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At least 1,243 records · Page 69Linked to original sources
PubMed1992

[General anesthesia vs. retrobulbar anesthesia in cataract surgery. A randomized comparison of patients at risk].

Several studies comparing retrobulbar block (RB) and general anaesthesia (GA) for cataract surgery in the elderly have been published. Most of them were retrospective. Our prospective study was designed in order to determine the benefits or disadvantages using RB or GA. Arterial blood gases (ABG) and cardiovascular stability were explored in high-risk patients undergoing elective unilateral cataract extraction. METHODS. Forty patients over 65 years of age and with other co-existing diseases (ASA III-IV) were allocated randomly to receive either GA or RB. No premedication was given to either group of patients. On arrival in the anaesthetic room, a radial artery was cannulated for collection of blood samples and direct monitoring of the blood pressure. Pulse oximetry and ECG were continuously monitored in all patients, the end-expiratory CO2 (F(eexCO2)) only in the GA group. GA was induced with vecuronium 0.1 mg/kg and thiopentone 5 mg/kg; the lungs were ventilated with 100% oxygen. After intubation of the trachea controlled mechanical ventilation was continued with N2O/O2 (55:45) and enflurane 1%-2%. Only enflurane concentrations were varied to correct changes in mean arterial pressure (MAP) if these exceeded +/- 20%. Respiratory frequency and tidal volume were kept constant until completion of surgery. The patients were extubated when they were able to ventilate more than 5 1/min (pressure support 10 cmH2O; PEEP 5 cmH2O). After extubation no O2 was given. In the RB group neural block was undertaken with prilocaine 2% (3 ml) as a retrobulbar injection and prilocaine 1% (5 ml) to block the facial innervation of the orbicularis muscle (Van Lint, O'Brien). Oxygen 3 1/min was administered by nasal tube during the operation. Nine arterial samples for blood gas analysis were collected: (1) control; (2) before operation; (3) 5 min after beginning the operation; (4) 15 min after beginning the operation and before i.v. administration of 500 mg acetazolamide over 5 min; (5) after acetazolamide; (6 and 7) 10 and 20 min after acetazolamide; and (8 and 9) 15 and 30 min after operation (RB) or extubation (GA). RESULTS. The patient demography, including duration of anaesthesia and operation, was similar in both groups (Table 1). Four patients in the GA group (2 needed O2 after extubation because of hypoxaemia) and 2 in the RB group were excluded. No significant differences were seen in base excess (BE) and standard bicarbonate (SHCO3). Arterial O2 tension, arterial O2 saturation, and pulse-oximetric O2 saturation were higher in the RB group intra- and postoperatively (Figs. 1, 3, 4). Arterial CO2 tension (PaCO2) was significantly higher in the GA group during the pre- and postoperative period (Fig. 2), but not during the operation. The PaCO2- F(eexCO2) gradient ranged between 5 and 9 mmHg. Administration of acetazolamide did not influence this gradient by regressive analysis. The postoperative outcome of the patients was comparable in both groups. Nausea or vomiting did not occur. MAP was significantly higher in the RB group during the operation. No significant differences were seen in the pre- and postoperative period. Heart rate in the GA group was higher only after extubation, but was within physiological limits. DISCUSSION. Despite the differing results between the two groups, our study showed no important advantage related to either RB or GA. Changes in ABG, MAP, and heart rate during the investigation period were within physiological limits in elderly patients. Intravenous acetazolamide did not influence ABG in a significant manner. With regard to the preference of each patient, we recommend both RB and GA for cataract surgery in high-risk patients on the assumption of sufficient preoperative treatment of co-existing diseases. In conclusion, cardiovascular and ABG stability were maintained during both anaesthetic techniques.

Aged↗
PubMed2006

CT fluoroscopy shielding: decreases in scattered radiation for the patient and operator.

