Journal of Aesthetic & Reconstructive Surgery ISSN 2472-1905

2017Vol. 3 No.2: 6

iMedPub Journals www.imedpub.com

Case Report

DOI: 10.4172/2472-1905.100029

1© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://aesthetic-reconstructive-surgery.imedpub.com/archive.php

Valderi Vieira da Silva Júnior*

SteticClassClinic,InstituteDr.JoséFrota,GeneralHospitalDr.CésarCals,Fortaleza,Ceará,Brazil

*Corresponding author: Dr.ValderiVieiradaSilvaJúnior

valderijr@hotmail.com

SteticClassClinic,InstituteDr.JoséFrota,GeneralHospitalDr.CésarCals,RuaBarãodeAracati,1304-Aldeota,Fortaleza,Ceará,CEP:60.115-081,Brazil.

Citation: daSilvaJúniorVV(2017)ANovelSkinMarkingTechniqueforExcessSkinResectionbyFleur-de-lisAbdominoplasty.JAesthetReconstrSurg.Vol.3No.2:6.

IntroductionAnchor abdominoplasty was first performed by Weinhold intheearlytwentiethcentury.Theprocedurewas laterperfectedbySomalo(1940),Dufourmentel(1959),Castañares(1967)andRegnald(1975)whointroducedthefleur-de-lisdesign[1,2].

Theprocedurecorrectsexcessskinintheverticalandhorizontaldimension,butdeterminingtheamountofskintoresectcanbechallenging.Thefinaltension,symmetryandqualityofthescarandtheriskofdehiscence,necrosisandcomplicationspotentiallycompromisingtheoutcomealldependonthecaretakenatthisfirststep[3,4].

Thepurposeofthisstudywastoprovideastepwisedescriptionof anovel techniqueof skinmarking for resectionbyfleur-de-lis abdominoplasty in formerly obese patients and identify theadvantagesassociatedwithit.

Patients and MethodsThe study included 24 formerly obese patients of both sexessubmittedtofleur-de-lisabdominoplastybythesamesurgeonatapublicreferralhospitalinNortheasternBrazilbetweenApril2012andJune2016.Allpatientshadexperiencedconsiderableweightloss following bariatric surgery two or more years previously.Allhadexcessskinintheverticalandhorizontaldimensionandindication for fleur-de-lis abdominoplasty. Patients with excessskininonlyonedimension(verticalorhorizontal)wereineligible.The procedurewas performed under peridural anesthesia andsedation,withoutliposuction.

TechniquesWiththepatientintheorthostaticposition,thesurgeonplacesamarkonthexiphoidprocessandanotheronthepubicmidlineat 5-7 cm above the vaginal commissure (women) or base of

Received: August10,2016; Accepted: August17,2017;Published: August28,2017

AbstractIntroduction: Fleur-de-lis abdominoplasty is used in vertical and horizontalcorrectionofexcessskin.However,determininghowmuchskintoresectcanbechallenging.Inthispaperwedescribeahigh-precisionskinmarkingtechniqueforthispurpose.

Patients and methods:BetweenApril2012andJune2016,24patientsofbothsexesweresubmittedtofleur-de-lisabdominoplastyunderperiduralanesthesiaandsedation,withoutliposuction,bythesamesurgeon.

Results: The average age was 44 years (range: 23-61). The mean duration ofsurgerywas144min(range:120-160).Allscarswereadequatelyaligned.

Conclusion: The technique was found to be safe and easy to perform andreproduce.Moreover,highprecisionhelpsavoidsinuousandtensescars.

Level IV: Evidence obtained from multiple time series with or without theintervention,suchascasestudies.Dramaticresults inuncontrolledtrialsmightalsoberegardedasthistypeofevidence.

Keywords: Fleur-de-lis;Abdominoplasty;Skin;Anesthesia;En bloc

A Novel Skin Marking Technique for Excess Skin Resection by Fleur-de-lis

Abdominoplasty

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the penis (men) (Figure 1). From this point, a horizontal andslightly rising line isdrawn to the right (X)and to the left,andtwo reference points equidistant in relation to themidline aremarkedoneachside.Thentheabdomenisdividedverticallyintothreesections.

