Dermolipectomies Following Weight Loss after Surgery for Morbid Obesity

Background: Dermolipectomies play a major role in the functional and esthetic deformities which result from massive weight loss. Methods: From June 1994 to June 2000, 148 morbidly obese patients underwent various bariatric surgical procedures. After at least 1 year, 33 patients underwent 51 regional dermolipectomies performed by the same plastic surgeon. Results: All 33 patients underwent abdominal dermolipectomy. The average operative time was 194.2 min (110-420 min). The average amount of tissue excised was 2948.6 g (850-7525 g). 4 patients (12.1%) required blood transfusion. 6 patients (18.1%) developed complications, which included 1 case of post-operative bleeding, 3 wound infections and 2 skin dehiscences. Average length of hospital stay was 9.5 days (5-22 days). 15 of these patients (45.4%) simultaneously underwent abdominal incisional hernia repair; in 9 (24.2%), a Gore-Tex® mesh was used. In 2 patients the procedure was performed under emergency conditions due to small bowel obstruction. In 2 patients, simultaneous cholecystectomy was also performed. In 1 patient, a suction-assisted lipectomy of both thighs was necessary. 7 patients (21.2%) had mammaplasty, with average operative time 175.7 min (140-210 min). In 1 of them, breast implants were placed. There was no morbidity, and the average hospitalization was 6 days (4-9 days). Flankplasty was done in 4 patients (12.1%), thigh reduction plasty in 4 patients (12.1%), and arm reduction plasty in 3 patients (9%). The average operative time was 302.5 min (160-420), 246.2 min (230-280) and 203.3 min (180-240) respectively. Average tissue excised was 1503 g (725-2400 g), 1342.5 g (1050-1550 g), and 572.6 g (400-848 g), respectively. Morbidity was related to wound infection in 1 patient, and persistent edema of the left lower extremity in another. 4 of these 18 patients required blood transfusion. Average hospitalization was 8.2 days (6-11), 8 days (7-9) and 6 days (5-7) respectively. Conclusions: Regional dermolipectomies constitute the only available treatment for deformities following massive weight loss after bariatric surgery. Based on our experience, these procedures are safe, without serious complications and with good functional and esthetic results.