Abdominoplasty in multiparous women with severe musculoaponeurotic laxity

Abdominoplasty versus endoscopic approach to diastasis recti repair: A comparative study of outcomes

Diastasis recti (DR) is characterized by the deviation of the abdominal rectus muscle due to widening of the linea alba and laxity of the abdominal wall musculature.1,2 This condition affects the quality of life, in terms of performance of activities of daily living and physical tasks.3-7 Several techniques have been described to correct DR.11 This prospective research aimed at comparing the traditional approaches vs endoscopic plication for DR repair in terms of safety, effectiveness and satisfaction of the patients based on patient-reported outcome measures via the BODY-Q abdomen scale.

Materials and Methods

We performed a retrospective multicenter study in 2 departments of aesthetic and plastic surgery, Department of Plastic Surgery, San Carlo of Nancy Hospital, Rome (group I) and Hospital Británico de Buenos Aires, Argentina group II). A total of 85 consecutive patients treated using abdominoplasty access (group I) and 85 consecutive patients treated using an endoscopic approach (group II) were enrolled in the study. The minimum follow-up was 12 months.

Results

Descriptive statistics were used to report the counts and frequencies for categorical data. Continuous normally and non-normally distributed data were described as means with standard deviations and medians with interquartile ranges as appropriate. All analyses were performed using the STATA/IC 16.0 software.

Conclusion

Our multicenter experience reveals that open and minimally invasive approaches are viable options. Identifying the optimal approach for DR repair should also rely on the patient's desired treatment outcome.

Ventral ETEP Versus REPA, Comparison of Two Novel Minimally Invasive Techniques for Midline Defects

Introduction: This report aimed to compare ventral extended vision extraperitoneal (ETEP) and preaponeurotic repair (REPA) techniques in terms of surgical procedure, outcomes, and patient evolution. Methods: This was a retrospective study performed at a tertiary care academic center between 2017 and 2022. All consecutive patients operated on for midline hernias and rectus diastasis using REPA and ETEP were included. Follow-up visits were at 15 days, 30 days, and 6 months postoperative. Age, sex, BMI, American Surgical Anesthesiologic Classification (ASA), surgical time, need for conversion to open surgery, time of stay, seroma, hematoma, surgical site infection (SSI), recurrence, and re-interventions were assessed. Results: For the present study, 148 patients were included. From them, 62 patients received the REPA procedure and 86 were operated on using the ETEP technique. REPA average time was 105 minutes (interquartile range [IR] 80-130), and ETEP average time was 120 minutes (RIC 95-285) (p = 0.03). Ambulatory procedures were 32.3% (n = 20) REPA and 20.9% (n = 18) ETEP (p = 0.23). In REPA, the mean time for drain extraction was 11.92 days and 8 days in ETEP (p < 0.001). Seroma incidence was identified in 40.3% (n = 25) of the REPA cases and 5.8% (n = 5) of the ETEP procedures (p = 0.001). In a multivariate analysis for seroma incidence REPA technique was associated with a significant risk of its incidence [odds ratio (OR) 16, 67 95% confidence interval ((CI95) 4.67-59.52), p < 0.001]. Conclusion: REPA and ETEP are safe and reproducible. Both approaches reported short hospitalization times and almost no major complications. We found a longer surgical time in ETEP and a higher incidence of seroma in REPA.

Clinical and Radiological Evaluation of Onlay Mesh Abdominoplasty in Obese Multiparous Patients with Moderate-to-Severe Rectus Diastasis

BACKGROUND

Women with multiple pregnancies often experience abdominal protrusion and/or a lax abdominal wall. Various open surgical techniques have been developed to address rectus diastasis in abdominoplasty, ranging from suture plication to mesh reinforcement. This study aims to compare the clinical and radiological changes between traditional abdominal plication and the addition of non-absorbable mesh for rectus muscle (RM) diastasis repair in terms of function, postoperative outcome, and recurrence.

PATIENTS AND METHOD

This prospective retrospective study involved 63 women who underwent cosmetic tummy tuck surgery and met certain eligibility criteria. Patients with only mild diastasis recti, midline hernia, contraindications for major surgery, recent smoking history, or refusal of mesh augmentation were excluded. Clinical examination for abdominal protrusion or bulging and CT imaging was performed to check for recurrence of diastasis recti. The study included 33 patients who underwent mesh repair and 30 who underwent traditional abdominal plication. Follow-up was conducted after 1 year using CT and a questionnaire to assess various factors compared to preoperative measurements, with overall satisfaction rated on a 10-point Likert scale.

RESULTS

There was no significant difference in demographic data between the two groups. Patients who underwent mesh repair had a slightly longer hospital stay and drain duration. The average waist circumference decreased in both groups without any statistically significant difference. Objective CT showed significant reductions in both groups in inter-rectus distance, RM width and circumference, and intra-abdominal circumference compared to preoperative values. All patients expressed satisfaction with scar quality and umbilicus aesthetics, and no recurrence was detected either clinically or radiologically during the follow-up period.

CONCLUSION

Comprehensive preoperative assessment and imaging techniques like ultrasound and CT scans allow surgeons to detect postpartum changes in the abdominal wall. Mesh reinforcement may be indicated for diastasis above 4 cm in obese multiparous females. Thorough preoperative evaluation permits customized surgical plans to optimally restore abdominal wall anatomy and function.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

Indications, outcomes, and complications of neoumbilical reconstruction: A systematic review

BACKGROUND AND OBJECTIVES

Neoumbilicoplasty aims to reconstruct an aesthetically pleasing new umbilicus following agenesis, malignancy, anatomical distortion, or umbilicus loss. Despite the wide variety of surgical techniques described, literature is scarce when it comes to standardized categorization of these as well as the clear definition of patients' selections, specific indications, final outcomes, and possible complications. According to available literature, this work aims to evaluate different surgical approaches, and correlate them to specific surgical needs, to simplify the surgical choice and patient management.

