While I appreciate the comments of Dr. Anous, I would like to point out a few points of disagreement. The locations of the five vertical lines on which he bases his design are straightforward, but relying on the height of the stretch marks and the elasticity of the skin to determine placement of the horizontal line (of resection) is imprecise, since striae may be present throughout the abdomen and skin elasticity is subjective. Preliminary skin stapling may add a few minutes to the procedure, but confirmation of the exact amount of safe skin resection is worth the tradeoff. Safety is improved by caution, not speed.
The grid pattern allows precise determination of the amount of skin resected by transposing the coordinates of the specimen to the preoperative photograph (Fig. 1). The same cannot be said of the pattern outlined by Dr. Anous on his patient, since we do not know if it is identical to the resection.
The map projection devised by Mercator in 1569 is helpful for navigation, but its widespread use has given many people a distorted vision of the world. For example, it shows Europe to be larger than South America, even though the latter is almost double the size of the former. In a similar way, blind trust in any preoperative abdominoplasty design is hazardous. The grid/staple technique allows a truer vision of the operation we are performing.
Edward A. Pechter, M.D.
25880 Tournament Road, Suite 217
Valencia, Calif. 91355-2844
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