Table 1.

Medical and nursing management and treatment protocol

Pre-operative stage: - Medical history with attention to comorbidities and drugs (steroids, contraceptives, antihypertensives, anticoagulants, hypoglycemic agents, antibiotics, sedatives, stimulants) - Check of the BMI and of any changes in the last 6-12 months - Blood chemistry and instrumental screening - Evaluation of diet and / or nutritional deficiency - Visit by the anesthetist - Psychiatric / psychological counseling - Suspension of drugs containing acetylsalicylic acid 30 days prior to surgery - Abstention from smoking at least 30 days before and 30 days after surgery - Topic therapy in skin folds (infections, intertrigo or maceration) - Discussion and signing of informed consent In the 24 hours before surgery: - Complete bathroom / shower with antiseptic soap (possibly early in the morning and in any case within 24 hours) - Fasting from midnight On the day: - Trichotomy 2 hours before entering the operating room - Preoperative planning - Antithrombotic therapy (low molecular weight heparin, first administration 5.000U / 30’ before inducing anesthesia) Intraoperative surgical strategies: - Ligation of the perforating arteries - “Quilting sutures” - Intraoperative microcirculation check with spectrophotometer laser - Compression dressing Post-operative management: - Heating of the patient - Garments and compression dressing - Antithrombotic, antibiotic and pain therapy - Early mobilization of the patient - Ordinary discharge (if the weight loss is <50 Kg) - Assisted discharge (if the weight loss is >50 Kg) - Nutritional protocol - In the first 10-15 days night’s sleep with suggested posture (angle of 30 degrees) and abstention from driving - Abstention from sport for at least a mounth - Cleaning shower only after the stitches’ removal - Compression dressing for 4-6 weeks - It is recommended to avoid direct exposure to sunlight or heat sources for at least 4-6 weeks