.3 kg/m2 (P<.001) in the body contouring group compared with the bariatric surgery-only group, respectively. Multivariate analysis indicated that body contouring after bariatric surgery is significantly associated with increase and durable weight loss (odds ratio 3.59, 95% confidence interval 2.04-5.14, P< .001). CONCLUSION Patients who underwent body contouring procedures after bariatric surgery had significantly better long-term weight loss than a matched cohort of patients. This finding likely has many contributing factors, and the association between long-term weight loss and body contouring procedures after bariatric surgery requires more detailed study.

Long-term outcomes of total knee arthroplasty following soft-tissue defect reconstruction with muscle and fasciocutaneous flaps

Background: Insufficient soft-tissue coverage following total knee arthroplasty jeopardizes prosthesis retention and may lead to significant complications. The aim of this study was to evaluate the natural history of total knee arthroplasty following flap reconstruction of soft-tissue defects. Methods: A retrospective review of patients treated with flaps after failed total knee arthroplasty between 1998 and 2013 was conducted. Patients with preexisting soft-tissue defects who required reactive flap reconstruction were included in group 1. Patients with no preexisting soft-tissue defects, but with extensive débridement during revision total knee arthroplasty requiring immediate proactive flap coverage, were included in group 2. Results: Fifty-eight patients in group 1 were treated with 86 flaps, and 15 patients in group 2 were treated with 17 flaps. Mean length of follow-up was 67.0 and 54.7 months, respectively (p = 0.21). Flap-related complications and number of subsequent flap revisions were comparable in both groups. Patients in group 1 had a higher rate of implant reinfection (58 percent versus 27 percent; p < 0.05), amputations (25 percent versus 0 percent; p < 0.05), and subsequent prosthesis revisions (2.2 versus 0.9; p < 0.05). Functional joint was preserved in 54 percent and 80 percent of cases, respectively. Mean gain in range of motion and quality of life were significantly better in group 2 (p < 0.05). Conclusions: Early proactive soft-tissue coverage of total-knee arthroplasty is critical to long-term success. In cases where reactive treatment is required, significantly worse outcomes and a high rate of complications should be expected. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Adipofascial Flap in the Recipient Incision Site for Coverage of Vascular Pedicle in Free Tissue Transfer.

Summary: The recipient incision adipofascial flap offers a simple approach to address a tight skin closure over a vascular pedicle. This technique is not just fast and easy to perform but also adds little to no morbidity, removing a potential source of flap failure.

The Role of Injectables in Aesthetic Surgery: Financial Implications

Background The plastic surgeon competes with both core and noncore physicians and surgeons for traditional cosmetic procedures. In 2007, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) joined efforts to form a Cosmetic Medicine Task Force to further analyze this trend. Objectives Our objective is to document and quantify the patient capture and total collections generated in a single surgeons practice exclusive from Botulinum Toxin A and filler injections over a 10-year period. We subsequently identified the effect and importance that fillers and Botulinum Toxin A have on an active cosmetic practice. Methods A retrospective chart review of all male and female patients who received Botulinum Toxin A or soft tissue filler injections (noninvasive aesthetic treatment) in a single surgeons practice from January 2004 to December 2013 was undertaken. Only those patients new to the practice and who were exclusively seeking out Botulinum Toxin A or fillers were included in the study. Chart review then identified which of these selected patients ultimately underwent invasive aesthetic surgery during this 10-year period. Noninvasive and invasive aesthetic surgery total collections were calculated using billing records. Results From January 2004 to December 2013, 375 patients entered the senior surgeons practice specifically requesting and receiving noninvasive aesthetic treatments. Of these 375 patients, 59 patients (15.7%) subsequently underwent an aesthetic surgery procedure at an average of 19 months following initial noninvasive aesthetic treatment. Of these 375 patients, 369 were female and 6 were male. The most common initial invasive aesthetic procedure performed after injectable treatment included 22 facelifts (18.5%), 21 upper eyelid blepharoplasties (17.6%), and 15 endoscopic brow lifts (12.6%). Total collections from noninvasive aesthetic sessions and invasive surgery combined represented US

Traumatic Facial Myopericytoma: A Differential to Consider

762,470 over this 10-year span. This represented US

Long Term Outcomes of Total Knee Arthroplasty Following Soft Tissue Defect Reconstruction with Flaps.

524,771 and US

Prognostic value of sentinel lymph node biopsy according to Breslow thickness for cutaneous melanoma

396,166 in total collections for injectables and surgery respectively. Conclusions Noninvasive aesthetic surgery is a critical part of a plastic surgery practice. A measurable and significant number of patients who sought out a single plastic surgeon exclusively for noninvasive treatment ultimately underwent traditional invasive cosmetic surgical procedures.

Abstract P46: 20 Year Review of Merkel Cell Carcinoma from a Single Institution

Myopericytoma is a slow-growing, benign soft tissue neoplasm that arises from perivascular smooth muscle cells. This tumor is a rare entity itself, but it is only scarcely mentioned in the literature occurring secondary to trauma. The authors report a 21-year-old male patient who presented with a pulsatile mass in the medial canthal area where he had experienced previous trauma from a car accident 1-year prior. The mass was excised and histopathology revealed myopericytoma. This clinical report adds to the limited body of evidence supporting trauma as an etiology for this rare tumor.

Abstract 47: Natural History of Total Knee Arthroplasty Following Soft Tissue Defect Reconstruction with Flaps

PURPOSE: Infections following total knee arthroplasty (TKA) often result in plastic surgery consultation in attempt to salvage the prosthesis. Muscle and fasciocutaneous flaps have become a mainstay of this salvage reconstruction.1,2 These flaps often lead to short-term success.3-5 However, does short-term success result in long-term knee salvage? Does flap reconstruction help eradicate infection when a large foreign body must be maintained in the wound? Or does the flap merely suppress the infection with later failure of the knee reconstruction? We have attempted to answer these questions by retrospectively analyzing a large number of TKA reconstructions requiring muscle or fasciocutaneous flap coverage.