Wallach Steven G
Aesthet Surg J. 2005 Sep-Oct;25(5):454-65. doi: 10.1016/j.asj.2005.06.001.
Massive weight loss patients often have significant upper midline abdominal fullness that contributes to the overall abdominal girth. This region frequently is not adequately treated with conventional abdominoplasty techniques.
The author used a fleur-de-lis pattern when performing a full abdominoplasty or circumferential abdominoplasty. The technical refinements of this procedure for massive weight-loss patients are presented, as well as considerations of the technique's safety.
A full abdominoplasty pattern was marked, and the inferior incision was lowered along the midline to adjust for mons pubis ptosis as necessary. The vertical component of the abdominoplasty was marked as an inverted "V" or triangle to decrease the abdominal girth, and the cephalic portion was "rounded off" to create an inverted "U." It was important to lower the final incision of the superior margin of the original abdominal pannus resection approximately 2 to 3 cm to allow for minimal tension at the lower abdominal midline closure. The back and flanks were marked for those patients undergoing a circumferential procedure using a gull-wing type incision, joining it with the anterior abdominal marks. The mid-axillary line was marked bilaterally. Vertical reference lines were also drawn along the back to aid in aligning the upper and lower back incisions. The back was treated first for those patients undergoing a circumferential procedure, and then the patient was repositioned supine for treatment of the abdomen and flanks.
Ten patients whose average weight loss was 137 pounds after gastric bypass surgery underwent abdominal contour surgery incorporating a fleur-de-lis pattern. Two men and 8 women with ages ranging from 17 to 53 years (average, 39 years) were treated. Seven underwent a circumferential procedure whereas 3 underwent an isolated abdominoplasty. The follow-up period ranged from 1 month to 26 months, with an average follow-up of 9.5 months. Five patients had a hernia repair performed in conjunction with the abdominal contour surgery. There was no flap loss or wound dehiscence at the inverted "T" closure for any patient.
Use of a fleur-de-lis pattern in abdominal body contouring is a safe and effective technique for properly selected massive weight-loss patients. It is particularly appropriate for those patients with significant upper midline abdominal fullness.
大量减重患者常在上腹部中线处有明显饱满感，这增加了整体腹围。该区域通常无法通过传统腹壁成形术得到充分治疗。
作者在进行全腹壁成形术或环形腹壁成形术时采用了百合花图案。本文介绍了该手术针对大量减重患者的技术改进以及对该技术安全性的考量。
标记全腹壁成形术的图案，必要时沿中线降低下切口以调整耻骨联合下垂。将腹壁成形术的垂直部分标记为倒“V”形或三角形以减小腹围，头部部分“修圆”以形成倒“U”形。将原腹壁皮瓣切除上缘的最终切口向下降低约2至3厘米很重要，以便在下腹部中线缝合时张力最小。对于接受环形手术的患者，用鸥翼型切口标记背部和侧面，并将其与腹部前方标记相连。双侧标记腋中线。还沿背部绘制垂直参考线，以帮助对齐上下背部切口。对于接受环形手术的患者，先处理背部，然后将患者重新置于仰卧位处理腹部和侧面。
10例胃旁路手术后平均减重137磅的患者接受了采用百合花图案的腹部轮廓手术。治疗了2名男性和8名女性，年龄在17至53岁之间（平均39岁）。7例接受了环形手术，3例接受了单纯腹壁成形术。随访期为1个月至26个月，平均随访9.5个月。5例患者在腹部轮廓手术的同时进行了疝修补术。所有患者在倒“T”形缝合处均未出现皮瓣丢失或伤口裂开。
在腹部塑形中使用百合花图案对于经过适当选择的大量减重患者是一种安全有效的技术。它特别适用于上腹部中线明显饱满的患者。
