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The Influence Of Pre-Existing Lower Extremity Edema And Venous Stasis Disease On Body Contouring Outcomes
Evan B. Katzel, MD1, Harry S. Nayar, BS1, Michael P. Davenport2, Ronald P. Bossert, MD1, J Peter Rubin, MD1, Jeffrey A. Gusenoff, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Colorado College, Colorado Springs, CO, USA.

BACKGROUND:
Certain body contouring procedures, including thighplasty and circumferential lower body lifts, have been noted to have an increased risk of post-operative lymphedema. While a cause and effect relationship is traditionally thought to exist between thigh surgeries and postoperative lymphedema, the link between pre-massive weight loss lymphatic and/or venous disease and post-body contouring lymphedema has yet to be investigated. We hypothesize that patients who experience lymphedema following lower body lift and thighplasty are pre-disposed to developing this complication due to unrecognized lympho-vascular disease in the preoperative obese state.
METHODS:
Fifty-five patients were identified from our established Life after Weight Loss (LAWL) database based on a history of thighplasty or lower body lift surgery. Of the 55 patients who fit the search criteria, 28 completed a lymphedema questionnaire that included the Venous Clinical Severity Score (VCSS): a validated outcome measure of venous disease. Using these measures, patients were asked specifically regarding three time points: pre-weight loss (T1), post-weight loss but pre-body contouring (T2), and post-body contouring surgery (T3). Based on T3 VCSS, patients were divided into two groups--a T3 VCSS less than or equal to 3 (Group 1; N=13) and a T3 VCSS of greater than 3 (Group 2; N=15). A VCSS of 3 or less was shown in the vascular surgery literature to be associated with absence of lower extremity venous disease (sensitivity of 76% and specificity of 90%). Age, BMI indices, and comorbidities were also assessed. T-tests and regression analyses were used as appropriate with a significance set at p<0.05.
RESULTS:
Of the 28 patients completing the questionnaire, 16 had a full-length vertical medial thighplasty, 6 had short-scar vertical medial thighplasty and 6 had a circumferential lower body lift procedure. At T3, Group 1 VCSS scores were 1.5±0.35 (mean±SEM) compared to 6.8±0.63 for Group 2 (p<0.0001). There were no differences in age, BMI indices, or comorbidities between the groups. At T1, patients’ VCSS was 3.3±0.55 for Group 1 compared to 6.3±1.1 for Group 2 (p<0.05). At T2, patients’ VCSS was 1.5±0.35 for Group 1 compared to 6.8±0.63 for Group 2 (p<0.0001). Patients’ pain score at T1 was 0.67±0.26 for Group 1 compared to 1.1±0.24 for Group 2 (p<0.05). Edema scores at T3 were 0.15±0.10 Group 1 compared to 2.1±0.24 for Group 2 (p<0.0001). Edema scores at T1 were 0.69±0.29 for Group 1 compared to 1.9±0.35 for Group 2 (p<0.05). At T2, edema scores were 0.08±0.08 for Group 1 compared to 1.1±0.31 for Group 2 (p<0.001).
CONCLUSIONS:
Using VCSS to analyze body contouring patients, our study shows that patients with clinically significant lymphedema following thighplasty and lower body lift experienced clinically identifiable signs of lymphedema and venous disease prior to weight loss and body contouring surgery. These signs included statistically significant differences in pain, edema and VCSS when compared to patients who did not experience post-body contouring lymphedema. Thus, comprehensive pre-operative evaluation and counseling may help in identifying at risk patients and aid in managing expectations in this population.


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