Umbilicoplasty in Abdominoplasty: Modifications for Improved Aesthetic Results.
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ABSTRACT:
SUBMITTER: Hespe GE
PROVIDER: S-EPMC8374960 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe goals of abdominoplasty in massive weight loss (MWL) patients are often functional, with a greater emphasis on safety than on aesthetic rejuvenation. As important as functional improvements and safety are, however, there may be room for increasing the aesthetic potential of abdominoplasties in these patients.ObjectivesTo determine the safety of the pursuit of aesthetic goals for abdominoplasty in MWL patients.MethodsThis is a retrospective study examining 910 consecutive female patients consisting of 3 groups: postpartum (n = 718), dietary MWL (n = 65), and bariatric MWL (n = 127). All patients were approached with a well-defined set of aesthetic goals which were pursued as needed and as feasible.ResultsThe utilization of aesthetic abdominoplasty components was similar in all groups, supporting the assertion that the groups were subjected to a similar aesthetic emphasis. Logistic regression showed that a history of bariatric MWL was an independent risk factor for multiple complications (odds ratio 2.738, P = 0.014) and that elevated body mass index (BMI), smoking, diabetes, and age were likewise independent risk factors for complications. Propensity score-matched case-control pairs showed that bariatric MWL patients were more likely than dietary MWL patients to experience multiple complications (9.52% vs 0%, P = 0.031).ConclusionsBariatric MWL patients but not dietary weight loss patients seem to have a higher risk than postpartum patients. Other comorbidities (elevated BMI, smoking, diabetes, and age) seem to be more important predictors of complications than MWL status. Select MWL patients can likely be approached with an emphasis on aesthetic goals, without increasing risks as compared with the postpartum population.Level of evidence 2
| S-EPMC8240744 | biostudies-literature
Project description:BackgroundFew studies have examined the impact of abdominoplasty on chronic back pain.ObjectivesThe aim of this study was to test our hypothesis that patients undergoing abdominoplasty with anterior abdominal wall plication will show significant improvements in back pain and physical function compared with those without plication.MethodsWe utilized Current Procedural Terminology (CPT) codes to identify patients who underwent abdominoplasty with the senior author over a 10-year period. The Oswestry Disability Index (ODI) and the RAND 36-Item Short-Form Health Survey (SF-36) were administered. All patients indicating preoperative back pain were reviewed.ResultsOf 338 patients, 143 surveys (42.3%) were returned; 51 patients (35.7%; n = 28 aesthetic, n = 23 massive weight loss) reported preoperative back pain on the ODI. Paired t tests compared overall and strata-specific changes in ODI and SF-36 pre- and postsurgery. Multivariable linear regression models were fitted to model relations between scores and plication, adjusting for presurgery scores and patient variables. There were significant improvements in overall patient cohort in ODI (-15.14), SF-36 physical function (19.92), and pain (17.42) (P < 0.001), as well as when patients were stratified by plication status. However, outcomes between those with plication and those without were not significantly different.ConclusionsAbdominoplasty with and without anterior abdominal wall plication significantly improves ODI and SF-36 scores relating to physical function and pain, in both aesthetic and massive weight loss patients. Outcomes did not differ based on plication status. All patients with preoperative back pain showed improvement regardless of operation performed, suggesting that abdominoplasty with or without abdominal wall plication improves chronic back pain in this patient population.Level of evidence: 4
| S-EPMC7676454 | biostudies-literature
Project description:BackgroundAbdominoplasty has been evolving since the 1960s with many technical innovations throughout the years. It has become one of the most frequent and common procedures done in aesthetic plastic surgery, with the ultimate goal of not only to remove the excess tissue in the abdominal area but also to achieve an aesthetic trunk silhouette.ObjectiveThe prime objective of this article was to describe our preferred approach for a full cosmetic abdominoplasty.MethodsWe summarized all the key technical aspects from our shared surgical approach for abdominoplasty. The article describes collective experiences from authors performing the surgery in South America, North America, and Asia.ResultsThe key technical aspects identified were conservative muscle plication, customized excess tissue resection, and ultrasound-assisted liposuction to improve definition in the abdominal lines and body curves, combined with lipofilling. The aesthetic results are presented.ConclusionsAbdominoplasty should be customized to every patient's anatomy and desired cosmetic outcome, taking into consideration all the anatomical areas surrounding the abdominal wall.
