title: The influence of preexisting lower extremity edema and venous stasis disease on body contouring outcomes.
abstract: BACKGROUND
  While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity-related lymphatic and/or venous disease and post-body contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are predisposed to developing this complication due to unrecognized preoperative lymphovascular disease.
  
  
  METHODS
  Fifty-five patients who had undergone body contouring surgery were identified from our prospective registry. Twenty-eight patients completed the Venous Clinical Severity Score (VCSS), a validated outcome measure of venous disease. Three time points were assessed: pre-weight loss (T1), post-weight loss but pre-body contouring (T2), and post-body contouring (T3). Based on T3 VCSS, patients were divided into 2 groups-a T3 VCSS ≤3 (group 1; N = 13) and a T3 VCSS ≥4 (group 2; N = 15).
  
  
  RESULTS
  VCSS for group 1 at T1, T2, and T3 were 3.31 ± 0.55, 1.85 ± 0.27, and 1.54 ± 0.35 (mean ± SEM), respectively, versus 6.3 ± 1.10, 4.33 ± 0.8, and 6.8 ± 0.63 for group 2 (P < 0.05, P < 0.05, and P < 0.0001). Pain scores at T1 was 0.46 ± 0.21 for group 1 versus 1.1 ± 0.24 for group 2 (P < 0.05). Edema scores for group 1 at T1, T2, and T3 were 0.69 ± 0.29, 0.08 ± 0.08, and 0.15 ± 0.10 versus 1.87 ± 0.35, 1.13 ± 0.31, and 2.13 ± 0.24 for group 2 (P < 0.05, P < 0.001, and P < 0.0001, respectively).
  
  
  CONCLUSIONS
  Using VCSS, post-bariatric patients with prolonged lower extremity edema experienced clinically identifiable signs of disease prior to weight loss and body contouring surgery. Thus, careful preoperative evaluation may help identify at-risk patients and aid in managing postoperative expectations.
authors.affiliation: From the *Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; †Colorado College, Colorado Springs, Colorado; and ‡Division of Plastic and Reconstructive Surgery, Department of General Surgery, University of Rochester Medical Center, Rochester, NY. This paper was presented as a poster on September 27, 2012 at the Northeastern Society of Plastic Surgery in Boston, Massachusetts.
authors.forename: Evan B
authors.initials: EB
authors.lastname: Katzel
authors.forename: Harry S
authors.initials: HS
authors.lastname: Nayar
authors.forename: Michael P
authors.initials: MP
authors.lastname: Davenport
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Bossert
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
mesh_terms: D000328:Adult; D003357:Cosmetic Techniques; D004487:Edema / Q000209:etiology*; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008209:Lymphedema / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013848:Thigh / Q000601:surgery*; D014689:Venous Insufficiency / Q000150:complications* / Q000175:diagnosis; D015431:Weight Loss