改良腹壁整形术

目的为进一步增进脂肪抽吸的效果,解决脂肪抽吸后皮肤松弛、皱纹增多、腹部仍有膨隆等的不足.方法在腹壁整形治疗中,联合采用脂肪抽吸术和腹壁整形术.首先根据腹部脂肪堆积的位置和高低程度的不同,均匀抽吸脂肪.完成脂肪抽吸后,根据术前皮肤、腹肌的松弛情况,再行腹壁整形术,沿腹肌筋膜表面分离,缩紧腹肌,向下拉动腹壁皮肤,确定多余皮肤的切除.结果自2003年至今,共治疗10例,手术效果良好,腹部形态明显改善,受术者满意.结论施行腹壁整形治疗时需要考虑腹部皮肤、皮下脂肪、腹壁肌肉以及腹内脂肪等多方面的情况,综合评估.单纯的脂肪抽吸只能解决皮下脂肪的堆积膨隆;而结合传统腹壁整形术和脂肪抽吸术的特点,针对腹部具体条件,有针对性的联合采用脂肪抽吸和腹壁整形等不同的手术方法,才能获得更为理想的腹壁整形效果.     

脂肪抽吸腹壁整形术的临床进展

腹壁整形术分为很多种类,其中脂肪抽吸腹壁整形术联合了吸脂术和腹部整形术两种技术,是目前广泛应用的术式之一。通过肿胀技术的应用、抽吸套管的改良、脐旁的高张力缝合等技术,大大减少了血肿、皮肤坏死等并发症的发生。本文对脂肪抽吸腹壁整形术的临床进展进行综述。     

体外超声辅助下的脂肪抽吸术

目的 介绍体外超声辅助下的脂肪抽吸技术的操作要点及206例患者的临床体会。方法 运用肿胀麻醉技术进行术区浸润后，应用体外超声设备对术区进行体外超声处理，能量设置为3W；作用时间为10～15min。然后，运用传统的脂肪抽吸方法进行吸脂塑形。结果 206例患者，脂肪抽吸量为200～4300ml,其中有1例患者发生局部小面积皮肤浅层坏死，3例发生血清肿，经换药1～2周后痊愈，其余患者无严重的并发症发生。206例患者均获得较明显的吸脂塑形效果，吸脂后术区皮肤均有一定程度的回缩。结论 体外超声波辅助下的脂肪抽吸术安全可靠、易于掌握。其对脂肪的乳化作用有利于脂肪的吸出，同时有利于皮肤的回缩。     

腹壁整形术研究进展北大核心CSCD

目的总结腹壁整形术的研究进展。方法广泛查阅近年国内外腹壁整形术相关文献,就该术式历史沿革及相关手术技术进展进行总结。结果腹壁整形术是通过去除腹壁多余皮肤脂肪组织,加强松弛肌肉筋膜系统,达到改善腹壁轮廓目的。随着脂肪抽吸、选择性皮瓣分离、进行性减张缝合和Scarpa筋膜保留等技术的发展,腹壁整形术创伤和并发症均明显减少,取得了较好美学效果。结论目前腹壁整形术仍是美容手术中并发症发生率最高的术式,需要进一步探索降低并发症、改善美学效果的方法。     

脂肪抽吸辅助以脐为中心的腹壁成形术

目的:探讨增进腹壁脂肪抽吸术的效果,解决脂肪抽吸后皮肤松垂、皱纹增多、腹部仍有膨隆等问题。方法:采用腹壁脂肪抽吸结合以脐为中心的腹壁成形术进行腹部塑形。先行腹壁脂肪抽吸术,再视腹壁有无剖宫产术后瘢痕分别实施双环正圆、双环椭圆及单环椭圆切除缝合腹壁成形术。结果:共治疗12例,随访1～5年,除腹部纵向缝合瘢痕部分变宽(0.2～0.4cm)外,外形满意,获良好的腹壁减肥塑形效果,无严重并发症发生,其中有2例行双环正圆切除缝合术和1例行单环椭圆切除缝合术的患者于术后一年为追崇时尚再次行脐周色彩文饰(呈太阳放射状图案)。结论:本方法是治疗腹壁脂肪堆积和腹壁皮肤松弛的较理想的方法。     

