In this video-based CME activity, Al Aly, MD performs a bilateral brachioplasty on a 39-year-old patient who has lost 180 pounds after having gastric bypass surgery. Body contouring following massive weight loss has gained popularity, and the demand for upper arm contouring procedures has increased. Dr. Aly demonstrates proper surgical site markings for the double ellipse technique. Once the excess skin and subcutaneous tissue are marked anteriorly and posteriorly, and this process is repeated distally to include the total extent of the excess, the same process is used to delineate the lateral chest excess guided by the amount of tissue necessary to eliminate the horizontal thoracic excess. Then all the anterior and posterior marks are connected to create the outer ellipse. The principal behind the double ellipse technique lies in the fact that if the outer ellipse were used as the actual incision line, the defect could not be closed because the distance between the examiner's fingers, while pinching, would not be taken into consideration. The second ellipse is created to accommodate for that distance. This allows a natural tapering of the arm toward the axilla, leaving the scar in a posterior position compared to the more traditional bicipital groove location. The video continues in the operating room where Dr. Aly demonstrates how the skin resection is then performed to remove the excess tissue of the upper arm down to the fascia in a "segmental resection closure technique" which prevents swelling from developing in the arm during the procedure. Postoperatively the patient is asked to keep the arms raised and in a neutral position during the healing process.
After viewing this course, the participant should be able to:
- Align realistic goals for the procedure with the patient, as well as determine whether the patient is a suitable candidate for the procedure (weight has stabilized) during the physical exam.
- Know how to mark the surgical site for a double ellipse brachioplasty technique.
- Understand the advantages of double and triple checking the markings preoperatively and interaoperatively to prevent over or under resection.
- Implement postoperative management strategies to prevent swelling, numbness, and dehiscence.
AMA PRA Category 1 CreditTM: .75
Patient Safety Credit: .5
Release Date: 2/23/2012
Reviewed Date: 7/1/2018
Expiration Date: 7/1/2021
Estimated time to complete this course: 45 minutes
Directly provided by the American Society of Plastic Surgeons® (ASPS®)
The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASPS designates this enduring material for a maximum of .75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.
Dr. Aly has nothing to disclose. All ASPS staff members managing this activity have no relevant financial relationships or affiliations to disclose. All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.
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Product Code: 16603