| S-EPMC7969168 | biostudies-literature
Project description:BACKGROUND:An increasing number of patients need reconstructive surgery after massive weight loss. The hypothesis was that surgical experience together with standardised management guidelines significantly decreases early complication rates after abdominoplasty for massive weight loss. The primary aim was to assess the 30-day complication rate after abdominoplasty following increased surgical training and experience. The secondary aim was to assess whether optimised management guidelines have an impact on the complication rate and patient safety. METHODS:The outcome of 69 consecutive abdominoplasties operated by surgeons in 2011 (Group A) and 70 consecutive patients operated by plastic surgeons in 2010-2012 (Group B) was compared. Another Group of 70 consecutive patients operated by surgeons in 2013-2014 (Group C) was assessed since standardised guidelines for pre- and post-operative treatments and refinement of surgical technique had been introduced. The same surgeons participated in operations of Groups A and C. ? 2-test and Fisher's exact test were applied to dichotomous data. Logistic regression test and ANOVA were used. RESULTS:Group C had more comorbidities and was significantly older. 48 patients in Group A (70%), 31 in Group B (44%) and 13 patients in Group C (19%) had early complications. A significantly decreased rate of complications occurred with improved guidelines and surgical training and experience. (A vs. C p < 0.001 and A vs. B p = 0.008). CONCLUSIONS:Our results indicate that the rate of early complications after abdominoplasty for massive weight loss can be significantly reduced with improved surgical experience and standardised management guidelines. Registered at Clinical Trial.gov (ID: NCT02679391).
| S-EPMC5934449 | biostudies-literature
Project description:BackgroundDimples on the cheeks can make the smile look more cheerful and attractive. Therefore, some people who do not have dimples may choose to undergo dimple creation surgery. Although dimple surgery is quite common, those desiring this procedure often lack information about it. Therefore, we conducted the present study to share our surgical tips and clinical experiences regarding safe dimple creation surgery.MethodsThis study included 2,048 patients who underwent dimple creation surgery at our plastic surgery clinic between April 2010 and June 2014. These patients were selected from those who displayed no scarring from injury or tumor removal in the central face during the presurgical evaluation. Medical records were used to identify the age and sex of each patient, the location of dimple creation, any postoperative complications, reoperation, and the reason for reoperation.ResultsOf the 2,048 patients, 159 (7.7%) underwent reoperation. The reason for reoperation was undercorrection in 78 cases (49.0%), disappearance of the dimple in 62 cases (38.9%), and overcorrection in nine cases (5.6%). Five patients (3.1%) had their stitches removed to eliminate the created dimple because they changed their minds, and five patients (3.1%) had their stitches removed because of infection. No patients reported complications after reoperation, and no other complications, such as hyperpigmentation or foreign body reaction, were observed.ConclusionsSafe surgery with minimal complications and satisfying cosmetic results can be achieved via accurate knowledge of the relevant anatomy and its relationship with dimples, as well as appropriate surgical methodology.
| S-EPMC7520249 | biostudies-literature
Project description:Hypodontia often leads to limited bone availability of the alveolar ridges. Oral rehabilitation of severe hypodontia patients is challenging. In this retrospective study, we evaluated the functional and aesthetic results after dental implants in hypodontia patients, corroborated by Albrektsson implant success criteria. Over a period of 15 years (2000-2015), a total of 43 patients were diagnosed with hypodontia and 165 dental implants were inserted. Six patients who received 10 implants were lost in the follow-up. We examined 155 implants in 37 patients between December 2015 and May 2017. Besides family history, patients evaluated the general satisfaction, functionality, and aesthetics of the implants. Study subjects were between 17 and 44 years old (mean ± SD: 21.4 ± 5.6). Hypodontia patients were missing one to five teeth (n = 28), whereas patients diagnosed with oligodontia (?6 missing teeth, n = 9). In this study, 24 patients (64.9%) with hypodontia had a positive family history; the remaining 13 patients had no family member with hypodontia. The final follow-up time ranged between 5 and 189 months after implant placement. Orthodontic treatment was performed in 32 patients (86%) before implant placement. Rehabilitation resulted in 62% of the cases being treated with 1-2 implants and 38% treated with 3-15 implants. However, out of 155 inserted dental implants, 18 implants failed to meet Albrektsson criteria, under which two implants were removed. Only autografts were used for bone augmentation with 97 implants. More than two-thirds of the patients showed high general satisfaction and masticatory function (69.4%) as well as phonetic ability (80.6%). The aesthetic outcome was rated as excellent by 17 patients (47.2%). The findings emphasize the importance of interdisciplinary treatment of hypodontia, leading to a satisfactory, functional, and long-term fixed prosthodontics using dental implants.