PURPOSE: High-radiation exposure occurs during computed tomographic (CT) fluoroscopy. Patient and operator doses during thoracic and abdominal interventional procedures were studied in the present experiment, and a novel shielding device to reduce exposure to the patient and operator was evaluated. MATERIALS AND METHODS: With a 16-slice CT scanner in CT fluoroscopy mode (120 kVp, 30 mA), surface dosimetry was performed on adult and pediatric phantoms. The shielding was composed of tungsten antimony in the form of a lightweight polymer sheet. Doses to the patient were measured with and without shielding for thoracic and abdominal procedures. Doses to the operator were recorded with and without phantom, gantry, and table shielding in place. Double-layer lead-free gloves were used by the operator during the procedures. RESULTS: Tungsten antimony shielding adjacent to the scan plane resulted in a maximum dose reduction of 92.3% to the patient. Maximum 85.6%, 93.3%, and 85.1% dose reductions were observed for the operator's torso, gonads, and hands, respectively. The use of double-layer lead-free gloves resulted in a maximum radiation dose reduction of 97%. CONCLUSIONS: Methods to reduce exposure during CT fluoroscopy are effective and should be searched for. Significant reduction in radiation doses to the patient and operator can be accomplished with tungsten antimony shielding.

Antimony↗
PubMed1980

[Prognostic importance of ballistocardiographic indices in myocardial contractile function during a mitral commissurotomy during the late stages of mitral stenosis].

In 100 patients under retrospective analysis was the role of ballistocardiograms taken before operation for prognosis of the myocardium contractive function during narcosis and operation. The ballistocardiographic record made on the Starr table enables, with the aid of the work and power formula, to quantitatively estimate the stage of narcosis and operation.

Adult↗
PubMed1975

Carotid endarterectomy: survival rates of 227 patients.

From March 1963 to March 1974, 227 patients with carotid stenosis underwent unilateral or bilateral carotid endarterectomy at l'Hôpital de l'Enfant-Jésus in Québec. Survival during the first 7 years after operation was analysed by life-table methods based on full intervals. The observed probability of death in this group was significantly higher than the probability expected in the general population, by 6.8% in the 1st year and 3.9% in the 2nd year. In the next 3 years the differences were much smaller (0.5, 0.9 and 1.4%). The major causes of death were myocardial infarction and stroke. Women fared somewhat better than men after the 1st year of follow-up. Unexpectedly, patients who underwent unilateral endarterectomy had lower survival rates in each of the first 5 years after operation than patients who underwent staged bilateral operations, whether survival was measured from the date of the first or the second operation.

Adult↗
PubMed1991

Distribution of bacteria in the operating room environment and its relation to ventricular shunt infections: a prospective study.

In order to study the distribution of bacteria in the operating room environment, cultures were obtained during 111 unselected shunt operations throughout a 10-month period. After routine skin preparation, bacteria were collected by placing Millipore filters on the patient's prepped skin underneath the drapes, on top of the drapes in the operative field, and/or on the sterile instrument table, and left in place for the duration of the case. In 48 patients, full-thickness skin biopsies taken at the initial incision were cultured in lieu of skin surface cultures. Perioperative cerebrospinal fluid cultures and subsequent shunt infections were monitored. Of the 288 environmental (skin and surfaces) cultures, 24 were positive (20 coagulase-negative Staphylococcus and 4 Staphylococcus aureus). Positive cultures were found in 15 of 111 drape cultures (13.5%), 7 of 77 instrument table cultures (9.1%), and 2 of 97 skin cultures (2.1%). Positive environmental cultures were not correlated with the surgeon, length of case, time of day, or type of shunt operation, but were more likely to occur in a room other than the designated neurosurgical operating room. There was a correlation between the occurrence of positive environmental cultures and positive cerebrospinal fluid cultures, although the organisms were not always the same. Coagulase-negative Staphylococcus was the most common organism isolated from all sites. We conclude that bacteria most often associated with shunt infections are airborne in the operating room, rather than originating from the patient's skin, and are distributed in the highest concentration near the surgical team.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Systematic review of conservative operative caries management strategies.

