Post-operative care for skin fat removal surgery: prevention of complications and scientific weight loss

Skin and Fat Removal Surgery:

When excessive fat accumulates in obese patients in areas such as the abdomen, buttocks, inner and outer thighs, and inner upper arms, causing localized skin and fat laxity, skin and fat removal surgery or a combination of liposuction and skin and fat removal can be considered for weight loss treatment. By removing the loose, sagging skin and fat, or simultaneously tightening deep fascia tissue, excessive local bulging can be corrected, and the inconvenience caused by obesity in daily life and work can be alleviated.

Postoperative Care: A slightly flexed hip and semi-recumbent position is maintained for one week postoperatively to facilitate abdominal wall relaxation, reduce flap tension, and prevent distal flap necrosis and wound dehiscence. Drainage tubes can be removed 28–48 hours postoperatively. Patients are encouraged to get out of bed and move around 48 hours postoperatively. Sutures are removed 7–10 days postoperatively. Normal life can be resumed one week postoperatively, and physical activity can be resumed after four weeks. An elastic waistband should be used for immobilization for three months postoperatively.

Complications:
1. Hematoma: Hematoma not only affects wound healing and the recovery of local trauma but can also cause flap necrosis and postoperative wound infection. Therefore, surgical hemostasis must be thorough and reliable; larger blood vessels should be ligated for hemostasis. Postoperative pressure bandaging and effective negative pressure drainage can prevent hematoma.

2. Infection: Adipose tissue has poor resistance to infection; therefore, strict aseptic technique, prevention of hematoma formation, and effective and adequate antibiotic use are important preventive measures.

3. Skin Flap Necrosis: Subcutaneous fat at the edge of the abdominal skin flap is easily thinned, and the tip of the flap with an inverted "T" shaped incision is prone to necrosis. If necrosis occurs, the necrotic tissue should be excised and sutured.

4. Scarring: Due to the high tension of wound suturing, proliferative scarring is more likely to occur. It generally begins to lessen after six months. If scar proliferation begins, local injection of triamcinolone or dapoxetine can prevent its development; if necessary, scar excision can be performed again.

5. Abnormal Skin Sensation: This is mainly due to damage to sensory nerves, manifesting as decreased sensation and numbness in the abdominal skin. It generally recovers to normal in about six months.

6. Pulmonary embolism is the most serious complication. Statistics show an incidence of approximately 1%, and the mortality rate of pulmonary embolism is relatively high. Intraoperatively, 5% low molecular weight liposuction and 5% ethanol can be administered via intravenous infusion (see Management of Complications of Wet Liposuction).