Excisional thigh and buttock operations present a traumatic surgery and result in significant scarring. Serdev suture is a method allowing an atraumatic scarless lift of the inner thigh skin.
Anatomy
Inner thigh fat is attached to the skin that looses with the time and drops down with age, abesity, weight loss.
Between the major labia and the inner thigh fat deposit, there is about 3-5 cm skin free from attached fat. The length of the free from fat skin depends on age, fat heaviness and skin laxity.
Idea
Serdev suture method is a stable suture of movable to nonmovable fibrous structures. Use of semi-elastic. long time absorbable threads is crutios. That semi-elastic thread sutures do not cut the moving tissue and when fibrosis is finalizsed (6 to 18 months) the threads will be absorbed (in 2-3 years).
The Procedure
Dermis portion exactly over the fat deposit has to be sutured to the gracilis tendon near to the attachment point at the pubis.
Position the patient so the upper inner thigh is exposed (leg externally rotated). In this position the gracilis muscle is the only visible prominating muscle under the skin of the inner thigh. To identify the Gracilis tendon, palpate along the Gracilis muscle. The Gracilis tendon will be located immediately below the Pubic Tubercle.
Administer local anaesthetic injection to the skin to be sutured (exactly over the upper fat border), surrounding soft tissues and in the proximal Gracilis tendon.
Make a stab incision with an 11 blade to free from fat skin (in the lowest point possible) on both sides of the Gracilis Tendon. Incisions will be 1-1.5cm apart.
Perforate skin opening A with the Serdev needle (mini-mini, or mini), elevate the skin with the needle to the Gracilis tendon incertion and securely pass through the tendon incertion. Lift the skin from the other side to the fixed in the tendon needle point and pass the needle through opening B in the skin the other side of the Gracilis Tendon. Load a No. 2 Bulgarian (Polycon) thread (semi-elastic, long-time-absorbable, braided, antimicrobial) into the eye of the needle at point B and retrogradely withdraw the needle through point A. With this pass the thread is fixed in the non-movable Gracilis Tendon incertion. Leave the skin relax back on place. Now make the second pass exactly through the hard skin dermis along from A to B (very difficult – twisting forward (not pushing) the Serdev needle) and passing through the skin opening in point B thread the suture into the eye of the needle. Retrogradely withdraw the needle from point B through the dermis pass and point A. With this pass the movable hard dermis is attached and now a circulage suture is in place with the 2 free suture stands at point A.
Tie a secure surgical knot under elastic medial tension. Pull out skin in points A and B with only one branch of a heamostat instrument (mosquito) to remove dimpling. Cut the suture just short of the knot and leave it dive into the openingusing a branch of a mosquito instrument. Make sure Now release any tethered skin from the subcutaneous tissues at points A and B with the blade of a curved artery forceps.
The medial thigh will now be lifted and the skin stretched.
Any skin folding should be placed exactly high to hide in the fold laterally from the major labia. The initial skin folding due to skin lifting, anesthesia and swelling should adapt to the very wrinkled skin in this area - the fold laterally from the major labia and disappear in 2-4 weeks.
