Muscular fascia plication in L-scar brachioplasty

Objective. Brachioplasty is a surgical procedure to reshape the upper arm after massive weight loss or elderly skin ptosis. According to El Khatib HA classification, patients are assessed as stages 1 to 4, depending on adipose tissue deposit and skin amount, with indications for different treatments. Many authors proposed correction of skin excess and laxity; noone describes a surgical procedure focused on muscular ptosis correction. Methods. From October, 2005, to April, 2008, we treated ten patients with grade 3 ptosis, dividing them into two Groups: 4 patients (Group 1) underwent brachioplasty with L-scars, 6 patients (Group 2) brachioplasty with L-scars and muscular fascia plication. In Group 2 patients four or five Vicryl 1-0 stitches were placed, connecting the biceps muscle fascia to the triceps muscle fascia, along the medial aspect of the arm, following the direction of the groove between the biceps and the triceps muscles. Patients were followed-up in the first weeks and then at 3, 6, 12, 24 months after surgery. A MR scan was obtain preoperatively and 3 months post surgery. Results. No loss of sensibility or muscular function, no lymphatic edema in any patient were observed. Only a dehiscence Group-2 occurred. The appearance and the arm contour were significantly improved. Conclusions. Muscular fascia plication reduces the tension of the suture line, provides a better layer for lymphatic drainage, a safe protection to nerve injuries and allows to correct muscular ptosis with good results without skin ptosis relapse.