Safe Abdominoplasty With Extensive Liposuctioning

Challenging the Subcostal Incision Scar with the Two-staged Abdominoplasty: An Innovative Approach

Abdominoplasty is a commonly sought-after procedure due to its life-transforming results, but is limited, as in any other operation, by a number of contraindications. One of these contraindications is a subcostal scar, which may jeopardize blood supply to the upper flap of the abdominoplasty, resulting in skin necrosis. Herein, we challenge this dogma by introducing the two-staged abdominoplasty with the utilization of a delayed flap in a 48-year-old multiparous woman presenting with a Kocher incision of open cholecystectomy, with good results and a complication-free course of 3 postoperative months. We recommend this approach in patients with subcostal scars. However, more research into the utilization of delayed flaps in abdominoplasty should be done to have a more well-founded conclusion.

"Abdominoplasty with "En block" removal of the skin island: a safe and fast approach"

The aim of abdominoplasty is to restore a normal abdominal contour, with minimal signs of the surgery. The purpose of this study was to determine the feasibility, safety, and advantages of en block removal of a skin island before upper abdominal dissection during abdominoplasty. Five hundred-forty female patients who underwent abdominoplasties between January 2004 and December 2018 were retrospectively analyzed. In these cases, the planned skin resection was initially made en block, as done with an elliptic skin excision. In this way, symmetric skin removal is achieved. After the removal of this skin, epigastric skin undermining was easily achieved. The mean age of the patients was 41.4 y, and the mean body mass of index was 27.3 kg/m². The mean operative time for abdominoplasty only was 98 min. Eight patients had minor skin problems, 22 patients needed aspiration for seroma formation, and 7 patients needed scar revision surgery. There was only one hematoma postoperatively. The final position of the scar from the upper vulvar commissure was 8.9 cm. The results obtained were comparable to those of classical abdominoplasty, suggesting that en block removal of the skin before upper flap dissection is a safe maneuver. En block removal of skin island at the start of the surgery has the added advantage of a reduced operative time and acceptable aesthetic outcome, without an increase in complication rates. In cases of planned abdominoplasties, we suggest that removal of the abdominal skin at the beginning of the operation is a safe and feasible procedure.Abbreviation: PDS: polydioxanone.

[Abdominoplasties: Do we still need to drain in 2021?]

OBJECTIVE

The purpose of this study was to consider the use of drainage when performing an abdominoplasty with regards to postoperative complications for two groups of patients.

PATIENTS AND METHOD

From January 1st 2017 to December 31th 2019, 215 patients underwent an abdominoplasty in our institution. In this retrospective, comparative, single institution study, patients were divided into two groups: "drainage" D (n=162) when suction completed abdominoplasty, "no drainage" ND (n=53) when suction didn't completed abdominoplasty. Early and distant complications were retrieved for each group and compared.

RESULTS

There was no significant difference between the two groups concerning the occurrence of seroma postoperatively (8% of patients in group D and 11.3% of patients in group AD). The drainage group D experienced more seroma's punctures (2,3± 1,0) and the mean of punctured fluid was higher (386,5ml±350,4ml) compared to the no drainage group ND (1,3+- 0,5 number of punctures with a mean punctured fluid of 165,8mL± 224,2mL). The mean hospital stay was shorter for group ND (2,9± 1,8 days) than for group D (4,4+- 1,7 days), P<0,0001.

CONCLUSION

Performing an abdominoplasty with quilting suture but drainless doesn't seem to increase postoperative complications statistically. The authors recommend, under the guise of a quilting suture, not to systematically drain the abdominoplasties and to reserve this technique for patients at risk of complications (high BMI, significant weight loss and co-morbidities).

The Addition of Partial or Circumferential Liposuction to Abdominoplasty Is Not Associated With a Higher Risk of Skin Necrosis

BACKGROUND

Combining abdominoplasty with liposuction is a common practice for optimal patient aesthetic outcomes. In the past, several practitioners have argued against liposuction due to the potential for vascular insufficiency, especially with central liposuction. Despite these concerns for flap damage with resultant necrosis, the incidence of this complication has not been comprehensively investigated.