超声波辅助吸脂在人体塑形中的应用

目的：探讨体内超声波辅助吸脂术外科中的临床效果。方法：对153例求术者进行脂肪抽吸，采用超声波体内导入结合技术使超声波有效作用范围内的脂肪细胞破裂，乳化，同时对于纤维组织密集的脂肪坠区脂肪易于去除。结果：通过脂肪抽吸，153例临床疗效满意，术区平坦，手感柔软，术后术区皮肤回缩明显，并发症较少，该技术安全，有效，操作简便。结论：体内超声波辅助吸脂技术是一项安全可靠的方法,值得临床应用推广。     

体外超声辅助下的脂肪抽吸术

目的介绍体外超声辅助下的脂肪抽吸技术的操作要点及206例患者的临床体会.方法运用肿胀麻醉技术进行术区浸润后,应用体外超声设备对术区进行体外超声处理,能量设置为3 W;作用时间为10～15*!min.然后,运用传统的脂肪抽吸方法进行吸脂塑形.结果 206例患者,脂肪抽吸量为200～4*!300*!ml,其中有1例患者发生局部小面积皮肤浅层坏死,3例发生血清肿,经换药1～2周后痊愈,其余患者无严重的并发症发生.206例患者均获得较明显的吸脂塑形效果,吸脂后术区皮肤均有一定程度的回缩.结论体外超声波辅助下的脂肪抽吸术安全可靠、易于掌握,其对脂肪的乳化作用有利于脂肪的吸出,同时有利于皮肤的回缩.     

脂肪抽吸联合腹壁成形术改善腹部形态临床应用

目的探讨脂肪抽吸与腹壁成形术联合进行腹壁体形重塑的临床疗效,总结手术成功与减少并发症的经验。方法对18例腹部脂肪堆积伴腹壁皮肤松弛的患者采用肿胀麻醉,负压吸引器行腹壁脂肪抽吸;做耻骨联合上W形切口,折叠缝合腹直肌前鞘,切除多余皮瓣后分层缝合腹壁。结果所有切口均Ⅰ期愈合,随访4~24个月,腹部平坦,切口瘢痕不明显,腹围平均缩小15 cm,外形满意。结论根据患者腹部皮肤、皮下脂肪、腹壁肌肉等多方面的情况,有针对性的采用脂肪抽吸与腹壁整形相结合的腹壁体形重塑术,能够获得满意的效果,手术方法安全可靠。     

手术切除联合Ⅱ期脂肪抽吸腹部整形术

目的 探讨手术切除联合Ⅱ期脂肪抽吸腹部整形的手术效果及手术适应证。方法 首先行常规腹壁切除整形术，切除下腹松弛皮肤，折叠缝合腹直肌前鞘，缩小腹围；2个月后行脂肪抽吸术，吸出腹部皮下脂肪，加压包扎，穿紧身服塑形。结果 11例患者经手术切除联合Ⅱ期脂肪抽吸术，其皮瓣血运好，术后经6个月的随访，腹部平坦，效果满意。结论 手术切除联合Ⅱ期脂肪抽吸可达到更好的腹部整形效果，对于腹部肥胖伴有腹部须行倒“T”型切口以缝合皮瓣的重度皮肤松垂以及有剖腹产史等患者．手术切除与脂肪抽吸应分期进行．     

脂肪抽吸与腹壁整形相结合的腹壁体形重塑术

目的介绍联合运用脂肪抽吸与腹壁整形术进行腹壁体形重塑的方法,总结降低手术并发症和获得满意效果的经验.方法采用肿胀麻醉技术,利用负压吸引器或注射器进行腹壁深层脂肪抽吸;做耻骨联合上W形切口行腹壁整形术,视腹肌松弛情况进行腹直肌前鞘折叠缝合,切除多余皮瓣后分层缝合腹壁.结果共治疗30例,27例Ⅰ期愈合,另3例中1例皮瓣远端局部坏死,1例出现小范围血清肿,1例局部伤口裂开.随访3～12个月,腹壁平坦,腹围平均缩小16.4 cm,外形满意.结论在严格筛选受术者前提下,谨慎进行手术操作,脂肪抽吸与腹壁整形相结合的腹壁体形重塑术,能够获得较单独进行腹壁整形术更满意的效果,安全可靠,值得推广.     

Refinements in abdominoplasty

When performing traditional abdominoplasty, three fundamental defects of the abdominal wall must always be addressed by the plastic surgeon. They include redundant skin, excess fat, and musculofascial laxity. Plastic surgeons have found that this procedure consists of dermolipectomy and rectus plication, extremely effective in restoring the abdomen to its youthful shape in the vast majority of patients. This article will review the recent advancements in body contouring surgery while focusing on the recent technical refinements in abdominoplasty.     

