Dissection Technique for Abdominoplasty With Scarpa Fascia Preservation: Comparative Study on Avulsion Technique Versus Diathermocoagulation

Abstract

Background Many strategies have been developed to lower the high complications rate associated with a full abdominoplasty. The dissection technique may have a role to achieve this goal. Objectives The present study compares two different dissection techniques to perform a full abdominoplasty with Scarpa fascia preservation: avulsion technique and electrodissection. Methods A retrospective observational cohort study was performed in two health institutions from January 2005 to January 2019. A total of 251 patients were involved: 122 patients submitted to abdominoplasty using the avulsion technique (Group A) and 129 with diathermocoagulation (coagulation mode) (Group B). The latter was further divided into group B1(57 patients with device settings according to surgeon’s preferences) and B2(72 patients with a specific regulation aiming at minimal tissue damage). Several variables were analyzed: population characteristics, time of hospital stay, time to drain removal, total and daily drain output, emergency department visits, readmission, reoperation, local and systemic complications. Results There were no statistically significant differences between the general characteristics of both groups, except for previous abdominal surgery. The diathermocoagulation group had a significantly lower length of hospital stay and time to drain removal. Moreover, these advantages were maximized when electrocautery was done with a specific low voltage setting as significant differences were found. The other outcomes were identical. Conclusions Limiting the extension of electrodissection with the avulsion technique didn´t present any advantage. Using diathermocoagulation (coagulation mode) during a full abdominoplasty with Scarpa fascia preservation, especially when it’s aimed at minimal tissue damage, reduces patients’ time with drains.

Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level

“…1,2,11,13 In 15 publications, suitable photographs were available (Table 4). 3,15,19,22,[24][25][26][27][28]33,36,40,48,49,60 The scar level ranged from 8.6 to 14.1 cm.…”

“…Her tan line shows that the scar is concealed, but the bikini covers more than half of the abdomen below the umbilicus. Adapted from Torres-Silva et al 49 the additional volume that is left on the abdominal wall and more limited mobility of the abdominal flap (Fig. 12).…”

“…The authors recognize the additional thermal injury associated with Bovie electrodissection and have changed the energy setting from a cutting mode to coagulation mode in subsequent studies. 44,49 In a 2020 study by the same senior author comparing 2 versus 3 closed-suction drains, the authors treated 9 seromas among 73 patients (12.3%). 44 This seroma rate was much higher than their earlier reported rate of 2.5%.…”

“…The authors believe that their Bovie dissection preserving the Scarpa fascia represents a major improvement over classic abdominoplasty and that the evidence is robust, and there is no reason to consider avoiding electrodissection. 49 The hypothetical basis for Scarpa fascia preservation is that a dissection plane superficial to the Scarpa fascia preserves vascular and lymphatic structures. 38 Anatomic studies have examined this possibility.…”

“…Most recent publications on abdominoplasty focus on reducing the risk of complications, particularly seromas 1–55 . Outcome surveys have been published, documenting a high level of patient satisfaction and improved quality of life after traditional abdominoplasty, 56–62 especially when combined with liposuction 58,59 .…”