Expanding the Progressive Tension Suture Concept: A Study of its Utility in Body Contouring Procedures

2021 ◽  
Author(s):  
Nneamaka Agochukwu-Nwubah ◽  
Christopher Patronella
Keyword(s):  
Body Contouring ◽  
Wound Dehiscence ◽  
Diep Flap ◽  
Potential Space ◽  
Effective Technique ◽  
Patient Demographics ◽  
Progressive Tension Sutures ◽  
Latissimus Flap ◽  
Flap Procedure

Abstract Background Seroma is one of the most common complications following body contouring. Progressive tension sutures have been shown to decrease the seroma rate following abdominoplasty, component separation, facelifts and following latissimus flap and DIEP flap harvest. Objectives The objective of our study was to look at the effects of progressive tension suture techniques and their role on the seroma rate in body contouring flap procedures. Methods A retrospective review was performed of all patients undergoing a flap procedure (defined as any procedure that produces a dead space and subsequent susceptibility to seroma) by a single surgeon at a single institution over 3 years. All patients/procedures utilized progressive tension techniques, as is routine in the surgeon’s practice. No drains were used. Patient demographics and complications, including seroma, were tracked. Results A total of 441 flap procedures were performed in 351 patients over the 3-year study period. There were 305 abdominoplasties, 68 lower body lifts, 17 medial thigh lifts, 36 brachioplasties and 15 torsoplasties. Progressive tension sutures were used in all procedures. No drains were utilized. Complications occurred in 72 procedures (16.3%), with the most common complication being minor wound dehiscence without infection. There were no cases of seroma. Conclusions Progressive tension sutures represent an effective technique for reducing the seroma rate, eliminating the potential space and promoting tissue adherence in flap procedures for body contouring. This is the first study of its kind demonstrating the use and role of this technique in body contouring procedures beyond the scope of abdominoplasty.

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

2021 ◽  
Author(s):  
Taehee Jo ◽  
Dong Nyeok Jeon ◽  
Hyun Ho Han
Keyword(s):  
Donor Site ◽  
Wound Dehiscence ◽  
Diep Flap ◽  
Separate Analysis ◽  
Flap Reconstruction ◽  
Average Body Mass Index ◽  
Deep Inferior Epigastric Perforator ◽  
Average Body Mass ◽  
Artery Perforator ◽  
Average Body

Abstract Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

scholarly journals Significance and Impact of the Intersphincteric Plane Sepsis in the Management of the Perianal Sepsis: Ultrasound Study

2021 ◽  
Author(s):  
Ashraf Talaat Youssef
Keyword(s):  
Digital Rectal Examination ◽  
Perianal Fistula ◽  
Final Diagnosis ◽  
Abscess Formation ◽  
Study Group ◽  
Potential Space ◽  
Anal Glands ◽  
Ultrasound Study ◽  
Perianal Sepsis

Abstract Background The intersphincteric plane (ISP) is a potential space between the external and the internal anal sphincters. About 90% of the perianal sepsis is caused by an obstruction of the ducts of anal glands with subsequent secondary bacterial infection. The imaging modalities used to diagnose perianal sepsis are the ultrasound via endoanal and transperineal routes and magnetic resonance imaging. Objective  The study aimed to identify the various patterns of the ISP sepsis and their incidence among our study group and to clarify the significance of ISP in the pathogenesis of anorectal abscesses and various types of perianal fistula tracts, to optimize the surgical management. Methods Retrospective descriptive study in which 57 patients with an ISP sepsis were evaluated with full medical history, clinical exam, and ultrasound; the final diagnosis was based on combining the results of ultrasound, digital rectal examination under anesthesia, and the operative results. Results The current study showed many patterns of the ISP sepsis and estimated the incidence of each pattern among our study group; such patterns could be fistula tracts, sinus tracts, abscesses, intersphincteric abscess with supralevator extension, sinus with abscess formation, fistula with abscess formation, distension of the ISP with free pus, and other complex patterns like horse abscess, abscess with transsphincteric sinus, and ISP fistula/sinus with transsphincteric branches. Conclusion Understanding the role of the ISP in the pathogenesis of anorectal abscesses and perianal fistula tracts can help in reaching the optimum way of management.

scholarly journals Inevitable future: space colonization beyond Earth with microbes first

2019 ◽  
Vol 95 (10) ◽  
Author(s):  
Jose V Lopez ◽  
Raquel S Peixoto ◽  
Alexandre S Rosado
Keyword(s):  
Potential Space ◽  
Public And Private ◽  
Planetary Protection ◽  
Overwhelming Evidence ◽  
Future Space ◽  
Private Research ◽  
Life On Earth ◽  
Space Colonization ◽  
Future Plans

ABSTRACT Based on modern microbiology, we propose a major revision in current space exploration philosophy and planetary protection policy, especially regarding microorganisms in space. Mainly, microbial introduction should not be considered accidental but inevitable. We hypothesize the near impossibility of exploring new planets without carrying and/or delivering any microbial travelers. In addition, although we highlight the importance of controlling and tracking such contaminations—to explore the existence of extraterrestrial microorganisms—we also believe that we must discuss the role of microbes as primary colonists and assets, rather than serendipitous accidents, for future plans of extraterrestrial colonization. This paradigm shift stems partly from the overwhelming evidence of microorganisms’ diverse roles in sustaining life on Earth, such as symbioses and ecosystem services (decomposition, atmosphere effects, nitrogen fixation, etc.). Therefore, we propose a framework for new discussion based on the scientific implications of future colonization and terraforming: (i) focus on methods to track and avoid accidental delivery of Earth's harmful microorganisms and genes to extraterrestrial areas; (ii) begin a rigorous program to develop and explore ‘Proactive Inoculation Protocols’. We outline a rationale and solicit feedback to drive a public and private research agenda that optimizes diverse organisms for potential space colonization.

