Best Technique for a Tummy Tuck for Ehlers Dan Los?

Hi, thanks for posting your case.  My guess is that after 100 lbs of weight loss, you are very concerned about the excess skin and the laxity in your abdominal wall.  What types of issues are you having.  You will stretch after any body contouring procedures.  The main issue here is that your skin and abdominal fascia is genetically prone to laxity.  Despite this issue, body contouring can be successful in that you can resect the excess skin and tighten the fascia.  If you maintain your current weight, you will never return to the degree of laxity that you currently have.  Basically, if you do not gain weight again, the internal forces that will cause your abdomen to protrude (intraabdominal fat) will not return.  You will have stretching of the skin once it has been resected, but not to the degree that you currently have.  Additional measures for the abdominal wall may be valid if you have a frank hernia.

Hello,

Thank you for the question.  I have not performed a tummy tuck on a patient with EDS.  My best recommendation is to seek out support groups in your community that may have advice or recommendation of plastic surgeons who have performed body contouring procedures of EDS patients.  The more experience with this issue in terms of body contouring and healing the better.

All the best,

Dr. Remus Repta

Thank you for the question. This is a difficult problem to tackle. As you are aware of, this is a condition characterized by skin hyperextensibility, joint laxity, and friable tissues. Typical manifestations include dystrophic scarring and easy bruisability. These are as a direct result of the what becomes readily apparent tissue friability. There is poor purchase by the suture, which coupled with the laxity makes undermining of the soft tissues and their plication almost impossible. Other problems readily encountered include wound dehiscence, wide scar formation, and bleeding from small vessels which can be difficult to control.

While it is not impossible to operate on a patient with Ehlers-Danlos syndrome one should proceed with the utmost of caution. A frank discussion which includes the possible post operative complications secondary to Ehlers-Danlos syndrome and the benefits of the planned procedure must take place between the patient and their plastic surgeon.

As you are aware Ehlers-Danlos syndrome (EDS) is a group of inherited disorders. There are six major types and at least five minor types of Ehlers-Danlos syndrome. All patients with Ehlers-Danlos syndrome, regardless of severity, usually have abnormalities in wound healing and may have catastrophic complications after surgical procedures. May I suggest you first start with the Physician who is taking care of you for EDS and obtain pre-operative clearance. If you have obtained this clearance then, yes the use of expensive acellular dermal matrix ( ADM) may be of great benefit depending upon which EDS you have. This is what you referring to as “Cow Skin.” There are actually several different types of ADM derived from human, pig &/ or cow skin.
If you are uncomfortable with your surgeons knowledge of your EDS then, perhaps a second option with a plastic surgeon in your area who is more knowledgable of the condition, complications and risks in EDS would be appropriate. Consider a member of the ASAPS/ ASPS. Best,

 

Gary R Culbertson, MD, FACS

The material at issue is an acellular dermal matrix, that is eventually repopulated by cells from your own body. It seems likely that the same collagen issues would be present once the material is replaced by your own tissues

Many patients who have had TT and have EDS, have a nice improvement in terms of removing excess skin, but often the abdominal wall tightening is not successful.Using mesh does not alway help because the tissue adjacent to which the mesh is attached pulls away. 

 

Thanks and best wishes.