O'Brien Julie Anne, Broderick Genevieve B, Hurwitz Zachary M, Montilla Richard, Castle John, Dunn Raymond M, Akyurek Mustafa, Lalikos Janice F
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, USA.
Ann Plast Surg. 2012 Jan;68(1):74-8. doi: 10.1097/SAP.0b013e31820eb92d.
Plastic surgeons are faced with increasing numbers of patients presenting for insurance-covered skin excision procedures following bariatric surgery. Panniculectomy for symptomatic relief of rashes is commonly performed, but an isolated infraumbilical amputation-type panniculectomy is a highly unaesthetic procedure, leaving many patients deeply dissatisfied. It may be also fraught with complications due to large incisions and potential for dead-space. In these patients, many surgeons avoid the fleur-de-lis panniculectomy, despite the body contour aesthetic advantage, because of increased time, more scarring, and a perceived increase in complications.
This is a retrospective chart review of 130 consecutive postbariatric surgery patients who had panniculectomy over a 2-year period at our institution.
A total of 30 patients underwent a traditional panniculectomy and 100 patients had a fleur-de-lis panniculectomy. Mean weight loss from bariatric surgery to panniculectomy was 58.2 kg, with an average body mass index (BMI) of 30. Fifty-seven patients had additional procedures performed at the time of panniculectomy. Twenty-two patients (17%) had complications, with 5 in the traditional group (17%) and 17 in the fleur-de-lis group (17%) (P = 1.0). Six males (40%) had more complications compared with 18 females (15.7%) (P = 0.034). Patients with BMI <30 had 10 complications compared with patients with BMI ≥30 had 15 complications.
There are many benefits of fleur-de-lis over traditional panniculectomy, even for medical necessity cases. There is limited undermining of tissue which minimizes/eliminates skin necrosis. Our experience with primarily fleur-de-lis panniculectomies shows a complication rate lower than most published data. Fleur-de-lis potentially creates a better symptom correction and cosmetic outcome by resecting maximal skin in both vertical and horizontal directions. These findings must be balanced against a potentially longer operation.
整形外科医生面对越来越多接受减重手术后因保险覆盖而前来进行皮肤切除手术的患者。为缓解皮疹症状而进行的腹壁成形术很常见，但单纯的脐下截肢式腹壁成形术是一种极不美观的手术，让许多患者深感不满。由于切口大且存在死腔的可能性，该手术还可能充满并发症。在这些患者中，尽管“百合花”式腹壁成形术在身体轮廓美观方面具有优势，但由于手术时间延长、瘢痕增多以及并发症发生率被认为有所增加，许多外科医生避免采用这种手术方式。
这是一项对我院在两年期间连续接受腹壁成形术的130例减重手术后患者进行的回顾性病历审查。
共有30例患者接受了传统腹壁成形术，100例患者接受了“百合花”式腹壁成形术。从减重手术到腹壁成形术的平均体重减轻为58.2千克，平均体重指数（BMI）为30。57例患者在腹壁成形术时还进行了其他手术。22例患者（17%）出现并发症，传统组5例（17%），“百合花”式组17例（17%）（P = 1.0）。6例男性（40%）的并发症多于18例女性（15.7%）（P = 0.034）。BMI<30的患者有10例并发症，而BMI≥30的患者有15例并发症。
即使对于有医疗必要的病例，“百合花”式腹壁成形术相对于传统腹壁成形术也有许多益处。组织潜行分离有限，可将皮肤坏死降至最低/消除。我们主要采用“百合花”式腹壁成形术的经验显示并发症发生率低于大多数已发表的数据。“百合花”式手术通过在垂直和水平方向切除最大量的皮肤，有可能更好地纠正症状并改善美容效果。这些发现必须与可能更长的手术时间相权衡。
