2.4.1- Type of the study: 2.4. 2- Study Setting: Plastic and Reconstructive Surgery Department, Assuit University Hospital 2.4. 3- Study subjects:
a. Inclusion criteria:
* Group (A) this group will be available for measurements only with no interventions needed.
* Group (B) Include patients asking for arm aesthetic surgery .
* Group B1: patients will be submitted for liposuction only. liposuction is the preferred approach, particularly in young patients after massive weight loss.
* Group B2: patients will be submitted for liposuction and brachioplasty in same setting. When skin laxity is excessive, even in young patients, an extensive arm-long operation that extends across the axilla and onto the lateral chest is indicated.
* Group B3: patients will be submitted for liposuction then brachioplasty after 3 months.
in borderline cases to take chance for skin retraction .
c. Sample Size Calculation: sample size was calculated using g power program version 3.1.9.7 in order to detect anthropometric measures of arm and compare these measures with post operative cases, assumed effect size 0.8 based on clinical assumption (novel study) , α error 0.2 power 0.8 and allocation 1:1:1 the sample size will be 40 patients for each group. 2.4.4 -Study tools (in detail, e.g., lab methods, instruments, steps, chemicals, …): Group (A) will be subjected to these measures
\*Arm length : Lateral length from acromion to lateral epicondyle Medial length from axilla to medial epicondyle
\*Arm circumference : upper arm circumference Mid arm Lower arm
* Forearm circumference at widest point Arm assessed with elbow flexed at 90 degree and shoulder abducted at 90 degree. Group (B) will be subjected to
* Group B1: patients will be submitted for liposuction only.
* Group B2: patients will be submitted for liposuction and brachioplasty in the same setting.
* Group B3: patients will be submitted for liposuction then brachioplasty after 3, 6 and 12 months.
Pre-operative Assessment:
1. Patient history.
2. History of massive weight loss or any operation
3. Preoperative investigations
4. Informed consent.
5. Pre-operative photography. operative technique :- 1- most patients will take general anaesthesia . 2- then sterilization with betadine solution . 3 - pt positioned in supine position . 4- patient will be subjected according to its group to group(A): after injection of tumescent fluids - waiting 15 minutes - liposuction will be done circumferential in arm with cannula 4 .
group(B): after injection of tumescent fluids in the medial part of arm only(excised part ) - waiting 15 minute - then excision of medial part according to pinch test .
group (C): after injection of tumescent fluids all around \_ waiting 15 minutes - liposuction will be done circumferential in arm with cannula 4 .
excision of the excessed part medially will be done after 3 months .
Patients will be subjected to arm measures before and after operation
* Arm length :
Lateral length from acromion to lateral epicondyle Medial length from axilla to medial epicondyle
\*Arm circumference : upper arm circumference Mid arm Lower arm
* Forearm circumference at widest point Arm assessed with elbow flexed at 90 degree and shoulder abducted at 90 degree
* Pinch Test:
* Excess skin :
* Site of maximum redundancy:(Upper - Middle - Lower) arm
* Grade of Lipodystrophy:
Grade 1 :minimal fat with no ptosis Grade 2A :moderate fat with ptosis less than 5 cm Grade 2B : moderate to severe fat with ptosis 5- 10 cm Grade 3: extreme fat with ptosis more than 10 cm Grade 4 : mild to moderate fat with ptosis more than 10 cm. (3) Then comparing of post operative measurements after 3 , 6 and 12 months with the anthropometric measures of group (A) .
