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Tissue Expander Reconstruction of Centrifugal Lipodystrophy of the Abdominal Wall

Patel, Kamlesh Babulal M.D.; Vu, Hugh M.D.; Owens, Victoria F.N.P.

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Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 150e-151e
doi: 10.1097/PRS.0b013e3181e3b68d
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Sir:

Centrifugal lipodystrophy of the abdominal wall is a rare condition that is similar to large burn scars encompassing the entire abdominal wall. Imamura et al.1 originally described the condition in 1971, with most of the reports from Japan, Korea, and Singapore. The age of onset is usually younger than 3 years. The exact cause is unknown, although several hypotheses have been presented, including traumatic stimuli, infection, metabolic abnormality, and genetic abnormality.2 Children with this condition are limited in their range of motion, have abdominal wall tissue that is fragile and unstable, and are embarrassed about their appearance. The purpose of this report is to demonstrate the feasibility of treating centrifugal abdominal wall lipodystrophy by using tissue expander reconstruction.

An 11-year-old boy who was born with lipodystrophy of the abdominal wall was referred to our center for reconstruction. Physical examination showed a young boy with an atrophic area involving the entire lower anterior abdominal wall and bilateral flanks (Fig. 1). The underlying blood vessels could be clearly visualized under the skin. His torso range of motion was reduced because of tightness and fragility of the affected skin. Three tissue expanders were implanted subcutaneously in the upper abdomen and flanks immediately adjacent to the defect. Areas under each nipple-areola complex were avoided to prevent nipple malposition during the expansion process. Weekly expansion was performed over 4 months. The expanders were removed and flaps were advanced to replace the defective abdominal wall soft tissue. The patient had a residual band of lipodystrophy from below his umbilicus to the suprapubic region and 2 years later underwent placement of two tissue expanders to readvance the previously expanded flap. This was complicated by cellulitis refractory to antibiotic treatment. The patient had premature removal of the expanders and advancement of 3 cm (Fig. 2). The patient and his family were happy with the outcome and the patient required no more procedures at 4-year follow-up.

Fig. 1.
Fig. 1.:
An 11-year-old boy with centrifugal lipodystrophy of the abdominal wall.
Fig. 2.
Fig. 2.:
The patient at 4-year follow-up after two episodes of tissue expansion and flap advancement.

There is no effective medical treatment for children with centrifugal lipodystrophy. Review of the literature finds no surgical treatment for this condition. Practitioners are told to reassure their patients that the condition is self-limiting and that further enlargement stops spontaneously by age 13 years.3 The patient presented here was told by other major medical centers that there are no surgical options for his condition. Our institution has significant experience with burn reconstruction. Centrifugal lipodystrophy is anatomically analogous to a large burn scar and thus can be reconstructed using tissue expander reconstruction.

Kamlesh Babulal Patel, M.D.

Hugh Vu, M.D.

Victoria Owens, F.N.P.

Division of Plastic Surgery

University of California Davis Medical Center

Sacramento, Calif.

REFERENCES

1.Imamura S, Yamada M, Ikeda T. Lipodystrophia centrifugalis abdominalis infantilis. Arch Dermatol. 1971;104:291–298.
2.Garg A. Lipodystrophies. Am J Med. 2000;108:143–152.
3.Tay YK, Ong BH. Localized lipodystrophy in a child. Pediatr Dermatol. 2002;19:365–367.

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