Safety of Outpatient Circumferential Body Lift: Evidence from 42 Consecutive Cases.

BACKGROUND: Circumferential lower body lifts have become more prevalent with the rise of massive weight loss surgery. This has historically required inpatient admission. Only three previous groups have published their experience with outpatient lower body lifts. METHODS: The authors reviewed their experience with 42 consecutive outpatient circumferential body lifts from 2010 to 2016, and report patient demographics, operative details, and postoperative outcomes. Several variables are evaluated for statistical associations with complications and revisions. In addition, the three largest published accounts of inpatient lower body lifts are summarized and presented for comparison, with the data from this group pooled with the three previously published accounts of outpatient circumferential lower body lifts. RESULTS: Forty-two consecutive circumferential lower body lifts were performed with and without a diverse array of other procedures. Average follow-up was 10.4 months. No patients required hospitalization. A complication rate of 36 percent and a revision rate of 26 percent were similar to those for inpatient groups. As with inpatient cohorts, the vast majority of complications were related to minor incisional separations. No statistical association was made between complications or revisions and the presence of (1) multiple surgeons, (2) fleur-de-lis modification, (3) concurrent cosmetic procedures, (4) liposuction, or (5) body mass index greater than 25 kg/m. An association was identified between venous thromboembolic events and admission for circumferential body lift. CONCLUSIONS: The authors report the third largest, and fourth ever, published account of circumferential lower body lift in the English language literature. Based on these data, it safe to offer outpatient lower body lifts to appropriately chosen patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Modulación inflamatoria en el shock traumático: [revisión] / Inflammatory modulation in traumatic shock: [review]

Hemorrhagic hypovolemic shock secondary to trauma is an important cause of morbidity and mortality worldwide. During the last few years, new concepts have emerged and the guidelines of fluid resuscitation in these patients have been redefined. The concept of hypotensive resuscitation has been established and new colloid solutions based on starch have been manufactured, been hydroxyethyl starch in a balanced electrolytic solution, the most studied and successful one. It has been reported, as well, the positive effects of the pharmacologic modulation of the inflammatory pathways in experimental model subjects submitted to hypovolemic shock. Products such as, ethyl pyruvate and the Na+/H+ type 1 inhibitor, BIIB513, have been Studies only experimentally in rodent models using colloids as the primary resuscitation fluid. The significant improvement in the hemodinamyc, pattern and the cardiac and inflammatory indexes and mediators, has created the basis for their use in clinical trials in the near future. The systemic inflammatory response is an important cause of multiple organ failure that increases the late mortality of patients surviving the initial early phases of hypovolemic traumatic shock and its experimental modulation in rodent models with products such as ethyl pyruvate and BIIB513 has produced excellent in vivo and in vitro results.

Universalmente se considera el Shock hipovolémico de origen hemorrágico como una importante causa de morbi-mortalidad. Durante los últimos años se ha redefinido los conceptos de la reanimación con líquidos intravenosos en los pacientes con choque hipovolémico y establecido los conceptos de reanimación hipotensa con el uso de nuevos coloides derivados del almidón, tales como el hidroxietil-almidón en solución electrolítica balanceada (Hextend®). Así mismo, se ha reportado el beneficio que conlleva el uso de modificadores de la cascada inflamatoria en modelos experimentales de sujetos sometidos a choque hipovolémico hemorrágico. Productos como el etil piruvato y la BIIB513, un inhibidor selectivo del intercambiador Na+/H+ tipo 1, han sido estudiados sólo experimentalmente en modelos roedores, empleando coloides como principal elemento de reanimación. Al mejorar el perfil hemodinámico, parámetros cardíacos y niveles de mediadores inflamatorios, estos compuestos constituyen una base cierta para ser incluidos en estudios clínicos en un futuro próximo. La respuesta inflamatoria sistémica está íntimamente implicada en la patogénesis de la Falla Orgánica Múltiple, aumentando la mortalidad tardía de pacientes que sobreviven las etapas tempranas del shock hipovolémico hemorrágico traumático. Su modulación experimental con el etil piruvato o bien la BIIB513 ha dado excelente resultado tanto en modelos experimentales in vivo como in vitro.