Single Flap Upper Medial Vector Brachioplasty: A Modification to The Fascial Suspension Technique

Abstract

Background: Arm contouring for lipodystrophy and ptosisare increasing in demand with age and especially after massiveweight loss following bariatric surgeries. Aesthetic arm contouringis one of the most requested surgeries to those patients.Multiple classification systems were described to guide themanagement during pre-operative assessment. Treatmentoptions vary between liposuction only, skin resection only, acombination of liposuction and excision, or possibly the useof newer energy based skin tightening devices. One of themost undesirable sequelae is visible scarring either due towidening or migration of the scars. Location of the scar andelimination of fat deposits and excess skin are the ultimateconcerns of patients seeking this surgery. The focus of thisstudy modification has been aimed to improve the pooraesthetic result of scar sequelae and over all arm contouring.Aim of Work: Developing a modification in surgicaltechnique for brachioplasty, that eliminates excess skin withadequate arm contouring, and position scars in the least visiblelocation, thus achieving better overall patient satisfaction.Methodology: This study was conducted on 15 patientswho presented seeking arm contouring in the period fromOctober 2017 to May 2019. Among these patients the averageage was 38. Average BMI was 27.5kg/m2. 60% of the casespresented following Bariatric surgeries, 26.7% presented withskin excess following fluctuations in weight and effect ofaging, and 13.3% presented with excess skin following previousunsatisfactory liposuction.Routine liposuction done initially, incision done down tothe honeycomb plane, undermining was carried deep to thesuperficial fascia up to the anterior border of triceps. Skinflap was redraped and pulled in an upper medial vector.Results: This upper medial vector helped in improvingthe contour of the arm in a homogenous way, eliminating skinexcess especially in the area above the olecranon in the distalarm and also avoids the presence of bands while closure.Early complications was limited to one case with 2cm wounddehiscence, while late complications showed 5 cases withscar hypertrophy and 4 cases with scar pigmentation.Conclusion: The mentioned technique proved to be reliablein achieving favorable arm contouring, with acceptable scarringand a low incidence of complications.