Application of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Mingyue ¹ , CHEN Wanghaonan ¹ , SHU Feihong ² , LIU Ye ¹ , TAO Kerong ¹ , ZHANG Chi ¹ , YOU Xing ¹ ,  SUN Guangfeng ¹

1. Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
2. College of the First Clinical Institute, Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

SUN Guangfeng, Email: sgfzyt@163.com

Keywords：

Huge fat pad; nape and back; hairpin shaped incision; cover-lifting flap; plastic surgery

DOI：

10.7507/1002-1892.202305016

Video：

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Objective To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. Methods Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation. Results The operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence. Conclusion For the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.

Citation： ZHANG Mingyue, CHEN Wanghaonan, SHU Feihong, LIU Ye, TAO Kerong, ZHANG Chi, YOU Xing, SUN Guangfeng. Application of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1133-1137. doi: 10.7507/1002-1892.202305016 Copy

1.	Wang G, Zhao J, Zhang X, et al. Liposuction to improve the dorsocervical fat pad in esthetic need: Anatomical study and clinical case series. J Cosmet Dermatol, 2022, 21(11): 5942-5951.
2.	车可心, 马桂娥. 脂肪抽吸术在项背部脂肪垫治疗中的应用与展望. 中国美容整形外科杂志, 2020, 31(4): 254-256.
3.	Lee HR, Lee DH, Seok SY, et al. What type of incision for anterior cervical spine surgery involving long segments can bring better cosmetic and functional outcomes? Neurospine, 2022, 19(2): 412-421.
4.	王淑娟, 李娜. 瘢痕评估方法研究进展. 皮肤病与性病, 2022, 44(1): 19-22.
5.	Guallar JP, Gallego-Escuredo JM, Domingo JC, et al. Differential gene expression indicates that ‘buffalo hump’ is a distinct adipose tissue disturbance in HIV-1-associated lipodystrophy. AIDS, 2008, 22(5): 575-584.
6.	Rahman F, McLaughlin T, Mesquita P, et al. Effect of tesamorelin in people with HIV with and without dorsocervical fat: Post hoc analysis of phase Ⅲ double-blind placebo-controlled trial. J Clin Transl Sci, 2022, 7(1): e40.
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8.	Kaplan JL. The single incision minimally invasive (SIMI) neck lift. Plast Reconstr Surg Glob Open, 2019, 7(5): e2208.
9.	Si L, Li H, Li Z, et al. The superficial fascia system: anatomical guideline for zoning in liposuction-assisted back contouring. Plast Reconstr Surg, 2023, 151(5): 989-998.
10.	Bartow MJ, Raggio BS. Liposuction [M/OL]. Treasure Island: StatPearls Publishing, 2023.(2023-02-14)[2023-08-08]. https:// www.ncbi.nlm.nih.gov/books/NBK563135/.
11.	石杰, 袁继龙, 肖明, 等. 负压抽吸技术治疗项背部脂肪垫的效果观察. 中国美容整形外科杂志, 2020, 31(12): 735-737.
12.	Chen S, Gui XE, Cao Q, et al. Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation: An observational cohort study. Medicine (Baltimore), 2019, 98(25): e16112.
13.	Warren AG, Borud LJ. Excisional lipectomy for HIV-associated cervicodorsal lipodystrophy. Aesthet Surg J, 2008, 28(2): 147-152.
14.	崔江波, 易成刚, 马显杰. 减张缝合联合拉力胶在张力性切口中的应用. 中国美容整形外科杂志, 2016, 27(9): 547-550.
15.	Marsidi N, Scheepens KMJ, Goeman JJ, et al. Dynamic characteristics of skin reaction force in different body postures. Sci Rep, 2023, 13(1): 2222.
16.	陈王浩男, 张明月, 陶科融, 等. 筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面疗效观察. 中国修复重建外科杂志, 2023, 37(4): 478-481.
17.	Parsa FD, Castel N, Parsa NN. A modified, direct neck lift technique: The cervical wave-plasty. Arch Plast Surg, 2016, 43(2): 181-188.
18.	Bednarek RS, Sequeira Campos M, Hohman MH, et al. Transposition flaps [M/OL]. Treasure Island: StatPearls, 2023.(2023-04-14)[2023-08-08]. https://www.ncbi.nlm.nih.gov/ books/NBK500028/.
19.	侯春林, 顾玉东. 皮瓣外科学. 上海: 上海科学技术出版社, 2019: 41-43.

