Abstract

Objectives: Some massive weight loss patients may present with an important skin excess in the upper and mid abdomen and pubic region and little excess in the lower abdomen. That is usually due to the constant use of a belt. Patients that already have a vertical abdominal scar may request an abdominoplasty. In both cases a long transverse scar is not need, but a mini abdominoplasty will not remove enough skin. A variation of the fleur de lis was thus developed with a limited transverse scar to remove the lower skin excess, while the epigastric and periumbilical skin is removed with the vertical incision. Introduction: The abdominoplasty is a very common aesthetic and functional surgical procedure. Every abdominoplasty should be tailored to the patient. Most patients can be successfully treated with transverse scars of variable length and design, while some massive weight loss patients will require a "fleur de lis" excision with both a vertical and a horizontal scar. The vertical abdominoplasty is a rare procedure due to an unnecessarily visible scar. Materials / method: The new procedure was performed on 4 male patients and 1 female patients. Four patients were treated after massive weight loss, the fifth was paraplegic due to a motorcycle accident, had a median laparotomy scar and requested an aesthetic procedure to remove as much excess skin as possible. The skin excess was marked before the procedure in standing/sitting position. The procedures were performed in the operating theatre in general anaesthesia. The undermining of the residual skin was minimal. The shape of the excised specimen resembled a fish and gave the name to the procedure. Results: Minimal skin necrosis occurred in the paraplegic patient. The vertical scar widened in the months following surgery in the same patient and in one other male patient. No significant complications occurred in the other patients. At the last follow-up the scars were almost invisible in the male patients due to the body hair growth and overlapping on the vertical scar due to the advancement of the lateral skin flaps. In the female patient the vertical scar was more visible. At the last follow up all patients had a much better abdominal contour and were satisfied with the result. Conclusion: The fish abdominoplasty has limited indications, but it is an easy and straightforward procedure that can provide very good results with limited morbidity and fast recovery due to the limited tension applied to the skin flaps. The pre-existent vertical scar is usually improved while the new scar in massive weight loss patients is usually inconspicuous.