Obesity Surgery

, Volume 21, Issue 11, pp 1781–1786 | Cite as

Wide Topical Negative Pressure Wound Dressing Treatment for Patients Undergoing Abdominal Dermolipectomy Following Massive Weight Loss

  • Adrian Dragu
  • Stefan Schnürer
  • Frank Unglaub
  • Maya B. Wolf
  • Justus P. Beier
  • Ulrich Kneser
  • Raymund E. Horch
New Concepts

Abstract

Postbariatric plastic surgery is considered to be a high-risk procedure, which entails such frequent minor complications as postoperative seroma, bleeding and wound dehiscence. These occur with a high incidence, especially, following postbariatric abdominal dermolipectomy. In order to reduce these complication rates, a new type of dressing with wide abdominal topical negative pressure (TNP) application was applied. We performed abdominal dermolipectomy in 23 obese patients. The average body mass index was 32.8 kg/m2, and the median age of the patients was 42.9 years. Ten patients received conventional standard dressings (control group I), whereas the other 13 patients received a wide TNP dressing including the ventral and lateral trunk (negative pressure group II). Postoperative exudate volumes were collected, tallied and documented for each group separately until all drains could be removed. The conventionally treated control group (I) showed a significantly higher postoperative secretion volume compared with the negative pressure group (II). In addition, the average time to postoperative final drain removal was significantly lower in the negative pressure group (II) compared with the control group (I). The results indicate that widely applied external TNP wound dressing on the ventral and lateral trunk following postbariatric abdominal dermolipectomy leads to a significant reduction in exudate formation, enables early drain removal and thus, decreases length of hospitalization.

Keywords

Topical negative pressure Dressing Seroma Massive weight loss Dermolipectomy 

Notes

Conflict of Interest Statement

The authors declare that they have no conflict of interest. The co-author U.K. and the senior author R.E.H. have served as lecturers for KCI, San Antonio, TX, USA. Parts of the data have been presented as a poster abstract on the 26th Annual Meeting of the German Adipositas Society “DAG” (Deutsche Adipositas Gesellschaft) in Berlin, Germany on November 5, 2010.