OBJECTIVES

The authors therefore examined the incidence of necrotic complications, including skin and fat necrosis as well as partial/total flap loss, in patients who underwent abdominoplasty alone (AA) or abdominoplasty with partial or circumferential liposuction (APCL).

METHODS

Literature searches were performed in PubMed/Medline and Embase with no query limits. For the systematic review, data from the studies were extracted into a form including primary author, publication year, study design, number of AA and APCL patients, abdominal zone(s) treated with liposuction, average lipoaspirate volume, follow-up time, necrotic complications, and revision procedures. A meta-analysis was separately performed for 13 studies that included patients who underwent both AA and APCL.

RESULTS

The overall rate of necrotic complications was lower in the APCL group (0.39%) compared with the AA group (1.01%). The incidence of necrotic complications was low for all patients, with a pooled partial flap loss rate of 0.24% and a pooled skin necrosis rate of 0.23%. The forest plots revealed that patients who underwent APCL do not face a higher risk of skin necrosis or revision compared with those who underwent AA.

CONCLUSIONS

Performing APCL is a safe combined procedural approach and can confer added benefits of improved patient satisfaction and aesthetic outcomes.

LEVEL OF EVIDENCE: 4

Classic high lateral tension and triangular resection methods to prevent dog ear and elongation scar in patients undergoing abdominoplasty: A comparative open-label clinical trial

Background:

One of the most common operations in the plastic surgery curse is abdominoplasty. Several methods were recommended for achieving better results. In the present study, efficacy of a new method compared with classical high lateral tension on preventing dog ear and elongation scar was evaluated.

Materials and Methods:

in an open-label, randomized clinical trial, seventy patients who were candidates for abdominoplasty were selected and randomly divided into two groups. The first group was operated by classic high lateral method and the second group was operated by a new method concentrating on changing incision line and angle. Dog ear prevention, length of scar, improvement, and postoperative complications were compared between the two groups.

Results:

The mean ± standard deviation (SD) length of scar in treated patients with classical and new abdominoplasty surgical methods was 53.68 ± 6.34 and 41.71 ± 1.78 cm, respectively, and the length of scar in the group treated with the new method was significantly shorter (P < 0.001). The mean ± SD distance between two anterior superior iliac spine in group treated by new method was significantly decreased after surgery (31.3 ± 1.3 cm) compared to before intervention (36.7 ± 3.9 cm) (P < 0.01).

Conclusion:

The new method is more likely to be successful in patients with high lateral tension abdominoplasty. However, according to the lack of similar studies in this regard and the fact that this method was introduced for the first time, it is recommended that further studies in this area are needed and patients in term of complications after surgery need a longer period of follow-up.

Natural evolution of seroma in abdominoplasty

BACKGROUND

Abdominoplasty is one of the most performed aesthetic surgical procedures, and seroma is a common local complication. The aim of this study was to investigate the beginning of seroma formation after abdominoplasty and its progression.

METHODS

Twenty-one female patients underwent standard abdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (i.e., epigastric, umbilical, hypogastric, right iliac fossa, and left iliac fossa regions) at five different time points: postoperative days 4, 11, 18, 25, and 32.

RESULTS

The incidence of seroma was 4.8 percent on postoperative day 4, 38.1 percent on postoperative day 11, 33.3 percent on postoperative day 18, 23.8 percent on postoperative day 25, and 19 percent on postoperative day 32. The left iliac fossa region had the highest relative volume of fluid collection on postoperative day 4, as did both the right iliac fossa and left iliac fossa regions on postoperative day 11. At other time points, the relative volume of fluid collection was significantly higher in the right iliac fossa region.

CONCLUSION

The highest incidence of seroma occurred on postoperative day 11, and the iliac fossae were the most common locations of seroma.

Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps

Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author's own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.

