Plastic Surgery Research Council
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THE INFLUENCE OF PRE-EXISTING LOWER EXTREMITY EDEMA AND VENOUS STASIS DISEASE ON BODY CONTOURING OUTCOMES
Presenter: Evan B Katzel, MD
Co-Authors: Nayar HS; Davenport MP; Bossert RP; Rubin JP; Gusenoff JA
The University of Pittsburgh Medical Center

Background: While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity related lymphatic and/or venous disease and post-body contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are pre-disposed to developing this complication due to unrecognized pre-operative lympho-vascular disease.

Methods: Fifty-five patients who had undergone body contouring surgery were identified from our prospective registry. Twenty-eight patients completed Venous Clinical Severity Score (VCSS): a validated outcome measure of venous disease. Three time points were assessed: pre-weight loss (T1), post-weight loss but pre-body contouring (T2), and post-body contouring (T3). Based on T3 VCSS, patients were divided into two groups a T3 VCSS ? 3 (Group 1; N=13) and a T3 VCSS ? 4 (Group 2; N=15).

Results: VCSS for Group 1 at T1, T2, and T3 were 3.31±0.55, 1.85±0.27, and 1.54±0.35 (mean±SEM) respectively vs. 6.3±1.10, 4.33±0.8, and 6.8±0.63 for Group 2 (p<0.05, p<0.05, and p<0.0001). Pain scores at T1 was 0.46±0.21 for Group 1 vs. 1.1±0.24 for Group 2 (p<0.05). Edema scores for Group 1 at T1, T2, and T3 were 0.69±0.29, 0.08±0.08, and 0.15±0.10 vs. 1.87±0.35, 1.13±0.31, and 2.13±0.24 for Group 2 (p<0.05, p<0.001, and p<0.0001, respectively).

Conclusions: Using VCSS, post-bariatric patients with prolonged lower extremity edema experienced clinically identifiable signs of disease prior to weight loss and body contouring surgery. Thus, careful pre-operative evaluation may help identify at risk patients and aid in managing post-operative expectations.


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