Background: Traditional abdominoplasty techniques often fail to adequately correct the complex contour deformities in the massive weight loss patient. To address these deformities, addition of a vertical skin resection to the traditional horizontal excision has become a popular procedure. The authors analyzed the impact of vertical (fleur-de-lis) excision on complications when compared with traditional transverse excision. Methods: A review of massive weight loss patients enrolled in an institutional review board-approved prospective registry was performed on consecutive patients undergoing abdominoplasty by a single surgeon. Patients were included if they underwent at least 50 pounds of weight loss. Demographic information, procedural data, and outcome measures were studied. Logistic regression and t tests were performed to analyze differences in complication rates for both procedures and identify risk factors for complications. Results: Four hundred ninety-nine patients met inclusion criteria, of whom 154 (31 percent) had a fleur-de-lis vertical component. The overall abdominal complication rate for all patients was 26.3 percent, with a 5.0 percent rate of major complications. Transverse-only and fleur-de-lis abdominoplasty had similar rates of complications with the exception of a higher rate of wound infection in the fleur-de-lis group on multivariate analysis. Risk factors for abdominal wound complications with either procedure included male sex, high body mass index, concurrent component separation, and previous subcostal scars. Conclusions: Fleur-de-lis abdominoplasty can be safely performed with complication rates comparable to those of traditional abdominoplasty techniques. Ideal candidates are patients with upper abdominal skin laxity who may not achieve an adequate aesthetic result with transverse-only excision.
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