Abdominoplasty with thorough concurrent circumferential abdominal tumescent liposuction

Abdominoplasty, the removal of excess skin combined with muscle plication of a patient's abdominal region, can yield pleasing postoperative results alone, but adding significant concurrent circumferential abdominal liposuction to the procedure can dramatically improve the overall shape and contour of the final result. The perceived risk of performing this combined procedure involves potential skin necrosis resulting from devascularization of the abdominal flap, but when performed with proper technique-including thorough tumescent infiltration and vascular preservation during the liposuction portion-the procedure delivers superior results with a minimal risk of ischemia and necrosis.

Seroma in lipoabdominoplasty and abdominoplasty: a comparative study using ultrasound

BACKGROUND

Abdominoplasty is one of the most frequently performed cosmetic procedures, and its combination with liposuction has become more common. Seroma is one of the most common complications in abdominoplasty. The aim of this study was to compare the rate of seroma formation in patients who underwent either abdominoplasty with or without the use of quilting sutures or lipoabdominoplasty.

METHODS

Fifty-eight female patients were divided into three groups and underwent one of the following procedures: group A (n=21), abdominoplasty without quilting sutures; group B (n=17), abdominoplasty with quilting sutures; and group C (n=20), lipoabdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (epigastrium, umbilical, hypogastrium, right iliac fossa, and left iliac fossa) at two postoperative periods (P1, between postoperative days 11 and 14; and P2, between postoperative days 18 and 21).

RESULTS

The rate of seroma formation at both P1 and P2 was significantly higher in group A. It was observed that in group A at P1, the regions of right iliac fossa and left iliac fossa developed larger fluid collections. In group B, there were no significant differences with respect to fluid collections among the five study regions at both P1 and P2. In group C, there were significantly larger fluid collections in the hypogastrium region at P1 and in the umbilical and hypogastrium regions at P2.

CONCLUSION

Abdominoplasty with quilting sutures and lipoabdominoplasty are effective techniques for the prevention of seromas compared with abdominoplasty without quilting sutures.

A case for the safety and efficacy of lipoabdominoplasty: a single surgeon retrospective review of 173 consecutive cases

BACKGROUND

The combination of liposuction and abdominoplasty has been slow to be accepted, primarily due to a perceived higher incidence of complications associated with the procedure. There has also been extensive debate about the combined procedure's effects on flap vascularity and viability and the extent to which liposuction may be performed in conjunction with surgical abdominoplasty.

OBJECTIVE

The authors present data from their four-year experience supporting lipoabdominoplasty as a safe and effective procedure for body contouring.

METHODS

The authors retrospectively reviewed a case series of lipoabdominoplasties performed between 2004 and 2008 by the senior author (KK). A total of 173 consecutive patients who presented for abdominal contouring were included in the study. Each patient underwent a combined procedure beginning with liposuction utilizing the superwet technique, followed by an inverted V-pattern abdominoplasty.

RESULTS

Of the patients included in this study, 171 (98.8%) were women and two (1.2%) were men. The average age of the patients was 41.53 years, and the average body mass index was 26. The average amount of total lipoaspirate from the flanks was 2166.09 mL, and the average specimen weight resected was 972.80 g. Complications included partial dehiscence/skin necrosis (12 patients; 6.9%), infection requiring antibiotic therapy and/or intervention (13 patients; 7.5%), suture spitting (one patient; 0.5%), seroma (six patients; 3.4%), major fat necrosis requiring local debridement (one patient; 0.5%), and skin flap necrosis requiring readvancement of the abdominal flap (two patients; 1.1%). There was a revision rate of 8.0%: two patients required additional liposuction to smooth out unevenness, five patients required scar revision, and seven patients had dog-ears requiring intervention. All revisions were performed under local anesthesia. There were also five instances of confirmed deep vein thrombosis (2.8%) and two cases of pulmonary embolism requiring hospitalization (1.1%).

CONCLUSIONS

The senior author's (KK) lipoabdominoplasty technique, combined with his current preoperative and postoperative protocols, is believed to be a safe procedure that results in excellent cosmetic results. In contrast to some of the current literature, the data show a reduction of overall complications as compared to historical norms.