Costa Luiz Fernando da, Landecker Alan, Manta Anísio Marinho
Department of Plastic Surgery, Ipanema Hospital, Rio de Janeiro, Brazil.
Plast Reconstr Surg. 2004 Dec;114(7):1917-23; discussion 1924-6. doi: 10.1097/01.prs.0000142997.63346.95.
In morbid obesity, contour deformities of the abdomen are common after bariatric surgery and radical weight loss. Traditional abdominoplasty techniques often fail to maximally improve body contour in these cases because adjacent sites such as the hip rolls and flanks are not treated, leaving the patient with large lateral tissue redundancies and dog-ears. In an attempt to solve these challenging problems, the authors present the modified vertical abdominoplasty technique, a single-stage procedure that involves a combined vertical and transverse approach in which an "en bloc" resection of the redundant tissues is performed without undermining, drainage, or reinforcement of the abdominal wall. The latter is only carried out when diastasis and/or hernias are present, and Marlex mesh may be utilized when indicated. In patients with simultaneous large umbilical hernias and/or excessively long stalks, neoumbilicoplasty is recommended. A significant improvement of abdominal contour was obtained in the vast majority of patients because the resection design offers simultaneous treatment of both vertical and transverse tissue redundancies in the abdomen and neighboring regions, with more harmonic results when compared with purely vertical or transverse approaches. The modified vertical abdominoplasty technique is an easy, fast, and reliable alternative for treating these patients, with less intraoperative bleeding, reduced overall cost, and low morbidity rates. In selected cases, the technique is capable of offering excellent results in terms of contouring and maximizes the overall outcome of treatment protocols for these patients, who can then be integrated into normal life with heightened self-esteem, happiness, and productivity.
在病态肥胖患者中，减肥手术后及大幅减重后腹部轮廓畸形很常见。传统腹壁成形术技术在这些病例中往往无法最大程度改善身体轮廓，因为诸如髋部赘肉和侧腹等相邻部位未得到处理，导致患者出现大量外侧组织冗余和“狗耳”畸形。为解决这些具有挑战性的问题，作者提出了改良垂直腹壁成形术技术，这是一种单阶段手术，采用垂直和横向联合入路，对冗余组织进行“整块”切除，无需对腹壁进行潜行分离、引流或加强。仅在存在腹直肌分离和/或疝气时才进行腹壁加强，如有指征可使用Marlex网片。对于同时患有大型脐疝和/或脐蒂过长的患者，建议进行新脐成形术。绝大多数患者的腹部轮廓得到了显著改善，因为切除设计能同时处理腹部及邻近区域的垂直和横向组织冗余，与单纯的垂直或横向入路相比，效果更协调。改良垂直腹壁成形术技术是治疗这些患者的一种简便、快速且可靠的方法，术中出血少，总体成本降低，发病率低。在特定病例中，该技术在塑形方面能够取得优异效果，并使这些患者治疗方案的总体结果最大化，患者随后能够以更高的自尊、幸福感和生产力融入正常生活。
