Lipoabdominoplasty with Selective and Safe Undermining

Abstract

Our objective is to present a new surgical concept for the aesthetic treatment of the abdominal region using the principles of liposuction associated with the traditional abdominoplasty. Lipoabdominoplasty is different from other techniques because it has the advantages of conserving perforator vessels of the abdominal wall, it preserves suprapubic sensibility, results in better abdominal contouring, has a low rate of complications, and a faster recuperation after surgery. The traditional abdominoplasty has been used for many years with several modifications intending to achieve better aesthetic contouring and to reduce complications. However, each modification solves problems only partially. The authors perform the surgery beginning with wet lipoplasty in superficial and deep fat layers. The skin below the umbilical scar is excised as in classical abdominoplasty. After that, selective and safe undermining of the dermocutaneous flap is done in the middle section of the upper abdomen between the borders of the rectus abdominis muscle, preserving mainly supply vessels of the abdominal wall.

Lipoabdominoplasty with Progressive Traction Sutures

“…8,19,34 Another possible complication is infection of the fluid collection. Some of the techniques that have been developed to decrease the rate of seroma formation include tension sutures and quilting sutures.…”

“…The placement of postoperative drains may lead to infection and discomfort in patients. 8,19,20 There have been no cases of hematomas caused by limited space allowed by sutures for the formation of large collection areas of blood. 25 Another possibility is infection of the hematoma or another fluid collection.…”

“…The ultrasound was not used on the infra-umbilical area, but this area was aspirated, allowing pretunneling in the supra- and infra-umbilical areas for dissection. 9,18,19–22 The aspiration was first performed on the flanks, which usually have large areas of lipodystrophy, and then on the anterior abdomen. A cushion or pillow was placed under the patient’s back to hyperextend the abdomen and prevent perforation of the abdominal wall or viscera.…”

“…In the middle third, the fascia was removed to allow muscle plication. 29 Taking the guidelines published by Dr. Saldanha 19 into account, we performed a selective supra-umbilical undermining, preserving the perforating vessels of the upper abdomen, with previous liposuction of the flap. 26,27 The dissection was carried out using a cold scalpel.…”

“…1 Then, the entire supra-umbilical area was undermined up to the region of the lateral perforating vessels of the abdominal rectus muscles. 1,9,19,30 This dissection left a thin layer of adipose tissue on the abdominal rectus muscles to prevent seroma formation. After careful hemostasis with a monopolar double clamp, plication of the diastasis of the rectus abdominis was performed with a 2-0 Mononylon X-type suture, as described by Nahas and Ferreira.…”