An Easy and Novel Method of Preoperative Laser-Assisted Marking for Body Lift Procedures

Abstract

Sir: We read with great interest the article “Simplifying Circumferential Body Contouring: The Central Body Lift Evolution” by Rohrich et al.1 The authors present the evolution of their technique and experience with the central body lift procedure in a greater than 12-year period and emphasize the key operative elements and strict safety guidelines that afford optimal results with minimal morbidity. We would hereby like to introduce a novel technique to facilitate the preoperative planning and marking concerning the body lift procedure in massive weight loss patients. Preoperative markings are set in standing position,2,3 and this sometimes implicates difficulties for the surgeon, especially in drawing straight vertical and horizontal lines, which later on will be the position of the horizontal scar on the typical position of the abdomen and the back. Scar placement is crucial and the result of a precise marking technique. In the massive weight loss patient, excess skin may make identification of the anatomical landmarks (which are often used for orientation to achieve symmetry) difficult.4 Kalbermatten et al.5 in 2009 suggested body taping to visualize the optimal position for skin incision. This technique makes preoperative marking objectively reproducible. The authors also postulated demands for a sufficient marking technique, which are all fulfilled by our new method too: minimal expenditure of time, congruence of marked and later resected area, and finally cost efficiency. In this Viewpoint, we present a new simple method of reproducibly defining the incision lines for body lift procedures with an available laser marking device (Fig. 1).Fig. 1: Laser device placed opposite the standing patient (Stanley XP180 Cross Line and Laser Plumb; Stanley Deutschland–HDL Industrievertretung GmbH).The patient is placed standing with hanging arms to avoid a tightening effect on the lateral trunk. The laser marking light lines (horizontal and vertical light) are turned on and the vertical light line is placed exactly on the anal cleft. The designated scar line is generally defined by placing the horizontal laser light approximately 2 cm below the upper impression of the underwear’s elastic strap. After marking of a median line, further vertical lines are drawn at a distance of 5 cm (2 inches) as far as the spina iliaca anterior superior by turning the patient. For defining the resection margins, skin is moved upward and downward using the tip of the index finger at each vertical line. Immediately before skin slips of the fingertip, a skin mark is set at the place where the vertical line and laser light intersect. This maneuver is started medially and continued to the lateral side as far as resection is planned. To complete the drawing of the inferior and superior incision line, these points are connected (Fig. 2).Fig. 2: Laser marking light lines (horizontal and vertical light) placed on the back of the patient.The use of this simple instrument allows placement of reproducible skin markings, pays respect to varying tissue mobility, and reduces time needed for preoperative skin marking. As a sighting device, the laser marking device gives the surgeon a secure instrument with which to draw precise lines that finally will result in a more precise positioning of the scar and thus a better postoperative outcome for the massive weight loss patient. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. No funding was received for this work. Lorenz Larcher, M.D. Hospital of St. John of God (Barmherzige Brüder) Salzburg (A) Department of Plastic, Aesthetic, and Reconstructive Surgery Academic Teaching Hospital Paracelsus Medical University Salzburg Karl Schwaiger Paracelsus Medical University Salzburg Florian Ensat, M.D. Gottfried Wechselberger, M.D., M.Sc. Heinrich M. Schubert, M.D. Hospital of St. John of God (Barmherzige Brüder) Salzburg (A) Department of Plastic, Aesthetic, and Reconstructive Surgery Academic Teaching Hospital Paracelsus Medical University Salzburg Salzburg, Austria