Valerio Cervelli

How fat is obese

Abstract.The aim of the study was a comparison between body fat measurements and body mass index. We analyzed the data of 890 subjects, 596 females and 294 males, ranging in age from 18 to 83 years, in body mass index (BMI) from 14 to 54 kg/m2, and in body fat percentage (BF%) from 4% to 57%. A considerable number of subjects, both males and females, could not be classified as obese based on their BMI alone. Such a misclassification is undesirable, especially in general practice, and it calls for diagnostic criteria other than the BMI alone to be used for obesity.

Nanocrystalline silver: a systematic review of randomized trials conducted on burned patients and an evidence-based assessment of potential advantages over older silver formulations.

The aim of this meta-analysis was to collect data from randomized trials in burn patients and to analyze them with a meta-analytic approach to give a clear message of potential advantages of nanocrystalline silver (NC) versus older silver formulations (SS).A review of all-English prospective randomized trials that compared NC versus silver sulfadiazine or silver nitrate was conducted. Primary outcome was the evaluation of differences in the infection rate of burns. Secondary outcomes were the eventual differences in the pain experienced during medications, the length of hospitalization (LOS) and costs.Five articles that met the inclusion criteria were selected (n = 285 patients). The NC group had a significant lower incidence of infections compared with the SS group (9.5% vs. 27.8%, odds ratio: 0.14 [95% CI: 0.06–0.35]; &khgr;2 test, P < 0.001), with a 2.9-fold decrease of the risk. Not all studies investigated the pain during change of dressings, LOS and costs. However, when data were available, these showed lower costs (US

Infections of Breast Implants in Aesthetic Breast Augmentations: A Single-Center Review of 3,002 Patients

1533 per patient for the SS group and US

A Retrospective Analysis of 3,000 Primary Aesthetic Breast Augmentations: Postoperative Complications and Associated Factors

946 per patient for the NC group) and decreased pain values in the NC group (Hedges’ G: −1.44 [95% CI: −1.86/−1.01]; P < 0.0001), while contrasting results were obtained for LOS.Nanocrystalline silver is a relatively new product with a significant stronger antimicrobial activity compared with older formulations. Its long lasting properties reduce dressing change frequency and are probably responsible for the decreased pain and the minor costs experienced.

Concise Review: Adipose-Derived Stromal Vascular Fraction Cells and Platelet-Rich Plasma: Basic and Clinical Implications for Tissue Engineering Therapies in Regenerative Surgery

BackgroundA large retrospective analysis examined primary aesthetic breast augmentations to find specific factors that could favor or counteract the occurrence of infections.MethodsData were collected from the personal databases of two different surgeons at the Crown House Hospital, Oldbury, Birmingham, United Kingdom, from January 1999 to December 2004. All the patients who received primary aesthetic breast augmentation with or without associated mastopexy were recorded.ResultsA total of 3,002 women were reviewed. Infections were experienced by 33 patients (1.1%). The analysis showed that Mentor prostheses and local antibiotics both were protective against the occurrence of infections (p < 0.05). On the contrary, the use of drains significantly increased the risk fivefold (p < 0.05).ConclusionsThe incidence of infections in aesthetic breast augmentations is 1.1%, and Mentor prostheses, antibiotics in the pocket, and the use of drains seem associated with their occurrence.

Predicting fat-free mass in children using bioimpedance analysis

BackgroundA large retrospective analysis was performed on a homogeneous group of patients undergoing primary aesthetic breast augmentations to define complication rates and find associated factors.MethodsData were collected from the personal databases of two different surgeons working at the Crown House Hospital, Oldbury, Birmingham, United Kingdom. The period considered was January 1996 to December 2001. All patients who received primary breast augmentation with or without associated mastopexy for cosmetic purposes were recorded.ResultsA total of 3,002 women were included in the study. Hematomas were present in 46 patients (1.5%), infections in 33 patients (1.1%), breast asymmetries in 23 patients (0.8%), rippling in 21 patients (0.7%), and capsular contractures in 14 patients (0.5%). The multivariate analysis found that implant placement and the technique used for pocket creation were variables associated with complications (p < 0.05). Capsular contractures carried a progressive cumulative risk and, in our series, appeared 5 years after surgery. No association was found between contractures and hematomas or infections.ConclusionsThe overall incidence of complications in our series was relatively high (4.6%). Surgical placement of prostheses and the technique used for pocket creation were associated with complications. However, few patients required reoperation (1.6%), and the overall satisfaction rate was acceptable (visual analog score, 7).

