Labia Majora Hypertrophy in a Patient Affected by Familial Partial Lipodystrophy Type 5: A Case Report on Diagnosis, Presentation, and Surgical Correction.

BACKGROUND: Familial partial lipodystrophy (FPLD) is a rare disease, presenting as localized areas of lipodystrophy in the body and associated with defined genes mutations. Labia majora hypertrophy is rarely reported in the literature, and it has been described only once associated with the FLPD syndrome. We present a rare case of labia majora lipodystrophy successfully corrected with a pubo-pexy and a labial reduction plasty. METHODS: A 26-year-old girl presents with massive labia majora hypertrophy, not associated with any type of systemic comorbidity or infection. The hypertrophy was pure adipose and subcutaneous tissue. After exclusion of lymphedema, a lateral reduction labioplasty with pubo-pexy was performed in general anesthesia. RESULTS: The patient presented also a c.623G>A p. (Arg208Lys) missense mutation in AKT2 gene, usually associated with insulin resistance and lipodystrophy. After genetic counseling, the patient was diagnosed with FPLD type 5. The wounds healed perfectly, and the patient returned to normal life after 4 weeks from the operation. CONCLUSIONS: We report the first case in the literature of FPLD type 5 associated with labia majora lipodystrophy and successfully corrected with reduction labioplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Brachioplasty with Extended Incision at the Elbow: A Comparison with the Traditional Short Technique.

BACKGROUND: The elbow area is frequently affected by excessive sagging skin post-massive weight loss. The aim of this study is to present a brachioplasty with distal extension of incision to the anticubital surface, in order to make the transition from middle arm to distal arm/elbow more nuanced and aesthetically pleasing. MATERIAL AND METHODS: An observational retrospective comparative study was performed confronting two groups of female patients. All patients treated with brachioplasty between January 2015 and December 2020 due to brachial laxity following massive weight loss were included in the study. Group A consisted of patients who underwent the novel procedure and Group B comprised subjects with the standard brachioplasty technique. Demographics, including age, BMI and comorbidities were taken into account. The mean outcome measure was the Body-QTM-satisfaction with upper arms score, which was administered preoperatively and one year postoperatively. RESULTS: In the period considered, Group A consisted of 92 patients and Group B of 78. No difference was found between groups concerning BMI and age. The groups were comparable also based on the Body-Q pre-surgery levels. The Body-Q scores at one year postoperatively were 22.80 ± 2.28 in group A and 19.50 ± 2.42 in group B. The postoperative Body-Q scores across the two groups were a higher in group A, and the result is statistically significant (p < 0.05). CONCLUSION: The utilization of the proposed elbow-extended technique allows an improvement of the upper limb profile, with far higher satisfaction of patients, at the price of minimal sequelae in terms of scar. The elbow area is a critical part in post-obese deformities of the brachium, and is frequently neglected. In case of skin laxity and redundancy an elbow extension of the brachioplasty incision is indicated. Results of elbow-extended brachioplasty are p valid and the additional scar well concealed and accepted by patients. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical usefulness of oral supplementation with alpha-lipoic Acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment.

We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation). Patients in Group C (n = 60) received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05). Moreover, patients in Group B had a significantly lower number of positive Phalen's tests at 3 months compared with the other study groups (P < 0.05). We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.