Royal Plastic Surgery

Thigh lifts is a procedure almost exclusive for the weight loss patient. In plastic surgery literature there are not many current scientific articles related to thigh lifts. There are 2 types of thigh lifts: short scar or mini thigh lift and the inverted t or extended thigh lift. The short scar thigh lift is indicated when there’s only horizontal excess of the inner thigh. The inverted t or extended is indicated in the severe ptosis (saggy) where the excess skin has both vectors horizontal and vertical. Both procedures undergo previous liposuction for debulking and sparing the neurovascular and lymphatic structures. Overall, complication rates after thigh lift are described with high numbers, including wound-associated problems, such as dehiscence, infection or necrosis as well as lymphatic edema, hematoma, seroma or scar migration or widening, and remaining tissue excess. When compared with other body contouring procedures, thigh lift has some of the highest complication rates. Recent published data showed complication rates ranging from 45% to 68%. Most of these complications are minor and can be managed in the office on an outpatient basis. The most commonly observed complications are wound dehiscence (17%–51%), seroma (10%–25%), and infection (1%–15%). There are a lot of factors that are against wound healing because of the anatomical location of the incisions:
1. Incisions bare a lot of weight and tension or shearing forces constantly pulls them down (the heavier the thighs the higher the risk of complications)
2. The groin is a very humid and macerates the skin on the incision lines making them weak
3. Occurring natural orifices are near the wounds, so contaminations of local bacteria is common with gut bacteria
4. Continuous movement stretches them
5. Presence of varicose veins can be added as a potential risk due to poor circulation and increasing the risk of flap necrosis
Openings happen between the 1-3 weeks, being most common at the T junction of the extended thigh lift. Wound care consists of cleaning the area daily and applying antibiotic ointment and a dry dressing to the area daily. If the area is large enough to be packed with a wet to dry dressing, the patients are instructed to do this daily and then begin the antibiotic ointment once the area gets smaller. Silver nitrate may also need to be used in areas of hypergranulation tissue formation to allow for faster epithelialization of the wounds.
Patients seeking this procedure should be aware of these potential complications and assume the risks, also take in mind that postoperative care is difficult and tedious. In the event that an opening occurs, it may take up to 3 months to close with proper wound care that can include a vacuum assisted closure (VAC). However, until today there is no technique that lowers these complications. The good news is that all wounds always close, just takes time.

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