Gusenoff Jeffrey A, Rubin J Peter
Life After Weight Loss Center, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
Aesthet Surg J. 2008 Jul-Aug;28(4):452-5. doi: 10.1016/j.asj.2008.06.001.
The authors begin their discussion of current concepts in massive weight loss (MWL) surgery by offering terminological guidelines that help define reconstructive and aesthetic concepts and procedures for the post-MWL patient. Measures for effective preoperative nutritional and metabolic screening include assessment of weight fluctuations over time, constitutional symptoms, and medications and nutritional supplements. Although there is no established body-mass index (BMI) threshold above which surgery should be refused, higher BMIs have been associated with increased complications. Residual medical problems and psychosocial issues require assessment before surgery, with appropriate specialist consultation as necessary. Consultation with patients concerning the different expectations for functional versus aesthetic procedures and issues such as postoperative scarring and the common incidence of wound healing problems is essential. Patient safety is paramount in decisions to combine multiple procedures and plan stages. The authors often recommend combining abdominoplasty and mastopexy. Surgeon experience, operative setting, and a patient's medical status are factors which influence how much surgery should be performed in the same operative setting. Centers of Excellence in body contouring that provide a team approach combining comprehensive patient evaluation, outcomes research, and surgical training may be the optimal approach for treating the massive weight loss patient.
作者通过提供术语指南来开始他们对减重手术（MWL）当前概念的讨论，这些指南有助于为MWL术后患者定义重建和美学概念及手术方法。有效的术前营养和代谢筛查措施包括评估随时间的体重波动、体质症状以及药物和营养补充剂。虽然没有确定的体重指数（BMI）阈值高于此就应拒绝手术，但较高的BMI与并发症增加有关。术前需要评估残留的医疗问题和心理社会问题，必要时进行适当的专科会诊。就功能与美学手术不同期望以及诸如术后瘢痕和伤口愈合问题的常见发生率等问题与患者进行会诊至关重要。在决定联合多种手术和规划分期时，患者安全至关重要。作者经常建议联合腹壁成形术和乳房固定术。外科医生经验、手术环境以及患者的医疗状况是影响在同一手术环境中应进行多少手术的因素。提供综合患者评估、结果研究和手术培训相结合的团队方法的身体塑形卓越中心可能是治疗减重患者的最佳方法。