The relationship between cavity preparation extension and restoration longevity is examined through a systemic review of the available evidence on specific conservative, operative caries-management strategies. Evidence tables are provided for three specific techniques in the permanent dentition: 1) the proximal "tunnel" restoration, 2) the proximal "box-only" restoration, and 3) the preventive resin restoration. In the primary dentition, the clinical trials involving the proximal box-only restoration, most of which involved glass-ionomer materials, are reviewed. In the permanent dentition, the evidence reveals low effectiveness for "tunnel" restorations, limited but supportive results for proximal-only restorations, and generally favorable outcomes for the occlusal composite resin-sealant restoration. The weak link in the latter is the overlying fissure sealant, which requires adequate ongoing maintenance. Conservative operative strategies in the primary dentition have not been uniformly successful, and deleterious material effects dominate restoration performance. This systematic review concludes that operative conservatism per se does not guarantee increased restoration longevity and that all restorations are vulnerable to caries recurrence, material failures, and technical deficiencies. The more successful conservative strategies are expected to enhance tooth longevity, provided concomitant caries control is effective.

Composite Resins↗
PubMed1992

Pre-operative assessment of ventricular function in patients considered for Fontan procedure.

In 1978 Choussat and Fontan established ten criteria, which should be fulfilled to achieve a successful outcome in Fontan operation. Recent data suggest that while some of these ten criteria need not be necessarrily be fulfilled, new criteria should be added. These include 1. good diastolic function, 2. normal or only slightly increased ventricular mass, and 3. absence of systemic outflow obstruction. In addition the morphology of the single ventricle may be important as long-term results in patients with single ventricle of right ventricular morphology may be worse than results in patients with single ventricle of left ventricular morphology. Ventricular size and pump function can be assessed by cardiac catherization, echocardiography or magnetic resonance imaging. Estimation of ejection fraction under stress by nuclear angiography may be indicated. Diastolic function can be examined using Doppler echocardiography or nuclear angiography. Myocardial mass may be assessed by echocardiography or magnetic resonance imaging. Normal reference values for different parameters of systolic and diastolic function are listed in the enclosed tables. Patients scheduled for a Fontan operation should have an ejection fraction less than 50%. Patients with borderline ejection fraction should be examined by echocardiography to determine the end-systolic wall stress, a parameter of ventricular contraction, which is independent of pre- and afterload. As afterload may decrease after a Fontan operation some patients with reduced ejection fraction but normal end-systolic wall stress may still be suitable candidates for Fontan operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Defects, Congenital↗
PubMed2002

[The safety of patients and staff in the operating room].

The risk of postoperative infection is determined by a number of factors including the underlying health of the patient, the type of surgery and the environment in which the procedure take place. The predominant infective organisms are Staphylococci. Coagulase-negative staphylococci are regarded as emerging pathogens, especially in clean surgery. The operating team is the major source of the contaminated bacteria. Bacteria dispersed from the skin is of greater importance than bacteria from the respiratory tract, so masks are not always necessary in the theatre during an operation except by those at the table. Masks that function as protective barriers are another emerging issue. Due to a greater awareness of HIV and other blood-borne viruses, masks are taking on a greater role in protection health care workers from potentially infectious blood and body fluids. Bloodborne infection pose a large risk to healthcare workers. The incidence of occupational HBV infection has decline as a result of vaccine-induced immunity. Future vaccines against HIV and HCV would be a boon to healthcare workers.

Humans↗
PubMed1995

Long-term follow-up study of Crohn's disease in Japan. The Research Committee of Inflammatory Bowel Disease in Japan.

