THE CROSS-INCISION FOR LIPOPLASTY: MINIMIZING LIPOPLASTY SCARS
Plastic and Reconstructive Surgery:Volume 116(3)1 September 2005pp 930-931
Man, Daniel M.D.
Suction cannulae and most other lipoplasty instruments are round. When a round instrument is passed back and forth through a traditional linear incision, the tension in the skin causes an elevation in the contact pressure between the skin and the instrument. This pressure is highest at the incision midpoints and is accompanied by tearing stresses at both ends of the incision. During the course of an operation, the incision edges are abraded and the incision ends are either torn or permanently stretched. This trauma to the skin is often seen postoperatively as increased redness in the early postoperative period and brown pigmentation that is frequently visible and long-lasting (Fig. 1).
Fig. 1. Typical postoperative incisions.
Much like the lid of a soft drink, which typically has a cross-shaped perforation through which a straw can easily be inserted, the cross-incision combines two incisions, with the second incision perpendicular to the first (Fig. 2). This pattern decreases the contact pressures for round instruments by providing a much more uniform stress pattern in the skin and by allowing the skin to stretch in two directions. As a result of using this incision, we have found a significant reduction in trauma to the skin edges, resulting in a better-healing scar that is both less visible and smoother.
Fig. 2. The cross-incision.
The edges of the skin can be further protected by using a Vaser skin port (Sound Surgical Technologies LLC, Louisville, Colo.) (Fig. 3). The skin port provides a percutaneous channel that completely eliminates instrument contact with the incision edges. Although the cross-incision may be used with or without a skin port, we have found that using the skin port further reduces trauma to the incision edges, resulting in further minimization of the scar (Fig. 4).
Fig. 3. The Vaser skin port.
Fig. 4. Suturing the skin port into place.
The cross-incision is made using a no. 11 blade, with the first incision measuring 3 to 4 mm in length. The second incision is then made perpendicular to the first at the midpoint. It is important that the blade penetrate deep enough to cut the tissues below the skin. The opening and tissues below the skin are gently stretched with a hemostat to provide easy entry for the suction cannula or the skin port. If a skin port is being used, we place the selected skin port in the incision using the skin port and plug. The tip of the plug opens the incision and tissues below the skin to make insertion easy. The plug can also be used to seal the skin port to prevent leakage of infused tumescent fluids or emulsion. The skin port is sutured to the skin on the edges of the disc. The Vaser skin port is reusable and can be cleaned and sterilized using autoclave sterilization.
The cross-incision may be closed with either a subcutaneous or an external circular stitch, or both. The subcutaneous approach is preferred and uses a circular closure with a 5-0 Monocryl suture, sewn tip by tip in a circular pattern so that the tied suture closes the wound. The skin edges are further secured with Dermabond and half-inch SteriStrips in a criss-cross pattern.
The Vaser skin ports were designed by William W. Cimino, Ph.D., of Sound Surgical Technologies LLC. I have no financial interest in Sound Surgical Technologies.
Daniel Man, M.D.
851 Meadows Road, Suite 222, Boca Raton, Fla. 33486-2348, info@drman.com