| S-EPMC6832447 | biostudies-literature
Project description:CRISPR/Cas is a transformative gene editing tool, that offers a simple and effective way to target a catalytic Cas9, the most widely used is derived from Streptococcus pyogenes (SpCas9), with a complementary small guide RNA (sgRNA) to inactivate endogenous genes resulting from insertions and deletions (indels). CRISPR/Cas9 has been rapidly applied to basic research as well as expanded for potential clinical applications. Utilization of spCas9 as an ribonuclearprotein complex (RNP) is considered the most safe and effective method to apply Cas9 technology, and the efficacy of this system is critically dependent on the ability of Cas9 to generate high levels of indels. We find here that novel sequence changes to the tracrRNA significantly improves Cas9 activity when delivered as an RNP. We demonstrate that a dual-guide RNA (dgRNA) with a modified tracrRNA can improve reporter knockdown and indel formation at several targets within the long terminal repeat (LTR) of HIV. Furthermore, the sequence-modified tracrRNAs improved Cas9-mediated reduction of CCR5 surface receptor expression in cell lines, which correlated with higher levels of indel formation. It was demonstrated that a Cas9 RNP with a sequence modified tracrRNA enhanced indel formation at the CCR5 target site in primary CD4+ T-cells. Finally, we show improved activity at two additional targets within the HBB locus and the BCL11A GATA site. Overall, the data presented here suggests that novel facile tracrRNA sequence changes could potentially be integrated with current dgRNA technology, and open up the possibility for the development of sequence modified tracrRNAs to improve Cas9 RNP activity.
| S-EPMC6834579 | biostudies-literature
Project description:ObjectivesAbdominoplasty is a very common surgery nowadays and mainly performed as an office-based procedure. Spinal anesthesia is assumed to be safer than general anesthesia in such operations. The aim of this study is to compare between spinal and general anesthesia for abdominoplasty.Patients and methodsTwo hundred patients undergoing abdominoplasty, American Society of Anesthesiologists physical status classes I and II, were enrolled in this randomized prospective study. One hundred patients were operated upon under general anesthesia (Group G) and another one hundred patients under spinal anesthesia (Group S). Any intraoperative complications such as hypotension, bradycardia, pain, shivering, nausea, and vomiting related to anesthesia were managed and recorded. Visual analog scale was used to assess postoperative pain severity and the need for analgesia to be administered till 12 h postoperatively.ResultsThere was no significant difference as regards patient's satisfaction in both groups although it was lower in Group G than in Group S. There were significant differences in between both groups as regards postoperative nausea and vomiting, early demand for analgesic and total dose of pain killer consumed in 12 h postoperatively which were higher in Group G than in Group S.ConclusionSpinal anesthesia can be an effective anesthetic technique for office-based abdominoplasty with less postoperative complications when compared with general anesthesia for short procedures with no extensive dissection and positioning.
| S-EPMC6545934 | biostudies-literature
Project description:While RNAi has traditionally relied on RNA duplexes, early evaluation of siRNAs demonstrated activity of the guide strand in the absence of the passenger strand. However, these single strands lacked the activity of duplex RNAs. Here, we report the systematic use of chemical modifications to optimize single-strand RNA (ssRNA)-mediated mRNA knockdown. We identify that 2'F ribose modifications coupled with 5'-end phosphorylation vastly improves ssRNA activity both in vitro and in vivo. The impact of specific chemical modifications on ssRNA activity implies an Ago-mediated mechanism but the hallmark mRNA cleavage sites were not observed which suggests ssRNA may operate through a mechanism beyond conventional Ago2 slicer activity. While currently less potent than duplex siRNAs, with additional chemical optimization and alternative routes of delivery, chemically modified ssRNAs could represent a powerful RNAi platform.
| S-EPMC3351186 | biostudies-literature
Project description:PurposeMeshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba.MethodsInclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates.ResultsSSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men.ConclusionRepair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis.
| S-EPMC8370955 | biostudies-literature