Two hundred and three patients with Crohn's disease seen at Kyushu University, Fukuoka University, and their affiliated centers from 1973 to 1988 were followed for 4.4 +/- 3.2 years (mean +/- SD), to evaluate the prognosis relative to life span and surgery. Cumulative survival rate and cumulative operation rate were calculated by the life table method. Cumulative survival rates 5 and 10 years after diagnosis were 98.9% and 98.9%, respectively; these figures were not different from the expected survival rates in the sex-and age-matched general population. Cumulative operation rates 5 and 10 years after the onset of symptoms were 16.2% and 39.1%, respectively, In a second study, we investigated 419 patients with Crohn's disease, diagnosed at nine institutions from 1975 to 1990. The follow-up period was 6.3 +/- 3.9 years and the information was obtained from mailed questionnaires. Cumulative survival rates 5 and 10 years after diagnosis were 99.2% and 96.9%, respectively. Cumulative operation rates 5 and 10 years after the onset of symptoms were 30.3% and 70.8%, respectively. These results indicate that the prognosis of Japanese patients with Crohn's disease may be superior to that reported in Western countries.

Adult↗
PubMed1999

Ipsilateral movement-evoked fields reconsidered.

The generation mechanism of movement-evoked fields (MEFs) is poorly known and the existence of ipsilateral MEFs is still in dispute. We recorded whole-scalp neuromagnetic activity from eight subjects who were pressing response keys alternately with the right 2nd and 4th digits, while keeping the left palm on the table containing the keys. Clear ipsilateral MEFs peaked 58 +/- 2 ms after the key touch, with sources in the hand area of the right primary somatosensory cortex. The ipsilateral MEFs decreased to half size when the resting left hand was palm up on the table. However, very similar responses were obtained when another person operated the response keys and the subjects just kept their left palm on the table. No signals were elicited when the subjects only viewed these actions with no hand contact to the table. The results indicate that the MEFs receive a strong contribution from tactile input. In our experiment the ipsilateral sensorimotor activation was triggered by the movement-related vibrations transmitted to the resting hand.

Adult↗
PubMed1977

Toward the operational identification of adverse drug reactions.

The evaluation of adverse drug reactions in clinical practice is somewhat arbitrary and is characterized by considerable differences of opinion. This report presents a decision table algorithm approach toward the development of an operational system for the identification of adverse drug reactions. The algorithm incorporates an estimate of the certainty of the link between the untoward clinical event and the suspect drug, and examines the underlying causes of the identified drug reactions. Use of such a system is a first step toward reducing ambiguity in the evaluation of adverse drug reactions.

Documentation↗
PubMed2003

[Clinical and hemodynamic results of the mosaic bioprosthesis in aortic position].

