plasticsurgeryblog

Post-Gastric Bypass Radical Body Contouring

When I was a general surgery resident in the early 90's in Los Angeles, I assisted on some of the early gastric bypass procedures for weight loss. At that time, I remember thinking that we had a lot of surgical complications, and that the anesthesia seemed dangerous. The procedure was thought of as "radical", and was undertaken in only the most extreme supermorbid obesity cases. I really never thought it would catch on. Well, I was wrong. Since then, advances in surgical technique and anesthesia have made it a common, everyday procedure at many hospitals with a fairly acceptable complication rate. More importantly, it's no longer perceived by the public as some radical, extreme measure and has gained widespread acceptance in many communities. Pop singers like Carnie Wilson have undergone the procedure with great success. Over 100,000 such procedures were done in the US in 2003. Sure, it's still a real operation with serious risks, and there are the occasional well-publicized disasters.

In my experience, patients lose weight for about 1.5 years, and then plateau at a new "set point," and fail to lose any further substantial weight after that. This is the time for plastic surgery consultation. When I'm taking their histories, I'm always astounded at how the procedure has changed their lives. "I'm not on those blood pressure meds anymore and my diabetes has gone away" is a frequent scenario for these patients. So what about all of the excess skin left on the now-shrunken body? That's where plastic surgery comes in. Last year, over 52,000 post-gastric bypass body contouring procedures were done. These kinds of procedures are very commonly performed in our practice, and in the days ahead we will go over the "real deal" on these procedures.

Dog Bite Case

This 55 year old female suffered a dog bite from an Italian greyhound that she was temporarily caring for. The injury and the recovered segment of lip are shown in the right two panels. Sometimes tissue fragments such as ears and lips can be replanted, if it is possible to reconnect their blood supply under the microscope. Unfortunately, the amputated lip had no satisfactory vessels and we could only close the wound (2nd photo). Several months later, the scars remain (left hand photo).

Real Plastic Surgery

At cocktail parties, plastic surgeons are favorite targets for tipsy partygoers. "What could you do with my nose?" "Should I have botox?" It's evident to most of us in the profession that the public equates plastic surgery with cosmetic surgery. No wonder. Nearly every media story involving plastic surgery focuses on aesthetic procedures. So it was refreshing to see Reuters carry a story about ear reconstruction among Iraqi victims of abuse and torture at the hands of Saddam. Ear amputation was a common form of punishment, meted out to an estimated 3500 victims. Surgeons are now beginning the complex task of reconstructing these ears, which generally requires multiple stages of fairly complex procedures. I couldn't help but draw an uncanny parallel. Historically, all plastic surgeons know that the first plastic surgery operation is credited to Sushruta, an Indian surgeon from the 7th century BC, who developed a technique to use forehead skin for nasal reconstruction. Why did so many noses need reconstruction in ancient India? Infection or trauma? No. Rather, because nasal amputation was a common form of punishment in those days.

Dog Bite Awareness

When I was at Bellevue Hospital training in plastic surgery, I saw a number of severe dog bites. The most memorable was a 9 year old boy who was playing with a neighbor's pet - a dog very familiar to the child from extensive previous contact. Without provocation, the dog (a german shep) attacked the boy, resulting in severe facial lacerations and multiple facial fractures. The teeth actually crushed the bones of the midface. This led me to study dog bites in New York, which I discovered were events that all physicians are supposed to report to the Dept of Health. We are now entering the time of year when dog bites are most common, according to the study data. Children are the most common victims, and the face and extremities are the most common sites of injury. Certain breeds are frequent offenders, even when properly raised and known to the victim. A reporter from the New York Post called me about the article yesterday, so it has been on my mind. I hope that some more publicity stimulates public support for: breed-specific legislation, leash laws, criminal prosecution for violations that result in injury, as well as more public education initiatives about precautions and proper breeding. I'm considering posting some photos of dog bite injuries in the next few days.

Wall Street Journal Perpetuates Lymphedema Myths

In an astonishingly misinformed article appearing in the June 1, 2004 issue of the Wall Street Journal entitled "Cancer Patients at Risk for Malady", reporter Tara Parker-Pope puts lymphedema patients at high risk for quackery. She reports that "even minor overuse of a limb can trigger extreme swelling" in patients who have undergone cancer treatment such as radiation or surgery. Nothing could be further from the truth. Movement of the limb causes muscular action which is vital in minimizing fluid buildup. After surgery and radiation, the worst possible advice for a patient is to minimize use of the arm or affected extremity - what the patient needs is to use the extremity normally to recover maximum function and reduce the stiffness and weakness that typically accompany such treatment. The WSJ article continues "working too long at the computer can trigger the swelling" - again, FALSE. Proper treatment should rather focus on leading a normal life and using the extremity as normally as possible, even in exercise. Compression garments and various physical therapy treatments are the mainstays of treatment. Surgery is indicated in a select group of patients. As a physician who treats lymphedema, I am always looking for increased attention to be focused on lymphedema - but a journalistic misadventure like the WSJ article is worse than no publicity at all. It makes me wonder about the quality of research that goes into maintstream media stories.

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