The bikini area and bikini line as a location for anterior subcutaneous pelvic fixation: An anatomic and clinical investigation

Abstract

Anterior external fixation for pelvic fractures has been the standard for acute stabilization but definitive treatment often leads to pin tract infection, is uncomfortable, and limits patient mobility. We recently developed a subcutaneous anterior pelvic fixator which addresses these issues (INFIX). The objective of this study is to introduce the Bikini Area and Bikini Line as the subcutaneous anatomical location where this apparatus is placed. A study was preformed on eight cadaveric specimens to define the location of the subcutaneous device with respect to anatomic structures. We examined 23 people of various body mass indexes to examine the anterior pelvic anatomy. This was followed by implantation on 42 individuals in whom we reviewed CT scans to assess the location of the implant. We asked these same 42 individuals whether they could sit, stand, and lie on their sides and if they had any discomfort. We measured the dimensions of 26 retrieved rods to approximate the curve of the Bikini Line. Finally in 14 individuals we performed vascular ultrasound to assess the flow in the iliac and femoral vessels with the implant in place in the sitting and standing position. Neurovascular structures are not affected by placing the INFIX device at the Bikini Line, patients are comfortable, mobile and complications are minimized by this procedure. A rod placed on the Bikini Line which connects screws inserted into the anterior inferior iliac spine on each side does not interfere with sitting, standing, or the neurovascular structures.

Surgical anatomy, fashion and the atomic bomb: a controversial word in medical nomenclature

“…Wheeless and Roenneburg 11 described it as a sloping U-shaped incision from the anterior superior iliac spine down slightly superior to the mons pubis to the superior iliac spine on the opposite side. This course is its main difference from the 'Bikini line' reported by Vaidya et al 8 .…”

“…The 'Bikini incision' suggested by Delany and Carnevale 5 was designed to allow the use of brief bathing suits, but those suits were dimensionally different four decades ago as compared to those used nowadays. Furthermore, the 'Bikini line' described by Leunig et al 9 defined a line more restricted and slightly more inferiorly placed than those reported by Vaidya et al 8 . Consequently, we notice the variability of this term's interpretation.…”

“…Furthermore, Ersoz et al 7 reported laparoscopic cholecystectomy on the 'Bikini line' with the major advantage of the method being an improved cosmetic outcome with no visible abdominal scars. Recently, Vaidya et al 8 investigated clinically and anatomically the 'Bikini area' and 'Bikini line' (connecting the anterior inferior iliac spines) as a location for anterior subcutaneous pelvic fixation. Even more recently, Leunig et al 9 reported the use of skin crease 'Bikini' incision for anterior approach total hip arthroplasty.…”

“…Vaidya et al 8 went further than reporting just a line or an incision, by describing an anatomical region. Their purpose was to describe a subcutaneous anatomical location for rod placement which they labelled as the 'Bikini line' and 'Bikini area'.…”

“…Their purpose was to describe a subcutaneous anatomical location for rod placement which they labelled as the 'Bikini line' and 'Bikini area'. They interestingly mentioned that the 'Bikini line' was visible in most individuals except very thin women and that it was more prominent in individuals who had higher body mass index (due to the related 'Bikini' crease of the overlying skin) 8 . The 'Maylard' transverse muscle cutting incision, preferred by many surgeons because it gives excellent exposure of the pelvic organs, is placed above but parallel to the traditional 'Pfannenstiel incision' 10 .…”