METHODS

A systematic review was performed in December 2020 in PubMed, Web of Science, and MedLine Ovid databases according to the PRISMA guidelines.

RESULTS

A total of 41 studies and 588 patients were finally included. On the basis of the evidence of the literature collected, we divided the studies into four groups according to the neoumbilicoplasty techniques: single suture or purse-string suture, single flap, multiple flap, and skin graft. Patients' surgical comorbidities, neoumbilicoplasty indications, and aesthetic and surgical outcomes were investigated. Direct suture and single and multiple flap techniques assured overall, satisfactory cosmetic outcomes with a low rate of surgical complications. Whereas suture-only techniques were chosen mostly by general surgeons/urologists in laparoscopic surgery, the single flap was the preferred method to reconstruct the umbilicus in open abdominal surgery or combined abdominoplasty with herniorrhaphy. Multiple flap and skin grafts were adopted in abdominoplasty-related umbilicus reconstruction, although the latter option showed impactful aesthetic and surgical complications.

CONCLUSIONS

Umbilicoplasty can assure generally pleasant aesthetic outcomes with relatively low complication rates. Indications for specific techniques correspond to different patient populations and surgical scenarios.

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

Background

This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty.

Materials and methods

One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result.

Results

No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results.

Conclusions

In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results.

Level of evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00266-021-02739-w.

Corset Autodermis External Obliqueplasty Reinforcement of Rectus Diastasis and Umbilical Hernia Repairs during Abdominoplasty

SUMMARY

Abdominoplasty is among the most commonly performed aesthetic operations and is frequently combined with rectus abdominis musculoaponeurotic plication of rectus diastasis and repair of umbilical and ventral hernias. The authors present a spare parts technique to assist in reinforcement of both rectus diastasis plication and hernia repair during abdominoplasty operations using an autodermis onlay reinforcement graft. The graft is harvested from the excess abdominal pannus normally discarded during abdominoplasty and is inset on tension between the bilateral semilunar lines and plicated along a concave "corset" contour. This reduces distracting forces on the hernia and diastasis repairs and further augments abdominal contour. This technique has been performed for 8 years on 82 low-surgical-risk patients, without any noted increase in complications. The corset autodermis external obliqueplasty is a spare parts technique that may reduce recurrence of rectus diastasis and abdominal hernias repaired at the time of abdominoplasty and is an alternative strategy to mesh placement in this risk-averse aesthetic surgery population.

Mesh Repair of Rectus Diastasis for Abdominoplasty is Safer than Suture Plication

Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication.

METHODS

Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last set of office photographs.

RESULTS

Surgical site occurrence rate was 0% of the 40 patients in the mesh group and 19% of the 37 patients in the standard group (P = 0.005); rates of soft-tissue revision were 23% in the mesh group and 27% in the standard group (P = 0.84). As to aesthetics, the mesh abdominoplasty patients had mean statistically lower preoperative scores in comparison with the standard plication group (65.8 ± 11.6 versus 70.3 ± 11.4, P = 0.0013). The mesh group had a statistical improvement to 75.9 ± 12.6 (P < 0.0001), whereas the standard plication group improved to 82.5 ± 11.4 (P < 0.0001).

CONCLUSIONS

Retrorectus mesh placement in a cohort of patients with severe rectus diastasis had a complication rate lower than that seen in a cohort of patients with less severe rectus diastasis, therefore negating our original hypothesis. This was done without compromising aesthetic improvement.

Diastasis recti repair with onlay mesh

INTRODUCTION

Diastasis recti represents a midline contour abnormality of the anterior abdominal wall that is secondary to attenuation of the linea alba. Severe diastasis recti is defined as attenuation of the linea alba as well as the linea semilunaris. Treatment options are variable and include conditioning exercises and surgical repair with or without mesh. This manuscript will review the indications and technique of onlay mesh for correction of severe diastasis recti.

METHODS

Abdominoplasty with diastasis repair has been performed in 63 women from January 2010 to January 2020. Of these, 4 had repair for severe diastasis that included plication and onlay mesh. The mesh was polypropylene in 3 patients and silk in 1 patient. Indications for onlay mesh included severe diastasis as a means of further reinforcing the strength of the anterior rectus sheath.

RESULTS

Of the 4 patients, all tolerated the operation well without morbidity. Natural contour was established in all. There were no infections, seromas, delayed healing or mesh removals. All drains were removed by 7 days.

CONCLUSION

The use of an onlay mesh has demonstrated success and should be considered in select patients for the surgical management of severe diastasis.

Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias

PURPOSE

Rectus diastasis (RD) associated with abdominal hernias present a surgical challenge associated with a paucity in treatment guidelines. The objective of this systematic review is to review surgical techniques and assess complication and recurrence rates of RD in patients with concurrent abdominal hernias.

METHODS

PubMed and EMBASE databases were systematically searched, and data extraction was performed on articles which met the inclusion criteria. Pooled analyses of complication and recurrence rates were performed to compare open vs. minimally invasive surgery. Student t tests were performed to compare differences in continuous outcomes.

RESULTS

Twenty-eight studies were included in this review. RD can be surgically repaired by both open and laparoscopic approaches using both non-absorbable and absorbable sutures. The majority of the techniques reported included mesh insertion either above the aponeurosis, retromuscular, preperitoneal, or intraperitoneal. Open techniques, compared to laparoscopic approaches, were associated with a significantly higher rate of skin dehiscence (6.79% vs. 2.86%; p = 0.003) and hematoma formation (4.73% vs. 1.09%; p < 0.001) and a significantly lower rate of post-operative seroma formation (2.47% vs. 8.29%; p < 0.001). No significant difference in RD recurrence rates were observed between open and laparoscopic repair (0.22 vs. 0.63%, p = 0.17).

CONCLUSION

Both open and laparoscopic surgery are safe and effective methods that can be used to repair RD in patients with RD and concurrent abdominal hernias as evident by the low recurrence and complication rates and almost negligible major complications post repair.

