Arm contouring after massive weight loss: Liposuction-assisted brachioplasty versus standard technique

Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience

Complex Abdominal Wall Repair Using a Porcine Dermal Matrix

Management of complex abdominal defects remains a significant challenge for many surgeons, especially in contaminated fields. Currently, available biosynthetic grafts include human cadaveric dermis (AlloDerm), porcine dermal (Permacol and Strattice), and submucosal (Surgisis) sources. All these grafts are composed of an acellular collagen scaffold to provide a bridge for tissue incorporation and neovascularization. The authors describe a case report of a woman who required dual mesh explantation and successive reparative surgery using a porcine dermal matrix for a complex and infected abdominal wound. Twelve months postdischarge the patient remains well, she is pain free, and she returned home to full activities with complete wound closure and without any evidence of residual or recurrent hernia. The patient was satisfied with her cosmetic results. In conclusion, the authors’ experience shows that the use of Permacol, a porcine dermal matrix, has been successful in treating an infected abdomen and a vast abdominal wall defect. </jats:p