INTRODUCTION: Aim of the study was to evaluate the hemodynamic and clinical performance of the Mosaic bioprosthesis in the aortic position. PATIENTS AND METHODS: The Mosaic bioprosthesis is a stented porcine heart valve for implantation in the aortic and mitral position, which combines zero pressure and root pressure fixation with glutaraldehyde, antimineralization treatment with alpha amino oleic acid (AOA) and a low profile stent, to optimize hemodynamic function and to minimize mechanical wear and thus to achieve longer tissue durability. Included in a multicenter study, 100 patients (49 females) underwent isolated aortic valve replacement with the Mosaic bioprosthesis between February 1994 and May 1999. Average age at implant was 73.4 +/- 7.3 years (range 31.3-86.8 years). Preoperative and operative clinical data are shown in Tables 1 and 2. Patients were followed-up within the first 30 postoperative days, after six months and at annual intervals, including transthoracic echocardiography and documentation of any adverse events. Mean follow-up was 3.8 years (range 0.1-7.1 years), total 383.1 patient-years. Follow-up is 100% complete. RESULTS: One year after implantation of the bioprosthesis, mean systolic pressure gradient was 15.3 +/- 6.7 mmHg (21), 14.5 +/- 5.7 mmHg (23), 12.7 +/- 4.1 mmHg (25) and 13.0 +/- 4.8 mmHg (27); effective orifice area (EOA) was 1.4 +/- 0.4 cm2 (21), 1.7 +/- 0.4 cm2 (23), 1.8 +/- 0.4 cm2 (25) and 2.6 +/- 0.4 cm2 (27) (Table 3). One year postoperative, nine patients (10.8%) showed mild aortic regurgitation and one patient (1.2%) moderate. Left ventricular mass index decreased significantly for all sizes within the first postoperative year from 159.7 +/- 56.8 g/m2 to 137.3 +/- 40.8 g/m2. Separating the patients with regard to valve size, only the 21-group (154.1 +/- 51.2 g/m2 to 129.1 +/- 34.6 g/m2) and the 27-group (237.7 +/- 59.2 g/m2 to 146.7 +/- 20.6 g/m2) showed significant results. Freedom from event rates at seven years were 96.8 +/- 1.8% for thromboembolic events, 97.2 +/- 2.0% for thrombosed bioprosthesis, 96.6 +/- 2.6% for structural valve deterioration, 98.2% +/- 1.8% for nonstructural dysfunction, 95.9% +/- 2.0% for antithromboembolic hemorrhage, 98.9 +/- 1.1% for endocarditis and 93.9 +/- 3.2% for reoperation and explant (see Table 4). Early mortality (within 30 days) was 3.0%; late mortality was 4.6%/patient-year, including a valve-related mortality of 0.6%/patient-year. Of the patients, 96.5% showed an improvement of at least one NYHA class when comparing preoperative and one year status. DISCUSSION: The hemodynamic performance and the frequency of adverse events of the Mosaic bioprosthesis in the aortic position were very satisfactory within the first seven postoperative years with excellent results, comparable to studies about other established bioprostheses and similar to the findings in other Mosaic series. Only the number of cases of antithromboembolic hemorrhage was noticeably high. One reason might be the high percentage of patients under continuous anti-coagulant therapy: Six months postoperative, still 52.2% of the patients received phenprocoumon, 6.7% acetylsalicylic acid. Concerning hemodynamics, patient-prosthesis mismatch appeared to be a common problem, especially in small valve sizes. Separating the sample in groups with EOA index < or = 0.75 cm2/m2 and EOA index > 0.75 cm2/m2 after one year, 51.6% in the 21-group had an EOA index < or = 0.75 cm2/m2, whereas it was 19.4% (23), 18.8% (25) and 0% (27) in the larger size groups. Generally, further data have to be collected to determine durability of the biological tissue, as the critical period has just started with the seventh year of the clinical trial. CONCLUSION: The Mosaic bioprosthesis proved to be a reliable and well-functioning device for aortic valve replacement, especially in larger sizes.

Adult↗
PubMed2006

Operator experience and sample quality in genetic amniocentesis.

OBJECTIVE: We sought to relate the frequency of maternal cell contamination in amniotic fluid samples that were submitted to a single laboratory for cytogenetic analysis to the experience and training of the physician who performed the amniocentesis. STUDY DESIGN: We reviewed the database of a single cytogenetics laboratory to compare the number of amniocenteses that were performed annually per physician to the rate of maternal cell contamination in genetic amniocentesis samples. Only samples that resulted in a 46 XY male karyotype were studied so that maternal cell contamination could be identified as having occurred when the karyotype revealed > or = 1 cell with 2 X chromosomes. Samples were categorized as being submitted by a physician who submitted > or = 50 or more samples annually versus < 50 samples to this laboratory. The frequency of maternal cell contamination was compared with annual operator volume with 2 x 2 tables and analyzed by chi-squared testing. RESULTS: Between 2000 and 2004, the laboratory received 6332 mid-trimester amniotic fluid samples that generated a male karyotype result. Fourteen of 2081 samples (0.67%) that were submitted by physicians who submitted < 50 samples grew > or = 1 46 XX cells, compared with 8 of 4251 samples (0.19%; chi-squared, 9.47; degrees of freedom, 1; P = .0021). CONCLUSION: Maternal cell contamination occurs more frequently in genetic amniocentesis samples that are obtained by physicians who perform < 50 genetic amniocenteses annually.

Amniocentesis↗
PubMed2004

Effect of NAPL entrapment conditions on air sparging remediation efficiency.

