Plastic Surgery after Massive Weight Loss.

Bariatric surgery rates have increased in the United States concurrent with the rise in obesity. As a result of the massive weight loss from these surgeries, patients are left with a different set of functional and cosmetic issues related to excess skin. Plastic surgery has evolved to treat these unique issues faced by this patient population and has demonstrated beneficial effects. This article will provide an overview of the options available to massive weight loss patients to treat specifically affected area of the body.

Lateral orbicularis oculi muscle plasty in conjunction with face lifting for periorbital rejuvenation.

BACKGROUND: The purpose of this study was to evaluate the lateral orbicularis oculi muscle plasty as an alternative periorbital rejuvenation technique during face lift. METHODS: The authors conducted a retrospective review of patients who underwent face lifts between 2004 and 2007. Postoperative follow-up, complications, aesthetic outcome, and patient satisfaction were recorded. The patients were further divided into four groups for the analysis: lateral orbicularis oculi muscle plasty with lower blepharoplasty (group 1), lower blepharoplasty without lateral orbicularis oculi muscle plasty (group 2), lateral orbicularis oculi muscle plasty without lower blepharoplasty (group 3), and neither lateral orbicularis oculi muscle plasty nor lower blepharoplasty (group 4). RESULTS: A total of 76 patients were identified as having had a midface lift with or without lateral orbicularis oculi muscle plasty in the study period. Sixty-eight percent of the patients had a lateral orbicularis oculi muscle plasty procedure. Group 3 showed the lowest complication rate followed by group 4, but there were no statistical differences in complication rates among the study groups. The higher aesthetic result and patient satisfaction were obtained by groups 3 and 4 (p < 0.01). Group 2 had the highest complication rate and lowest overall outcomes. CONCLUSION: The authors have been able to demonstrate that lateral orbicularis oculi muscle plasty is a safe technique that may be considered a good alternative for periorbital rejuvenation and may help in avoiding lower lid incisions or extensive dissections during face lifting in some cases.

Immediate versus delayed one-stage sternal débridement and pectoralis muscle flap reconstruction of deep sternal wound infections.

BACKGROUND: The management of postoperative deep sternal wound infection varies widely based on the discretion of the cardiovascular surgeon and the plastic surgeon. METHODS: Analysis of patients with deep sternal wound infection undergoing one-step radical sternal débridement and muscle flap reconstruction by a single plastic surgeon from 1986 to 2008 was conducted. Two groups of patients were identified. The immediate group was referred soon after diagnosis of sternal wound infection and without any débridement. The delayed group was referred much later after undergoing an extended management by their cardiovascular surgeon. Retrospective review was performed to compare morbidity, mortality, and length of stay between the two groups. RESULTS: There were a total of 583 patients with deep sternal wound infection. Of the 497 patients referred immediately, 22 (4.4 percent) patients required mechanical ventilation for an average of 4 days, eight (1.6 percent) required tracheotomy, 13 (2.6 percent) developed stage III/IV pressure sores, 24 (4.8 percent) developed major wound dehiscence, zero (0 percent) required skin grafting, average length of stay was 4.7 days, and five died (1 percent). Of the 86 patients with a delayed referral, 40 (46.5 percent) required mechanical ventilation for an average of 18.3 days, 31 (36 percent) required tracheotomy, 20 (23.3 percent) developed stage III/IV pressure sores, 12 (14 percent) developed major wound dehiscence, nine (10.5 percent) required skin grafts, the average length of stay was 19.3 days, and four died (4.7 percent). CONCLUSION: Patients with deep sternal wound infection following sternotomy benefit from one-step radical sternal débridement and muscle flap(s) reconstruction, as it results in a significant decrease in morbidity, mortality, and length of stay.

Surgical management of the symptomatic unstable sternum with pectoralis major muscle flaps.

BACKGROUND: Sternal nonunion after median sternotomy is an uncommon but potentially disabling complication. The management of nonunion varies based on the discretion of the cardiovascular surgeon. METHODS: An analysis of all patients with symptomatic sternal nonunion who underwent wire removal, subtotal sternal débridement, and muscle flap reconstruction from 1993 to 2008 was conducted. A retrospective review was performed to evaluate preoperative and postoperative symptoms, pain scores, procedures, length of hospital stay, operating time, complications, morbidity, and mortality. RESULTS: A total of 24 patients were identified. The male-to-female ratio was 11:1. Time from initial median sternotomy to consultation ranged from 5 to 48 months. All were referred when stability was not achieved by other means. None of the patients had clinical or laboratory evidence of sternal wound infection at presentation. The patients rated their preoperative pain severity at an average of 7.7 and a maximum of 10 on a scale of 1 to 10. All intraoperative cultures showed no growth. The operating time averaged 104 minutes. The average length of stay for these patients was 2.5 days. Follow-up ranged from 2 to 15 months, with an average of 4.2 months. All patients had clinically improved sternal stability. CONCLUSIONS: All patients experienced improvement of their preoperative symptoms, particularly pain, popping, and grinding. Average pain severity dropped from 7.7 preoperatively to 2.2, with a maximum of 4. Two patients developed seroma and required operative drainage. Both went on to complete healing. The mortality rate was 0 percent.