Biomedical subjects

Michele A Shermak

Publications and source records attributed to Michele A Shermak.

7 recordsLinked to original sources

PubMed2006

An outcomes analysis of patients undergoing body contouring surgery after massive weight loss.

BACKGROUND: Although published reports about technical management of massive weight loss patients are beginning to appear, risk factors for complications following body contouring operations are not known. METHODS: A retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and October of 2004 was performed. Demographic and surgical factors were analyzed. Outcome measures included seroma, wound dehiscence, thromboembolic complications, blood transfusion after surgery, and extended lengths of stay (>2 days). RESULTS: A total of 139 patients were analyzed; 82.7 percent of them were female; mean age was 41 years. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (odds ratio, 6.4; p = 0.01). There were also trends toward increased risk for wound dehiscence with hypothyroidism (odds ratio, 4.3; p = 0.06) and Ehlers-Danlos syndrome (odds ratio, 18.7; p = 0.05). In terms of risk of blood transfusion, asthma and having three or more procedures were the two variables that emerged with significant association (odds ratio, 16.8 and 13.7, respectively; both p < 0.01). Increased length of stay to greater than 2 days was also significantly associated with having three or more procedures (odds ratio, 4.72; p < 0.01). CONCLUSIONS: Male gender, hypothyroidism, and Ehlers-Danlos syndrome may be risk factors for wound dehiscence following body contour operations for massive weight loss. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Having three or more procedures is associated with an increased risk of blood transfusion and increased length of stay.

Adult↗

PubMed2006

Hernia repair and abdominoplasty in gastric bypass patients.

BACKGROUND: Patients who sustain massive weight loss after open gastric bypass surgery are prone to incisional hernias. The authors undertook a retrospective study with two objectives: to characterize this patient population at their institution and to review their experience with treatment of incisional hernias in massive weight loss patients who had open gastric bypass surgery. With increasing prevalence of such patients, the authors aim to improve understanding and treatment of this disease entity and thereby improve patient outcomes. METHODS: Operating room records and the patient database of the primary plastic surgeon treating massive weight loss patients at an academic teaching institution were retrospectively reviewed. Incisional hernia was often diagnosed before surgery but confirmed intraoperatively. Surgical management included primary repair of the hernia with plication of the abdominal wall from xiphoid to pubis and removal of redundant abdominal skin. RESULTS: From February of 2001 to December of 2003, 40 patients had hernia repair in combination with abdominoplasty. Average age was 42 years, and average weight loss was 152 pounds. Average body mass index at the time of plastic surgery was 35.6. Average abdominal skin resection was 9.9 pounds. Hernia recurred in one patient with a body mass index of 41.3 after heavy lifting within 1 year of hernia repair surgery. Other complications included wound-healing problems (20 percent); seroma (12.5 percent); bleeding requiring surgical take-back (2.5 percent); suture abscess requiring surgical removal of suture (7.5 percent); bleeding anastomotic ulcer requiring transfusion (2.5 percent); and fatal pulmonary embolus (2.5 percent). Of the group, 60 percent had uncomplicated healing. CONCLUSIONS: Hernias are safely and preferentially repaired at the time of removal of redundant abdominal panniculus after massive weight loss sustained from gastric bypass surgery. The authors present their approach to hernia repair and abdominoplasty in this patient group, with acceptable results.

Abdominal Muscles↗

PubMed2006

The effect of liposuction and diet on ghrelin, adiponectin, and leptin levels in obese Zucker rats.

BACKGROUND: The fat-regulating hormones, adiponectin, ghrelin, and leptin, have been studied extensively with the hope that some therapeutic modality might be gleaned from their augmentation or blockade. The authors studied levels of ghrelin, adiponectin, and leptin after liposuction in obese male Zucker rats. In addition, they altered the fat and carbohydrate content of the rats' postoperative diets to determine whether diet affects hormonal levels and/or liposuction outcome. METHODS: Thirty-five male, obese Zucker rats were divided into four experimental groups. Group I (n = 10) was fed a low-fat/low-carbohydrate diet; group II (n = 10) was fed a regular chow diet; and group III (n = 10) was fed a high-fat/high-carbohydrate diet. Five additional rats served as the baseline, unoperated group. The experimental rats underwent subcutaneous liposuction, and for 6 weeks they were then fed their experimental diets starting on day 0. Experimental rats were euthanized on day 42 and blood was sampled for hormonal, triglyceride, and cholesterol levels. RESULTS: Triglyceride levels were significantly higher in the high-fat/high-carbohydrate group compared with the regular chow and low-fat/low-carbohydrate groups, indicating an effect of diet on systemic circulation after liposuction. Ghrelin levels decreased significantly and leptin levels demonstrated an increasing trend after liposuction. Adiponectin levels did not demonstrate any change with alteration in diet or liposuction. CONCLUSIONS: Liposuction may prove to offer patients medically therapeutic benefits through hormonal alterations. After liposuction, diet plays an important role in weight gain.

Adipocytes↗

PubMed2006

Massive panniculectomy after massive weight loss.