Techniques of Concomitant Abdominoplasty and Umbilical Hernia Repair: A Review

BACKGROUND

Different methods of performing full abdominoplasty and umbilical hernia (UH) repair simultaneously have been proposed.

OBJECTIVES

The aim of this study was to review and compare UH repair outcomes and umbilical stalk survival.

METHODS

A literature research was performed through 28 December 2019. Other hernia repairs and mini-abdominoplasty (without umbilical transposition) were excluded. The primary outcomes analyzed were rates of UH recurrence, mesh infection, and umbilical necrosis.

RESULTS

Six studies were included (5 retrospectives series, 1 case report). Hernia was repaired by an open approach (3 studies, 28 patients) or a laparoscopic approach (3 studies, 67 patients). UH repair consisted of mesh placement in the intraperitoneal or retromuscular/preperitoneal plane, or suture technique in the intraperitoneal plane. No hernia recurrence, mesh infection, or umbilical necrosis was described.

CONCLUSIONS

Both open and laparoscopic approaches to simultaneous abdominoplasty and UH repair seem to be safe based on the rates of umbilical stalk vascularization, hernia recurrence, and mesh infection. However, more well-designed studies are needed to prove this hypothesis.

LEVEL OF EVIDENCE: 4

Nonsurgical Postpartum Abdominal Rejuvenation: A Review and Our Experience

BACKGROUND

A significant population of aesthetic patients are postpartum women motivated to achieve a more youthful abdomen. Although traditionally, abdominoplasty was the treatment of choice, minimally invasive procedures have grown in popularity because of minimal downtime and the favorable side effect profile. so many women share concerns regarding their postpartum abdominal appearance, a limited number of studies focus specifically on postpartum abdominal rejuvenation.

OBJECTIVE

To review pertinent aspects of abdominal anatomy, associated changes with pregnancy, available nonsurgical cosmetic procedures, and to provide our experience to help guide treatment combinations which comprehensively address the concerns of the postpartum patient.

MATERIALS AND METHODS

A review of the literature surrounding nonsurgical treatment options for postpartum abdominal lipohypertrophy, muscle changes, tissue laxity, and striae gravidarum, along with the authors' experience in this area are provided.

CONCLUSION

This review summarizes available nonsurgical modalities to address postpartum abdominal defects, including procedures that tone muscles, reduce fat, tighten skin, and improve the appearance of striae. Both the published literature and the authors' experience favor a combination of treatments to address the various lamellae affected by pregnancy. Further clinical trials focusing on the postpartum patient would further help create a standardized approach for postpartum abdominal rejuvenation.

Autologous Dermal Mesh in Severe Postpregnancy Recti Muscles Diastasis

INTRODUCTION

The severe postpregnancy diastasis of recti muscles causes a biomechanical alteration of the statics of the trunk and an unaesthetic bulging of the abdominal wall. This is always combined with cutaneous and subcutaneous excess, which is different on a case-by-case basis. There is not a consensus on the best way to treat it. The anterior sheath plication is the mostly used surgical technique, and many surgeons believe that the use of mesh is necessary in the cases of severe diastasis. The authors here report the outcomes of the use of dermal automesh in the retromuscular layer.

MATERIALS AND METHODS

Between January 2015 and December 2019, a retrospective study on 101 patients was conducted. All patients underwent the repairment of the diastasis recti with transversalis sheath plication and dermal automesh reinforcement in the sublay fashion. In addition, all the patients had an abdominal wall ultrasound before the operation and an ultrasound after 1 month, 3 months, 6 months, 1 year and every year afterward. The median follow-up was 32.5 months RESULTS: No major complications, such as infections, extrusions, respiratory diseases or thrombosis, were reported. The follow-up abdominal wall ultrasound reported the absence of muscle recti diastasis in all patients. All patients were completely satisfied with the final result.

CONCLUSION

In postpregnancy women, the severe recti muscles diastasis dermal automesh repair is safe and effective. The dermal graft is easy to handle, has demonstrated comparable tensile strength to alloplastic mesh and is available in abdominoplasty or miniabdominoplasty from the excised skin.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of rectus diastasis: should the midline always be reinforced with mesh? A systematic review

BACKGROUND

Two main trends are described for the treatment of diastasis recti: plication versus midline mesh reinforcement. Indications for these procedures have not been clearly described. This study reviewed the outcomes in the treatment of rectus diastasis with plication versus mesh by the assessment of durability, complications, and patient-reported outcomes.

MATERIALS AND METHODS

A systematic review of literature on the treatment of diastasis recti was performed searching through PubMed, Embase, Web of Science, and Cochrane databases. This resulted in 53 eligible articles and predefined inclusion criteria led to the selection of 24 articles. Primary outcomes included recurrence and perioperative complications and secondary outcomes were defined as patient satisfaction, chronic pain, and quality of life.

RESULTS

A total of 931 patients were surgically treated for rectus divarication (age range: 18 - 70 years). The most frequently noted comorbidity was obesity and 10.6 percent were smokers. Recurrence was reported in 5 percent of the patients. The most frequent complication was seroma (7 percent), followed by abdominal hypoesthesia (6 percent), and surgical site infection (2 percent). Chronic pain was reported in 4 percent of the patients. Satisfaction was assessed subjectively in the majority of patients and was generally rated as high. Follow-up period ranged from 3 weeks to 20 years.

CONCLUSIONS

Durability, safety, and high patient satisfaction support surgical correction of rectus diastasis and could not favor a treatment method. Inter-rectus distance could not be identified as the indicator for technique, which emphasizes that other factors might add to the entity of abdominal wall protrusion more than previously thought.

Evidence-Based Abdominoplasty Review With Body Contouring Algorithm

Abdominal contour deformities are an aesthetic challenge to the plastic surgeon. Patients present with diverse clinical histories, multiple comorbidities, and unique aesthetic demands. Weight loss, previous pregnancy, and aging are 3 principal indications for abdominoplasty. Bariatric surgery has increased demand for body contouring procedures. This heterogeneous patient cohort means a "one-size-fits-all" abdominoplasty is not appropriate. Precise evaluation, evidence-based decision-making, and artistic acumen are required while balancing patient goals with safe, realistic, and long-lasting aesthetic outcomes. This article reviews surgical options for abdominal body contouring, providing an evidence-based treatment algorithm for selecting the appropriate procedure for each patient to maximize clinical and patient reported outcomes.

