Physical measurements and patients’ perception of excess skin on arms and thighs before and after bariatric surgery

Background Bariatric surgery is an effective weight loss method for patients with obesity. One side effect of bariatric surgery is uncomfortable excess skin. Much remains to be learned about physical measurements and patients’ subjective perceptions of it. Here, we investigated the pre- to post-bariatric changes in patients’ perception and physical measurements of the skin on the arms and thighs, in order to find possible subgroups especially affected by post-operative excess skin and to identify predicting factors. Methods One hundred forty-seven patients eligible for bariatric surgery completed the Sahlgrenska Excess Skin Questionnaire (SESQ) and underwent measurements of their skin before and 18 months after the procedure. Results Although most physical measurements decreased post-operatively, many patients reported increased discomfort. We identified one subgroup particularly prone to report excess skin on the arms post-operatively: women with high discomfort from excess skin on the arms and high body mass index (BMI), pre-operatively. Ptosis of the excess skin seems to be a feasible measurement for predicting post-operative discomfort. For every centimetre of ptosis pre-operatively, patients had 1.37- and 1.31-fold higher odds of achieving a score for post-operative discomfort from excess skin on the upper arms and thighs, respectively, of ≥ 6 (on a 0–10 scale). Conclusions We identified a subgroup especially affected by discomforting excess skin on arms and thighs after weight loss. Furthermore, we suggest a pre-operative pro-operative ptosis measuring to predict post-operative discomfort level. The result of this study further increases the knowledge of excess skin and should be useful in further improving patient education. Level of Evidence: Level III, risk / prognostic study.

Transumbilical Repair for Umbilical Hernia: A New Technique

Although there are many reports on surgical repair for umbilical hernia, there is no standard procedure at present. Since 2012, we have performed surgery with transumbilical repair using an original procedure. With this procedure, a longitudinal incision is made in the umbilicus, and the fascial defect is closed. Excess skin is excised at a fixed length. The fascia and dermis are sutured vertically over a length of 15 mm. A total of 424 patients with pediatric umbilical hernia who underwent this procedure between September 2012 and December 2020 were reviewed. The mean operative duration was 52 minutes. All patients were followed up to 6 months after surgery. Postoperative complications included infection in 15 patients and wound granulation in 5 patients. The morphology of the umbilicus is natural and satisfying. We conclude that this procedure is safe and simple and the results are satisfactory.

A clinical case of successful treatment of a giant serous endometrial carcinoma imitating ovarian cancer

Background: Giant tumors of the abdominal cavity, as a rule, occur in elderly patients with characteristic features and represent a serious problem in terms of choosing a radical method of therapy. Of particular difficulty are cases of giant serous endometrial cancer, requiring a differential diagnosis with ovarian cancer. Clinical case description: A clinical case of giant serous endometrial cancer mimicking ovarian cancer in a 55-year-old woman is presented. The patient came to the oncology department with complaints of abdominal enlargement, difficulty breathing and bloody discharge from the genital tract. The examination revealed the following: a giant formation (4065 cm), occupying the entire pelvic and the entire abdominal cavities, ascites, lesions of the retroperitoneal lymph nodes, and the greater omentum, an umbilical hernia. A chest CT showed multiple contrast-accumulating circular shadows of 313 mm (metastases). By the decision of the council, after the preliminary chemoembolization of both the uterine and ovarian arteries, a supravaginal amputation of the uterus with appendages was performed, along with the resection of the greater omentum, removal of the umbilical hernia with positioning a plastic mesh implant and excision of an excess skin flap. The histological examination of the intraoperative material made it possible to verify the diagnosis of a serous endometrial carcinoma with subtotal tumor necrosis, the myometrium invasion of more than a half of its thickness, with the egress to the perimetrium, metastatic lesions of both ovaries, the greater omentum, anterior abdominal wall. Stage T3b (FIGO IIIB). In the postoperative period, 6 courses of Paclitaxel / Carboplatin (AUC4-5) chemotherapy were carried out with a pronounced clinical effect. The patient was discharged in a satisfactory condition. The control PET-CT scan after the 6th chemotherapy course showed no pathology in the thoracic cavity, and no process progress in the abdominal cavity. Currently, the remission of the disease is 9 months. Conclusion: An algorithm for the diagnostic measures aimed at making the correct diagnosis is presented, and the tactics of treating a patient with giant serous endometrial cancer is described.

