Perez, Mauricio E.

Background: Rib remodeling, particularly targeting ribs 11 and 12, is gaining popularity in aesthetic body contouring to reduce waist circumference. Although rib manipulation techniques have been applied in other surgical fields, their use in plastic surgery has focused on achieving aesthetic goals. This study investigates the complications associated with rib remodeling techniques to enhance waistline contouring. Methods: A global cross-sectional survey was conducted among board-certified plastic surgeons who perform rib remodeling. Data from 2351 patient records (2018–2024) were collected, including demographic details, surgical information, and complications. Rib remodeling techniques assessed included surgical greenstick fracture modification and osteosynthesis. Results: The overall complication rate was 3.7% (86 of 2351 patients). Hyperpigmentation (17.4%), nonconsolidation (15.1%), burns (12.7%), and corset-related pressure ulcers (12.7%) were the most common complications. Major complications such as pneumothorax were rare (0.17%) and occurred only in RibXcar cases. Rib extraction/removal techniques had no reported complications, whereas Riboss had the lowest complication rate (1.96%) due to the use of osteosynthesis material for fracture stabilization. Conclusions: The incidence of complications related to the rib remodeling procedures in our study was 3.7%. However, some procedure-related complications—such as pneumothorax and hemothorax—can pose serious risks to the patient’s life. Nevertheless, when performed by a well-trained surgeon with an adequate learning curve, these procedures can be considered safe.

Background: Body contouring is an increasingly common trend in aesthetic plastic surgery. In the pursuit of ideal body proportions, anterior thoracic cage deformities, especially lower rib cartilage prominence have emerged as a frequent source of dissatisfaction. To address this concern, the anterior aesthetic rib cage remodeling with osteosynthesis (ARCO) technique was developed as an innovative method to reshape the anterior rib cage. Methods: A retrospective study was conducted in Colombia on patients who underwent the ARCO procedure. Preoperative and postoperative rib cage perimeter measurements were recorded. Spirometry was performed preoperatively and during long-term follow-up to assess potential changes in respiratory volumes. Intraoperative peak pressure and pulmonary compliance values were monitored to evaluate procedural safety. Postoperative satisfaction was assessed using the BODY-Q questionnaire, and all complications were documented. Results: A total of 34 patients were included, with a mean age of 34 years. A significant reduction in the inferior rib cage perimeter at the level of the eighth rib was observed (Mann-Whitney U =190, P < 0.001), with a mean decrease of 2 cm. Intraoperative peak inspiratory pressure and pulmonary compliance remained stable across all procedural stages. Spirometric analyses revealed no restrictive changes in respiratory volumes. Conclusions: The ARCO technique offers an effective approach for reducing chest circumference and enhancing the aesthetic contour of the anterior rib margin while achieving high patient satisfaction. It involves a controlled greenstick fracture followed by osteosynthesis to create a stable and natural rib curvature, reducing the risk of malunion and eliminating the need for postoperative corsets.

BACKGROUND: Use of cold tumescent solutions in liposuction is hypothesized to enhance vasoconstriction, potentially reducing bleeding and improving clinical outcomes. However, evidence for its efficacy in arm liposculpture remains inconclusive. PURPOSE: To compare the effects of cold (4°C) and warm (37°C) tumescent solutions on postoperative outcomes in arm liposculpture, focusing on pain, bruising, and fat emulsification quality. METHODS: This double-blinded, randomized clinical trial enrolled patients undergoing bilateral arm liposculpture. One arm was infiltrated with a cold tumescent solution and the other with a warm solution, randomly assigned. Liposuction was performed using VASER-assisted fat emulsification followed by Power-Assisted Liposuction (PAL) or conventional suction-assisted liposuction (SAL). Outcomes included pain (Visual Analog Scale) assessed at Days 1, 8, 15, and 30; bruising, and lipocrit values. RESULTS: A total of 104 arms were analyzed from 52 female participants (mean age: 39.7 years; mean BMI: 24.7 kg/m²). Pain scores were similar between groups at all time points (Day 1: Cold = 5 [2–9], Warm = 6 [2–9]; p = 0.9). Bruising areas were comparable (Cold: 40,444 mm²; Warm: 41,212 mm²; p > 0.05). Lipocrit values for Microaire and SAL techniques showed no significant differences (p > 0.05). Patients reported high satisfaction, with 78.7% "very satisfied" and 96.1% recommending the procedure. CONCLUSIONS: Cold tumescent solutions do not significantly enhance outcomes in arm liposculpture compared to warm solutions. Surgeons should exercise caution with cold solutions due to potential hypothermia risks. Further research is warranted to assess the potential long-term effects of cold tumescent infiltration.

