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surgicalaestheticsmagazine.com | MARCH 2015 57 © GETTY IMAGES Massive-weight-loss patients who undergo thigh lifts experience a high rate of complications, particularly when the lift is paired with liposuction, according to a January 2015 study in Plastic and Reconstructive Surgery. Researchers Jeffrey A. Gusenoff, MD, et al, from Johns Hopkins Hospital and the University of Pittsburgh Medical Center's departments of plastic surgery conducted a retrospective study in which they reviewed the experiences of 106 patients (90 women and 16 men) who underwent thighplasty between 2003 and 2012. The 14 patients who underwent horizontal thighplasty had a 43% complication rate; 24 underwent short-scar thighplasty with a complication rate of 67%; and 68 underwent full-length vertical thighplasty with a complication rate of 74%. In total, 72 of the 106 patients had at least one complication, including dehiscence (51%), seroma (25%), infection (16%) or hematoma (6%). Medial thighplasty patients had the highest rate of minor wound healing problems, while vertical thighplasty was associated with prolonged edema. Risk factors included hypertension, which was signifi cantly associated with postoperative seroma, and hypothyroidism and liposuction outside the area of resection, which were associated with postoperative infections. High Rate of Complications in MWL Medial Thigh Lift Mild Perioperative Hypothermia Not a Risk Factor in Wound Healing After reviewing the charts of 1,062 plastic surgery patients who underwent complex surgeries lasting more than one hour, researchers Ryan S. Constantine, MD, et al, concluded that perioperative hypothermia does not increase the risk of wound healing complications. The study, published in Aesthetic Surgery (January 2015), defi ned hypothermia as body temperature at or below 36°C; 820 of 1,062 (77.2%) patients had perioperative body temperatures at or below 36°C. All patients had received perioperative warming and the mean operating time was 4.4 ± 3.0 hours. After collecting data on postoperative complications, including infection, delayed wound healing, seroma, hematoma, dehiscence, deep venous thrombosis and overall wound problems, the researchers used three multivariate logistic regression models of hypothermia and one model of body contouring procedures that included pre- warming to estimate odds ratios (ORs). In the univariate analysis, there was no signifi cant difference in outcomes between hypothermic and normothermic patients. In the other models—multivariate logistic regression, aggregate base model, stratifi ed model (which compared three perioperative body temperatures) and interaction model between surgery time and level of hypothermia—they found no statistically signifi cant increase in wound healing complications among hypothermic patients. In addition, pre-warming did not signifi cantly affect perioperative hypothermia. The most signifi cant predictor of poor wound healing in the body-contouring procedures with pre-warming as a categorical variable was massive weight loss. Researchers Mehdi Sanatkar, et al, of the Tehran University of Medical Sciences compared two ratios of propofol/ketamine anesthesia to determine the safest and most effective regimen for plastic and reconstructive surgery patients. This randomized, double-blind clinical trial included 80 patients randomized to two groups (40 subjects each). Group 1 received a 2:1 mixture of 9mg/mL propofol and 4.5mg/mL ketamine. Group 2 received a 4:1 mixture of 9mg/ mL propofol and 2.25mg/mL ketamine. Induction time, sedation effi cacy, cardiovascular and respiratory events, recovery time, and incidence of adverse events during and after the procedure were recorded. The induction time for sedation was 2.8 ± 0.8 minutes in Group 1 and 2.6 ± 0.4 minutes in Group 2. While the sedation effi cacy was similar between the two groups, hemodynamic changes during the procedure were greater in Group 2. Recovery time was not signifi cantly different between the two groups, but the mean pain score in the recovery room was lower in Group 1 than Group 2. More patients from Group 2 (10 vs. 4) required opioid administration following surgery. Postoperative adverse events were similar between the two groups. The researchers recommend the use of a 2:1 combination of propofol to ketamine, "because it reduced the rescue propofol requirement and consequently produced lower cardiovascular and respiratory depression effects and also less postoperative pain." The study appeared in Aesthetic Plastic Surgery (January 2015). 2:1 Propofol/Ketamine Regimen Superior CUTTING EDGE SURGICAL AESTHETICS