Midline Skin Incision Research Articles

Individual modifications in body contour surgery: the "limited" abdominoplasty.

Stretching of the abdominal wall and skin following pregnancy or excessive weight gain may be limited to the infraumbilical area. In these patients, abdominal repair may be accomplished with a shorter incision and without the necessity for relocating the umbilicus with its attendant visible scar. Forty patients are presented in whom excellent aesthetic repairs were effected through short curvilinear, low abdominal incisions with removal of a modest amount of excess skin. Fascial plication from pubis to umbilicus or above is facilitated by buried figure-of-eight sutures. Suction-assisted lipectomy may be employed as an adjunct. Recovery is facilitated by the reduced incision line length, reduced undermined area, and absence of tension in the midline skin incision, such as may occur in a standard abdominoplasty in which large amounts of panniculus and skin are removed with a complete repair of the abdominal wall. The limited abdominoplasty may be safely performed with ketamine-diazepam anesthesia in an office surgical center. Major complications are few and generally reflect the unpredictable nature of the elasticity of the abdominal skin.

Improved approach for posterior upper thoracic sympathectomy.

The still popular and standard procedure for posterior upper dorsal sympathectomy was designed and described by Adson, 1 first in 1929 and again in 1931. Experimenting with midline, transverse, and hockey-stick skin incisions only to discard them, he finally adopted the well-known oblique paramedian skin incision. Irrespective of the site, incision is continued down only to the trapezius fascia, followed by undesirable division and separation of the large upper back muscles away from the midline to expose several centimeters of ribs and transverse processes. A large extent of rib and its entire transverse process must then be removed to permit the necessary additional excision of the resected rib neck and head. Distant from the midline, the parietal pleura is intimately applied to the ribs, intercostal muscles, and fascia; the intercostal neurovascular bundles are fixed in the concave costal surfaces, and the superior intercostal artery can occasionally become a problem. These