CURRENT TRENDS IN ABDOMINOPLASTY
Kerollis Samy Yousssef Narouz;
Abstract
SUMMARY AND CONCLUSION
W
e all know that the anterior abdominal wall is one of the body areas most affected by aging, body weight variations, non disciplined life style, adipose tissue anomalous accumulations, celiotomies and pregnancies. For decades, these dysmorphisms have led many men and women to pursue exercise, physiotherapy, sports, dietary regimens and all sorts of non invasive treatments to solve their physical problems, of which the anterior abdominal wall is one of the most important. And in face of the very limited and unsatisfactory results achieved, the best solution turned out to be cosmetic abdominoplasty.
Surgical correction of abdominal wall laxity, tissue redundancy, and increased lipodystrophy through an open abdominoplasty procedure has been an accepted practice since the mid-twentieth century. The procedure has been revised and updated countless times, whereas the principal belief of reduction of the redundant panniculus and correction of rectus fascia diastasis has remained.
When performing abdominal contouring procedures, it is necessary to understand the anatomy of the abdominal region and how it relates to the specific surgical operation being performed. The anatomy of the abdominal wall is both straightforward and elegant. A thorough knowledge of the vascular source, the innervation, the lymphatics, as well as the deep and superficial structures of the abdominal wall is important for performing abdominoplasty and abdominal contouring procedures. Most importantly, knowledge of the vascular supply to the abdominal soft tissue as well as the superficial soft-tissue structures, specifically Scarpa’s fascia, is critical to safely achieve an optimum aesthetic result.
Understanding the muscular and fascial components of the abdominal wall is important for myofascial plication and hernia repair. The sensory distribution is also important when considering incision placement for abdominal body contouring procedures.
The form of the abdomen is defined by the skeletal structure, as well as the quantity and distribution of fat, the appearance and condition of the skin, the tonus of the aponeurotic and muscular system, and the protrusion of the intra-abdominal organs. Each of these components constitutes an independent variable within the diagnosis of deformity of the abdominal wall, and will determine the type of treatment indicated for the patient. Abdominal alterations may be summarized as: cutaneous (redundancies, stretch marks, scars, flaccidity and retractions); accumulation of subcutaneous tissue (lipodystrophy); and those affecting the muscular-aponeurotic system (diastasis, hernia, eventration and convexity). The ultimate goal of surgery is to achieve an aesthetic contour, with acceptable scars, and the return of full function of the abdominal girdle.
Proper patient selection and education are paramount factors to ensure long-term success of the procedure. Selection of the ideal abdominoplasty procedure depends on the grade of excess skin and stretch marks, lipodystrophy, and musculoaponeurotic laxity. Patients opting for abdominoplasty must have realistic expectations and should be committed to implementing some healthy lifestyle changes that include eating, a well-balanced diet and exercising regularly. Several authors created useful classifications mostly on the basis of subcutaneous excess fat, skin deformity, and rectus diastasis secondary to pregnancy.
Many surgical techniques are currently available for abdominal contouring. Based on the individual characteristic of the patient’s anatomy and their goals, these abdominal contouring procedures include liposuction alone and different techniques of abdominoplasty procedures with or without liposuction.
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.
Despite advancements in abdominoplasty techniques, however, a significant complication rate still is associated with abdominoplasty including flap necrosis, seroma, hematoma, infections, and fat necrosis, wound dehiscence, and delayed healing. Because this procedure involves extensive undermining, denervation occurs, and the skin flap loses vascularity. The flap, with its reduced blood flow and innervations, then is stretched maximally and sutured under tension, which results in ischemia and lack of sensation in the lower abdominal skin. Moreover, even with adequate drainage, there still is a high rate of postoperative seroma.
W
e all know that the anterior abdominal wall is one of the body areas most affected by aging, body weight variations, non disciplined life style, adipose tissue anomalous accumulations, celiotomies and pregnancies. For decades, these dysmorphisms have led many men and women to pursue exercise, physiotherapy, sports, dietary regimens and all sorts of non invasive treatments to solve their physical problems, of which the anterior abdominal wall is one of the most important. And in face of the very limited and unsatisfactory results achieved, the best solution turned out to be cosmetic abdominoplasty.
Surgical correction of abdominal wall laxity, tissue redundancy, and increased lipodystrophy through an open abdominoplasty procedure has been an accepted practice since the mid-twentieth century. The procedure has been revised and updated countless times, whereas the principal belief of reduction of the redundant panniculus and correction of rectus fascia diastasis has remained.
When performing abdominal contouring procedures, it is necessary to understand the anatomy of the abdominal region and how it relates to the specific surgical operation being performed. The anatomy of the abdominal wall is both straightforward and elegant. A thorough knowledge of the vascular source, the innervation, the lymphatics, as well as the deep and superficial structures of the abdominal wall is important for performing abdominoplasty and abdominal contouring procedures. Most importantly, knowledge of the vascular supply to the abdominal soft tissue as well as the superficial soft-tissue structures, specifically Scarpa’s fascia, is critical to safely achieve an optimum aesthetic result.
Understanding the muscular and fascial components of the abdominal wall is important for myofascial plication and hernia repair. The sensory distribution is also important when considering incision placement for abdominal body contouring procedures.
The form of the abdomen is defined by the skeletal structure, as well as the quantity and distribution of fat, the appearance and condition of the skin, the tonus of the aponeurotic and muscular system, and the protrusion of the intra-abdominal organs. Each of these components constitutes an independent variable within the diagnosis of deformity of the abdominal wall, and will determine the type of treatment indicated for the patient. Abdominal alterations may be summarized as: cutaneous (redundancies, stretch marks, scars, flaccidity and retractions); accumulation of subcutaneous tissue (lipodystrophy); and those affecting the muscular-aponeurotic system (diastasis, hernia, eventration and convexity). The ultimate goal of surgery is to achieve an aesthetic contour, with acceptable scars, and the return of full function of the abdominal girdle.
Proper patient selection and education are paramount factors to ensure long-term success of the procedure. Selection of the ideal abdominoplasty procedure depends on the grade of excess skin and stretch marks, lipodystrophy, and musculoaponeurotic laxity. Patients opting for abdominoplasty must have realistic expectations and should be committed to implementing some healthy lifestyle changes that include eating, a well-balanced diet and exercising regularly. Several authors created useful classifications mostly on the basis of subcutaneous excess fat, skin deformity, and rectus diastasis secondary to pregnancy.
Many surgical techniques are currently available for abdominal contouring. Based on the individual characteristic of the patient’s anatomy and their goals, these abdominal contouring procedures include liposuction alone and different techniques of abdominoplasty procedures with or without liposuction.
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.
Despite advancements in abdominoplasty techniques, however, a significant complication rate still is associated with abdominoplasty including flap necrosis, seroma, hematoma, infections, and fat necrosis, wound dehiscence, and delayed healing. Because this procedure involves extensive undermining, denervation occurs, and the skin flap loses vascularity. The flap, with its reduced blood flow and innervations, then is stretched maximally and sutured under tension, which results in ischemia and lack of sensation in the lower abdominal skin. Moreover, even with adequate drainage, there still is a high rate of postoperative seroma.
Other data
| Title | CURRENT TRENDS IN ABDOMINOPLASTY | Other Titles | التقنيات المستخدمة في عمليات شد البطن الجراحي | Authors | Kerollis Samy Yousssef Narouz | Issue Date | 2015 |
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