الفهرس 
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Abstract
With the evolution of bariatric surgery, a new population of people appeared known as post bariatric patients. Massive weight loss induced by bariatric surgery generally results in redundant and amorphous skin in the abdomen, breasts, arms and thighs. Loose skin can cause many problems, including intertrigo, difficulty in performing activities such as walking, urinating, or performing sexual activity. After massive weight loss, former obese patients have adipose and cutaneous excess, the skin has lost most of its elasticity. Brachioplasty was first introduced by Correa-Iturraspe and Fernandez in 1954. Since then, the procedure has undergone a series of modifications to improve the appearance of the scar and the resulting contour of the arm. This includes techniques such as S-incisions, W-plasty, depithelialization rolled-up flaps, T-incision, fascial system suspensions and using molds. Flaws and complications may affect patient satisfaction. They include incorrectly placed incisions, asymmetric widened hypertrophic scar and pale scars similar to striae which may need revision. Edema, seroma, wound dehiscence, subcutaneous abscess, and a short period of lymphorrhea may occur. Median antebrachial cutaneous nerve injury (paresthesia), MACN injury and chronic regional pain syndrome were recorded. So, the aim of this study is to evaluate the aesthetic outcome and complications of brachioplasty in post massive weight loss patients. To elucidate our aim, this was a prospective comparative study conducted on 24 patients with brachioplasty; to evaluate the aesthetic outcome and complications of brachioplasty in post massive weight loss patients, in the Plastic Surgery Department of Menoufia University and Maadi Military Hospital, during a period time from April 2019 to October 2022.
They were divided into 3 groups according to type of brachioplasty technique: Mini brachioplasty (4 patients), Standard brachioplasty (15 patients) and Two-ellipse brachioplasty (5 patients). All patients were subjected to: Complete history was obtained, including weight loss/gain, tobacco use, nutritional status and co- morbid diseases. Physical examination will be performed to: Evaluate the arms, including range of movement at shoulder/elbow/hand and grip strength. Assess excess fat, excess skin, particular areas of excess and overall skin quality and tone. Routine preoperative investigations (complete blood count, coagulation profile, kidney function tests and liver function tests). The results of this study could be summarized as follow: The mean age of all patients was (41.5 ± 4.9) years. Regarding gender of the patients, the majority (95.8%) of patients were females, while (4.2%) were males. Regarding post-operative safety data (bad outcomes), (16.7%) of patients had edema, (4.2%) had hematoma formation and infection, (20.8%) had seroma, (8.3%) had wound dehiscence, (4.2%) had paresthesia, and (16.7%) had bad scar outcome. Comparative study between the 3 groups revealed non-significant difference as regards all pre-operative data (BMI, arm circumference and comorbidities) (p > 0.05). Comparative study between the 3 groups revealed non-significant difference as regards all post-operative efficacy data (arm circumference and patient satisfaction) (p > 0.05). A comparative study between the 3 groups revealed, significant increase in complications rate in two-ellipse brachioplasty (100%), compared to standard brachioplasty (53.3%), compared to mini brachioplasty (0%), (p = 0.011). Comparative study between the 3 groups revealed non-significant difference as regards scar outcomes (p > 0.05).
By using ROC-curve analysis, all 3 techniques showed non-significant predictive values in discrimination of patients with decreased arm circumference from patients without (p > 0.05).