Using one hand, the surgeon tractions the excess skin of theupper third portion contralaterally and, starting at the xiphoidprocess,marksalineatrightangleswiththefloor.Thesameisdone for themiddle thirdportionand the lower thirdportion.Theprocedureisrepeatedcontralaterally.Theresultisacurvedlineoneachside,joinedatthexiphoidmarkandthepubicmark(Figure 1).

Then the skin on the right side is tractioned downwards andmedially in order to draw a second horizontal line joinedwiththepreviouslydrawnlowerhorizontallineontherightside.Theprocedure is repeated contralaterally (Figure 2). After placingthepatientindorsaldecubitus,allmarkingsarereviewedand,if

necessary,corrected.Alittleslackshouldbeallowedtoavoidtheproblemofinsufficientskinatthecloseofthesurgery.

After organizing the surgical field, the excess skin is resecteden bloc, followedbyhemostasis,verticalplicatureoftherectusabdominis muscles and insertion of a continuous vacuumsuctiondrain(removedduringrecovery).Theumbilicalstumpispreservedandsuturedontotheabdominalflapusingmononylonthread size 4.0. The deeper layer is sutured with polyglactinthreadsize3.0andthesurfacelayerissuturedwithpolyglactinthreadsize4.0(Figure 3).

ResultsTwenty-four formerlyobesepatientsofboth sexes (M=4/F=20)aged44yearsontheaverage(range:23-61)weresubmittedtofleur-de-lisabdominoplastybythesamesurgeonbetweenApril2012 and June 2016. The mean duration of surgery was 144min(range:120-160).Follow-upintheoutpatientsettinglasted

Figure 1 Skinmarking:horizontalandslightlyrisinglinetotherightandtotheleftofthemidline;bilateralreferencepointsequidistantin

relationtothemidline;divisionoftheabdomenintothreeverticalsections;verticalcurvedlineoneachside(joinedatthexiphoidmarkandthepubicmark)madewhiletractioningtheexcessskincontralaterally.

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2017Journal of Aesthetic & Reconstructive Surgery

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Figure 2 Skinmarking:secondhorizontalline(joinedwiththeextremityofthefirsthorizontalline)madewhiletractioningtheexcessskin

downwardsandmedially;finalmarking.

Figure 3 Closureofsurgicalwound;finalaspect.

2017Journal of Aesthetic & Reconstructive Surgery

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7.5 months on the average (range: 3-12). No hematoma, skinnecrosis,tensionuponsurgicalclosureorneedforadditionalskin

detachmentoccurred.Allscarswereadequatelyaligned(Figures 4-6).

Figure 4 AandB:Preoperativeview.CandD:Postoperativeview(45days).

Figure 5 AandB:Preoperativeview.CandD:Postoperativeview(70days).

Vol. 3 No. 2: 6

2017Journal of Aesthetic & Reconstructive Surgery

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Figure 6 AandB:Preoperativeview.CandD:Postoperativeview(90days).

DiscussionFleur-de-lis abdominoplasty is themost appropriate techniqueforhorizontalandverticalresectionofexcessskin[3-6].Surgicalmarkinghastraditionallybeenbasedonthepinchtest,butwiththistechniquetheamountofresectedskinwilldependonhowcarefullythetestisperformed,andtheresultisnotuncommonlya sinuous or tense scar. In addition, scars vary considerablyfrom one surgeon to another. In contrast, our technique usesreference points and lines which reduce these variables andareeasilyreproduced.Preciseskinmarkingmakesresectionen bloc possible, reducing time of surgery. Moreover, the woundcanbeclosedwithoutadditionalskindetachment,whichmightotherwiseincreasetheriskofcomplications,suchasskinnecrosisandseromaformation.

ConclusionThetechniquedescribedinthispaperissafeandeasytoperformand reproduce. In addition, high precision helps avoid sinuousandtensescars.

AcknowledgmentThe authors declare that they have no conflicts of interest todisclose.

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