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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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10 Thigh and Buttock Lift
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Incision of the Skin (Fig. 10.8)
䊏
The incision is made according to the marks made preoperatively. Note
that the incision line runs for approximately two fingerwidths to the
cranial side of the groin, since the scar moves caudally owing to the
later traction.
䊏
The incision is made using a size 10 scalpel, radically, as far as the
subcutaneous adipose tissue and may, without repositioning the patient,
be continued as far as the middle third of the buttock region. If no
buttock lift is indicated, the incision should be as far as possible into
the buttock region so that the posterior part of the thigh is also tightened and modeled.
Dissection (Fig. 10.9)
䊏
When dissecting away the cutaneous/fatty flap, the assistant uses two
sharp retractors and holds these under tension so that the dissection
using sharp instruments can be carried out without any problems.
It is rigorously dissected off as low down the thigh as the extent of the
slackness demands.
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Fig. 10.8
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10 Thigh and Buttock Lift
Fig. 10.9
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Deep Dissection and Hemostasis (Fig. 10.10)
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䊏
Deep dissection is carried out using the Metzenbaum dissecting scissors by pulling the cutaneous/fatty flap caudally. Bleeding is stopped
using bipolar or monopolar tweezers. If dissection is carried out in the
correct layer, precisely above the thigh fascia, no vessel ligatures are
required.
10 Thigh and Buttock Lift
䊏
Deep dissection is taken as far as was drawn on the day before the
operation (dissection area) and discussed with the patient.
Only in rare cases do we carry out a vertical incision in addition to the
inguinal incision, since most patients, when given detailed information
about the operation, have problems with the prospect of what is usually
a visible scar. If, however, there is very loose skin as far down as the
knee, this incision line cannot be avoided.
Definition of Resection Boundaries (Fig. 10.11)
䊏
The assistant pushes the area of skin that has been dissected away in a
cranial direction. Similarly, the cutaneous flap is pulled upwards with a
sharp retractor and surgical tweezers in a cranial direction. The thigh is
rotated inwards by the assistant so as to achieve as straight a position as
possible, as is it would be in the standing position. The skin incisions
are made precisely in these positions so that step by step the incision
points (a) correspond with the cranial inguinal incision.
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Fig. 10.10
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10 Thigh and Buttock Lift
Fig. 10.11
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10 Thigh and Buttock Lift
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Skin Resection (Fig. 10.12)
䊏
Skin resection is performed with precise monitoring of the resulting
tension on the cutaneous suture. The resection boundaries are dictated
by the positions of the key sutures, which are taken out again after the
resection, because the cutaneous flap – and this is the most important
part of the operation – needs to be anchored deeply at two points with
permanent sutures in order to achieve a satisfactory long-term result.
䊏
After skin resection, residual areas of fat are removed. In the process, it
should be noted that subcutaneous fat is removed in the shape of a
wedge, so that later joining can be step by step without any excess
material. For all lifts concerning skin and extremities, it is important to
have wedge-shaped joining in the form of an equilateral triangle. This
prevents formation of seromas and promotes good wound healing, and
therefore scar healing.
Fixation Suture on the Pubic Bone with 2.0 Monocryl (Fig. 10.13)
䊏
Followingskinresection,theinguinalligamentisdissecteddeeply
using dissecting scissors. The same applies to the pubic bone further
caudally. The periosteum of the pubic bone can be felt easily. Suturing
to connect the subcutaneous fascia and adipose tissue of the cutaneous
flap with the periosteum of the pubic bone may be carried out using a
2.0 Monocryl™*
suture.WehavethebestexperiencewithMonocryl
and there has never been any impairment to wound healing. Owing to
the long absorption rate, Monocryl has the same life as a monofilament
cutaneous suture.
* Ethicon GmbH, Robert-Koch-Str.1, 22851 Norderstedt, Germany
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Fig. 10.12
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10 Thigh and Buttock Lift
Fig. 10.13
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10 Thigh and Buttock Lift
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Second Fixation Suture on the Inguinal Ligament (Fig. 10.14)
䊏
After the deep demonstration of the inguinal ligament has taken place
over its whole length using dissecting scissors, the subcutaneous adipose sheath with the subcutaneous fascia is anchored to the inguinal
ligament using 2.0 Monocryl interrupted sutures, to distribute the main
weight, avoid secondary descen t of the scars and divarification of the
labia majora.
Deep Wound Closure and Insertion of a Redon Drain (No. 10) (Fig. 10.15)
䊏
Before deep wound closure, the flap is trimmed and the excess fatty
tissue is resected. After dissection of the subcutaneous fascia (Scarpa’s
fascia), this is closed by means of deeply concealed 3.0 Monocryl interrupted sutures. This suture and the two fixation sutures on the inguinal
ligament and the periosteum of the pubic bone ensure that little tension
is placed on the final subcutaneous and cutaneous suture. This is
important to ensure good healing of the scar later on. Redon drains
(size10)areinserted.
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Fig. 10.14
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10 Thigh and Buttock Lift
Fig. 10.15
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Intracutaneous Skin Closure (Fig. 10.16)
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䊏
After subcutaneous adaptationusing 3.0 Monocryl interrupted sutur es,
the skin is closed without tension with a running intracutaneous 4.0
Monocryl suture. ‘Dog ears’ should be avoided and if they are present,
they should be corrected at the caudal end of the incision line running
into the buttock crease.
10 Thigh and Buttock Lift
䊏
If, following a thigh lift, a buttock lift is carried out, the patient is
turned onto his/her stomach, but in the same position.
䊏
The intervention is completed with a 4.0 running intracutaneous
Monocryl suture.
Dressing (Fig. 10.17)
䊏
Dressing is with Steri-Strips that are removed after 8 days once the
wound has been checked. For the first 2 days after the operation, compression dressings and Cutiplast® with special girdles are used. The
Redon drain can be removed on the first or second day after the operation, depending on the results. Antibiotics and thrombosis proph ylaxis
should be given.
454
Note:
If the fixation shown here appears to be too static, then it is possible
to suture the thigh fascia to the deep pubic fascia for dynamic
anchoring instead of fixation to the periosteum of the pubic bone.
Fig. 10.16
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10 Thigh and Buttock Lift
Fig. 10.17
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