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Does Colles fascia affect medial thighplasty?
Kevin H. Small, MD1, Shelly Xie, B.A.1, Ran Stark, M.D.1, Jordan Farkas, M.D.2, Jeffrey M. Kenkel, M.D.1.
1UT Southwestern Medical Center, Dallas, TX, USA, 2Private Practice, Paramus, NJ, USA.

Background: Lockwood described the importance of Colles fascia anchoring in medial thighplasty to reduce morbidity associated with the procedure. However, fixation of Colles fascia may still have complications including traumatic dissection, prolonged edema, and potential wound healing ramifications from tension applied in this area. To counteract these unwanted outcomes, we have oriented the tension in medial thighplasty massive weight loss (MWL) patients in the horizontal vector rather than a vertical direction, negating the need for Colles fascia anchoring. In this study, we compare the morbidities, complications, and outcomes between Colles' fascia anchoring and horizontal vector fixation in medial thighplasties in MWL patients.
Methods: A retrospective chart review was conducted on an IRB-approved database of patients who had medial thighplasty between October 2004 and March 2014. MWL patients were extrapolated. Patient demographics and surgical outcomes were reviewed between those MWL patients with Colles' fascia suture fixation (CFSF) and those with horizontal vector fixation (HVF).
Results: In this series, 86 patients had medial thighplasty; 65 patients were post MWL. In the MWL subset, 26 (40.0%) patients were in the CFSF group, and 39 (60.0%) patients were in the HVF group. The two groups were statistically equivocal with respect to gender, age, body mass index, diabetes, smoking, hypertension, coronary artery disease, pulmonary disease, renal disease, cancer, and DVT history. Intra-operatively, HVF group had increased use of barbed suture (92.3% vs. 30.6%, P<0.0001) and liposuction (71.8% vs. 26.9%, P<0.0001). Post-operatively, HVF group had decreased incidence of infection (5.1% vs. 23.0%, p=0.051) and seroma (2.5% vs. 30.76% p=0.002). No statistical differences were observed between the two groups for dehiscence, necrosis, hematoma, or lymphocele.
Conclusion: Horizontal vector fixation for medial thighplasty in MWL patients is a safe and efficient procedure, with a lower complication profile than Colles fascia anchoring. Furthermore, the incorporation of barbed sutures and/or liposuction in this novel technique may optimize results.

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