Endo-laparoscopic reconstruction of the abdominal wall midline with linear stapler, the THT technique. Early results of the first case series

Background

Midline primary hernias represent one of the most frequent abdominal wall defects in the adult population and in almost half of the cases they are associated with a rectus abdominis diastasis (RAD). Despite the high incidence of these defects there is currently no consensus in the literature on what is the preferred surgical technique for treatment. In this paper we present the first case series treated with an innovative technique that aims to repair the defects of the midline and RAD, while combining the advantages of the sublay Rives-Stoppa technique with those of the minimally-invasive surgery.

Methods

Between January 2018 and May 2018, 14 patients underwent endo-laparoscopic reconstruction of the midline. The surgery was performed under general anaesthesia through a 4 cm periumbilical incision with single port technique. The rectus abdominis sheaths were joined together and sutured lengthwise using a linear stapler. A tailor-made synthetic prosthesis was positioned in the retromuscular space.

Results

All cases had RAD with a mean width of 5.3 cm in the supraumbilical space. None of the surgeries needed laparotomic conversion. The average duration of the surgery was 80 min. The hospitalization was in all cases one day. The average follow-up period was 6 months. Neither recurrences, nor major or minor complications have been reported to date.

Conclusion

Our THT is a feasible technique, easily reproducible, and effective in the repair of primary defects of the midline and RAD, which greatly reduces the operating times and hospitalization allowing a quick return to active life.

•

The THT procedure is a surgical technique for repair of the abdominal wall midline hernias and rectus abdominis diastasis.

•

The THT procedure combines the advantages of endoscopic single port surgery with those of a retromuscular prosthetic reconstruction.

•

The THT procedure strongly reduces costs and operative times if compared to lap/robotic surgery while allows to avoid the complication risks related to a large laparotomy.

Concomitant Abdominoplasty and Laparoscopic Umbilical Hernia Repair

BACKGROUND

Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty.

OBJECTIVES

To present an effective and safe technique that can address large umbilical herniae during abdominoplasty.

METHODS

A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee.

RESULTS

At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes).

CONCLUSIONS

We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment.

LEVEL OF EVIDENCE 4

Management Strategies for Diastasis Recti

Diastasis recti is a relatively common condition in which there is a midline abdominal bulge that can affect a variety of individuals. The etiology and diagnosis is well understood and optimal management depends on the degree of severity. Patients at high risk for diastasis recti include multiparous women, obese patients, and those with multiple previous operations. Diagnosis includes clinical examination and assessment of symptoms. Physical characteristics include a midline abdominal bulge without a fascial defect. Classification systems are based on the degree of separation between the paired midline rectus and myofascial deformity. Optimal management varies and includes simple plication of the midline defect, extensive plication of the anterior abdominal wall, and sometimes the use of resorbable or nonresorbable mesh.

Neoumbilicoplasty With a Pedicled Deep Inferior Epigastric Perforator Island Flap

Management of the umbilicus is a common dilemma at the time of abdominoplasty and abdominal wall reconstruction. It is not uncommon for underlying pathologies, such as hernias and surgical scars, to result in a disfigured or obliterated native umbilicus or make the blood supply to the umbilical stalk unreliable. In these scenarios, the umbilicus is often sacrificed. Staged neoumbilical reconstruction may be offered and typically utilizes a small skin flap and full-thickness skin graft (Ann Plast Surg 2009;63:358-360). Our technique, in contrast, permits reconstruction of the neoumbilicus in the immediate setting utilizing normally discarded skin with a robust blood supply from a deep inferior epigastric artery perforator. In this series of 13 consecutive neoumbilicoplasties, the pedicled deep inferior epigastric artery perforator island flap provided reliable results and favorable aesthetic outcomes.

The Retro-Rectus Prosthesis for Core Myofascial Restoration in Cosmetic Abdominoplasty

BACKGROUND

The retro-rectus placement of a prosthesis for reinforcement of a hernia repair is a powerful surgical maneuver and results in reduced hernia recurrence rates in the absence of ventral hernia. Fascial reinforcement theoretically should improve columnar support to the spine and enhance athletic activity. The purpose of this study was to demonstrate the long-term efficacy of the restoration of the cylindrical lumbar abdominal myofascial complex as an adjunct to cosmetic abdominoplasty.

OBJECTIVES

A retrospective evaluation of retro-rectus inlay prosthesis during cosmetic abdominoplasty was undertaken to subjectively assess aesthetic and functional benefits.

METHODS

Six patients with severe anterior fascial laxity presenting for abdominoplasty underwent prosthetic augmentation of the posterior rectus sheath. The prosthesis was measured and contoured to provide structural support to the rectus sheath and linea Alba and to restore normal anatomic features to these structures. All procedures were performed via a traditional low abdominal curvilinear incision for optimum cosmesis.

RESULTS

All 6 patients had long-term follow up, ranging from 13 to 40 months. All patients reported improved core strength and relief of back pain. All patients were pleased with the cosmetic results.

CONCLUSIONS

Retro-rectus prosthetic augmentation for cosmetic abdominoplasty is effective in restoring anatomic relationships and can be used to improve core strength and to enhance aesthetic objectives.

LEVEL OF EVIDENCE

4.

Simultaneous Abdominoplasty and Umbilical Hernia Repair via Laparoscopy: a Preliminary Report

Background:Umbilical hernias (UH) are common in postpartum patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularisation with possible umbilical necrosis. To minimize this risk we associated abdominoplasty with laparoscopic UH repair. The aim of this study was to present the technique of simultaneous abdominoplasty and UH repair and the first results.

