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

Abstract

Summary: 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.

Use of Infrared Thermography for Abdominoplasty Procedures in Patients with Extensive Subcostal Scars: A Preliminary Analysis

“…3 Nevertheless, strategies must be implemented to avoid complications and improve outcomes. 2,6 IRT has already been proven useful for plastic surgery, 7,9,10 with good acuity for evaluating tissue perfusion. 1,7 Several studies have reported its value in monitoring flap perfusion and preoperative perforator mapping.…”

“…Surgeons show reluctance to perform full abdominoplasty in patients with a previous subcostal incision because of the risk of vascular disruption. 2 , 3 , 6 This risk may be less, especially if previous surgery was performed in the remote past and other risk factors are absent. 3 Nevertheless, strategies must be implemented to avoid complications and improve outcomes.…”

“…1 On the other hand, scars are often present in the abdomen of patients seeking abdominoplasty, aggravating the risk to the abdomen's regional blood supply. 2,3 To minimize complications of previous scars in abdominoplasty, some authors suggest lipoabdominoplasty and limited undermining, placing less tension on the flap closure, delaying it, or using a different type of resection, such as reverse or Corset abdominoplasty. 2,[4][5][6] The possibility of inferior aesthetic results and the high risk of complications must be carefully discussed with these patients.…”

“…2,3 To minimize complications of previous scars in abdominoplasty, some authors suggest lipoabdominoplasty and limited undermining, placing less tension on the flap closure, delaying it, or using a different type of resection, such as reverse or Corset abdominoplasty. 2,[4][5][6] The possibility of inferior aesthetic results and the high risk of complications must be carefully discussed with these patients. Noninvasive methods for evaluating abdominal wall perfusion may help surgeons decide on the best option in the presence of a subcostal scar.…”

“… 1 On the other hand, scars are often present in the abdomen of patients seeking abdominoplasty, aggravating the risk to the abdomen’s regional blood supply. 2 , 3…”