Hospital Municipal Barata Ribeiro, 1450 Rio de Janeiro, Brazil
Aesthetic Plast Surg. 2011 Oct;35(5):814-9. doi: 10.1007/s00266-011-9701-4. Epub 2011 Apr 1.
After massive weight loss (MWL), patients are known to experience significant improvement in obesity-associated comorbid conditions and metabolic disturbances, but almost two-thirds of them require reconstructive body-contouring surgery.
The authors present an anatomic study of surgical pieces obtained from 28 patients (17 women and 11 men) during torsoplasty and abdominoplasty procedures performed in their department from January 2007 to January 2008. The patients ranged in age from 39 to 52 years (mean, 43.3 years). The patients were divided into three groups. Group A consisted of 9 patients who had a normal body mass index (BMI) and stable weight (±5 kg) over the preceding 3 years. Group B consisted of 10 patients who had followed a nutritional diet over the preceding 3 years, achieving a mean weight loss of 42.2 kg (range, 38-52 kg). Group C consisted of 9 patients who had undergone bariatric surgery and insertion of a gastric band before 2004, achieving a mean weight loss of 47 kg (range, 40-57 kg). The authors evaluated the anatomy of the subcutaneous tissue in four body areas: the epigastric, umbilical, hypogastric, and lumbar regions.
The macroscopic anatomic results of the subcutaneous tissue in the three groups are presented. The patients who underwent bariatric surgery (group C) had significant alterations of the subcutaneous tissue anatomy in all four body areas studied. Plastic surgeons who perform composite body-contouring procedures for this group of patients, combining truncal liposuction and lipoabdominoplasty procedures, should be aware of these anatomic changes. The possibility of a cannula perforating an internal organ during liposuction may have been higher for the group C patients than for the group A and group B patients.
Knowledge concerning the anatomy of the subcutaneous fat in post-MWL patients allows a better choice of contouring procedure from an anatomic point of view, performance of a more rational and effective procedure, and differentiation of the technique depending on the area of the body, avoiding major complications.
大量减重（MWL）后，患者肥胖相关合并症和代谢紊乱显著改善，但近三分之二的患者需要进行重建身体塑形手术。
作者对 2007 年 1 月至 2008 年 1 月期间在其科室进行的 torsoplasty 和 abdominoplasty 手术中从 28 名患者（17 名女性和 11 名男性）获得的手术标本进行了解剖学研究。患者年龄 39 至 52 岁（平均 43.3 岁）。患者分为三组。A 组 9 例患者体质量指数（BMI）正常，且过去 3 年体重稳定（±5kg）。B 组 10 例患者过去 3 年遵循营养饮食，平均减重 42.2kg（范围 38-52kg）。C 组 9 例患者于 2004 年前接受过减重手术和胃带插入术，平均减重 47kg（范围 40-57kg）。作者评估了四个身体区域的皮下组织解剖：上腹部、脐部、下腹部和腰部。
呈现三组患者皮下组织的大体解剖结果。接受减重手术的患者（C 组）在所有四个研究部位的皮下组织解剖均发生显著改变。为这组患者进行复合身体塑形手术的整形医生，如同时进行躯干脂肪抽吸术和脂肪抽吸腹部整形术，应了解这些解剖变化。对于 C 组患者，脂肪抽吸过程中套管刺穿内脏器官的可能性可能高于 A 组和 B 组患者。
了解 MWL 后患者皮下脂肪的解剖结构，从解剖学角度可以更好地选择整形手术，进行更合理、更有效的手术，并根据身体部位区分技术，避免主要并发症。