Is it safe to combine abdominoplasty with other dermolipectomy procedures to correct skin excess after weight loss?

The development of sophisticated bariatric surgery techniques has led to an increasing number of patients demanding a complexity of body contouring procedures that can be achieved either with a step-by-step approach or by combining dermolipectomy in various regions. The aim of this study was to test the hypothesis that abdominoplasty-related morbidity and outcome may be worsened by combining abdominoplasty with other dermolipectomies and to determine whether any predictive risk factor could be identified. Seventy-three consecutive patients undergoing abdominoplasty with (n = 26) and without (n = 47) additional dermolipectomy on the upper arms, inner thighs, breasts, and buttocks were included in this study. Additional dermolipectomies did not increase abdominoplasty-related morbidity but revealed better long-term results (p = 0.10). Statistically significant risk factors were male sex, age (>41 years), overweight (BMI > 30), prolonged operations (>3 hours), and extensive blood loss (1,000 mL). Most importantly, better outcome was obtained in patients whose weight reduction was greater (p = 0.04). The authors' results suggest that combined dermolipectomy procedures can be advocated in patients who have reached their intended level of weight reduction and if prolonged operative time and excessive blood loss are avoided.     

Abdominoplasty in a patient with severe obesity

Abdominoplasty and dermolipectomy are, in some cases, the only tools that a surgeon has to treat patients with severe obesity. Although liposuction is useful in removing fatty deposits without traditional surgical incisions, its application is limited in extremely obese patients. In response to current esthetic expectations, reconstructive surgeons have to deal effectively both with the actual complaint and with the desire of the patient to have an incision as small as possible. We present a case of severe obesity with large amounts of redundant skin and fat extending to below the knees. At the time of surgery, a large area of the patient's lower abdomen had become ischemic, thus making abdominoplasty the only option for treatment. We believe it is important for the surgeon be familiar with this approach because it can occur in general practice and he should be prepared to deal with it both as a relative emergency and as an elective procedure.     

Abdominoplasty After Major Weight Loss: Improvement of Quality of Life and Psychological Status

Abdominoplasty provides a reconstructive but rarely aesthetic cosmetic solution after major weight loss. Few articles document quality of life (QOL) issues and the psychological impact of abdominoplasty on obese patients. We report a retrospective study of 41 abdominoplasties performed after an average weight loss of 40.2 kg. Data were obtained through review of patient medical files, double-blind surgical and psychological examinations, and two specifically designated questionnaires used to assess pre-abdominoplasty body perception and QOL, post-body contouring perception of improvement, and psychological status. To date, 14 patients have regained >10 kg; 84.6% have improved QOL; 86.5% have improved psychological status; 74% have better sexual relations; 53.9% admit liking their body; 76.9% are satisfied with the results of abdominoplasty; and 96.1% would be willing to undergo abdominoplasty again. Anterior dermolipectomy improves both QOL and psychological status. Provision of patient education, multidisciplinary management, and long-term follow up are necessary to obtain satisfactory results. This work was presented at the 51th International Symposium of the French Society of Plastic, Reconstructive and Aesthetic Surgery in Marseille, France, November 13–15, 2006     

"Classical" abdominoplasty]

The term "classical" abdominoplasty includes those procedures designed and performed before the introduction of liposuction techniques. All of these operations leave a considerable scar: the importance of this residual scar makes abdominoplasty the poor cousin of cosmetic plastic surgery. In practice, it should be generally considered to be a functional comfort surgery, which sometimes resembles cosmetic surgery. All wall lesions must be treated during abdominoplasty: retightening of the musculo-aponeurotic plane when it is distended, correction, of more or less localized fat overload, resection of any excess skin. The desire to obtain scars as small and as hidden as possible has led to the development of a large number of techniques, performed with varying frequencies. However, there has been a renewed interest in some of these techniques since the development of liposuction. The abdominoplasty skin procedures can be divided into two groups: localized abdominoplasties, only concerning a limited part of the abdomen, and extensive abdominoplasties, concern all of the abdominal wall and requiring extensive skin detachment and a procedure on the umbilicus. The most classical method of abdominoplasty is low transverse abdominoplasty with umbilical transposition. This operation raises a number of aesthetic problems and one or several defects are fairly frequently observed during objective analysis of our results. It nevertheless provides a real personal gain for the patient, in the way he or she moves and dresses and can even allow weight loss after the operation. This gain is not related to the results observed on photographs. The introduction of liposuction techniques has radically modified the technical modalities and indications for these so-called "classical" operations.     

