title: Fleur-de-lis panniculectomy after bariatric surgery: our experience.
abstract: BACKGROUND
  Plastic surgeons are faced with increasing numbers of patients presenting for insurance-covered skin excision procedures following bariatric surgery. Panniculectomy for symptomatic relief of rashes is commonly performed, but an isolated infraumbilical amputation-type panniculectomy is a highly unaesthetic procedure, leaving many patients deeply dissatisfied. It may be also fraught with complications due to large incisions and potential for dead-space. In these patients, many surgeons avoid the fleur-de-lis panniculectomy, despite the body contour aesthetic advantage, because of increased time, more scarring, and a perceived increase in complications.
  
  
  METHODS
  This is a retrospective chart review of 130 consecutive postbariatric surgery patients who had panniculectomy over a 2-year period at our institution.
  
  
  RESULTS
  A total of 30 patients underwent a traditional panniculectomy and 100 patients had a fleur-de-lis panniculectomy. Mean weight loss from bariatric surgery to panniculectomy was 58.2 kg, with an average body mass index (BMI) of 30. Fifty-seven patients had additional procedures performed at the time of panniculectomy. Twenty-two patients (17%) had complications, with 5 in the traditional group (17%) and 17 in the fleur-de-lis group (17%) (P = 1.0). Six males (40%) had more complications compared with 18 females (15.7%) (P = 0.034). Patients with BMI <30 had 10 complications compared with patients with BMI ≥30 had 15 complications.
  
  
  CONCLUSIONS
  There are many benefits of fleur-de-lis over traditional panniculectomy, even for medical necessity cases. There is limited undermining of tissue which minimizes/eliminates skin necrosis. Our experience with primarily fleur-de-lis panniculectomies shows a complication rate lower than most published data. Fleur-de-lis potentially creates a better symptom correction and cosmetic outcome by resecting maximal skin in both vertical and horizontal directions. These findings must be balanced against a potentially longer operation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, USA. julieobrien@massmed.org
authors.forename: Julie Anne
authors.initials: JA
authors.lastname: O'Brien
authors.forename: Genevieve B
authors.initials: GB
authors.lastname: Broderick
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Hurwitz
authors.forename: Richard
authors.initials: R
authors.lastname: Montilla
authors.forename: John
authors.initials: J
authors.lastname: Castle
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Dunn
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akyurek
authors.forename: Janice F
authors.initials: JF
authors.lastname: Lalikos
mesh_terms: D000328:Adult; D062109:Dermatologic Surgical Procedures; D005076:Exanthema / Q000209:etiology; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D050507:Subcutaneous Fat, Abdominal / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss