Abdominoplasty With Scarpa Fascia Preservation

Abstract

The plane of dissection used during a full abdominoplasty has been implicated on the seroma rate. Avoiding the classic plane of dissection on top of the rectus fascia and using a more superficial plane of dissection has been suggested as a strategy to improve recovery and lower the complication rate. The authors have been applying this principle in their practice for more than a decade, and they performed 2 prospective comparative studies to evaluate the clinical effects of using a more superficial plane of dissection (with Scarpa fascia preservation) during a full abdominoplasty.The technique is presented and explained along with the results of both comparative studies.The results of both studies are discussed particularly the effects on drain volume (total and daily), the duration of drain usage and the avoidance of "long drainers." These are very relevant advantages of the technique that have not been discussed in the literature. The results and surgical strategies used by other authors which apply a more superficial plane of dissection are presented.Controversy still exits on the manipulation of the deep fat compartment by liposuction or direct fat excision. No manipulation is another option which should be considered but it has been questioned due to the risk of aesthetic compromise. A morphometric study performed on the surgical specimens of 41 female patients submitted to a full abdominoplasty validates that option.Based on this evidence, the authors recommend that surgeons consider performing abdominoplasties using a more superficial plane of dissection in the infraumbilical area with total preservation of Scarpa fascia and the deep fat compartment. The classic plane of dissection, on top of the deep fascia, should be avoided in the lower abdomen.

Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay

“…noted that preservation of deep-fat tissues in zone 3 and 4 in TRAM flap harvest reduced postoperative donor site fluid exudates which enabled earlier removal of drains. This further supports results from a morphometric study by Costa-Ferreira recommending a more superficial plane of dissection in the infraumbilical area during abdominoplasty17 . However, conflicting results were published by Tourani et al18 following the superficial lymphatic drainage of eight hemiabdomen specimens from four human cadavers.…”

Efficacy And Saftey of Scarpa’s Fascia Preservation during Abdominoplasty; A Comparative Randomised Study

“…Postoperative seroma formation remains the most frequent complication after full abdominoplasty. [1,2] The beneficial effect of using a more superficial plane of dissection on the seroma rate has been fully confirmed along with other very relevant advantages: lower drain volume, earlier drain removal, shorter hospital stay, and lower hematoma and infection rates. The aesthetic result obtained with this technique was very good, considering both physician and patient evaluations [3]…”

“…Due to the number of variations and modification of abdominoplasty procedures, its critical to select the appropriate technique based upon patient characteristics in order to minimize morbidity and post-operative disability while providing a desirable and predictable result. [1] Despite the good results obtained with a classic full abdominoplasty, a significant complication and secondary surgical revision rates are still reported. Postoperative seroma formation remains the most frequent complication after full abdominoplasty.…”

Scarpa Fascia Preservation to Reduce Seroma Rate on Massive Weight Loss Patients Undergoing Abdominoplasty: A Comparative Study

“…All operations were performed under general anesthesia by the same local surgical team. SFP abdominoplasty or dual plane abdominoplasty was widely similar to classic full abdominoplasty [ 26 ]. An incision was made to the level of the symphysis pubis, 6–7 cm superior to the anterior vulva commissure, and the abdominal flap was elevated up to the subcostal margin.…”