Borud Loren J, Warren Anne G
Boston, Mass. From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
Plast Reconstr Surg. 2007 May;119(6):1911-1921. doi: 10.1097/01.prs.0000259192.79203.6f.
Patients with massive weight loss following bariatric surgery are now presenting in large numbers for body contouring. To achieve optimum cosmetic results in these patients, a comprehensive circumferential approach is usually required that includes the lateral thighs and buttocks. For a number of reasons, many patients are not candidates for these comprehensive procedures. Some patients view the circumferential procedures as too extensive or aggressive. Others have large hernias or other medical conditions that necessitate a more limited approach. Still others do not have sufficient resources to treat multiple areas.
A 2-year review of patients presenting with a chief complaint of anterior lower abdominal tissue excess as a consequence of massive weight loss following bariatric procedures was conducted. In 64 cases, patients opted for anterior-only treatment of the lower trunk.
Average operative time in patients undergoing modified abdominoplasty alone was 2.5 hours. The mean mass of the excised panniculectomy specimens was 3.8 kg (range, 1.1 to 10.0 kg). The most common complication was wound dehiscence at the T-junction (27 percent), which was treated successfully with local wound care in all cases and did not require reoperation to achieve wound closure. There were no known thromboembolic events.
Not all massive weight loss patients are suitable candidates for comprehensive circumferential body contouring procedures, and many patients desire a limited anterior approach to the frontal abdomen. The modified vertical abdominoplasty should be considered as an option in these patients.
减肥手术后体重大幅减轻的患者现在大量前来进行身体塑形。为了在这些患者中获得最佳的美容效果，通常需要采用包括大腿外侧和臀部在内的全面环形方法。由于多种原因，许多患者不适合进行这些全面的手术。一些患者认为环形手术过于广泛或激进。另一些患者有大的疝气或其他疾病，需要采用更有限的方法。还有一些患者没有足够的资源来治疗多个部位。
对因减肥手术后体重大幅减轻而以腹部下前方组织过多为主诉前来就诊的患者进行了为期2年的回顾。在64例患者中，患者选择仅对下腹部进行前方治疗。
仅接受改良腹壁成形术的患者平均手术时间为2.5小时。切除的腹壁脂肪切除术标本的平均质量为3.8千克（范围为1.1至10.0千克）。最常见的并发症是T形交界处伤口裂开（27%），所有病例均通过局部伤口护理成功治疗，无需再次手术即可实现伤口闭合。没有已知的血栓栓塞事件。
并非所有体重大幅减轻的患者都适合进行全面的环形身体塑形手术，许多患者希望对腹部前方采用有限的手术方法。在这些患者中，应考虑改良垂直腹壁成形术作为一种选择。