BACKGROUND: Massive weight loss, defined as loss of 50 percent of excess weight, often results in laxity and redundancy of the abdominal skin, causing disabling rashes, pain, physical limitation, back strain, and cosmetic deformity. The heavier the panniculus, the more marked the symptoms. Panniculectomy can treat these symptoms, but the approach must be customized because of complex medical and surgical histories related to obesity and the size of the panniculus. The aim of this study was to analyze a series of massive panniculectomies greater than 10 pounds following massive weight loss and to investigate the outcomes achieved. METHODS: All patients undergoing massive abdominal panniculectomy by a single plastic surgeon at an academic hospital from October of 2000 to December of 2003 were retrospectively studied. Seven men and 17 women qualified: one woman had a two-stage abdominal panniculectomy, each time with greater than 10-pound abdominal skin resections. All but one patient had gastric bypass. Average weight loss was 171 pounds, with an average maximum body mass index of 70.5 and a minimum body mass index of 43.7 (morbid obesity is defined as a body mass index greater than 40). Patient presentation was regularly complicated by abdominal scars. Abdominal panniculectomy was performed with conservative undermining. Hernias were repaired at the time of surgery. Routine prophylaxis against thromboembolism was performed. RESULTS: Average abdominal skin resection was 16.1 pounds, ranging from 10.3 to 49 pounds. Hernia repair was necessary in 13 patients. Additional surgery performed at the time of panniculectomy included skin reduction surgery of the back (40 percent), chest (32 percent), inner thigh (28 percent), and arm (28 percent). Blood transfusion was necessary in five of the cases (20 percent). Length of stay averaged 3 days. Complications included wounds requiring debridement, dressings, vacuum-assisted closure therapy and/or delayed primary closure (20 percent), and seroma requiring drain replacement or dressings (28 percent). Uncomplicated healing occurred in 44 percent of cases. CONCLUSION: Massive abdominal panniculectomy is challenging to plan, execute, and manage after surgery. The authors present their approach to these patients, with acceptable results.

Abdominal Wall↗

PubMed2005

Thromboembolism in plastic surgery.

Thromboembolism is a dreaded complication of surgery in multiple disciplines, including plastic surgery, and deep venous thrombosis and pulmonary embolus cause significant morbidity, even death. This article provides methods for understanding and preventing deep venous thrombosis and pulmonary embolus in plastic surgery.

Abdominal Wall↗

PubMed2005

Surgical management of groin lymphatic complications after arterial bypass surgery.

BACKGROUND: The authors undertook a retrospective study to define the incidence of groin wound lymphatic complications at their institution and to review their experience with treatment of the complications. METHODS: Operating room records and patient databases of the two primary vascular surgeons at an academic teaching institution were reviewed retrospectively. Groin lymphatic complications were diagnosed by clinical presentation and confirmed with noninvasive imaging. Surgical management included percutaneous methods, ligation of leaking lymphatics, excision, and/or muscle flap coverage. RESULTS: From June of 1989 to June of 2002, 538 patients had arterial revascularization procedures involving the groin. Twenty-seven patients with groin wound lymphatic complications were identified; seven of them had bilateral complications, for a total of 34 complication sites. Common comorbidities included hypertension, coronary artery disease, chronic renal insufficiency, and tobacco use. The majority (85 percent) had artificial material in the bypass graft, and 10 patients had undergone a previous operation at the same site. The mean time to identification of groin lymphatic complications after vascular surgery was 14 days. Common presentations included swelling (n = 16), drainage (n = 13), erythema (n = 4), and leg edema (n = 1). At presentation, 17 patients (63 percent) were receiving antibiotics and 21 (78 percent) were receiving anticoagulation or antiplatelet therapy. Of the 34 complication sites, 12 were managed with drainage or excision and 22 with muscle flap surgery, 10 of which failed less aggressive therapy. Muscle flaps included the gracilis (n = 19), sartorius (n = 1), rectus abdominis (n = 1), and rectus femoris muscles (n = 1). Operative cultures were positive in 23 of the 34 groin lymphatic complication sites. A biopsy specimen of a healed gracilis flap obtained at 1 year demonstrated notable lymphatic channels, possibly supporting theories that rotated muscle becomes a lymphatic conduit. CONCLUSIONS: The authors found that muscle flap surgery provides single-intervention therapy for successful resolution of lymphoceles, with a low complication rate and fairly rapid recovery in a high-risk patient population. Flaps also salvage cases that have failed conservative therapy and provide hardy coverage for a wound bed that is often infected.

Aged↗

PubMed2004

The use of Novabone and Norian in cranioplasty: a comparative study.

Bone replacement products have enhanced the ease of reconstructing bone while improving morbidity related to bone harvest. Although these products are successfully used, studies of bone healing and biomechanical strength are lacking. We aimed to compare how Norian CRS (cranial replacement substance) and Novabone C/M heal in a cranial defect. Adult New Zealand rabbits underwent removal of a critical size cranial defect. The defect was filled with Novabone (n = 8), Novabone plus demineralized bone matrix (n = 8), or Norian (n = 8), or it was left empty (n = 8). Rabbits were euthanized at 8 weeks. Cranial specimens were harvested and soft radiographs, contact microradiographs, and biomechanical testing were done. Soft radiographs revealed opacification like adjacent bone with Novabone, which was augmented when Novabone was combined with demineralized bone matrix. Norian maintained an opaque appearance. The control group did not heal. Contact microradiographs demonstrated bone within the healing defect with Novabone, which was augmented by demineralized bone matrix. Norian was not replaced with bone but served as a scaffold for bone formation. Biomechanical indentation testing demonstrated that the stiffness of Norian was the highest. Novabone plus demineralized bone matrix had a higher stiffness than Novabone alone. All experimental groups had a statistically significant difference compared with Norian. None of the groups achieved the strength of unoperated native bone. Studying two popular products, we found evidence that Novabone was incorporated into cranial bone, regenerating the bone. Novabone healed at a faster rate, creating a stronger product, with demineralized bone matrix. The biomechanical strength of the healed defect was higher in the Norian group, because the bone cement remained solid and was not incorporated, unlike crania reconstructed with Novabone.

Animals↗