Obese and Nonobese Patients: Complications of Abdominoplasty

Cell‐based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing loss of substance or volume and tissue or organ damage. Recently, many authors have focused their attention on mesenchymal stem cells for their capacity to differentiate into many cell lineages. The most widely studied types are bone marrow mesenchymal stem cells and adipose‐derived stem cells (ADSCs), which display similar results. Based on the literature, we believe that the ADSCs offer advantages because of lower morbidity during the harvesting procedure. Additionally, platelet‐rich plasma can be used in this field for its ability to stimulate tissue regeneration. The aims of this article are to describe ADSC preparation and isolation procedures, preparation of platelet‐rich plasma, and the application of ADSCs in regenerative plastic surgery. We also discuss the mechanisms and future role of ADSCs in cell‐based therapy and tissue engineering.

Pulmonary embolism after combined abdominoplasty and flank liposuction: a correlation with the amount of fat removed.

Abstract.Body composition assessment is a useful procedure for the study of nutritional status and water distribution. In adults, it is a predictor of morbidity and mortality, since body fatness is associated with risk factors for cardiovascular disease. Bioelectric impedance analysis (BIA) is a simple, safe, and inexpensive method for assessment of body composition both in pediatric and adult subjects. The aim of our study was to validate the impedance index, ZI (H2/Z, height in cm2/impedance), as a predictor factor of fatfree mass (FFM) and fat mass (FM) in a sample (n=75) of normal children. Dual-energy X-ray absorptiometry (DXA) was chosen as reference method. Despite some minor bias, DXAis considerably less expensive and easier to administer in pediatric subjects than other established gold standard reference methods for assessing body composition. ZI values were highly correlated with FFM measured with DXA. The following equations were obtained from the regression analysis: (a) male subjects, FFMDXA=0.6375 (ZI)+5.9913, r2=0.897, p<0.0001; (b) female subjects, FFMDXA=0.7597 (ZI)+ 3.5853, r2=0.903, p<0.0001. These data support the notion that BIA alone can be used as a surrogate to measure FFM in a pediatric sample.

Breast Reconstruction with Autologous Fat Graft Mixed with Platelet-Rich Plasma

We analyzed 80 patients who underwent abdominoplasty at the University of Tor Vergata “Policlinico Casilino”, Rome to determine the effect of obesity on the incidence of complications after this surgery. The study patients were divided into 3 groups, obese, overweight, and normal weight, based on the degree to which their preoperative weights varied from their ideal body weight. A history of previous bariatric surgery was also analyzed to determine what impact that might have on subsequent abdominoplasty. Results showed that the records of 80 patients who underwent an abdominoplasty at University of Tor Vergata Policlinico indicated that 76% of obese patients had complications compared with the overweight and normal-weight patients, who had complication rates of 35% and 33%, respectively. Previous gastric bypass surgery had no significant effect on the incidence of postabdominoplasty complications. Based on these findings, the authors conclude that obesity at the time of abdominoplasty has a profound influence on the wound complication rate following surgery, regardless of any previous weight-reduction surgery.

The use of MatriDerm® and skin grafting in post-traumatic wounds

Background:We prospectively followed patients who underwent esthetic abdominoplasty and flank liposuction to determine the influence of the amount of fat removed on the occurrence of pulmonary embolism. Materials and Methods:We recruited patients undergoing abdominoplasties and flank liposuction and composed 2 groups according to the amount of fat removed, one of small resections (<1500 g) and the other of great resections (>1500 g). All patients received deep vein thrombosis prophylaxis. Results:Since January 2005, we enrolled 103 patients and registered 3 embolisms (2.9%). All occurred in nonsmokers, had no risk factor for deep vein thrombosis, and a resection weight greater than 1500 g (21.4%; 3/14). The calculated relative risk conferred by the amount of fat greater than 1500 g was 7.4. An association was also found with duration of surgery: all embolisms occurred in patients that underwent long operation (>140 minutes; 8.8%; 3/34) with a relative risk of 3.0. Conclusions:The amount of fat removed during plastic surgery is a factor influencing the occurrence of pulmonary embolism in patients undergoing abdominoplasty/flank liposuction, and the duration of surgery is a concomitant factor. Should this data be confirmed, specific measures for prevention of this serious complication could be developed.