title: A clinical review of total body lift surgery.
abstract: BACKGROUND
  Until 2001, body contouring surgery after massive weight loss was uncoordinated, with few patients achieving compete rehabilitation.
  
  
  OBJECTIVE
  The authors report a 5-year, retrospective, 75-case clinical review to determine the effectiveness, reliability, and safety of single and multistage total body lift (TBL) surgery.
  
  
  METHODS
  Between January 2001 and June 2006, 59 single-stage, 15 two-stage, and 1 three-stage TBL surgeries were performed, involving a total of 605 separate procedures. Outcomes and complications were compared among all TBL patients and a contemporaneous published series.
  
  
  RESULTS
  Three representative cases are described. Overall, in patients under 55 years of age with a body mass index of less than 30, there was no significant difference in the choice of procedure (ie, single-stage TBL [95% confidence interval, 1.236-2.302] or multiple-stage TBL [95% confidence interval, 1.687-4.892]; P = .1882). Although there was no significant association between major complications and the number of procedures performed in this cohort of patients, there were increased wound healing problems following multiple-stage TBL (P > .5). Single-stage TBL surgery averaged 8.4 hours. Two-stage surgery took 7.4 hours for the first stage and 4.6 hours for the second stage, for a total of 11 hours. Banked blood transfusions for single-stage surgery were 1.5 per single-stage case and 0.78 per multi-stage case. Seventy-six percent of the patients experienced complications, mostly related to wound healing. All preoperative and postoperative Pittsburgh rating grades improved.
  
  
  CONCLUSIONS
  TBL is customized for individuals who desire a comprehensive approach to improvement of their loose skin. The rate of complications was high and comparable to other published series. There was no difference between the complications of the single-and two-stage patients. While there was an observable reduction in deformity and a high rate of satisfactory aesthetic outcomes, this high number of complications indicates a need to improve clinical performance.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hurwitz
authors.forename: Siamak
authors.initials: S
authors.lastname: Agha-Mohammadi
authors.forename: Ken
authors.initials: K
authors.lastname: Ota
authors.forename: Jignesh
authors.initials: J
authors.lastname: Unadkat
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D014945:Wound Healing