Pittsburgh, Pa. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pittsburgh Medical Center.
Plast Reconstr Surg. 2010 May;125(5):1525-1535. doi: 10.1097/PRS.0b013e3181d6e7e0.
Traditional abdominoplasty techniques often fail to adequately correct the complex contour deformities in the massive weight loss patient. To address these deformities, addition of a vertical skin resection to the traditional horizontal excision has become a popular procedure. The authors analyzed the impact of vertical (fleur-de-lis) excision on complications when compared with traditional transverse excision.
A review of massive weight loss patients enrolled in an institutional review board-approved prospective registry was performed on consecutive patients undergoing abdominoplasty by a single surgeon. Patients were included if they underwent at least 50 pounds of weight loss. Demographic information, procedural data, and outcome measures were studied. Logistic regression and t tests were performed to analyze differences in complication rates for both procedures and identify risk factors for complications.
Four hundred ninety-nine patients met inclusion criteria, of whom 154 (31 percent) had a fleur-de-lis vertical component. The overall abdominal complication rate for all patients was 26.3 percent, with a 5.0 percent rate of major complications. Transverse-only and fleur-de-lis abdominoplasty had similar rates of complications with the exception of a higher rate of wound infection in the fleur-de-lis group on multivariate analysis. Risk factors for abdominal wound complications with either procedure included male sex, high body mass index, concurrent component separation, and previous subcostal scars.
Fleur-de-lis abdominoplasty can be safely performed with complication rates comparable to those of traditional abdominoplasty techniques. Ideal candidates are patients with upper abdominal skin laxity who may not achieve an adequate aesthetic result with transverse-only excision.
传统的腹部整形技术往往无法充分纠正大量减重患者的复杂轮廓畸形。为了解决这些畸形问题，在传统的水平切除基础上增加垂直皮肤切除已成为一种流行的手术方法。作者分析了与传统横向切除相比，垂直（百合花饰）切除对并发症的影响。
对接受单一外科医生进行的腹部整形术的大量减重患者进行了机构审查委员会批准的前瞻性登记的回顾性分析。纳入标准为患者至少减重 50 磅。研究了人口统计学信息、手术数据和结果测量。使用逻辑回归和 t 检验分析两种手术的并发症发生率差异，并确定并发症的危险因素。
499 名患者符合纳入标准，其中 154 名（31%）患者行垂直百合花饰切除术。所有患者的腹部总体并发症发生率为 26.3%，严重并发症发生率为 5.0%。单纯横向组和百合花饰组的并发症发生率相似，但多变量分析显示百合花饰组的伤口感染发生率更高。两种手术腹部伤口并发症的危险因素包括男性、高身体质量指数、同时行腹直肌分离术和既往肋缘下瘢痕。
百合花饰腹部整形术可以安全实施，其并发症发生率与传统腹部整形技术相当。理想的患者是上腹部皮肤松弛的患者，他们可能无法通过单纯横向切除获得满意的美容效果。