Improving esthetics and safety in abdominoplasty with broad lateral subcostal perforator preservation and contouring with liposuction

Suction-assisted lipectomy (SAL) in association with abdominoplasty has been regarded with trepidation, with ischemia of the apron flap, skin loss, and open wounds among the potential dire consequences. Leaving midabdominal and epigastric fatty excess, however, confers suboptimal contour and often a mediocre cosmetic result. In this study, a theoretical and technical approach that improves esthetics and safety in anterior and circumferential abdominoplasty with contouring using SAL is described and evaluated. Forty-two patients were treated with follow-up ranging from 5 to 40 months (mean follow-up 19 months). Through a low-transverse incision, the upper flap is elevated widely to the umbilical horizontal. The umbilicus is circumcised. The dissection then proceeds in a narrow column above the rectus sheaths to the xiphoid. Judicious subcostal undermining is performed, maintaining an intact bilateral subcostal "perforator zone" of 4 to 6 cm. Diastasis repair and anterior sheath plication are performed, and the umbilicus is anchored to the fascia. Excess skin and fat are excised from the inferior aspect of the flap, and the flap is inset. Wetting solution is instilled, and SAL of the entire flap, particularly in the midline and in the region of the neoumbilicus, is performed. Data were reviewed retrospectively. Twenty-seven anterior and 15 circumferential procedures were performed. There were 36 females and 6 males. There was one hematoma (3%) requiring re-exploration (male, circumferential), and 3 seromas (7%) treated with percutaneous aspiration. There was no infection, skin loss, or wound dehiscence. Contrary to classic abdominoplasty undermining to the costal margins, the maintenance of a broad subcostal blood supply allows for liberal flap contouring with suction. With this technique, liposuction can be safely used in abdominoplasty to maximize esthetic outcomes.     

Heating-pad burn as a complication of abdominoplasty.

As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.     

Circumferential mesh in abdominal wall reconstruction: indications, technical notes and case report

The authors describe an original technique of abdominoplasty aiming at correcting ventral muscles, hypotonia, and relaxation, especially in formerly obese patients, pluriparae women, and patients with neuromuscular impairment. The technique encloses regular dermolipectomy, laparocele or hernia reduction (if existing), ventral fascia plication on the midline, and suprafascial application of a purposely built polypropylene mesh. The mesh consists of three continouos segments: two lateral, wider, rectangular segments to be fixed on the ventral area and one central and narrower (like a belt) segment to be inserted posteriorly into the deep subcutaneous tissue above the dorsal muscles and the spine. The vehicle of inserting circumferential mesh includes introducing a smooth, hollow rod through a small lateral skin access. Then, the two lateral segments are extended and criss-crossed over the abdominal muscles and are fixed to the iliac periosteum. This allows the dorsal and ventral muscles to be contained and supported by the mesh during prolonged standing and exercise.     

Use of the Pitanguy Large Flap Demarcator in Thigh Dermolipectomy with a Medioanterior Scar Extension

BACKGROUND: Thigh dermolipectomy is one the most challenging procedures for the treatment of postobesity deformities. Excessive tissue on the medial portion of the thigh is associated with the poor results of the classic approach. Recently, different techniques have been proposed with the goal of improving the results. The current study presents an alternative technique for thigh dermolipectomy using the Pitanguy flap demarcator with a medioanterior scar extension. METHODS: From January 2002 to July 2005, the authors prospectively followed up patients undergoing thigh dermolipectomy using the Pitanguy flap demarcator for marking resection areas and the medioanterior scar extension. RESULTS: Eight patients ranging in age from 30 to 54 years and with a weight loss of 30 to 59 kg were submitted to the medioanterior extension thigh dermolipectomy. All the patients displayed important soft tissue laxity and redundancy at the lower limbs. The postoperative follow-up period ranged from 5 to 40 months. The results attained were considered satisfactory, and few complications were observed. CONCLUSIONS: The poor results of previous procedures were disappointing to many patients and discouraged many others from undergoing thigh dermolipectomy. Using the Pitanguy flap demarcator for markings and the medioanterior scar extension, satisfactory results were increasingly common, and a growing number of patients may be encouraged to undergo thigh dermolipectomy procedures.