The effect of soil heterogeneity and the entrapment condition of NAPL source on the mass removal efficiency of air sparging coupled with soil vapour extraction (AS/SVE) was investigated using an intermediate scale two-dimensional laboratory soil tank. Four different NAPL entrapments were created by varying the height of the water table in heterogeneous soil models. Different mass removal efficiencies were achieved for different NAPL entrapment conditions, which were governed by soil heterogeneity and water table height before and during AS/SVE operation. Remobilization and redistribution of toluene and water improved the mass removal. Overall results suggested that it was difficult to achieve the complete remediation of NAPL source due to complex entrapment in heterogeneous soil system. In order to assess the potential contamination in the post-remediation stage, gas and dissolved concentrations of toluene were measured after the AS/SVE operation. The results showed that gas concentration close to remaining NAPL source zone increased rapidly and reached to steady state values, which were much smaller than the vapour pressure, whereas the aqueous phase concentrations increased continuously toward the solubility limit.

Air↗
PubMed1996

Composite polytetrafluroethylene/vein bypass grafts: conventional distal vein segment or vein cuff?

OBJECTIVES: To determine the current status of PTFE vein composite grafts, we reviewed our experience with 205 composite reconstructions and compared the results of conventional distal vein segment to that of distal vein cuff. DESIGN: Retrospective review. SETTING: Department of Surgery, University Hospital. PATIENTS AND METHODS: The series included 85 women and 102 men with a median age of 70. The indications for surgery were claudication in 30, rest pain in 71 and ulcer/gangrene in 103. The site of the distal anastomosis was the popliteal artery in 111 and crural artery in 94. The graft consisted of a proximal PTFE graft anastomosed to a distal segment of reversed saphenous vein in 169 or to a modified distal Miller cuff in 36 operations after 1992. RESULTS: Cumulative life table primary patency rates for the whole series at 12, 24 and 36 months were 39%, 32% and 25% respectively. Limbs with good run-off demonstrated significantly better patency rates compared to limbs with poor run-off (55% and 17% at 12 months, 35% and 11% at 36 months, p = 0.04). The patency rate of femorocrural grafts with poor run-off was only 4% at 12 months. The overall limb salvage rates at 12 and 36 months were 63% and 55%, respectively. Similar results were obtained in limbs with distal reversed vein segment and distal vein cuff. CONCLUSION: The results of this study suggest that for infrainguinal bypass grafting where the saphenous vein is unavailable, a composite PTFE-vein graft might be an acceptable alternative in limbs with good run-off. Although not a randomised study, the results using a distal reversed vein segment of a cuff were similar.

Adult↗
PubMed2000

Therapeutic drug monitoring of sirolimus: correlations with efficacy and toxicity.

UNLABELLED: We sought to examine the potential benefits of therapeutic drug monitoring of sirolimus, a potent immunosuppressive agent that displays a pleiotropic array of side effects. METHODS: A high-performance liquid chromatography (LC) procedure combined with ultraviolet detection (UV) was used to measure serial concentrations of parent compound sirolimus in 150 renal transplant recipients over a period of 4 yr. Drug concentrations in whole blood at trough time, as well as within pharmacokinetic profiles, were correlated with clinical events using contingency tables, logistic regression analysis, and receiver operating characteristic (ROC) curves. RESULTS: The LC/UV method showed an excellent correlation with detection of LC-resolved components by tandem mass spectrometry, demonstrating that the LC/UV method selectively detected parent compound. Sirolimus displayed the characteristics of a critical-dose drug: Its concentration could not be predicted by a standard body or demographic measure, or by dose, and it showed high degrees of intra- and inter-individual variability. However, there was a good correlation between trough and area-under-the-curve measurements. There was a significant association between trough values expressed as either observed ( < 5 ng/mL) or dose-corrected parameter ( < 1.7 ng/mL per mg administered drug) and the occurrence and severity of acute rejection episodes - despite the low overall incidence of 23 episodes among the cohort of 150 patients. Similarly, ROC functions showed a correlation of the occurrence of hypertriglyceridemia, thrombocytopenia, and leukopenia, but not hypercholesterolemia, with trough concentrations above 15 ng/mL. CONCLUSION: Due to its behavior as a critical-dose drug, therapeutic monitoring to measure sirolimus concentrations by a LC/UV method may provide clinicians with a tool to optimize outcomes.