High-Definition Liposuction Body Scale: Expanding Indications for High-Definition Liposuction

Introduction: Performing optimal gluteal augmentation using traditional methods in moderate to severe weight-loss patients poses a surgical challenge as such patients typically present with (1) severe skin redundancy, (2) soft tissues containing high-density connective tissues than fat content, and (3) ptotic buttock cheeks. Materials and Methods: This procedure uses a modified lateral thigh and buttock tuck excision not only to lift the buttock cheek complex but also to create a dermal fat flap that is transposed into the upper buttock pole to achieve upper buttock fullness. The remainder of the excised tissue undergoes novel ex vivo liposuction while remaining sterile, which allows for simultaneous repair of the created excision line. Results: This novel ex vivo liposuction technique provides several advantages that include (1) limiting operative time, (2) allowing for maximal fat removal while avoiding unnecessary trauma to the patient, and (3) providing improved quality with less blood and fat volumes. This ex vivo fat is then transferred to the mid- and lower buttock to complete buttock augmentation for the Brazilian buttock lift. Discussion: Excess skin redundancy and buttock check ptosis require consideration of supplemental excisional tucking to achieve optimal results. In addition, subcutaneous tissues that maintain more connective tissue pose difficulty with fat removal using traditional liposuction techniques. As such, we present a novel surgical technique to optimally augment and shape the buttock in patients who have undergone weight loss. Conclusion: In summary, we present a novel Brazilian buttock lift technique to augment the buttock in weight-loss patients that maximizes both patient safety and efficacy.

Pretarsal orbicularis oculi muscle tightening with skin flap excision in the treatment of lower eyelid involutional entropion

Background To evaluate a modified technique for involutional entropion correction in a retrospective cohort study. Methods The patients with involutional entropion eyelid were corrected by tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid. The patients received correction surgery from April 2013 to March 2019 were followed up for more than 6 months postoperatively. The outcome measures included the complications and the recurrence rates. Results Total 152 patients (169 eyes) were included. The mean follow-up period was 29.6 months (range: 6–36 months). Postoperative ectropion (over-correction) was observed in 1 patient with 1 eyelid (0.59%); yet, no further surgery was needed for this patient. Recurrence of entropion was found in 1 patient (0.59%). The patient with recurrent entropion received repeated surgery with the same method and achieved a good eyelid position. Conclusions This study demonstrated that tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid could be an effective surgical method to correct lower eyelid involutional entropion. This method is technically easy with a low recurrence rate and not associated with significant complications in Asians.

Augmentation mammaplasty by superolateral thoracic flap: a case report

Background The lateral chest wall is intimately associated with the esthetics of the breast. Patients with massive weight loss often have excess skin and fat in the lateral thoracic region causing functional, esthetic, and psychological discomfort. In addition, the breasts exhibit extreme ptosis after weight loss due to a reduction in volume and projection that is exacerbated by qualitative changes in the skin, with loss of its natural elasticity. This article describes a reliable new technique for simultaneous autologous breast augmentation and lateral thoracic dermolipectomy to provide autologous tissue for breast augmentation and simultaneous rejuvenation of the chest wall. Case presentation A 30-year-old Caucasian woman who had lost 58 kg after bariatric surgery had major skin excess sequelae combined with major breast ptosis. She wanted to correct her brachial and lateral thoracic skin and fat excess, as well as rejuvenate her breasts. The lateral thoracic panicle present was harvested and transposed in the retroglandular plane to perform autologous breast augmentation with lateral thoracic dermolipectomy. Results The patient was totally healed and complication-free at day 15. Both esthetic results and patient satisfaction were good at 6 months post-surgery. Conclusions Superolateral thoracic flap augmentation mammaplasty during thoracic dermolipectomy is a simple and safe procedure for selected patients. Durable and natural autologous breast augmentation may be achieved in a single step without the need for a breast implant, while rejuvenating the thoracic region.

Applications and Limitations of Suction Assisted Transverse Medial Thigh Lift

Aims and objectives: Skin laxity or excess can be a part of ageing process and weight loss. Skin laxity or excess is commonly experienced following weight loss around arms, thighs, face and neck, breast and abdomen. Various methods and techniques are described to address these excess skin issues. Liposuction assisted abdominoplasty has been described by Saldanha along with Colour Doppler studies of the superior and inferior epigastric arteries. Similarly DJ Hurwitz has described liposuction assisted brachioplasty. The process allows honeycombing of the subcutaneous tissue when suction lipectomy is performed using blunt tipped cannulas. Process allows creation of a safe plane superior to the deep fascial layer with preservation of the important nerves and vessels. Skin excess is removed without the need of sharp dissection or risks to the underlying structures. Postoperative bleeding and bruising is minimal and most of the instances the procedure is performed as a day case without drains. Patient postoperative analgesia requirements are minimal and allows patient to ambulate early with a quick recovery. Methods: Between 2009 and 2018, 153 suction assisted procedure were performed on various parts of the body. Of the 153 procedures 22 patients had thigh lifts as an outpatient. Results: There was no skin loss, DVT, PE or motor nerve damage. All patients retained sensation of the distal limbs.