Background: Over 2.3 million liposuctions are performed annually with a complication rate of approximately 5%, including a death rate of 1 in 5000 because of blood loss. Artificial intelligence models offer potential for improving blood loss prediction and management in these procedures, analyzing extensive data to identify risk factors and accurately estimate blood loss. Methods: Data from 721 large-volume liposuction patients at 2 centers in Bogotá, Colombia, and Loja, Ecuador, between 2019 and 2023 were evaluated. Both centers followed identical perioperative protocols. The data set was split into training (621 patients) and testing (100 patients) sets. A supervised machine learning model was trained to predict blood loss. Model predictions were compared with clinical data using statistical validation metrics. Results: Most patients were women (79.2%), with median values of age of 37 years; weight, 65 kg; height, 165 cm; body mass index, 24.34 kg/m²; volemia, 3924.41 mL; infiltrated volume, 5800 mL; and aspirated volume, 3900 mL. Previous liposuction was noted in 32%. No significant differences were found between training and testing cohorts. The model achieved a mean absolute error of 22.09 mL, root mean square error of 34.13 mL, and an R ² value of 0.974, indicating high predictive accuracy and excellent model fit. Conclusions: The authors’ study has developed and validated an accurate artificial intelligence–based model to predict blood loss in large-volume liposuction, showing 94.1% accuracy. The authors’ model enhances preoperative planning and intraoperative management, potentially reducing complications and improving outcomes.

Abstract Surgical abdominal emergencies among patients with cerebral palsy (CP) are infrequently reported. The most commonly reported reason for urgent and emergent abdominal surgery among patients with CP is intestinal volvulus. Intestinal volvulus leads to obstruction and vascular compromise, potentially resulting in life-threatening ischemia and necrosis. Volvulus typically presents with abdominal pain and decreased bowel function. When patients are nonverbal and have baseline bowel dysfunction, symptoms of volvulus can be difficult to diagnose. Here, we present a case of an adult female patient with CP who presented with ischemic colitis with perforation and underwent emergency total colectomy and end-ileostomy. Her postoperative course was complicated by two episodes of intestinal volvulus that occurred one and three months after the initial operation. At the second presentation, she had global bowel ischemia due to the volvulus, which led to her death. We have reviewed and summarized the current literature regarding abdominal emergencies among patients with CP.

Background: Rib cage remodeling has shown promising aesthetic results as a new technique for body contouring, and yet risks and complications associated with the procedure have not been well established. The aim of the authors’ study was to assess safety, efficacy, and patient satisfaction rate associated with a new surgical technique for waistline definition. Methods: The authors looked into their records for patients who underwent waist narrowing through a new rib remodeling procedure with osteosynthesis of ribs XI and XII from October of 2022 to June of 2023. Follow-up was carried out at 1 and 3 months after surgery. Outcomes were evaluated based on waist and hip measurements, body image, pain, and a patient satisfaction survey. Results: A total of 27 consecutive patients were included in the analysis. The authors’ technique resulted in a significant reduction in waist circumference, as evidenced by a decrease of 12.1 cm and 13.0 cm at the first and third months, respectively ( P < 0.005). A reduction of hip circumference of 6.2 cm and 8.7 cm at the first and third months, respectively, was also reported. A high patient satisfaction rate was reported. Postoperative complications included only 1 case of wound dehiscence and 1 case of mild pain. Pain levels were also reduced, with a mean pain score of 2.4 at week 1 and 0.26 at month 1. Conclusions: Rib osteotomy with osteosynthesis emerges as an innovative, safe, and reliable approach for waist narrowing. The authors’ results suggest that this technique can be applied to a wide variety of patients, and it might entail significant advantages compared with other techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Summary: Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.

Abstract Ganglioneuromas (GN) are benign neuroblastic tumors that arise from neural crest cells. Since they present with nonspecific symptoms, diagnosis is often incidental. We are reporting a case of an adult appendiceal GN incidentally found during rectal cancer surgery. A 42-year-old male was diagnosed with recurrent rectal cancer after experiencing urinary difficulties and buttock pain. A multiple-stage pelvic exenteration was carried out after neoadjuvant chemotherapy and chemoradiation. Prophylactic appendectomy was done during the course of surgery, and pathology reported an appendix with GN at the distal tip. GN are often found incidentally and rarely cause appendicitis. Depending on their location and size, they might become symptomatic. While there is some controversy on whether surgery is the treatment of choice for all GN, diagnosis is rarely apparent preoperatively, and all appendiceal masses should be resected.

Background: High-definition liposculpture allowed plastic surgeons to achieve better aesthetic results by carving the underlying muscles and contours in a new way. Several authors have improved the original technique by adding other procedures and new technologies. We designed a new improvement by incorporating bone transformation surgery to overcome the lack of silhouette at the waist and, as a result, optimize the breast-waist-hip ratios. Methods: We carried out a prospective multicenter study, with five different surgeons performing the same rib remodeling technique for waist definition. We used an ultrasonic piece for costal corticotomy and real-time ultrasound imaging to perform green-stick fractures over the last two or three floating ribs. Ours is a new technique based on the prior one described by Kudzaev. Results: We reported 131 consecutive patients who were enrolled in this study. Waistline diameter decreased an average of 8 cm after surgery ( P < 0.05). Most patients were women (n = 125, 95.4%). No major complications were reported. Most common complication was prolonged pain, with only three cases of contour asymmetry, all of which were attributable to noncompliance of constantly wearing the corset + compressive garments. Patients reported a high satisfaction rate and fast recovery (Body-QoL survey). Conclusions: Ultrasonic- and ultrasound- assisted indentation surgery of the thorax is a safe and reliable technique for waistline definition, with a high satisfaction rate, almost-invisible scars, and minimal risk for complications. Incorporation of high-definition liposculpture to rib remodeling opens up a new horizon for bone structure modification surgery (S-high-definition remodeling) that can be safely performed for patients who seek better aesthetic outcomes in body contouring.