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Single Flap Upper Medial Vector Brachioplasty: A Modification to The Fascial Suspension Technique

Background: Arm contouring for lipodystrophy and ptosis are increasing in demand with age and especially after massive weight loss following bariatric surgeries. Aesthetic arm contouring is one of the most requested surgeries to those patients. Multiple classification systems were described to guide the management during pre-operative assessment. Treatment options vary between liposuction only, skin resection only, a combination of liposuction and excision, or possibly the use of newer energy based skin tightening devices. One of the most undesirable sequelae is visible scarring either due to widening or migration of the scars. Location of the scar and elimination of fat deposits and excess skin are the ultimate concerns of patients seeking this surgery. The focus of this study modification has been aimed to improve the poor aesthetic result of scar sequelae and over all arm contouring. Aim of Work: Developing a modification in surgical technique for brachioplasty, that eliminates excess skin with adequate arm contouring, and position scars in the least visible location, thus achieving better overall patient satisfaction. Methodology: This study was conducted on 15 patients who presented seeking arm contouring in the period from October 2017 to May 2019. Among these patients the average age was 38. Average BMI was 27.5kg/m2. 60% of the cases presented following Bariatric surgeries, 26.7% presented with skin excess following fluctuations in weight and effect of aging, and 13.3% presented with excess skin following previous unsatisfactory liposuction. Routine liposuction done initially, incision done down to the honeycomb plane, undermining was carried deep to the superficial fascia up to the anterior border of triceps. Skin flap was redraped and pulled in an upper medial vector. Results: This upper medial vector helped in improving the contour of the arm in a homogenous way, eliminating skin excess especially in the area above the olecranon in the distal arm and also avoids the presence of bands while closure. Early complications was limited to one case with 2cm wound dehiscence, while late complications showed 5 cases with scar hypertrophy and 4 cases with scar pigmentation. Conclusion: The mentioned technique proved to be reliable in achieving favorable arm contouring, with acceptable scarring and a low incidence of complications. 83