Reducing complications in post-bariatric plastic surgery: our experience and literature review.

BACKGROUND: With the rise in obesity, there has been a similar increase in bariatric surgery. This resulted in numerous patients losing significant weight with accompanying circumferential body contouring issues. This has led to an amazing increase in the number of body contouring procedures performed. METHODS: The aim of this work is to revise the cases of body contouring in 78 ex-obese patients who underwent body contouring surgery in the Department of Health Life and Environmental Sciences - Plastic Reconstructive and Aesthetic Plastic Surgery Section, from 2007 to 2016. RESULTS: The authors have noticed a deep relationship between adverse events and cigarette smoking and with pre-operative BMI. Regardless of these variables, the authors focused on the protocol for the management of patients, which required a collaboration between medical and nursing staff. CONCLUSIONS: Ex-obese patients have an important risk for complications, but the comparison of our personal data with those of the international literature confirms the efficacy of our management protocol with regard to the prevention of complications. (www.actabiomedica.it).

Improving the outcome of fractional CO2 laser resurfacing using a probiotic skin cream: Preliminary clinical evaluation.

As known, fractional CO2 resurfacing treatments are more effective than non-ablative ones against aging signs, but post-operative redness and swelling prolong the overall downtime requiring up to steroid administration in order to reduce these local systems. In the last years, an increasing interest has been focused on the possible use of probiotics for treating inflammatory and allergic conditions suggesting that they can exert profound beneficial effects on skin homeostasis. In this work, the Authors report their experience on fractional CO2 laser resurfacing and provide the results of a new post-operative topical treatment with an experimental cream containing probiotic-derived active principles potentially able to modulate the inflammatory reaction associated to laser-treatment. The cream containing DermaACB (CERABEST™) was administered post-operatively to 42 consecutive patients who were treated with fractional CO2 laser. All patients adopted the cream twice a day for 2 weeks. Grades were given according to outcome scale. The efficacy of the cream containing DermaACB was evaluated comparing the rate of post-operative signs vanishing with a control group of 20 patients topically treated with an antibiotic cream and a hyaluronic acid based cream. Results registered with the experimental treatment were good in 22 patients, moderate in 17, and poor in 3 cases. Patients using the study cream took an average time of 14.3 days for erythema resolution and 9.3 days for swelling vanishing. The post-operative administration of the cream containing DermaACB induces a quicker reduction of post-operative erythema and swelling when compared to a standard treatment.

In vitro evaluation of different methods of handling human liposuction aspirate and their effect on adipocytes and adipose derived stem cells.

Nowadays, fat tissue transplantation is widely used in regenerative and reconstructive surgery. However, a shared method of lipoaspirate handling for ensuring a good quality fat transplant has not yet been established. The study was to identify a method to recover from the lipoaspirate samples the highest number of human viable adipose tissue-derived stem cells (hADSCs) included in stromal vascular fraction (SVF) cells and of adipocytes suitable for transplantation, avoiding an extreme handling. We compared the lipoaspirate spontaneous stratification (10-20-30 min) with the centrifugation technique at different speeds (90-400-1500 × g). After each procedure, lipoaspirate was separated into top oily lipid layer, liquid fraction, "middle layer", and bottom layer. We assessed the number of both adipocytes in the middle layer and SVF cells in all layers. The histology of middle layer and the surface phenotype of SVF cells by stemness markers (CD105+, CD90+, CD45-) was analyzed as well. The results showed a normal architecture in all conditions except for samples centrifuged at 1500 × g. In both methods, the flow cytometry analysis showed that greater number of ADSCs was in middle layer; in the fluid portion and in bottom layer was not revealed significant expression levels of stemness markers. Our findings indicate that spontaneous stratification at 20 min and centrifugation at 400 × g are efficient approaches to obtain highly viable ADSCs cells and adipocytes, ensuring a good thickness of lipoaspirate for autologous fat transfer. Since an important aspect of surgery practice consists of gain time, the 400 × g centrifugation could be the recommended method when the necessary instrumentation is available.

Multifrequency ultrasound-assisted liposuction: 5 years of experience.

BACKGROUND: The use of ultrasound in liposuction was first introduced by Kloehn. The ultrasound frequencies used in this technology have a high degree of selectivity for fat cells, thus reducing blood loss, postoperative edema, and ecchymosis and avoiding contour irregularities. The authors report their 5 years of experience with a multifrequency ultrasound generator and describe their series with the aim to focus attention on the problems linked with ultrasound use. METHODS: A total of 797 patients were selected to receive ultrasound assisted liposuction (UAL). Accurate preoperative planning was conducted for all the patients before admission to the surgical quarter. Liposuction was performed using general anesthesia for 538 patients (63 %), peripheral anesthesia for 220 patients (25.76 %), and local anesthesia for 96 patients (11.24 %). The ultrasound generator device was set by choosing the better working protocol (continuous or pulsed mode) according to the tissue characteristics, and the frequency test was performed. A photo of the patient was taken before surgery and at every follow-up visit to estimate the results and to have an objective evaluation of the outcome. The patient's opinion of the results also was recorded using a graduated scale. RESULTS: The results were excellent in 204 cases (25.4 %), good in 356 cases (44.6 %), moderate in 174 cases (22 %), and poor in 63 cases (8 %). CONCLUSIONS: For body contour improvement, UAL is an essential procedure. The introduction of multifrequency UAL, or rather the possibility of using the better working frequency during the treatment, allows better results, thus improving patient outcome. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article.