Division of Plastic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
Aesthet Surg J. 2009 Nov-Dec;29(6):513-22. doi: 10.1016/j.asj.2009.09.001.
After massive weight loss (MWL), many patients present with concerns about skin excess and laxity. The thigh is one of the more complex regions to address in MWL patients because of the differing degree, location, and quality of skin excess and fatty tissue, as well as surgical risk factors.
The authors describe a technique called the anterior proximal extended (APEX) thighlift to effectively treat upper thigh skin excess with a hidden scar while also enhancing adjacent body regions.
A review was performed of 97 MWL patients who underwent thighlift surgery between March 1998 and October 2007. Eighty-six women and 11 men, with average weight loss of 146 lb and average body mass index (BMI) at contouring of 29.8, were included in the study. The risk factors that were assessed included age, gender, medical conditions, tobacco use, BMI, weight of skin excised, and surgery performed. The outcomes that were assessed included wound healing and lymphedema. Extended vertical thighlift was performed in 11 patients and anterior superior thighlift in 86 patients.
Complications of thighlift included wound healing problems (n = 18; 18.6%); lymphedema (n = 8; 8.3%); cellulitis (n = 7; 7.2%); seroma (n = 3; 3.1%); and bleeding (n = 1; 1%). On multivariate statistical analysis, age and BMI were found to impair healing in the entire thighlift group. For patients with a BMI greater than or equal to 35, the odds ratio (OR) for a wound healing complication was 13.7 (P = .03). Hypothyroidism was strongly associated with lymphedema, with an OR of 23 (P = .06). Extended thighlift trended toward lymphedema (OR = 16.7; P = .08).
Thighlift can be a satisfying procedure for both the patient and surgeon because it provides aesthetic improvement in terms of skin excess and laxity. The APEX thighlift is a new technique that expands upon those previously described in the literature to effectively treat upper thigh laxity with a hidden scar after MWL.
大量体重减轻（MWL）后，许多患者对皮肤过多和松弛表示担忧。大腿是 MWL 患者中更复杂的区域之一，因为皮肤过多和脂肪组织的程度、位置和质量以及手术风险因素存在差异。
作者描述了一种称为前近端延伸（APEX）大腿提升术的技术，该技术可以有效地治疗大腿上部的皮肤过多，并隐藏疤痕，同时增强相邻的身体区域。
对 1998 年 3 月至 2007 年 10 月间接受大腿提升手术的 97 例 MWL 患者进行了回顾性研究。纳入研究的 86 名女性和 11 名男性患者，平均体重减轻 146 磅，平均身体质量指数（BMI）为 29.8。评估的风险因素包括年龄、性别、医疗状况、吸烟、BMI、切除的皮肤重量和手术方式。评估的结果包括伤口愈合和淋巴水肿。11 例患者行扩展垂直大腿提升术，86 例患者行前上大腿提升术。
大腿提升术的并发症包括伤口愈合问题（n = 18；18.6%）；淋巴水肿（n = 8；8.3%）；蜂窝织炎（n = 7；7.2%）；血清肿（n = 3；3.1%）和出血（n = 1；1%）。多元统计分析发现，年龄和 BMI 会影响整个大腿提升组的愈合。对于 BMI 大于或等于 35 的患者，伤口愈合并发症的比值比（OR）为 13.7（P =.03）。甲状腺功能减退症与淋巴水肿密切相关，OR 为 23（P =.06）。扩展大腿提升术有淋巴水肿的趋势（OR = 16.7；P =.08）。
大腿提升术对患者和外科医生来说都是一种令人满意的手术，因为它可以改善皮肤过多和松弛的外观。APEX 大腿提升术是一种新技术，扩展了文献中描述的技术，可有效治疗 MWL 后大腿上部的松弛，并隐藏疤痕。