Materials and methods:Simultaneous abdominoplasty and laparoscopic mesh UH repair was analysed in the first 10 cases. The intervention was performed by a plastic surgeon and a general surgeon. It begins as a standard abdominoplasty with flap elevation, umbilicus detachment and diastasis repair, if indicated. The second stage is the UH repair via laparoscopy using an intraperitoneal mesh. The third stage consists of umbilical transposition and closure of the abdominoplasty incision.

Results:We had no complications at the umbilicus or the hernia mesh. In all cases, umbilical vascularisation was preserved and no hernia recurrence was noted.

Conclusions:Our first results suggest that the simultaneous UH repair with abdominoplasty is safe, minimizing the risk to the umbilicus blood supply. These first results encourage us to recommend this approach and perform a more detailed analysis of the whole series since our first case.

Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function

BACKGROUND

Abdominal wall weakness is a consequence of rectus abdominis diastasis and flaccidity of the myofascial component. A degree of plicature of the rectus abdominis generates an increase of intra-abdominal pressure (IAP), which may result in an increase of intrathoracic pressure, thus affecting thoracic hemodynamics and leading to inadequate ventilation.

OBJECTIVES

To assess changes generated by plicature of the rectus abdominis on IAP and pulmonary function in patients undergoing abdominoplasty.

METHODS

A total of 10 female patients with abdominal ptosis were included. Chronic smokers and patients with respiratory co-morbidities were excluded. The IAP was measured using a modified Kron's trans-bladder technique. Pulmonary function was assessed by pulmonary compliance (P-Comp) and was calculated with parameters provided by the mechanical ventilator. Both were calculated before and after plicature.

RESULTS

The mean values for IAP before and after plicature were 6.6 and 9.3 mmHg respectively. Before plicature, the mean P-Comp value was 38.97 mL/cm of water, and after it was 36.54 mL/cm. Both differences were statistically significant.

CONCLUSIONS

Based on the results obtained, it is possible to conclude that plicature of the rectus abdominis generates significant physiological changes, such as an increase in IAP and a decrease of P-Comp, which do not have a clinically relevant impact on healthy individuals. Measuring IAP with the modified technique and the assessment of pulmonary function using P-Comp are both reliable and provide a more accurate correlation with such physiologic changes. LEVEL OF EVIDENCE 3: Therapeutic.

Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis - Early Results

INTRODUCTION

Symptomatic umbilical and/or epigastric hernias are often seen concomitantly with rectus abdominis diastasis (RAD), and suture repair of such defects has a high recurrence rate. In the literature, there are reports of both endoscopic and open techniques for repair of symptomatic umbilical and/or epigastric hernias in association with RAD. This paper now reports on the early results of a hybrid technique used for reconstruction of the linea alba and mesh augmentation [endoscopic-assisted linea alba reconstruction plus mesh augmentation (ELAR plus)].

MATERIALS AND METHODS

Between 15 June 2015 and 31 January 2016, 40 patients with symptomatic umbilical and/or epigastric hernia and concomitant RAD underwent reconstruction of the linea alba using a hybrid technique involving a small umbilical incision and the use of video-endoscopic equipment. The patients comprised 29 men and 11 women with a mean age of 53.6 years and mean BMI of 32.6. The mean operating time was 120 min. The mesh had a mean longitudinal extension of 18.6 cm and transverse extension of 9.1 cm.

RESULTS

Thirty-day follow-up results are available for all patients. Thirty-seven out of 40 patients (92.5%) experienced no postoperative complication. Two cases of discrete impaired umbilical wound healing and one seroma were successfully managed with conservative treatment. On 30-day follow-up, 3 out of 40 patients (7.5%) complained of intermittent pain on exertion, and 2 out of 40 patients (5%) still took painkillers when required.

CONCLUSION

ELAR plus is a novel minimally invasive procedure for repair of symptomatic umbilical and/or epigastric hernias with concomitant RAD. Reconstruction of the linea alba via a minimally invasive access route is able to restore the normal anatomy of the abdominal wall.

Severe Irreversible Diastasis Recti Abdominis and Abdominal Hernia in Postpartum Women: Rare Case Report

Diastasis recti abdominis is a condition defined as the separation between the rectus abdominis and the linea alba, which leads to weakness in the abdominal muscles. Diastasis may be slight or severe, sometimes resulting in herniation of the abdominal viscera. Following childbirth, most women develop some extent of muscle separation in the postpartum period. However, if the diastasis recti abdominis in the postpartum period remain severe, it should be corrected to prevent concurrent abdominal hernia, strangulation or incarceration. We herein present two Korean cases of postpartum women with severe diastasis recti abdominis with abdominal hernia; it is the first report of its kind from Korea. Two women were referred to our clinic with severe abdominal bulge. Computerized tomography scan showed widening of the linea alba with abdominal hernia. The standard abdominoplasty with multiple wide longitudinal plications of the abdominal wall was performed in each patient under general anesthesia. There was no recurrence of diastasis recti abdominis or abdominal hernia during follow-up periods. The application of abdominoplasty in postpartum women with severe diastasis recti abdominis with abdominal hernia is thus considered to be an efficient management option. We hope these cases can provide a reference for the treatment of similar situations.

Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs

BACKGROUND

Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors' experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias.

METHODS

A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.A.D.) was performed. Patients with abdominoplasty and either rectus diastasis repair with mesh or a combined ventral hernia repair were analyzed.

RESULTS

Thirty-two patients, 29 women and three men, underwent mesh-reinforced midline repair with horizontal or vertical abdominoplasty. Patient characteristics included the following: mean age, 53 years; mean body mass index, 26 kg/m; average width of diastasis or hernia, 6.7 cm; and average surgery time, 151 minutes. There were no surgical-site infections and two surgical-site occurrences-two seromas treated with drainage in the office. After an average of 471 days' follow-up, none of the patients had recurrence of a bulge or a hernia.

