Raphael Carloni1, Florian Naudet1, Benoit Chaput1, Antoine de Runz1, Christian Herlin1, Paul Girard1, Eric Watier1, Nicolas Bertheuil1. 1. Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France.
Abstract
BACKGROUND: The massive weight loss patient may require a circumferential contouring of the lower trunk. OBJECTIVES: To summarize the complication rates and explore the possibility of predictive risk factors for complications. METHODS: We performed a systematic review using the PubMed and Cochrane databases to identify published articles on the topic. Random effects meta-analyses and meta-regression were conducted to synthesize the data gathered. RESULTS: The analysis included 28 studies and 1380 patients. All but one were retrospective cohorts or case studies. Circumferential contouring of the lower trunk resulted in 37% [95%-CI 30%; 44%] overall complications; 17% [95%-CI 12%; 24%] wound dehiscences; 4% [95%-CI 3%; 5%] skin necrosis; 5% [95%-CI 3%; 9%] infections; 3% [95%-CI 2%; 4%] hematomas; 13% [95%-CI 9%; 18%] seromas; 12% [95%-CI 7%; 21%] scar irregularities; 3% [95%-CI 2%; 5%] thromboembolism; and 5% [95%-CI 3%; 8%] revisions for complications. Lower body lift-related techniques were associated with a higher rate of overall complications than belt lipectomy-related techniques (P = .002). No difference in complication rate was shown when performing a gluteal augmentation with flap. Due to insufficient data reported in the studies, risk factors for postoperative complications could not be assessed. CONCLUSIONS: The whole literature provides very low reliable information. Confusion factors could not be ruled out to explain the increased complications rate for the lower body lift compared to the belt lipectomy. This finding needs to be confirmed in randomized trials. Collaborative efforts must be made to improve the evidence level of our practices and to serve patients in an optimal way. LEVEL OF EVIDENCE: 3 Therapeutic.
BACKGROUND: The massive weight losspatient may require a circumferential contouring of the lower trunk. OBJECTIVES: To summarize the complication rates and explore the possibility of predictive risk factors for complications. METHODS: We performed a systematic review using the PubMed and Cochrane databases to identify published articles on the topic. Random effects meta-analyses and meta-regression were conducted to synthesize the data gathered. RESULTS: The analysis included 28 studies and 1380 patients. All but one were retrospective cohorts or case studies. Circumferential contouring of the lower trunk resulted in 37% [95%-CI 30%; 44%] overall complications; 17% [95%-CI 12%; 24%] wound dehiscences; 4% [95%-CI 3%; 5%] skin necrosis; 5% [95%-CI 3%; 9%] infections; 3% [95%-CI 2%; 4%] hematomas; 13% [95%-CI 9%; 18%] seromas; 12% [95%-CI 7%; 21%] scar irregularities; 3% [95%-CI 2%; 5%] thromboembolism; and 5% [95%-CI 3%; 8%] revisions for complications. Lower body lift-related techniques were associated with a higher rate of overall complications than belt lipectomy-related techniques (P = .002). No difference in complication rate was shown when performing a gluteal augmentation with flap. Due to insufficient data reported in the studies, risk factors for postoperative complications could not be assessed. CONCLUSIONS: The whole literature provides very low reliable information. Confusion factors could not be ruled out to explain the increased complications rate for the lower body lift compared to the belt lipectomy. This finding needs to be confirmed in randomized trials. Collaborative efforts must be made to improve the evidence level of our practices and to serve patients in an optimal way. LEVEL OF EVIDENCE: 3 Therapeutic.