Classic versus High Lateral Tension Abdominoplasty in Post-bariatric Patients

Background: Obesity is a chronic condition with a high prevalence and multifaceted etiologies; it is accompanied by an increased risk of morbidity and mortality. Bariatric surgeries (weight loss surgeries) include a variety of procedures performed on people who have obesity. Skin redundancy is a common post-bariatric complication. Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss. This study is a comparison between Classic and High lateral tension abdominoplasty techniques in treatment of abdominal skin redundancy in post bariatric patients. In our research, we compared between two techniques of abdominoplasty in treatment of post bariatric abdominal skin redundancy, the classic technique and High Lateral Tension technique, the comparison was in patient satisfaction and in post operative complications The study showed that patient satisfaction was higher in classic technique than the High lateral tension technique due to smaller and less apparent scar, while post operative complications were almost the same in both techniques According to our study, we advise plastic surgeons to perform classic abdominoplasty technique in treatment of post bariatric abdominal skin redundancy.

Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Introduction The demand for prophylactic mastectomy has increased significantly over the last 10 years. This can be explained by a substantial gain of knowledge about the clinical risk and outcome of patients with high risk mutations such as BRCA1 and 2, the improved diagnostic possibilities for detecting the genetic predisposition for the development of breast cancer and the awareness for those mutations by health care professionals as well as patients. In addition to expander-to-implant reconstruction and microsurgical flap surgery, definitive immediate reconstruction with subpectoral insertion of breast implants is often preferred. The prosthesis is covered at its inferior pole by a synthetic mesh or acellular dermal matrix. In these cases, in addition to the silicone prosthesis, a further foreign body must be implanted. This can be exposed in the event of wound healing disorder or necrosis of the usually thin soft tissue covering after subcutaneous mastectomy, thus calling into question the reconstructive result. In this study, the coverage of the lower pole by a caudal deepithelialized dermis flap, which allows the implant to be completely covered with well vascularized tissue, is compared to coverage by a synthetic mesh or acellular dermal matrix. Patients and methods From January 2014 to June 2020, 74 patients (106 breasts) underwent breast reconstruction following uni or bilateral prophylactic mastectomy. Reconstruction was performed with autologous tissue (15 breasts), with tissue expander or implant without implant support (15 breasts), with implant and use of an acellular dermal matrix or synthetic mesh (39 breasts) and with implant and caudal dermis flap (37 breasts). In this study, we compared the patients with implant and dermal matrix/mesh to the group reconstructed with implant and dermal flap. Results In the group with the caudal dermis flap, 4 patients developed skin necrosis, which all healed conservatively due to the sufficient blood supply through the dermis flap. In the group with the use of a synthetic mesh or acellular dermal matrix, skin necrosis was found in three cases. In one of these patients the implant was exposed and had to be removed. Discussion For patients with excess skin or macromastia, the caudal dermis flap is a reliable and less expensive option for complete coverage of an implant after prophylactic mastectomy. In particular, the vascularized dermis flap can protect the implant from the consequences of skin necrosis after prophylactic mastectomy.

Experience of Excess Skin and Attitude to Body Contouring Surgery of a Chinese Post-Bariatric Population

<b><i>Introduction:</i></b> Western studies have explored post-bariatric patients concerning their views on excess skin and body contouring surgery (BCS), but Asian data were lacking. This study aims to investigate the experience of excess skin and attitude to BCS of a Chinese post-bariatric population. <b><i>Methods:</i></b> A total of 210 Chinese patients who underwent bariatric surgery from March 2015 to September 2018 were cross-sectional studied using the Sahlgrenska Excess Skin Questionnaire and a study-specific questionnaire. <b><i>Results:</i></b> The survey response rate was 61.4%. Most responders (78.2%) reported they had excess skin, and the most common sites were the abdomen (70.2%) and the upper arms (61.3%). Most responders (66.1%) reported being bothered by impaired health-related quality of life (HRQoL), and the most common problem was “the feeling of having unattractive body appearance” (42.7%). Many patients (37.9%) desired for BCS, and “the impact of excess skin is not serious enough” was the reason why not undergoing BCS being chosen most (28.1%), then “the cost is too high” (20.2%) and “worrying about the risk or complications of BCS” (18.4%). Younger age, female gender, higher weight loss, having full-time job, and earning higher income were independent factors increasing their desires for BCS. <b><i>Conclusions:</i></b> Most Chinese post-bariatric patients have excess skin and are bothered by impaired HRQoL. The abdomen and upper arms are the sites where patients are most seriously affected and most eager for BCS. The conservative attitude toward BCS and the cost without reimbursement are the main barriers.