CONCLUSIONS

For patients with significant rectus diastasis, with or without concomitant hernias, the described mesh repair is both safe and durable. Although this operation requires additional dissection and placement of prosthetic mesh in the retrorectus plane, it may be safely combined with standard horizontal or vertical abdominoplasty skin excision techniques to provide an aesthetically pleasing overall result.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Abdominoplasty-related nerve injuries: systematic review and treatment options

BACKGROUND

Abdominoplasty is a common cosmetic procedure; nerve injury is an underexplored risk of the procedure.

OBJECTIVE

The authors review existing literature to examine the incidence and treatment of nerve injuries after abdominoplasty procedures and provide a treatment algorithm based on their results.

METHODS

A search of the literature on MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was undertaken. After full-text review, 23 articles met our criteria. Any mentions of nerve injury, including references to a lack of nerve injury, were documented. All data were pooled for analysis. From our combined data, we calculated the risks of postabdominoplasty nerve injury by dividing the total number of nerve injuries by the total number of patients.

RESULTS

Pooled data showed that 1.94% of patients sustained specific nerve injury, and 1.02% of patients sustained permanent injury after abdominoplasty. In addition, 7.67% experienced decreased sensation, 1.07% reported chronic pain, and 0.44% reported temporary weakness or paralysis. Nerves directly injured were the lateral femoral cutaneous (1.36% of patients) and iliohypogastric (0.10%) nerves. Nerves injured from surgical positioning were the brachial plexus (0.10%), musculocutaneous (0.10%), radial (0.05%), sciatic (0.19%), and common peroneal (0.05%) nerves.

CONCLUSIONS

Although our results showed a low incidence of postabdominoplasty nerve injury, the lasting impact on affected patients' quality of life can be significant. Appropriate and timely treatment by a multidisciplinary team is critical to optimize patient outcomes. Better reporting of nerve injuries in future studies of abdominoplasty will provide more accurate information about the incidence and consequences of these injuries.

LEVEL OF EVIDENCE

4.

Feasibility of abdominoplasty with Cesarean section

Abdominoplasty is an esthetic surgical procedure that restores abdominal contouring. Repeated pregnancies combined with advancing maternal age usually lead to lower abdominal skin redundancy and excess fat accumulation. Delivery via Cesarean section adds weakness to the lower abdominal wall muscles and yields a lower transverse Cesarean scar. Some patients request whether abdominoplasty can be performed with Cesarean section in the same setting, to avoid a future surgery. This study was designed to evaluate the outcome of combined abdominoplasty with Cesarean section. The study included 50 pregnant women from September 2009 to June 2010 with an average follow-up period of 9 months. Nine patients (18%) developed wound infection; three of them (6%) developed wound dehiscence. Six patients (12%) developed lower abdominal skin necrosis; three of them (6%) were treated conservatively and healed by secondary intention, while surgical debridement and secondary sutures were needed in the other three patients (6%). Residual abdominal skin redundancy in nine patients (18%), outward bulging of the abdomen and lack of waist definition in 16 patients (32%), and outward bulging of the umbilicus in twelve patients (24%) were the reported unesthetic results. The results were compared with results of 80 abdominoplasties in nonpregnant women.

Rectus sheath plication in abdominoplasty: assessment of its longevity and a review of the literature

BACKGROUND

Correction of rectus diastasis during abdominoplasty is controversial. Few published studies have investigated the long-term value of plication. This prospective study aims to assess the long-term durability of plication of the rectus sheath in abdominoplasty using ultrasound.

METHODS

A total of 28 consecutive abdominoplasty patients underwent rectus plication by the senior author (FSF) since 2006, using a 0/0 looped nylon suture. Rectus diastasis was measured preoperatively and postoperatively at 3, 6 and 12 month's intervals using a standardised ultrasound (7.5 MHz) probe, by the single senior radiologist (GJD). Diastasis of the recti was assessed at three fixed points: at the umbilicus, 6 cm above and 6 cm below the umbilicus. Diastasis was categorised using the Beer classification.

RESULTS

All patients were female with a mean age of 36 years and average of body mass index (BMI) 26 kg m(-2). The majority of subjects had previous abdominal surgery including caesarean sections (82%, n = 23) and had at least one previous pregnancy (87%), with only two patients (8.7%) in the study being nulliparous. Correction of diastasis was maintained in all patients despite previous pregnancies and abdominal surgery. Postoperative follow-up time averaged 28 months (range 12-43 months). According to the Beer classification, there was no recurrence of rectus diastasis at the 12-month postoperative ultrasound measurements. A significant reduction in the mean distance between rectus muscles before surgery and 12 months postoperatively was noted. Previous surgery did not have a statistically significant affect on preoperative rectus distance.

CONCLUSIONS

Vertical rectus plication with a non-absorbable suture demonstrates long-term durable results without any suture-related complications. Patient factors such as extent of preoperative rectus diastases and previous abdominal surgery did not appear to have a significant effect on the durability of the corrected diastasis.

Abdominoplasty combined with Cesarean delivery: evaluation of the practice

Abdominoplasty is an aesthetic surgical procedure that restores abdominal contouring. Repeated pregnancy usually leads to lower abdominal skin redundancy and excess fat accumulation. Delivery via Cesarean section adds weakness to the lower abdominal wall muscles and yields a lower transverse Cesarean scar. Recently and in some cultures, abdominoplasty is requested at the same time of Cesarean delivery. Those women usually want to get the benefit of undergoing the abdominoplasty combined with Cesarean delivery in the same setting, thus avoiding a future surgery. This study was designed to evaluate the aesthetic outcome of combined abdominoplasty with Cesarean delivery. The study included 50 pregnant women from February 2008 to December 2009 with an average follow up period of 6 months. Nine patients (18%) developed wound infection; three of them (9%) developed wound dehiscence. Six patients (12%) developed lower abdominal skin necrosis; three of them (6%) were treated conservatively and healed by secondary intention, while surgical debridement and secondary sutures were needed in the other three patients (6%). Residual abdominal skin redundancy in 9 patients (18%), outward bulging of the abdomen and lack of waist definition in 16 patients (32%), and outward bulging of the umbilicus in 12 patients (24%) were the reported unaesthetic results. The results were compared with results of 80 abdominoplasties in nonpregnant women. The study concluded that abdominoplasty combined with Cesarean delivery carries a higher incidence of complications and does not give the desired aesthetic outcome. The authors do not recommend this practice.

