Page 167 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). This tool gives a complete picture of the patient and how excess skin influences the patients’ well-being based on a combination of weight loss results, complaints of excess skin and smoking behavior. It assesses medical complaints (intertrigo, dermatitis, infec- tion, ulceration, lymphedema and hidradenitis), psychological complaints (fear, de- pression, sleep disturbance, stress) and physical complaints (in daily routine, at work and during physical activity). Moreover, impact on patient well-being was assessed with the BODY-Q, a questionnaire specifically designed to measure HRQoL in the (post-) bariatric population 24.
We showed that patients with less weight loss, higher BMI and more complaints had higher screening tool scores. And more importantly, we showed that the screening tool scores correlated with the BODY-Q scores. Patients who had higher scoring on the screening tool had lower HRQoL. Based on the results of the study, we proposed three additional modifications to the modified BAPRAS screening tool. Patients with an unstable weight, a recent pregnancy or planning to have children in the near future cannot be referred. And all patients with a recent life-event, a history of psychological issues and/or addiction, should be evaluated by the psychologist (of the bariatric team) in order to decide whether these issues can be seen as a contra-indication for BCS. With these additional modifications, we created the Dutch Reboc Tool.
Definition of mutilation
Currently, when a plastic surgeon or insurance company rates the amount of excess skin, the photograph of the patient is not systematically compared to the photograph of the PRS. This makes grading more dependent on the subjective interpretation of the plastic surgeon / insurance company and limits reliability. Currently, our study group is working on an improved version of the PRS: the PRS Rainbow Scale. This Rainbow Scale of the PRS is based on a study in patients with upper eyelid ptosis, which showed that estimation of the ptosis of the upper eyelid improved when the photograph of the patient was compared to pictures with eyelid ptosis with increasing severity 25.
In the PRS Rainbow Scale the photograph of the patient is presented in the center of the PRS photographs (see figure 1). The first version of this system was recently test- ed and showed that validity was better when using the PRS Rainbow Scale compared to the normal PRS (results not published yet).
167