Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана

Up per-arm tightening is requested increasingly by women over the age of 60. It is often surprising that women of this age do not have a facelift; instead they are more bothered by their flabby upper arms when they want to wear a bathing suit or sleeveless clothes. The only way of elimi­nating the surplus skin and the wrinkles in the long term is cutaneous excision. The art of the surgeon in doing this is to position the incision in such a way that it is on the medial side of the upper arm and to ensure that the resection of the skin is carried out so generously that the entire upper-arm region is tightened. Upper -arm tightening is not technically difficult. The thick skin/fat flaps are dissected off the fascia, protecting the nerves and vessels, fol­lowing exact marking of the incision line. The same basic principle applies to all operations to tighten the skin, namely , that the flap is mobilized and, following appropriate measurement, is then fixed in place in stages with key sutures so that neither too much nor too little skin is removed. Mang’s principle always applies: I can measure ten times but only cut once. This should always be kept in mind so that each resection border is measured precisely. The resection border will then be sutured without tension and no surplus.

9 Four-pro nged retractor 10 Cooper scissors 11 Insulated anatomical tweezers for hemostasis 12 Large Metzenbaum dissection scissors 13 Large needle holder 14 Small needle holder 15 Curved forceps 16 Roux hook