Neoumbilicoplasty Is a Useful Adjuvant Procedure in Abdominoplasty

Background

Neoumbilicoplasties are indicated in congenital conditions associated with umbilical agenesis, umbilical loss due to inflammatory destruction, excision of skin cancer involving the umbilical stump and in surgical procedures for herniorrhaphy, as well as in the rare condition of umbilical endometriosis.

Objective

Neoumbilicoplasty is an adjuvant procedure that may be necessary during abdominoplasty with wide myofascial plication, or repair of concomitant hernias of the abdominal wall. The present article justifies sacrificing the umbilicus followed by neoumbilicoplasty in patients with significant wide myofascial plication or concomitant hernias of the abdominal wall.

Methods

Seventeen patients underwent a combination of abdominoplasty and wide (greater than 10 cm) vertical plication of the myofascial complex and required neoumbilicoplasty. The male to female ratio was 1:16; mean age was 44 years, mean weight 94.1 kg and mean height 160.2 cm. Characteristic body morphology included gross trunk obesity with a prominent anterior abdominal wall. The female patients were multiparous. Sacrificing the umbilici followed by neoumbilicoplasty was required in patients with umbilical hernias and patients who had divarication of the rectus abdominis muscles with short umbilical stumps.

Results

Nine patients had concomitant ventral hernias (52.94%) and eight patients had divarication of the rectus abdominis muscles with short umbilical stumps (47.05%). The mean perioperative myofascial plication distance was 15.41 cm and the gap closure required three to five rows of sutures.

Conclusion

Neoumbilicoplasty is a useful adjuvant procedure during abdominoplasty with wide myofascial plication or repair of concomitant hernias of the abdominal wall.

The normal width of the linea alba in nulliparous women

The function of the linea alba is to maintain the abdominal muscles at a certain proximity to each other. In the case of long-lasting increased intra-abdominal pressure, the linea alba widens. Yet, as the existence of the linea a priori implicates a physiological distance between the two rectus muscles, the question arises as to what the normal width of the linea alba is. To evaluate the normal width of the linea alba, we examined 150 nulliparous women between 20 and 45 years of age with a body mass index < 30 kg m(-2) by ultrasound at three reference points: the origin at the xiphoid and 3 cm above and 2 cm below the umbilicus. The examination revealed a broad range of widths at the three reference points. The linea was widest at 3 cm above the umbilicus (-35 mm), followed by the reference point 2 cm below the umbilicus (-31 mm) and the origin at the xiphoid (-31 mm). The mean width was 7 +/- 5 mm at the xiphoid and 13 +/- 7 mm above and 8 +/- 6 mm below the umbilicus. For the definition of the normal width of the linea, the 10th and 90th percentiles were taken. The linea alba can be considered "normal" up to a width of 15 mm at the xiphoid, up to 22 mm at the reference point 3 cm above the umbilicus and up to 16 mm at the reference point 2 cm below the umbilicus in nulliparous women.

Use of a submuscular resorbable mesh for correction of severe postpregnancy musculoaponeurotic laxity: an 11-year retrospective study

BACKGROUND

The management of severe postpregnancy musculoaponeurotic laxity remains a challenge for plastic and reconstructive surgeons. Several techniques have been proposed, but there is no consensus on the best treatment. The authors report the validity of their abdominoplasty method.

METHODS

From May of 1995 to May of 2006, a retrospective chart review was conducted on 52 women who underwent the authors' abdominoplasty technique. The average age was 39 years (range, 25 to 60 years). They had an average of 3.2 children (range, two to six). The average preoperative body mass index was 23.5 (range, 20 to 31.5). None of the patients included had preexisting medical conditions. The posterior rectus fascia was released and plicated at the midline. A resorbable mesh was used to reinforce the plication and to reduce the tension of the traction.

RESULTS

Follow-up ranged from 6 months to 11 years, with an average of 54 months. Complications included a bladder injury in one patient during posterior fascia release and epigastric bulging in one woman immediately after extubation. The local complications were seromas in two patients, skin flap necrosis in one smoking patient, and umbilical necrosis in one patient. Four patients required minor scar revision and liposuction under local anesthesia. There were no cases of systemic complications. No incidence of infection, dehiscence, or extrusion of the mesh was noted. All patients were completely satisfied.

CONCLUSION

The release and plication of the posterior rectus sheath associated with the use of submuscular resorbable mesh is a long-lasting and reliable procedure in multiparous women with severe myoaponeurotic laxity.

Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital

The number of abdominoplasties performed in the United States has been steadily increasing over the past decade. A large proportion of these patients are bariatric patients who remain obese despite prior weight-reduction surgery. This study was done to review the experience of patients undergoing abdominoplasty at a university hospital. A retrospective chart review of 206 consecutive patients was performed. The overall complication rate was 37.4%. Major complications [hematoma requiring surgical intervention, seroma requiring aspiration or surgical drainage, cellulitis or abscess requiring hospitalization and intravenous (IV) antibiotics, deep vein thrombosis (DVT), and pulmonary embolism (PE)] occurred in 16% of patients. The rate of minor complications (hematoma or seroma requiring no intervention, epidermolysis, small-wound dehiscence, neuropathic pain, and minor cellulitis) was 26.7%. Obese patients had a significantly increased risk of developing major complications as compared with nonobese patients (53.4% versus 28.8%, P = 0.001). An in-depth analysis of all complications and risk factors was done.

