Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Rome, Italy.
Aesthetic Plast Surg. 2012 Oct;36(5):1179-85. doi: 10.1007/s00266-012-9956-4. Epub 2012 Aug 31.
The post-bariatric surgery patient presents several challenges to the surgeon. Correction of skin and subcutaneous redundancy can be difficult, particularly in massive-weight-loss patients with horizontal laxity, upper abdominal or flank laxity, and "double-roll" deformities. The aim of our study was to propose our modification of the "vest-over-pants" abdominoplasty technique to exploit all the advantages of the Planas technique in bariatric surgery patients and to solve the problem of extreme epigastric skin redundancy in difficult abdominal contour cases.
Sixteen post-bariatric surgery patients (10 females and 6 males, nonsmokers) with moderate to severe epigastric skin laxity were enrolled in the study. They all had undergone a biliopancreatic diversion (BPD) by laparotomy and had undergone this body-contouring procedure from 2006 to 2010.
After the inverted-Y abdominoplasty, 12 patients (75 %) had an uneventful recovery. On the other hand, one subject (6.25 %) had a seroma and four (25 %) had wound dehiscence and delayed wound healing. No skin necrosis was reported. In one patient (6.25 %) scar revision in areas that had delayed healing was performed. The addition of a vertical incision has not led to an increased rate of postoperative complications, but the rates are in line with the satisfactory results described with the Planas technique in bariatric surgery patients. In addition, various advantages have been observed compared to traditional vertical resection patterns.
This case series has quantitative limitations and further investigations are needed. However, this study suggests that inverted-Y abdominoplasty could be a good compromise between the need to minimize complication rates and ensure an optimum aesthetic result and patient satisfaction rate in some abdominal defects in massive-weight-loss patients.
This journal requires that authors assign a level of evidence to each article.
减重手术后的患者给外科医生带来了诸多挑战。纠正皮肤和皮下组织冗余是困难的，特别是在大量减重患者中，存在水平松弛、上腹部或侧腹松弛以及“双卷”畸形。我们的研究旨在提出对“背心式裤装”腹部整形术的改良，以利用 Planas 技术在减重手术患者中的所有优势，并解决困难腹部轮廓病例中极度上腹皮肤冗余的问题。
本研究纳入了 16 例接受过减重手术（10 名女性和 6 名男性，不吸烟）且存在中度至重度上腹皮肤松弛的患者。所有患者均通过剖腹手术接受了胆胰分流术（BPD），并于 2006 年至 2010 年接受了该身体整形手术。
在倒 Y 形腹部整形术后，12 例患者（75%）恢复顺利。另一方面，1 例患者（6.25%）出现血清肿，4 例患者（25%）出现伤口裂开和延迟愈合。未报告皮肤坏死。在 1 例患者（6.25%）中，对延迟愈合的区域进行了瘢痕修整。增加垂直切口并没有导致术后并发症发生率增加，但发生率与 Planas 技术在减重手术患者中描述的满意结果相符。此外，与传统的垂直切除模式相比，观察到了各种优势。
本病例系列存在定量局限性，需要进一步研究。然而，本研究表明，在一些大量减重患者的腹部缺陷中，倒 Y 形腹部整形术可能是一种在最小化并发症发生率和确保最佳美学效果和患者满意度之间的良好折衷方案。
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