Obesity, But Not High Fat Diet, Impairs Lymphatic Function

Vol. 221, No. 4S1, October 2015

outcomes of a novel method of securing stents without sutures or adhesives. METHODS: We performed a 43-month review of primary unilateral cleft rhinoplasty by a single surgeon. Inclusion required basal photos nearly 3 months after stents were discontinued. Coefficient of asymmetry was nostril difference over non-cleft nostril: nostril height (NH), nostril width (NW), and midline-alar width (MAW). Change (C) equalled preoperative minus postoperative coefficients. Paired t-tests and Fisher exact tests were used. Times are average months. RESULTS: Twenty-three consecutive patients fulfilled photo criteria: 15 sutured stents, 8 fixation with no sutures, follow-up 17.8 days (range 3.7-43.6 days). Age at surgery of the sutured group was 6.3 years; of the nonsutured group, 6.8 years (p¼0.542). Stent duration: sutured group, 1.47; nonsutured group, 2.09 (p¼0.346). Time of photos before operation: sutured group, 0.5; nonsutured group, 0.3 (p¼0.696). Time of photos after stents were discontinued: sutured group, 5.9; nonsutured group, 5.5 (p¼0.750). Postoperative NH: sutured group, 24.1%, nonsutured group, 20.6% (p¼0.586). Change for NW: sutured group, 64.03; nonsutured group, 47.87 (p¼0.680). MAW: sutured group, 6.68, nonsutured group, 3.02 (p¼0.528). The sutured group had 3 traumatic stent columellar transections, and 3 erythema cases requiring antibiotics or removals; complication rate in the sutured group was 6 of 15 (40.0%), and in the nonsutured group, was 0 of 8 (0.0%), p¼0.058. CONCLUSIONS: Our novel nasal stent fixation technique without sutures had clinically fewer complications than sutured stents, without significant differences in nostril symmetry. Obesity, But Not High Fat Diet, Impairs Lymphatic Function Gabriela D Garcı´a Nores, MD, Jason C Gardenier, MD, Ira L Savetsky, MD, Jeremy S Torrisi, Matthew D Nitti, Geoffrey E Hespe, Raghu P Kataru, PhD, Babak J Mehrara, MD, FACS Memorial Sloan-Kettering Cancer Center, New York, NY INTRODUCTION: Diet-induced obesity is associated with lymphatic abnormalities in both humans and mice. The goal of this study was to determine the independent effects of prolonged exposure to high fat diet (HFD) with or without obesity on lymphatic function and identify the cellular mechanisms of lymphatic injury. METHODS: Obesity-prone and -resistant mice were maintained either on a normal chow diet or HFD for 10 to 12 weeks followed by analysis of lymphatic function, architecture, and gene expression in isolated lymphatic endothelial cells (LECs). Correlative in vitro studies were also performed to analyze intracellular signaling pathways using isolated LECs exposed to free fatty acids. RESULTS: Obesity-prone but not obesity-resistant mice, had leaky initial lymphatics, perilymphatic inflammation, significantly

Scientific Forum Abstracts

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impaired ability to transport interstitial fluid, and decreased trafficking of antigen-presenting cells after prolonged HFD exposure. Analysis of isolated LECs demonstrated that only obesity-prone mice fed an HFD had markedly impaired lymphatic gene expression, with decreased levels of vascular endothelial growth factor (VEGF)R-3, Prox1, and VEGF-C. Exposure of LECs to stearic acid, a long chain fatty acid known to be increased in obesity, resulted in apoptosis and impaired proliferation. These effects were abrogated by pre-treatment with an inhibitor of PTEN that increased intracellular expression of pathways downstream from the VEGF-C/VEGFR-3 signaling axis. CONCLUSIONS: Dietary changes, independent of obesity, do not have significant effects on lymphatic function, suggesting that obesity-induced subcutaneous inflammation and release of free fatty acids are necessary for lymphatic dysfunction. This effect is associated with LEC gene expression changes, decreased proliferation, and increased apoptosis. Panniculectomy with Open Ventral Hernia Repair: A Prospective, Randomized (by Insurance) Study Ciara Huntington, MD, Catherine E Jachthuber, Tiffany C Cox, MD, Laurel J Blair, MD, Stanley B Getz Jr., MD, FACS, Vedra A Augenstein, MD, FACS, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC INTRODUCTION: This study examined the outcomes of patients who were denied for concomitant panniculectomy with open ventral hernia repair (OVHR) by an insurance company vs those patients approved for panniculectomy. METHODS: Cases of patients approved and denied for panniculectomy with OVHR from 2011 to 2014 were reviewed and compared. In all cases, the intended surgery was combined panniculectomy-OVHR performed by 1 of 2 general surgeons specializing in abdominal wall reconstruction, partnered with a plastic surgeon. RESULTS: Of the 45 patients not approved for panniculectomy, 32 (71%) had documented cellulitis under the pannus. After a mean wait of 194 days, 4 patients (8.9%) succeeded with appeals and underwent panniculectomy-OVHR. Nine (20%) patients are awaiting unresolved insurance appeals. Of those denied panniculectomy, 2 patients underwent a laparoscopic instead of open repair, and 3 had OVHR with unbilled panniculectomy performed by general surgeons. The remaining 22 patients underwent OVHR without panniculectomy through a midline incision; however, 2 of 22 patients (9.0%) required salvage panniculectomy secondary to wound necrosis; an additional patient is awaiting salvage panniculectomy (3 of 22 patients, 13.6%). Patients denied panniculectomy, who underwent OVHR via midline incision (n¼22), were compared with patients who underwent approved panniculectomy-OVHR (n¼143). Though average hernia defect size was larger in the denial group (507  184.4 cm2 vs 169.5  179.9 cm2, p<0.0001), average mesh