New Devices to Improve the Quality of Scar after Brachioplasty

Massive weight loss after bariatric surgeries is often associated with the development of redundant skin with unaesthetic appearance. Given the visibility of naked arms in everyday life, the demands for brachioplasty as a body contouring surgery is increasing.

All the various surgical techniques pay some immediate surgical site complications as well as late scar inconveniences, like widening and hypertrophying, that represent the main factor for surgical revision. Bad cicatrization's etiology is multifactorial and mainly concerns difficult wound healing and the lack of skin elasticity in massive weight loss patients.

We present now our pilot prospective studio on the treatment of brachioplasty scars with two new devices for postsurgical incision treatment, the ZipLine dressing (Zip 16/24 Surgical Skin Closure System, ZipLine Medical, Campbell, CA), which consists of two opposed hydrocolloid adherent strips locked by superficial bridging polyurethane skirts, and the portable disposable negative pressure system PICO (Smith and Nephew Medical Ltd, UK).

Two random cohorts were arranged, in which patients served as their own control: one cohort was treated with ZipLine on one arm and classic dressing on the other arm (fixation strips STERI-Strip, 3M, St. Paul, MN, USA), and the other cohort was treated with PICO on one arm and conventional dressing on the other arm.

Preoperative patient variables including age, gender, body mass index, American Society of Anesthesiologists (ASA) score and history of medical comorbidities were recorded. All patients had the dressing applied in the theatre at the end of surgery. Dressings were removed at the outpatient service at the 7th day post surgery and any evidence of wound complication (e.g. delayed healing, dehiscence, hematoma, infection, etc.) was recorded, as well as VAS (Visual Analogue Scale) pain at the dressing removal and patient's home discomfort referral. After surgery, all patients followed the same indications: massages with silicone cream and use of garments for at least 12 hours a day. A second visit was made 6 months later for scar check: aesthetic appearance and quality of scarring were recorded using VAS (visual analogue scale) questionnaires.

For the 20 included patients (40 arms: 10 ZipLine, 10 PICO, 20 controls), the number of early wound complications was lower for cases compared to controls, and both pain at the removal and home discomfort were particularly reduced; a similar high quality of scarring was noticed for both ZipLine and PICO treated arms compared to the classic dressings.

In conclusion, we found that both ZipLine dressing and PICO system reduced the incidence of early brachioplasty wound-related complications and late pathologic scarring with improvement in the aesthetic appearance in post-bariatric patients.