ABSTRACT
BACKGROUND: Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the SCIP flap. METHODS: This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24 minutes after indocyanine green (ICG) lymphography injection. Standardized procedures were implemented for all participants in both hospitals. RESULTS: The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the SCIP flap were oriented toward the inguinal lymph node (ILN). However, the left SCIP zone lymphatic vessels were directed opposite to the ILN. CONCLUSION: The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was toward the ILN, although only single-side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.
ABSTRACT
PURPOSE: Particular trends of postoperative complications following abdominoplasty are seen when patients present with a history of bariatric surgery. This study aims to analyze the risk factors for complications following abdominoplasty among those who did and did not undergo prior bariatric weight loss surgery. METHOD: Data of 144 patients who underwent abdominoplasty at our institution between 2009 and 2015 were reviewed. Prevalence of existing comorbidities and incidences of postoperative complications were recorded, and statistical analysis was carried out to establish differences between our cohorts. RESULTS: Of 144 patients, 49 patients had prior bariatric surgery and 95 patients did not undergo surgery. There was no statistically significant difference between the groups for the prevalence of diabetes mellitus, coronary artery disease, hypertension, and anemia, although differences did exist for hypothyroidism and smoking history (p = 0.04 and 0.037, respectively). Postbariatric patients had more comorbidities than nonbariatric patients (p = 0.024). Postoperatively, there was no statistically significant difference between the groups for incidences of hematoma, necrosis, active bleeding, and symptomatic decrease in Hb, although differences did exist for infection (OR = 13.12), seroma (OR = 9.07), prolonged healing (OR = 5.28), and abundant drain secretions (OR = 5.24). Male gender and prior bariatric surgery were associated with higher overall rates of postoperative complications. CONCLUSIONS: Our findings validate the results of prior studies that report a higher prevalence of underlying comorbidities and postoperative complications among postbariatric surgery patients undergoing abdominoplasty. Furthermore, prior bariatric surgery was found to be an independent risk factor for the presence of any (OR 4.78 and p < 0.001) and major (OR 4.050 and p = 0.018) complications after abdominoplasty.
