Upper body lift

An upper body lift is needed whenever a massive weight loss patient presents with a "dropped out" lateral inframammary crease. It is a combination of a brachioplasty, upper-back resection, and breast reconstruction. The operation is designed to reverse the particular deformity a patient presents with. This article describes three patterns of resection, one for males and two for females.     

Carotid body tumors

We present our approach to the management of patients with carotid body tumors, emphasizing the role of magnetic resonance angiography for the identification of these tumors. Medical records of all patients with carotid body tumors who were managed between 1991 and 2001 were retrospectively reviewed. Nine patients with carotid body tumors were identified. There were four males and five females, ranging in age from 28 to 74 years. Duplux scanning, computed tomography (CT) scanning, and angiography were performed for seven patients, whereas Duplux and magnetic resonance angiography were performed for the remaining two patients. Eight patients underwent successful excision of the tumor. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in two patients. One patient developed local recurrence 5 years later. Early diagnosis of carotid body tumors with Duplex and magnetic resonance angiography is possible. Early surgery for carotid body tumors minimizes the risk of complications associated with large tumors.     

Talar body fractures

Fractures to the body of the talus include a wide array of injuries, varying from relatively minor posterior tuberosity fractures to devastating comminuted body fractures. Fracture types include osteochondral fractures, sagittal transverse or coronal whole-body fractures, posterior tubercle fractures, lateral process fractures, and crush injuries. Treatment varies from excision of small fragments, such as arthroscopic treatment of osteochondral injuries, to open reduction and internal fixation of body fractures, usually by a medial malleolar osteotomy. Prognosis logically correlates with the magnitude of the injury with whole-body fractures, especially crush injuries, having the worst prognosis. Talar body fractures, similar to talar neck fractures, also can be complicated by subtalar arthritis, ankle arthritis, malunion, and avascular necrosis.     

Carotid body tumours

Twenty-one patients with 22 carotid body tumours have been managed between 1963 and 1982. All presented with a neck mass and, if the tumour was extensive, pain. The diagnosis was made clinically, by ultrasound (2) and by angiography (16) and confirmed by biopsy in 19 patients. Eighteen resections were performed, without mortality but with a stroke rate of 16% and an overall complication rate of 36%. Four patients required reconstruction of the internal carotid artery.     

One-stage body contouring

Body contouring for patients who have experienced massive weight loss requires multiple and extensive operations. A one-stage operative procedure was performed on 10 patients who have been followed for at least 18 months postoperatively. Combined brachioplasty, mammaplasty, abdominoplasty, and thigh reduction was carried out in one operation and proved to be safe, effective, and satisfactory. With this technique, we have achieved the goal of reducing the number of procedures while obtaining satisfactory results.