Plication of the Brachial Fascia: An Important Step in Dermolipectomy Procedures of the Arm

Abstract

Both the aging process and postobesity deformities of the upper extremities are associated with lipodystrophy, loss of muscular mass, weakening of the fascia, and skin laxity. Many different surgical procedures have been described to correct these deformities, but most of them have limitations, particularly with respect to postsurgical scarring. The authors present a technique in which plication of the brachial fascia is performed before dermolipectomy in order to obtain greater flap advancement and limit tension on the final scars, thereby diminishing postoperative complications. From 1997 to 2007, the authors retrospectively followed 41 female patients who had undergone brachial dermolipectomy procedures associated with plication of the fascia on the internal aspect of the arm. This technique permitted greater advancement of the entire thickness of the flap, creating a better support for the flap with larger skin resection. The distance between the two incisions was also shortened, reducing dead space between the two planes, the incidence of seromas, and tension on the suture line. The scarring complications caused by tension on the skin were eliminated. Therefore, our complication rate was low, with only three cases of small foci of dehiscence, two cases of seroma, and four cases of hypertrophic scars in certain areas. The mean follow-up period was seven years, during which 92% of the patients were pleased with their outcomes. The described surgical approach provided excellent overall extremity contour with favorable scars while simultaneously addressing axillary contour and forearm deformities when present.