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

Abstract

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.

Necrose de parede abdominal após lipoabdominoplastia: relato de caso

“…Visando reduzir o risco de necrose do retalho abdominal, conforme objeto de estudo do caso apresentado, são citados na literatura a lipoaspiração, como etapa inicial, a realização de suturas de ancoragem preconizadas por Baroudi, para alívio da tensão e fechamento do espaço morto, além da recomendação de se evitar procedimentos cirúrgicos combinados 6,9 . Evitar a lipoaspiração excessiva, o fechamento sob tensão e o uso de malhas compressivas muito apertadas reduz o risco de isquemia 7,8 . A preservação dos vasos perfurantes com descolamento seletivo do retalho abdominal, como proposto na lipoabdominaplastia por Saldanha, também demonstrou redução na incidência de necrose 2 .…”

Can drains be avoided in lipo-abdominoplasty?

“…Rangaswamy [ 4 ] advocates initial synchronous liposuction, flap elevation at Scarpa's fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of sub-flap suture by multiple sutures for avoiding complications in abdominoplasty. We had started operating on similar lines from the beginning of our series in 2006.…”

“… Incidence of seromas and wound dehiscence has been shown to have reduced, per se , over the years and reduced further with incorporation of thorough liposuction in abdominoplasty. [ 4 ] Najera et al . [ 5 ] described increase in the incidence of seroma if combined with flank liposuction and in high BMI patients between 2004 and 2007.…”

Anesthesia for Plastic Surgery Procedures

“…Aspirin has been used successfully in major orthopedic surgery [85] and could have utility in plastic surgery with the risk of DVT/PE. The use of direct and indirect factor Xa inhibitions and thrombin inhibitors may be contraindicated since they induce greater postoperative bleeding [86,87]. There is controversy about the risk of combining two or more plastic surgery procedures or other types (hysterectomy, colpoplasty, cholecystectomy).…”

“…From anesthesia view, it is known that if there is longer operative time there are more possibilities of complications (bleeding, atelectasis, DVT, PE, alterations of the immune response, among others). The surgical literature is contradictory, and there are studies that favor combinations [83,86,87] and others that do not support this procedure [86].…”