Adolescent↗
PubMed1996

Simplified brain slice glucose utilization.

Brain slice glucose utilization (SGU) can be measured by methods analogous to those used for in vivo cerebral glucose utilization. In order to make this technique more accessible and applicable to a broad range of experimental conditions, we have derived a simplified operational rate equation and generated the table of apparent rate coefficients necessary to apply the equation under different experimental situations. Calculations of the apparent rate coefficients were based upon an eight-parameter kinetic model combined with Michaelis-Menten theory to account for changes in the rate constants as a function of buffer glucose concentration. The theory was tested with a series of experiments using rat brain slices. [14C]-2-deoxyglucose (2DG) and [14C]-3-O-methylglucose (3OMG). The errors involved in the simplified technique were estimated by a variety of techniques and found to be acceptable over a broad range of conditions. A detailed, practical protocol for the simplified method is presented.

3-O-Methylglucose↗
PubMed2004

Correcting the saddlebag deformity in the massive weight loss patient.

Skin redundancy of the trunk and thigh is treated by a circumferential abdominoplasty and a lower body lift. Despite preservation and tight approximation of the subcutaneous facial system, the authors have failed to adequately correct severe saddlebag deformity and midthigh laxity in the massive weight loss patient. The technique used in the last nine of the senior author's 43 lower body lifts was modified by fully abducting each operated thigh on a side utility table, before closure in the prone position. This maneuver permits an increase in width of skin excision and causes the lateral thigh skin to be taut upon leg adduction. This is a retrospective review of the senior surgeon's experience over a 3-year period. Postoperative follow-up of the nine-patient cohort ranged from 8 to 12 months. A standardized set of six-view preoperative and postoperative photographs was available for each patient. A regional grading system was developed to assign points for deformity seen in preoperative and postoperative photographs. To compare the effect of the new technique on the correction of hip/lateral thigh deformities, the authors used this same grading system to analyze 10 other lower body lift patients treated by the same surgeon without full thigh abduction who had six sets of standardized photographs. A deformity severity score was determined for each anatomic region by four trained observers blinded to the surgical technique. The nonparametric Mann-Whitney U test using exact p values was used to compare preoperative and percentage change in deformity severity score from preoperative to postoperative scores relative to preoperative scores for each anatomical region among subjects in each treatment group. The nonparametric Wilcoxon signed rank test using exact p values was used to evaluate the change in deformity severity score from preoperative to postoperative values. The change in technique resulted in an observable symmetrical correction of the severe saddlebag deformity and better contour to the distal lateral thighs. All evaluated patients were satisfied with the lateral thigh skin contour. The grading system revealed that patients treated with or without intraoperative thigh abduction had similar preoperative deformity severity scores for each anatomic region (p > 0.05). Postoperatively, all subjects showed improvement in scores for all treated regions. However, patients closed during full thigh abduction had significantly lower deformity severity scores for the hip/thigh complex when compared with patients treated without full thigh abduction (p < 0.05). Complications in these 19 patients consisted of one 6-cm superficial skin layer dehiscence due to a broken polyester suture that healed spontaneously. There were three seromas that responded to a short series of aspirations or catheter drainage. There were no infections. Distal abdominal flap tip skin necrosis in four patients responded to outpatient débridement and healed secondarily. A new grading system for body contour deformities was successfully utilized to judge differences in the quality of trunk and thigh deformity and outcome in 19 patients with adequate photographic records. Tight suture closure in full thigh abduction in the prone position results in improved treatment of significant saddlebag deformity and midthigh skin laxity in the massive weight loss patient. The essential principles are meticulous planning, careful isolation, tight closure of the lateral trunk and thigh subcutaneous fascial system, and artistic contouring of remaining tissues. Dehiscence, undesirable scarring, and seromas were minor issues in the entire group of 43 patients.

Abdomen↗