Eur J Plast Surg (1994) 17:233-235 European ~ 1 ~ ,,=0 Journal of II-,W I d+~~Irlldr-ll © Springer-Verlag 1994 Brachial dermolipectomy (brachioplasty) A. Marques, E. Brenda, A. C. Abramo and M. T. J. Amarante Division of Plastic Surgery, Hospital Alemfio Oswaldo Cruz, S~o Paulo, Brazil Summary. Because of dissatisfaction with the limited re- sults attained with traditional brachial dermolipectomy, a new approach is presented. Placement of the incisions, as well as plane of dissection, are designed to avoid the most significant and frequently encountered complica- tions. The dermolipectomy is outlined over three seg- ments: axilla, arm and elbow. On the axilla, an elliptical excision, parallel to the local crease lines, is performed. Along the long axis of the arm, on the medial surface, excision is performed through an anteriorly convex inci- sion. The axillary and brachial incision lines are united by a W-plasty at the posterior pillar of the axilla. No complications were observed in 14 patients treated. Bet- ter contour and inconspicuous scars were achieved. Key words: Upper arm - Brachioplasty - Plastic surgery Brachial dermolipectomy is an efficient method of treat- ment for dermolipodystrophy of the upper extremity re- suiting from weight loss or aging. The excessive skin and fat that hangs during abduction of the arm, and con- tributes to the contour deformity, is excised. Unfortu- nately, this has frequently resulted in unsightly scars and contour deformity [3]. Pitanguy [7] advocated his tech- nique only for patients after significant weight loss. Sev- eral modifications have been suggested to reduce postop- erative complications and to produce better results [1, 6]. Borges [2] used a long W-plasty to produce a better scar. Juri [5] used a posterior superiorly based flap near the axilla to achieve better contour. However, there is still room for improvement. Correspondence to: A. Marques, Av. Rept~blica do Libano, 894, S~o Paulo, Brazil, CEP 04502-001 The approach presented here emphasizes not only a modified and extended incision design, but also a more superficial dissection plane above the superficial fascia. Deep lipectomy, as advocated by Grazer [4], could com- promise lymphatic and venous drainage. Better contour and inconspicuous scars were achieved with fewer complications. Materials and methods Fourteen female patients, aged 48-53, were operated on. The fol- low-up was a minimum of 12 months. The incisions were marked with the patient seated, with her arms abducted at 90°. The dermolipectomy is drawn in three segments: axilla, arm and elbow (Fig. la). On the axilla, the excision is elliptical parallel to the local crease lines. Along the medial long axis of the arm, the exci- sion is performed through an anteriorly convex incision. The brachial incision is taken to the posterior surface of the elbow, parallel to the local creases, The axillary and brachial incision lines are united by a W-plasty at the posterior pillar of the axilla. The anterior line of the brachial portion of the resection is drawn 11/2 cm anterior to the bicipital groove; the posterior line is estimated by manually grasping the redundant skin. The greatest distance be- tween the posterior and the anterior line in the brachial region is at the point of greatest tissue redundancy. However, both the posterior brachial and the elbow incisions are only made after completely undermining the area at the superficial fascia leveI and reevaluating the excess of skin and fat tissue (Fig. lb, c). The wound is closed in three layers - subcutaneous, deep dermis and skin with non-ab- sorbable interrupted sutures. Elastic adhesive tape is applied for 60 days to reduce tension along the suture line. No drainage is used. Results The wounds healed uneventfully. Neither lymphedema nor hyperesthesia were observed in any of the patients. The resulting scars were inconspicuous six months postoperatively. Two patients in which the W-plasty was not performed developed hypertrophic scars in that area. The shape obtained for the arm was satisfactory (Figs. 2, 3).