Comparison of Complication Rates of Horizontal and Vertical Medial Thighplasty Following Massive Weight Loss: A Systematic Review and Meta-Analysis

Purpose
Massive weight loss patients often desire thighplasty to address their excess thigh skin, but they are at risk for increased complications due to diminished skin quality. This study sought to compare the complication rates between two common thighplasty techniques: horizontal and vertical incision.

Methods
A systematic review following PRISMA guidelines was performed to assess complication rates from different thighplasty techniques. Five papers met inclusion criteria and were used to compare horizontal and vertical incision thighplasty complication rates. Complications included seroma, hematoma, wound dehiscence, skin necrosis, deep vein thrombosis, infection, scar migration, wound healing problems, lymphedema, and re-operation.

Results
285 patients (mean age 44 years, 91% female) were treated with horizontal (N = 80) or vertical (N = 205) incision medial thighplasty. Common complications in both groups included wound dehiscence, wound infection, and seroma. Wound dehiscence was the only complication that showed a statistically significant difference between the horizontal (16.3%) and vertical (28.8%) thighplasty cohorts (p=0.029). Although not statistically significant, the vertical incision group also had a greater percentage of reoperation (4.9%) compared to the horizontal incision group (1.25%). The correlation of complication rates and patient comorbidities and demographics was not possible to calculate due to inconsistent reporting of data across the studies.

Conclusion
Complications are common after medial thighplasty. Wound dehiscence was found to be less likely to occur with the horizontal thighplasty technique, which may indicate its superiority in certain patient populations. Horizontal incisions may also provide an additional aesthetic benefit due to the hidden nature of the scar. The reoperation rate should also be considered, particularly among elective surgery patients. The choice to perform horizontal or vertical incision medial thighplasty may be influenced by patient demographics and history, which could also impact complication rates. The current study demonstrated that published research is lacking in the standardized reporting of factors that likely impact complication rates of thighplasty beyond the technique itself. Future research should aim to assess the impact of variables such as patient comorbidities, concomitant liposuction, average weight loss prior to surgery, resection weights, and drain use in order to determine optimal thighplasty practices.

Aesthetic

PSTM 2024