1. Wang G, Zhao J, Zhang X, et al. Liposuction to improve the dorsocervical fat pad in esthetic need: Anatomical study and clinical case series. J Cosmet Dermatol, 2022, 21(11): 5942-5951.
2. 车可心, 马桂娥. 脂肪抽吸术在项背部脂肪垫治疗中的应用与展望. 中国美容整形外科杂志, 2020, 31(4): 254-256.
3. Lee HR, Lee DH, Seok SY, et al. What type of incision for anterior cervical spine surgery involving long segments can bring better cosmetic and functional outcomes? Neurospine, 2022, 19(2): 412-421.
4. 王淑娟, 李娜. 瘢痕评估方法研究进展. 皮肤病与性病, 2022, 44(1): 19-22.
5. Guallar JP, Gallego-Escuredo JM, Domingo JC, et al. Differential gene expression indicates that ‘buffalo hump’ is a distinct adipose tissue disturbance in HIV-1-associated lipodystrophy. AIDS, 2008, 22(5): 575-584.
6. Rahman F, McLaughlin T, Mesquita P, et al. Effect of tesamorelin in people with HIV with and without dorsocervical fat: Post hoc analysis of phase Ⅲ double-blind placebo-controlled trial. J Clin Transl Sci, 2022, 7(1): e40.
7. Guzman N, Vijayan V. HIV-associated lipodystrophy [M/OL]. Treasure Island: StatPearls Publishing, 2023. (2022-11-07)[2023-08-08]. https: //www.ncbi.nlm.nih.gov/books/NBK493183/.
8. Kaplan JL. The single incision minimally invasive (SIMI) neck lift. Plast Reconstr Surg Glob Open, 2019, 7(5): e2208.
9. Si L, Li H, Li Z, et al. The superficial fascia system: anatomical guideline for zoning in liposuction-assisted back contouring. Plast Reconstr Surg, 2023, 151(5): 989-998.
10. Bartow MJ, Raggio BS. Liposuction [M/OL]. Treasure Island: StatPearls Publishing, 2023.(2023-02-14)[2023-08-08]. https:// www.ncbi.nlm.nih.gov/books/NBK563135/.
11. 石杰, 袁继龙, 肖明, 等. 负压抽吸技术治疗项背部脂肪垫的效果观察. 中国美容整形外科杂志, 2020, 31(12): 735-737.
12. Chen S, Gui XE, Cao Q, et al. Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation: An observational cohort study. Medicine (Baltimore), 2019, 98(25): e16112.
13. Warren AG, Borud LJ. Excisional lipectomy for HIV-associated cervicodorsal lipodystrophy. Aesthet Surg J, 2008, 28(2): 147-152.
14. 崔江波, 易成刚, 马显杰. 减张缝合联合拉力胶在张力性切口中的应用. 中国美容整形外科杂志, 2016, 27(9): 547-550.
15. Marsidi N, Scheepens KMJ, Goeman JJ, et al. Dynamic characteristics of skin reaction force in different body postures. Sci Rep, 2023, 13(1): 2222.
16. 陈王浩男, 张明月, 陶科融, 等. 筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面疗效观察. 中国修复重建外科杂志, 2023, 37(4): 478-481.
17. Parsa FD, Castel N, Parsa NN. A modified, direct neck lift technique: The cervical wave-plasty. Arch Plast Surg, 2016, 43(2): 181-188.
18. Bednarek RS, Sequeira Campos M, Hohman MH, et al. Transposition flaps [M/OL]. Treasure Island: StatPearls, 2023.(2023-04-14)[2023-08-08]. https://www.ncbi.nlm.nih.gov/ books/NBK500028/.
19. 侯春林, 顾玉东. 皮瓣外科学. 上海: 上海科学技术出版社, 2019: 41-43.

Chinese Journal of Reparative and Reconstructive Surgery

Application of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back

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