Outcomes of Abdominoplasty with Scarpa’s Fascia Preservation: A Systematic Review

Abstract

assive weight loss and pregnancy occasionally result in permanent abdominal tissue excess, which can cause functional and psychological problems, may inhibit a normal life, and reduce the quality-of-life. In the more severe cases the tissue excess is associated with a musculoaponeurotic laxity in the abdominal wall, which has been hypothesized to cause lumbar pain and reduced respiratory function. According to the American Society for Aesthetic Plastic Surgery's 2013 Cosmetic Surgery National Data Bank, the number of abdominoplasty procedures performed has increased approximately 371% since 1997. Complications related to abdominoplasty include seromas, which have a reported incidence of 0.1 and 50 percent, and hematomas, which have a high reoperation rate. The anatomy and physiology of lymphatic vessels in the abdominal wall have been described to be an important factor in the status of the abdominal wall following abdominal lipectomy. Violation of the deep lymphatic vessels that run just superficial to the abdominal wall muscular fascia is thought to further compromise lymphatic drain- age of the serous fluid produced at the surfaces of the undermined tissue. One technical modification to flap elevation is the dissection of a more superficial plane, which can be found just below the Scarpa’s fascia in thin patients. This systematic review and Meta-Analysis were conducted to estimate the pooled benefits and adverse of preserving Scarpa’s fascia during abdominoplasty, highlight the evidence and quality of the included studies and to share in modifying the current guidelines. Methodology The review was restricted to clinical studies that were done to investigate the preservation of Scarpa’s fascia during abdominoplasty. Any reported benefits such as cosmetic outcome, patient satisfaction and surgeon satisfaction, or any reported adverse such as complication rates, infection, seroma, hematoma, skin necrosis, wound dehiscence and cosmetic disfigurement all were reported and pooled to the review. The pooled estimate of the five included trials suggested that Scarpa’s fascia preservation was associated with significantly reduced seromas relative to the control group. However, Scarpa’s fascia preservation could not significantly decrease the risk of hematoma. Compared with the control group, Scarpa’s fascia preservation was associated with a significantly reduced time until drain removal, drain output, infection and hospital stay, but it failed to decrease the incidence of suture rupture. Conclusion Scarpa’s fascia preservation could significantly reduce seroma, time until drain removal, infection, drain output, and hospital stay following abdominoplasty. It is recommended to be administrated in patients undergoing abdominoplasty.

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