■ After shaving and careful disinfection of the whole operating area, the tumescence solution (0.9 % NaCl 500 ml, 1 % prilocaine 250 mg = 25 ml, epinephrine 0.5 mg, 8.4% NaHCO3 5 mEq) is infiltrated into the skin area to be resected along the predrawn incision and dissection boundaries. For each side, depending on the extent of the flabby skin, one needs between 250 and 500 ml of tumescence solution. The tumescence solution is pumped in manually, until a taut elastic skin tension and the typical blanching effect are noted.
The resection area (a) is, as in all tightening operations, only established when, following dissection (b), the exact superfluous skin has been fixed using key sutures. Consequently, the same basic principle always applies that before the skin flap is resected one makes the incision on the resection line that has been pulled over and only then carries out the whole dissection.
Dissection boundary is dependent on how far the loose skin extends.
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