Irvine, Calif. — Belt lipectomy that addresses circumferential excess tissue is the procedure of choice for truncal contouring in massive-weight-loss patients. This procedure has not been widely adopted by plastic surgeons in the United States, however, and the majority of massive-weight-loss patients seeking body contouring to address post-weight-loss deformities are inappropriately undergoing abdominoplasty instead. Recently, innovations in technique have improved the efficiency of belt lipectomy and reduced its complication rate. These advances may encourage more plastic surgeons to learn the procedure so they can provide optimal body contouring for massive-weight-loss patients, says Al S. Aly, M.D. Dr. Aly is clinical professor of surgery, School of Medicine, University of California, Irvine, and he pioneered the belt lipectomy procedure in collaboration with Albert E. Cram, M.D., when they were faculty members at the University of Iowa, Iowa City. CLOSURE Dr. Aly notes that the closure, which was the most time-consuming portion of the operation, was the target for several of the changes. Originally, the deep layers were closed using interrupted sutures and the superficial layers were closed with either interrupted or running sutures. About three years ago, Dr. Aly began using barbed sutures to plicate the abdominal wall and the deep layers; absorbable subcuticular staples for the superficial layer closure; absorbable subcuticular running monofilament suture; 3-0 Monocryl (Ethicon) to approximate skin edges; and tissue glue (Dermabond, Ethicon)."The closure in belt lipectomy takes a very long time because the incisions are so long. Each of the modifications in closure technique speeds up the respective step, and when used together, there is a significant reduction in total operative time. A shorter procedure is a safer one," Dr. Aly says. REDUCING SEROMA Other surgical modifications have aimed to reduce the rate of seroma, which is the most common complication of the circumferential procedure. Instead of elevating the abdominal flaps at the level of the rectus fascia as originally performed, a revised technique elevates the flap at or just below the Scarpa fascia. That modification by itself reduces the risk of seroma, but in addition, placement of quilting sutures to close the dead space between the flap and abdominal wall seems to provide further benefit, Dr. Aly says. Quilting sutures were first popularized by Ricardo Baroudi, M.D., Sao Paulo, for use in abdominoplasty, and Harlan and Todd Pollock, M.D., a father-and-son team of plastic surgeons in Dallas, introduced their own modification that they've termed progressive tension sutures. "By any name, these sutures seem to significantly reduce the risk of seroma. However, while their use and the modification in flap elevation technique have been well adopted by plastic surgeons in South America and Europe, they are catching on more slowly in the U.S.," Dr. Aly says. Disclosures: Dr. Aly is a consultant for Ethicon and has a financial interest in Incisive Surgical, the maker of the subcuticular stapler. |