Antibiotic use in abdominoplasty: prospective analysis of 207 cases

The increasing demand for plastic surgery of the abdomen has also increased the number of complications, some of them very difficult to manage. It has been stated that antibiotics are unquestionably effective in preventing postoperative wound infections. In the present study, we aimed to provide guidelines for the use of prophylactic antibiotics in abdominoplasty operations. A prospective study was planned on 207 patients. Three study groups were formed according to the administration of antibiotics as follows: group 1, no antibiotics; group 2, preoperative antibiotics only; and group 3, both preoperative and postoperative antibiotics. Twenty patients showed bacterial growth in the intraoperative bacterial culture. There was significant difference in the incidence of infection between groups 1 and 2, groups 1 and 3, but there was no difference between groups 2 and 3. In conclusion, we recommend a single preoperative dose of intravenous antibiotic to prevent infection and also secure the patient from antibiotic side effects.

Intraabdominal pressure in abdominoplasty patients

Abdominal compartment syndrome is directly related to an increase in intraabdominal pressure (IAP), which can lead in severe cases to serious clinical consequences. Routine measurement of IAP in specific cases has been advocated by some surgical specialties. However, few studies in plastic surgery have focused on the use of IAP. The authors review the literature and describe a method of IAP analysis used for 12 patients who underwent abdominoplasty.

[Abdominoplasty after twin pregnancy: study of 30 cases]

INTRODUCTION

Compared to single mother-hood, the twin pregnancy results in important esthetic and functional sequelae of the abdominal wall. The considerable uterine growth involves a musculocutaneous diastasis of both the supra-umbilical and the infra-umbilical area. This study presents the modified abdominoplasty technique with an inverted T scar as the appropriate treatment of supra-umbilical and infra-umbilical musculocutaneous defects.

METHODS AND MATERIALS

This series reviews a total of 30 female patients of 35 years on average. There was no cases obesity or smoking reported. Surgical treatment consisted in a skin and fat resection following an inverted T scar design and associated to a muscle plication. In 6 patients it has been necessary to repeat the procedure in 6 months time.

RESULTS

All 30 patients resolved with an aesthetic and functional improvement. No instances of abdominal diastasis recidivation occurred. There were no complication observed and no impact on the healing process was referred.

CONCLUSION

on of the main differences between single and twin pregnancies is that the second ones are concerned by an abdominal diastasis marked on both a vertical and a transversal direction. The complete surgical treatment sometimes includes a second intervention. Clinical results and luck of complications suggest that the T-type abdominoplasty associated to a muscle re-tightening offers an appropriate surgical treatment of patients concerned.

The encircling mesh in abdominal wall surgery: rationale and technical details of a dorso-ventral physiological restoration

We describe a new, functional surgical technique, known as 'encircling mesh', designed to address abdominal wall problems. The rationale of the procedure is to connect the anterior and posterior trunk muscle compartments by means of a purpose built polypropylene mesh that encloses a belt shifted posteriorly across the spine subcutaneously, through use of a disposable introducer. The technical details and a case presentation, with specific references to the cosmetic and functional outcomes are described.

Liposuction abdominoplasty: an evolving concept

Liposuction abdominoplasty-liposuction of abdominal subcutaneous tissue deep and superficial to Scarpa's fascia, with excision of excess abdominal skin and, when indicated, plication of the anterior rectus sheath without undermining-is an effective, low-risk approach to minimizing abdominal flap undermining. The technique allows aggressive thinning and "sculpting" of full-thickness abdominal subcutaneous tissue and achieves a natural (not featureless) abdominal contour. It minimizes the creation of "dead space," which often leads to postoperative complications, as well as preserves sensory nerve and blood supply to the abdominal skin. The operation may be performed with the patient under local anesthesia, which probably diminishes the risk for deep vein thrombosis. Moreover, additional procedures can be conducted safely and the postoperative course is short, uneventful, and without restrictions; patients return to normal activity within a week or so. New evaluation criteria for abdominoplasty are discussed in this article, the most important of which is the assessment of intraabdominal fat content and its impact on surgical outcome and the decision to perform anterior rectus sheath plication. The concept of a sliding, mobile, sensate abdominal flap, created by liposuction and sustained by multiple neurovascular mesenteries, is also offered.

Complications of abdominoplasty in 86 patients

A total of 101 consecutive abdominoplasty patients were reviewed retrospectively. Of these, 14 male (mean age at time of operation, 34.3 years; range, 23 to 53 years) and 72 female (mean age at time of operation, 38.9 years; range, 19 to 64 years) patients had adequate documentation for inclusion in this study. Complications were recorded as either wound complications (wound infection, partial wound dehiscence, seroma, hematoma, and skin edge necrosis) or complications after surgery (deep vein thrombosis, pulmonary emboli, ileus, sensibility disorder of the skin of the thighs, and death). The complications were subsequently correlated for sex, race, the patient's age at surgery, body mass index before surgery, and the seniority of the surgeon. Nine male patients (64.3 percent) and 11 female patients (15.3 percent) had wound complications. Almost 10 percent of our patients sustained an injury to the lateral cutaneous nerve of the thigh. Male patients should be informed about their possible higher risk of complications, and special attention must be given by the surgeon to the prevention of such complications.Moreover, specific attention must be given to the preservation of the lateral cutaneous nerves of the thigh in both male and female patients undergoing abdominoplasties.

The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography

The purpose of this study was to assess the long-term durability of a standard vertical plication of the anterior rectus sheath. For this purpose, 70 women who had undergone this procedure as part of an abdominoplasty were sent a questionnaire, their records were studied, and they were invited back to the clinic for an examination using ultrasound. A total of 63 patients returned the questionnaire, and 40 were willing to attend a follow-up consultation and ultrasound investigation. The presence of rectus diastasis was assessed by ultrasound (a real time scanner with a 7.5-MHz linear probe). The study showed that after a follow-up of 32 to 109 months (mean, 64 months), standard plication of the abdominal wall with absorbable material led to residual or recurrent diastasis in 40 percent of the patients. It also confirmed that vertical plication only is not enough to improve the waistline and may eventually lead to epigastric bulging.