Background: Excess fat and skin in the upper arms have become troublesome with aging and especially after the advancement in methods of weight reduction. Arm contouring procedures can be divided into three groups: those dealing with skin redundancy, those dealing with the lipodystrophy, and a combination of both. This study tries to find an answer to the debate about the safety of simultaneous circumferential liposuction and brachioplasty. Methods: Sixty-two patients (49 women and 13 men) were operated on by simultaneous circumferential suction-assisted lipectomy followed by brachioplasty. Preoperative and postoperative arm circumferences and outcomes (including complications and patient satisfaction) were evaluated starting at least 6 months after the procedure. Results: Only two patients (3.2 percent) developed small areas of wound dehiscence that healed after repeated dressing and an extended period of compression garment use. One patient (1.6 percent) complained of hypertrophic scarring, which was managed by local compression and silicone sheets. The average reduction in mid arm circumference was 9 cm (range, 5 to 14 cm). Approximately 95.2 percent of the patients in the study are highly satisfied, and 4.8 percent reported a mild degree of satisfaction. Conclusions: Simultaneous circumferential arm liposuction followed by brachioplasty addresses both the lipodystrophy and arm ptosis in a single hospital admission. This combination does not increase the complication rate. The results are highly satisfactory to the patients. According to the results of this study, circumferential arm lipobrachioplasty is considered to be a safe, efficient, reliable, and feasible procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Background: Pilonidal sinus is a chronic recurrent medical disease. The exact etiology of the disease is still unknown, but the most accepted theory is an acquired condition characterized by infected sinus in the natal cleft area containing a lifeless hair tuft. Multiple techniques were prescribed for its treatment; however, the ideal method is not yet defined. Methods: The study population includes 58 male patients who underwent excision of their recurrent pilonidal sinus, and the resulting defects were reconstructed using combined horizontal split gluteus maximus flaps and rhomboid flaps. Outcomes were revised from patient case files and followed up in our outpatient clinic and via questionnaires. Results: The mean hospital stay was 3 days. The mean time to return to work was 16 days. Partial wound dehiscences occurred in 2 patients. Distal end flap necrosis occurred in 1 patient. There were no flap losses, no recurrences, no infections, no loss of function, and no seromas during a mean follow-up period of 24 months. All patients were satisfied with the results. Conclusions: This technique has an operative time and hospital stays comparable to those of other techniques. It has minimal and acceptable complication rates and no recurrences. We can conclude that this procedure of combined split gluteus maximus muscle flap and rhomboid flap provides an excellent, effective, easy, and feasible method of choice for reconstructing defects of recurrent pilonidal sinus disease.

The average volume of fat removed is already described in the Table 2. 8 In my study, there was no control group. 8 The results were compared with those of previous studies that did have control groups. My study results revealed comparable complication rates; however, all other series cited in the Discussion section reported other types of complications, such as seromas, secondary operations, wound infections, hematomas, and lymphedemas, which did not occur in my study. I reported a very high patient satisfaction rate (95.2 percent highly satisfied) in comparison to others, such as de Runz et al., 10 who mentioned overall satisfaction classified as excellent in 12 patients (22.6 percent) and pleasing for 24 (45.3 percent), while other authors did not mention numbers. Han et al. 9 reported that most of their patients were satisfied, although most of them developed hypertrophic scars. Nguyen and Rohrich 11 reported achieving good results. Hill et al. 12 reported that circumferential liposuction with a short-scar brachioplasty is simple and safe, with high patient and surgeon satisfaction.With regard to sharp versus electrocautery dissection, although this comparison has no issue in lipobrachioplasty, there is great consensus that electrocautery leads to a greater incidence of seroma formation. Such comparison is valuable in areas that require too much dissection, as in lipoabdominoplasty, in which case the controversy remains, but most series recommend sharp dissection. [13][14][15][16][17][18][19][20][21][22][23] Few studies have found sharp dissection and electrocautery to be equivalent or consider both sharp and electrocautery dissection to have the same incidence of postoperative seroma. [24][25][26]