Lipoabdominoplasty with Anatomic Definition

Secondary Body Contouring

Body contouring surgeries, common yet intricate owing to unique patient characteristics, often necessitate revisions or secondary procedures. Balancing patient expectations and surgical limitations while methodically addressing shortcomings is crucial. This article aims to provide an extensive understanding of managing such complex cases, thus enhancing the reader's approach to secondary body contouring surgeries.

Classic Versus Scarpa-sparing abdominoplasty: An infrared thermographic comparative analysis

BACKGROUND

Scarpa fascia preservation during abdominoplasty has been shown to have several clinical advantages. The mechanisms behind its efficiency have been the subject of several studies. Three theories have been proposed, relating to mechanical factors, lymphatic preservation, and improved vascularization. This study aimed to further investigate the possible vascular impact of Scarpa fascia preservation by using a thermographic analysis.

METHODS

A single-center prospective study was conducted, involving 12 female patients randomly and equally assigned to one of two surgical procedures: classic (Group A) and Scarpa-sparing abdominoplasty (Group B). Dynamic thermography was applied before and after surgery (one and six months), and two regions of interest (ROIs) were considered. The latter had the same location on every sample, and corresponded to areas where different surgical planes had been used. Static thermography was applied intraoperatively, and four ROIs were considered, located over Scarpa and over the deep fascia. The respective thermal data were analyzed.

RESULTS

The general characteristics of both groups were identical. Preoperative thermography demonstrated no differences between groups. Intraoperative higher thermal gradients between lateral and medial ROIs were observed in Group B (P = 0.037, right side). Dynamic thermography at one month demonstrated a trend for better thermal recovery and better thermal symmetry (P = 0.035, 1-min mark) in Group B. No other differences were found.

CONCLUSION

Dynamic thermography presented a better response when Scarpa fascia was preserved: stronger, faster, and more symmetric. Based on these results, improved vascularization may have a role in explaining the clinical efficiency of a Scarpa-sparing abdominoplasty.

Predicting lipoabdominoplasty complications with infrared thermography: a delta-R analysis

The diagnosis of the main complications resulting from lipoabdominoplasty has not yet been standardized. Infrared thermal imaging has been used to assess possible complications, such as necrosis and changes in micro- and macro-circulation, based on perforator mapping techniques, among others. The objective of this study was to present two clinical cases involving thermal imaging monitoring of the healing process of lipoabdominoplasty in the immediate postoperative evaluation and its preliminary results. Infrared thermography was performed 24 hours after the operation and on postoperative days 5, 25, and 27. In clinical case 1, it was found that the delta-R (∆TR)-defined as the difference in minimum temperature between the highest and lowest points in the SA3 region (caution suction area) following the classification established by Matarasso-was 0.4°C at 24 hours after surgery and decreased to 0.1°C on a postoperative day 5. There were no complications in this case. In contrast, in clinical case 2, the ∆TR was 1.7°C at 24 hours after surgery (upon hospital discharge) and remained high, at 2.2°C, on postoperative day 5. A higher ∆TR was found in the second patient, who developed necrosis of the surgical wound. The ∆TR thermal index may be a new tool for predicting possible complications, complementing the clinical evaluation and therapeutic decision-making.

Endoscopic Lipoabdominoplasty

Endoscopic lipoabdominoplasty is the surgical technique utilizing endoscopy, as in a conventional abdominoplasty, to repair acquired abdominal wall defects, such as diastasis recti or ventral hernias. A conventional liposuction is carried out through 4 ports, which shall be used later to place the laparoscopic trocars for fat removal and supra-aponeurotic undermining. Three trocars are introduced through these ports, one for the camera and the others to introduce surgical instruments. A CO2 insufflation is carried out; the supra-aponeurotic space is undermined up to the xiphoid process. Then a rectus muscle plication is carried out with slow-absorbing sutures in 2 or 3 sections. Two Jackson Pratt drains are placed, and the incisions are closed. The objective of this article is to describe the technique and establish the necessary safety criteria to obtain good results in patients with minimal skin laxity, with moderate fat tissue distribution, with musculofascial diastasis, with ventral hernias, and who do not need or do not accept a visible surgical scar.