Reply: Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients.

Abstract

Sir: We would like to thank Dr. Bertheuil and colleagues for their insightful comments on our article about liposuction-assisted medial thigh lifts.1 We are grateful that our article was perceived as “interesting” and “with rigorous methodology.” In our clinical study, we were clearly able to demonstrate the benefits of concomitant liposuction in a comparison of excisional only versus liposuction-assisted patient groups undergoing thigh lift after massive weight loss. We postulate that the preservation of lymphatic vessels and blood supply to the wound might be responsible for our observations. We congratulate Dr. Bertheuil et al. on their recently published study, where they were able to demonstrate preservation of a significant part of the microvascular network within the remaining connective tissues after liposuction.2 This corroborates our presumption that liposuction before skin removal maximizes the vascularity of wound edges and the wound bed, thus enhancing healing and recovery. The benefits of liposuction may be most obvious in thigh lift procedures, as a major portion of the lymphatic drainage of the lower extremity takes place through lymphatic vessels located directly in the surgical field. However, we fully agree that the emerging principle of adding liposuction to excisional body contouring is potentially beneficial in other procedures such as brachioplasty, abdominoplasty, and upper and lower body lifts. With respect to the technical aspect of removing the redundant skin, we have had good experiences using the avulsion technique. After rigorous liposuction, the remaining skin is circumferentially incised and then avulsed from proximal to distal with gentle traction, without the use of electrocautery. Hunstad et al. recently published their result of avulsion thighplasty and brachioplasty with favorable results.3,4 We believe that avoiding the additional thermal tissue damage induced by skin removal by means of electrosurgery5 adds to preservation of the wound edge blood supply and lymphatic microvasculature. If sharp skin removal is performed, the use of a scalpel or scissors seems advisable. We are aware that the traction applied for skin removal carries a risk of tissue trauma. If liposuction is performed aggressively, skin avulsion might damage only the smallest of lymphatic and blood vessel branches. Despite its clear importance, the technical aspect of skin island removal may not be the major contributor to the eventual outcome because preservation of lymphatic and blood vessels is determined mostly by effective and rigorous liposuction. Nevertheless, a direct comparison of avulsion versus superficial resection of the excess skin is welcomed and would help to clarify this point of discussion. We want to thank Dr. Bertheuil et al. again for their kind comments and appreciation of our described technique as a valuable advancement for medial thigh lifts. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. No funding was received for this work. Manfred Schmidt, M.D.Dominik Duscher, M.D.Georg M. Huemer, M.D., M.Sc., M.B.A.Section of Plastic, Aesthetic, and Reconstructive SurgeryDepartment of General SurgeryKepler University HospitalLinz, Austria