PHOENIX Large, depressed abdominal scars that complicate liposuction can be safely removed using "a novel technique" involving standard laparoscopic scissors, Dr. Marco A. Pelosi II said at the annual meeting of the American Academy of Cosmetic Surgery.
The technique has no laparoscopic component, he said in an interview, and following his success with standard laparoscopic scissors in this study, he has since designed the Pelosi Liposcar scissors, which are specifically intended for this purpose.
Surgical scars that do not involve direct adherence of the dermis to the muscle fascia are relatively simple to manage at the time of liposuction using either small-diameter liposuction cannulas or V-tip dissector cannulas, Dr. Pelosi said. However, more complicated scars that involve the aponeurosis cannot be eliminated using these tools.
In a study of 20 consecutive patients who required release of such depressed abdominal scars prior to office liposuction, standard laparoscopic scissors were safe and effective, reported Dr. Pelosi, who is a gynecologist in Bayonne, N.J.
Computed axial tomography scans of all scars were performed preoperatively to rule out incisional hernias, and all surgeries were performed under tumescent anesthesia.
The laparoscopic scissors were introduced through a 3- to 4-mm incision parallel to the skin surface in the superficial subcutaneous layer and advanced toward the scar. As soon as fibrotic resistance was encountered, the operator's free hand was used to stabilize the area while the other hand moved the scissors in "a lancing and fanning motion" to cut the subcutaneous fibrotic strands, Dr. Pelosi explained.
The scissors were then directed into the deep dermis to cut the fibrotic strands attached to the muscle fascia. Finally, the scissors were used to feel and release any remnants of fibrotic tissue holding the scar. After full release of the scar, standard liposuction was performed.
Complete release of the scar was achieved in all of the study subjects without any intraoperative or postoperative complications.
At 12 months post procedure there was no evidence of recurring subcutaneous fibrotic strands, he said.
JULIE KELLER/ELSEVIER GLOBAL MEDICAL NEWS
This depressed scar, caused by three previous laparotomies, can be released with standard laparoscopic scissors.
The scar has been safely and fully released in preparation for liposuction. Photos courtesy Dr. Marco A. Pelosi II