scholarly journals Flap fixation in preventing seroma formation after mastectomy: an updated meta-analysis

2021 ◽  
Author(s):  
Nunzio Velotti ◽  
Gennaro Limite ◽  
Antonio Vitiello ◽  
Giovanna Berardi ◽  
Mario Musella
Keyword(s):  
Meta Analysis ◽  
Seroma Formation ◽  
Secondary Outcome ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Inclusion Criteria ◽  
Effective Technique ◽  
Strong Evaluation ◽  
Flap Fixation

AbstractSeroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013).The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction.

scholarly journals The role of inflammation in adipocytolytic nonsurgical esthetic procedures for body contouring

2017 ◽  
Vol Volume 10 ◽  
pp. 57-66 ◽  
Author(s):  
Jonathas Pereira ◽  
Yuri Cavalcante ◽  
Riane Wanzeler
Keyword(s):  
Body Contouring

scholarly journals Systemic Endotoxin in Peritoneal Dialysis Patients

2018 ◽  
Vol 38 (5) ◽  
pp. 381-384 ◽  
Author(s):  
Ali M. Shendi ◽  
Nathan Davies ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Extracellular Volume ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Fungal Cell ◽  
Membrane Function ◽  
Patient Demographics ◽  
Markers Of Inflammation ◽  
Systemic Endotoxemia

Previous reports linked systemic endotoxemia in dialysis patients to increased markers of inflammation, cardiovascular disease, and mortality. Many peritoneal dialysis (PD) patients use acidic, hypertonic dialysates, which could potentially increase gut permeability, resulting in systemic endotoxemia. However, the results from studies measuring endotoxin in PD patients are discordant. We therefore measured systemic endotoxin in 55 PD outpatients attending for routine assessment of peritoneal membrane function; mean age 58.7 ± 16.4 years, 32 (58.2%) male, 21 (38.2%) diabetic, median duration of PD treatment 19.5 (13 – 31) months, 32 (58.2%) using 22.7 g/L dextrose dialysates, and 47 (85.5%) icodextrin. The median systemic endotoxin concentration was 0.0485 (0.0043 – 0.103) Eu/mL. We found no association between endotoxin levels and patient demographics, markers of inflammation, serum albumin, N-terminal pro-brain natriuretic peptide, extracellular volume measured by bioimpedance, blood pressure, PD prescriptions or peritoneal membrane transporter status, or medications. The measurement of endotoxin can be lowered by failure to effectively release protein-bound endotoxin prior to analysis and increased by contamination when taking blood samples and processing and storing the samples. Additionally, contamination with β–glucan from fungal cell walls and the use of different assays to analyze endotoxin can also give differing results. These factors may help to explain the disparate results reported in different studies. Our study would suggest that exposure to standard peritoneal dialysates does not substantially increase systemic endotoxin. However, until endotoxin assays can measure free and bound endotoxin separately, the role of endotoxin causing inflammation in PD patients remains to be determined.

‘Lipo-tourism’ gone wrong: blood transfusion-transmitted cytomegalovirus disease

2021 ◽  
Vol 14 (3) ◽  
pp. e236892
Author(s):  
Mark Brahier ◽  
Rhanika Neuda ◽  
William Davis ◽  
Rita Poon
Keyword(s):  
Blood Transfusion ◽  
Medical Tourism ◽  
Wound Dehiscence ◽  
Immunocompetent Patient ◽  
Cytomegalovirus Disease ◽  
Diagnostic Challenge ◽  
Risks And Benefits ◽  
Life Threatening ◽  
Cmv Disease

Medical tourism is the pursuit of more affordable surgeries; however, this comes at the risk of suboptimal standards and potential for life-threatening complications. In this case, we describe the diagnostic challenge of cytomegalovirus (CMV) pneumonia in a 40-year-old woman who experienced wound dehiscence and subsequent blood transfusion-transmitted CMV as complications of liposuction in the Dominican Republic. We explore the role of histopathology in the diagnosis of disseminated CMV, discuss the underlying aetiology of CMV pneumonia in this patient and weigh the risks and benefits of initiating antiviral therapy in an immunocompetent patient with CMV disease.

scholarly journals Effects of Bariatric Surgery on Depression: Role of Body Image

2020 ◽  
Author(s):  
Simone C. Behrens ◽  
Konrad Lenhard ◽  
Florian Junne ◽  
Katrin Ziser ◽  
Jessica Lange ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Image ◽  
Depressive Symptoms ◽  
Psychosocial Functioning ◽  
Body Contouring ◽  
The Body ◽  
Negative Evaluation ◽  
Psychological Interventions ◽  
Patient Health

Abstract Background It has been suggested that psychosocial functioning improves after bariatric surgery, but the mechanism of this effect remains unclear. We propose that body image mediates the association between %EWL and improvement in depressive symptoms. Materials and Methods To investigate this hypothesis, we conducted a mediation analysis in longitudinal data from 52 patients after LSG. Results %EWL had no direct effect on depressive symptoms as assessed through the patient health questionnaire (PHQ-9), but a small indirect effect that was mediated through negative evaluation of the body (BIQ-20). Conclusions We interpret this observation in the context of complex individual etiologies of obesity and argue for a stronger focus on psychological interventions in aftercare regimes. This may be specifically relevant for patients with eating disorders or a desire for body contouring surgery.

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