References

  1. 1.
    Wang Y, Beydoun MA. The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28.PubMedCrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303:242–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Cunneen SA. Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4:47–55.CrossRefGoogle Scholar
  5. 5.
    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev 2009: CD003641.Google Scholar
  6. 6.
    Blackstone RP, Cortes MC. Metabolic acuity score: effect on major complications after bariatric surgery. Surg Obes Relat Dis. 2010;6:267–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Blackstone RP, Cortes MC, Messer LB, et al. Psychological classification as a communication and management tool in obese patients undergoing bariatric surgery. Surg Obes Relat Dis. 2010;6:274–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Pallua N, Demir E. Postbariatric plastic surgery. Chirurg. 2008;79:843–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Agha-Mohammadi S, Hurwitz DJ. Enhanced recovery after body-contouring surgery: reducing surgical complication rates by optimizing nutrition. Aesthet Plast Surg. 2010;34:617–25.CrossRefGoogle Scholar
  10. 10.
    Neaman KC, Hansen JE. Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital. Ann Plast Surg. 2007;58:292–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Brolin RE, Cody RP. Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg. 2008;248:227–32.PubMedCrossRefGoogle Scholar
  13. 13.
    Marjanovic G, Winkler K, Schewe T, et al. Metabolic surgery and remission of type 2 diabetes. Dtsch Med Wochenschr. 2010;135:1020–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Dragu A, Bach AD, Polykandriotis E, et al. Pseudotumors after primary abdominal lipectomy as a new sequela in patients with abdominal apron. Obes Surg. 2009;19:1599–604.PubMedCrossRefGoogle Scholar
  15. 15.
    Waseem T, Mogensen KM, Lautz DB, et al. Pathophysiology of obesity: why surgery remains the most effective treatment. Obes Surg. 2007;17:1389–98.PubMedCrossRefGoogle Scholar
  16. 16.
    Laville M, Disse E. Bariatric surgery for diabetes treatment: why should we go rapidly to surgery. Diab Metab. 2009;35:562–3.CrossRefGoogle Scholar
  17. 17.
    O'Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg. 2010;20:1199–205.PubMedCrossRefGoogle Scholar
  18. 18.
    van der Beek ES, Te Riele W, Specken TF, et al. The impact of reconstructive procedures following bariatric surgery on patient well-being and quality of life. Obes Surg. 2010;20:36–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Nemerofsky RB, Oliak DA, Capella JF. Body lift: an account of 200 consecutive cases in the massive weight loss patient. Plast Reconstr Surg. 2006;117:414–30.PubMedCrossRefGoogle Scholar
  20. 20.
    Gusenoff JA, Coon D, Rubin JP. Implications of weight loss method in body contouring outcomes. Plast Reconstr Surg. 2009;123:373–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Manahan MA, Shermak MA. Massive panniculectomy after massive weight loss. Plast Reconstr Surg. 2006;117:2191–7. discussion 2198–2199.PubMedCrossRefGoogle Scholar
  22. 22.
    Menderes A, Baytekin C, Haciyanli M, et al. Dermalipectomy for body contouring after bariatric surgery in Aegean region of Turkey. Obes Surg. 2003;13:637–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Naal FD, Neuerburg C, Salzmann GM, et al. Association of body mass index and clinical outcome 2 years after unicompartmental knee arthroplasty. Arch Orthop Trauma Surg. 2009;129:463–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Orpheu SC, Coltro PS, Scopel GP, et al. Collagen and elastic content of abdominal skin after surgical weight loss. Obes Surg. 2010;20:480–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Light D, Arvanitis GM, Abramson D, et al. Effect of weight loss after bariatric surgery on skin and the extracellular matrix. Plast Reconstr Surg. 2010;125:343–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Dragu A, Schnurer S, Surmann-Schmitt C, et al. Gene expression analysis of ischemia and reperfusion in human microsurgical free muscle tissue transfer. J Cell Mol Med 2010; doi: 10.1111/j.1582-4934.2010.01061.x.
  27. 27.
    Hutmacher DW, Horch RE, Loessner D, et al. Translating tissue engineering technology platforms into cancer research. J Cell Mol Med. 2009;13:1417–27.PubMedCrossRefGoogle Scholar
  28. 28.
    Polykandriotis E, Euler S, Arkudas A, et al. Regression and Persistence: Remodelling in a Tissue Engineered Axial Vascular Assembly. J Cell Mol Med. 2009;13:4166–75. doi: 10.1111/j.1582-4934.2009.00828.x.PubMedCrossRefGoogle Scholar
  29. 29.
    Antonetti JW, Antonetti AR. Reducing seroma in outpatient abdominoplasty: analysis of 516 consecutive cases. Aesthet Surg J. 2010;30:418–25.PubMedCrossRefGoogle Scholar
  30. 30.
    Di Martino M, Nahas FX, Barbosa MV, et al. Seroma in lipoabdominoplasty and abdominoplasty—a comparative study using ultrasound. Plast Reconstr Surg. 2010;126:1742–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Nahas FX, Ferreira LM, Ghelfond C. Does quilting suture prevent seroma in abdominoplasty? Plast Reconstr Surg. 2007;119:1060–4. discussion 1065–1066.PubMedCrossRefGoogle Scholar
  32. 32.
    Vacuum assisted closure: recommendations for use. A consensus document. Int Wound J 2008; 5 (Suppl 4): iii–19.Google Scholar
  33. 33.
    Timmers MS, Le Cessie S, Banwell P, et al. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg. 2005;55:665–71.PubMedCrossRefGoogle Scholar
  34. 34.
    Ichioka S, Watanabe H, Sekiya N, et al. A technique to visualize wound bed microcirculation and the acute effect of negative pressure. Wound Repair Regen. 2008;16:460–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Kairinos N, Voogd AM, Botha PH, et al. Negative-pressure wound therapy II: negative-pressure wound therapy and increased perfusion. Just an illusion? Plast Reconstr Surg. 2009;123:601–12.PubMedCrossRefGoogle Scholar
  36. 36.
    Stannard JP, Robinson JT, Anderson ER, et al. Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. J Trauma. 2006;60:1301–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Webb LX. New techniques in wound management: vacuum-assisted wound closure. J Am Acad Orthop Surg. 2002;10:303–11.PubMedGoogle Scholar
  38. 38.
    Bendewald FP, Cima RR, Metcalf DR, et al. Using negative pressure wound therapy following surgery for complex pilonidal disease: a case series. Ostomy Wound Manage. 2007;53:40–6.PubMedGoogle Scholar
  39. 39.
    Augustin M, Herberger K. Benefits and limitations of vacuum therapy in wounds. Hautarzt. 2007;58:945–51.PubMedCrossRefGoogle Scholar
  40. 40.
    Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am J Surg. 2009;197:660–5. Discussion 665.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Adrian Dragu
    • 1
  • Stefan Schnürer
    • 1
  • Frank Unglaub
    • 1
  • Maya B. Wolf
    • 1
  • Justus P. Beier
    • 1
  • Ulrich Kneser
    • 1
  • Raymund E. Horch
    • 1
  1. 1.Department of Plastic and Hand SurgeryFriedrich-Alexander-University of Erlangen-Nürnberg, University HospitalErlangenGermany

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