AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Thighplasty after Massive Weight Loss: A Description of Technique and an Analysis of Outcomes
Michele A. Shermak, M.D., Jessie Mallalieu, P.A.-C, David Chang, Ph.D., MPH, MBA.
Johns Hopkins Hospital, Baltimore, MD, USA.

PURPOSE: One of the more challenging regions to address in massive weight loss (MWL) patients is the thigh. While Lockwood popularized a technique for thighlift, it only allowed for limited resection of tissue. To meet the greater degree of skin excess in MWL, extended thighlifting with a vertical scar from pubis to knee has been adopted. While allowing for greater skin removal, vertical thighlift risks lymphatic/venous injury and creates a visible scar. We evolved a technique to realize the benefits of Lockwood’s hidden scar and to address the skin removal necessary in MWL, named the APEX thighlift, representing the Anterior Proximal Extended thighlift. Furthermore, we reviewed our experience with thighlift in MWL patients and analyzed factors that impacted patient outcomes.
METHODS: Review of all MWL patients who had thighlift was performed. Variables studied included age, gender, BMI, medical history, operative data and postoperative complications. Thighlift technique was chosen on the basis of degree of skin laxity and redundancy, as well as patient preference. Extended thighlift included medial vertical excision, performed supine with thigh spreader bars. The APEX thighlift was performed prone, suspending posterior skin to the ischial periosteum in the infragluteal crease; and then supine, suspending the anterior skin to the pubic periosteum, and transitioning the scar into the abdomen to further improve on the lift. Statistical analysis to assess outcomes was performed in Stata SE, version 9.
RESULTS: We performed thighlift on 97 MWL patients, including 86 females and 11 males. Average weight loss was 145.6 lbs, with an average BMI of 29.8 at bodylift. Extended vertical thighlift was performed in 11 patients, and the APEX thighlift in 86 patients. Thighlift was performed in conjunction with lifting of other body regions, including the abdomen(86), back(48), arms(42), and chest (25). Complications of thighlift included wound healing problems (18.6%); lymphedema (8.3%); cellulitis (7.2%); seroma (3.1%); and bleeding (1%). Age and BMI negatively impacted healing: every year increase in age causing 11% increased risk of wound (p=0.06) and every increase in unit of BMI increased wound risk by 18% (p=0.06). For BMI greater than 35, odds ratio for wound healing problem was 13.7 (p=0.03). Hypothyroidism was strongly associated with lymphedema, with an odds ratio of 23 (p=0.06). Extended thighlift trended toward lymphedema (OR 16.7, p=0.08). High BMI was less likely to be associated with lymphedema, with an odds ratio of 0.67 (p=0.05).
CONCLUSION: Age and BMI negatively impacted wound healing, while hypothyroidism was associated with lymphedema. The relationship between obesity and lymphedema might indicate that high BMI impairs VTE diagnosis. We discuss two major techniques for thighlift in MWL patients, the extended vertical thighlift and the newly introduced APEX technique.


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