Hurwitz Dennis J, Agha-Mohammadi Siamak, Ota Ken, Unadkat Jignesh
Division of Plastic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Aesthet Surg J. 2008 May-Jun;28(3):294-303; discussion 304-5. doi: 10.1016/j.asj.2008.03.001.
Until 2001, body contouring surgery after massive weight loss was uncoordinated, with few patients achieving compete rehabilitation.
The authors report a 5-year, retrospective, 75-case clinical review to determine the effectiveness, reliability, and safety of single and multistage total body lift (TBL) surgery.
Between January 2001 and June 2006, 59 single-stage, 15 two-stage, and 1 three-stage TBL surgeries were performed, involving a total of 605 separate procedures. Outcomes and complications were compared among all TBL patients and a contemporaneous published series.
Three representative cases are described. Overall, in patients under 55 years of age with a body mass index of less than 30, there was no significant difference in the choice of procedure (ie, single-stage TBL [95% confidence interval, 1.236-2.302] or multiple-stage TBL [95% confidence interval, 1.687-4.892]; P = .1882). Although there was no significant association between major complications and the number of procedures performed in this cohort of patients, there were increased wound healing problems following multiple-stage TBL (P > .5). Single-stage TBL surgery averaged 8.4 hours. Two-stage surgery took 7.4 hours for the first stage and 4.6 hours for the second stage, for a total of 11 hours. Banked blood transfusions for single-stage surgery were 1.5 per single-stage case and 0.78 per multi-stage case. Seventy-six percent of the patients experienced complications, mostly related to wound healing. All preoperative and postoperative Pittsburgh rating grades improved.
TBL is customized for individuals who desire a comprehensive approach to improvement of their loose skin. The rate of complications was high and comparable to other published series. There was no difference between the complications of the single-and two-stage patients. While there was an observable reduction in deformity and a high rate of satisfactory aesthetic outcomes, this high number of complications indicates a need to improve clinical performance.
直到2001年，大量体重减轻后的身体塑形手术都缺乏协调，很少有患者能实现完全康复。
作者报告了一项为期5年的、回顾性的、75例病例的临床研究，以确定单阶段和多阶段全身提升（TBL）手术的有效性、可靠性和安全性。
在2001年1月至2006年6月期间，进行了59例单阶段、15例两阶段和1例三阶段的TBL手术，总共涉及605个单独的手术步骤。对所有TBL患者与同期发表的系列病例的结果和并发症进行了比较。
描述了3个代表性病例。总体而言，在年龄小于55岁、体重指数小于30的患者中，手术方式的选择（即单阶段TBL [95%置信区间，1.236 - 2.302]或多阶段TBL [95%置信区间，1.687 - 4.892]）没有显著差异；P = 0.1882。虽然在该组患者中，主要并发症与所进行的手术步骤数量之间没有显著关联，但多阶段TBL后伤口愈合问题有所增加（P > 0.5）。单阶段TBL手术平均耗时8.4小时。两阶段手术第一阶段耗时7.4小时，第二阶段耗时4.6小时，总计11小时。单阶段手术的库存血输血率为每例单阶段手术1.5次，每例多阶段手术0.78次。76%的患者出现并发症，主要与伤口愈合有关。所有患者术前和术后的匹兹堡评分等级均有所改善。
TBL是为希望采用综合方法改善松弛皮肤的个体量身定制的。并发症发生率较高，与其他已发表的系列研究相当。单阶段和两阶段患者的并发症情况没有差异。虽然畸形有明显减轻，美学效果满意度较高，但如此高的并发症发生率表明需要改善临床操作。
