Flank Excision and Wound Separation

Question

40-year old man with TT after a 140-lb weight loss in 1996. I will be getting a 'Flank Excision' in Sept due to large love handles. My new PS told me this would be an extension of my TT scar to my back (both sides) and that wound separation is quite common. I see a lot of TT reviews here and some Belt Lipectomies, but I've never come across a 'Flank Excision' before and am wondering if you could shed some light on the wound separation frequency and perhaps any other info about this procedure. Thanks!

Richard H. Tholen, MD, FACS · Answer

After a 140 lb. weight loss (Congratulations, regardless of the method of loss!) your loose skin almost certainly extends around the entire abdomen, hip roll, lateral thigh, and buttock regions. You have already had a tummy tuck, and at the very end of your incisions on either side you have all the previously-existing loose skin remaining. These areas are properly called the flanks (literally, the area of tissue between the lowest ribs and the hips), hip rolls, or "love handles." How much loose skin is the issue I am concerned about for you.

	When a small amount of residual tissue protrudes after a tummy tuck, these are called "dog ears," and excision with a somewhat longer scar can smooth the protrusion nicely. When more loose skin exists, a flank excision is absolutely appropriate. But after the amount of weight loss you describe, your more significant amount of loose skin may be better treated by a "buttock lift," "posterior lift," or what I would call a "completion belt lift." I call it that because I excise additional skin all the way to the upper point of the central gluteal crease, not just an ellipse  of skin and fat over your flanks.

	This is exactly what I do when I combine a tummy tuck and posterior lift into one operation called a circumferential belt lift, lower body lift, or belt lipectomy. But you have had the tummy tuck; you now likely need "completion" of what would be your belt lift. Flank excision alone may not be enough for your best result, and if this is done instead of a more aggressive excision, you may require yet another operation (removal of dog ears from your dog ears?)

	Of course, your PS has the benefit of direct examination, and your excision may require more, or less, as your degree of skin laxity requires. Don't be shy asking if you need or would benefit from excision of an entire band of tissue across your buttocks, lateral thigh, and hip roll (flank) areas rather than just an ellipse over each flank. Of course, the latter may be possible under local anesthesia, whereas the former will require a bigger operation, full anesthesia, and possibly drains--BUT, may well yield a substantially better result!

	As other have stated, unless you have an excessively tight closure, too much activity, or risk factors such as diabetes or tobacco (nicotine) use, you have no higher potential for wound separation than anyone (regardless of procedure.) This likelihood is quite low, but never zero. Best wishes! Dr. Tholen

Martin Jugenburg, MD · Answer

If you have diabetes,  if you continue to smoke, if your BMI is still elevated, and if the wound is in an area that moves a lot and is prone to being pulled apart then your risk of wound separation is something to consider.

Given the brief description you have given us I am not sure why wound separation would be a significant risk.

Sincerely,

Martin Jugenburg, MD FRCSC

David Shafer, MD, FACS · Answer

This is a good question.  My advice is not to get too tripped up on the terminology.  It sounds like basically you are going to have the extra skin around your love handles excised.  When contouring around the body, you can have an abdominoplasty in the front and a some variation of a belt lipectomy or buttocks lift in the back.  From what you describe, it sounds like you are having a portion of some or all of the above.  Without seeing you or seeing "before" pictures or knowing more about you specifically, it is difficult to give you complete advice.  As for wound separation, this is uncommon, but can occur more frequently in massive weight loss patients due to malnutrition and poor wound healing and in smokers due to disruption of the microcirculation.

	 

	Good luck.

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