Incidence of Haematoma in Post Bariatric Abdominoplasty Cases

Objective: This study aims at assessing the incidence of haematoma formation in abdominoplasty cases who had previous bariatric surgery and in those who did not have bariatric surgery before. Patients and Methods: This is a 4 years retrospective study involving patients who underwent abdominoplasty surgery between the period of July 2015 and June 2019. The incidence of haematoma formation was assessed in relation to history of previous bariatric surgery in these patients. Results: 164 patients met the inclusion criteria of the study;46 of them were males and 118 were females. The mean age of the patients included in the study was 38.6 (21 - 60 years). The mean BMI was 27 kg/m2 (21.4 - 34.7 Kg/m2). The mean hospital stay was 6.6 days (4 - 19 days). 107 patients had history of previous bariatric surgery performed and 57 had not. 21 patients developed haematoma (12.8%). 16 of the patients who had haematoma had previous bariatric surgery done (15% of post bariatric surgery cases) while 5 patients developed haematoma with no history of previous bariatric surgery (8.8%). Sixteen male patients out of the 46 male patients in the study developed postoperative haematoma (34.8% of the male patients) while only 5 of the 118 female patients developed postoperative haematoma (4.2% of the female patients) which shows a significant difference in haematoma formation when comparing males to females in general (p Conclusion: Our study shows that the incidence of post abdominoplasty haematoma formation is significantly higher in male patients who had bariatric surgery before when compared to those who had not (p < 0.05). The incidence was higher in males when compared to females (p < 0.001) indicating that males with previous history of bariatric surgery have the highest chance of developing haematoma formation. Combining liposuction of the lower flanks, plication of the recti muscles or both to the abdominoplasty procedure did not result significantly in an increased risk of haematoma formation.

Incidence of Haematoma Formation in Relation to Smoking in Abdominoplasty Cases

Objective: This study aims at assessing the relation between smoking and the incidence of haematoma formation in abdominoplasty surgery cases. Patients and Methods: This is a 4 years retrospective study involving the patients who underwent abdominoplasty surgery between the period of May 2015 and April 2019 in Zayed Military Hospital, Abu Dhabi, United Arab of Emirates. The incidence of haematoma formation was assessed in relation to tobacco use in these patients. Results: 164 patients met the inclusion criteria of the study. 35 patients were smokers (21.3%) and 129 patients were non-smokers (78.7%). The mean age was 38.4 (21 - 59 years). The mean BMI was 27 kg/m2 (21.4 - 34.7 kg/m2) and the mean hospital stay was 6.5 days (4 - 19). 23 patients in the study developed haematoma (14%). 11 of them had surgical evacuation of the haematoma (6.7%) while the rest were aspirated in the out-patient clinic. Out of the 23 patients who developed haematoma, 17 patients were smokers and 6 were non-smokers. The incidence of haematoma among smokers was 48.6% (17 out of 35 cases) while its incidence among nonsmokers was 4.7% (6 out of 129 cases) showing a clear relationship between smoking and hematoma formation (p Conclusion: Our study shows a direct relationship between smoking and haematoma formation in abdominoplasty cases. Cessation of smoking during the perioperative period is required before embarking on such a procedure.

Clinical Outcome of Abdominoplasty Cases—A Five-Year Retrospective Study

Aim: The aim of this study is to analyze the outcome of cases who underwent abdominoplasty surgery in our facility for the last five years. Patients and Methods: This is a retrospective study analyzing the outcome of patients who underwent abdominoplasty from the beginning of January 2015 till the end of December 2019 in Zayed Military Hospital, Abu Dhabi, United Arab of Emirates. Postoperative complications were recorded. The effects of risk factors including age, sex, smoking, body mass index, associated comorbidity, previous bariatric surgery and combined procedures were evaluated. Results: 213 patients were included in this five-year study. Majority of the patients were females 161 cases (75.6%) while males presented 52 cases (24.4%). The mean age was 38.3 years. The mean BMI was 27 Kg/m2. 127 patients had previous bariatric surgery (59.6%) while 86 patients had not (40.4%). There were no major systemic complications in the cases as deep venous thrombosis, pulmonary embolism or paralytic ileus. There was no mortality in the study cases. Out of the 213 cases included in the study, 23 patients developed haematoma (10.8%), 8 patients developed seroma formation (3.8%), 3 patients had wound infection (1.4%) and one patient had tissue necrosis (0.5%). The complication rate was higher in males 36.4% compared to females 9.9% (p < 0. 001). The patients who were 40 years old and above had less complications rate than those who were below 40 years 9.6% and 21% respectively (p < 0.005). The patients with BMI of 28 Kg/m2 or less had less complications 14.3% compared to those above that level 21.2% although it was not a significant difference (p = 0.231). 55.7% of the smokers had complications while the incidence among non smokers was 8.5% (p < 0.005). Those who underwent previous bariatric surgery had more complications 19.7% compared to those who had not undergone this surgery 11.6% but it was not statistically significant (p = 0.372). Those who had liposuction, plication of the recti muscles or both in combination with the abdominoplasty procedure had 8% complication rate compared to those who had not these combined procedures done 23.9% (p < 0.005). Associated comorbidity did not have statistical significance in the complication rate. Conclusion: Although abdominoplasty is a safe operative procedure, still it has its complications which are mostly haematoma, seroma, wound infection and tissue necrosis. The risk of developing these complications is higher among smokers and male patients. Although complication rate is higher among patients who have elevated BMI above 28 Kg/m2 and in those who underwent previous bariatric surgery, this was not statistically significant. Doing abdominoplasty for cases above the age of 40 years can be a safe procedure. Judicious liposuction and plication of the recti muscles do not carry higher risk of complications as well as associated comorbidity as long as it is well controlled along the perioperative period.

Umbilicoplasty: An Important Step in Abdominoplasty Surgery for Massive Weight Loss Cases

Aim: Excessive increase of weight followed by massive weight loss distorts the shape of the umbilicus as part of the affected skin of the abdomen. There is usually discrepancy between the elongated umbilicus at the time the patient was gaining excessive weight and the thinned abdominal wall after the massive weight loss. This study discusses a procedure that aims at restoring the shape of the umbilicus to its original shape as much as possible. Patients and Methods: In 4 years retrospective study from the 1st of March 2016 till the end of February 2020, the files of the patients who underwent abdominoplasty after massive weight loss with umbilicoplasty performed, as part of the procedure, were reviewed. In these patients the caudal part of the umbilicus at 6 o’clock site was excised in an oblique direction with slanting cut going to both 3 and 9 o’clock directions to shorten the elongated umbilicus keeping the cephalic part at 12 o’clock intact. This residual elongated cephalic part was utilized to make the shape of the hood of the umbilicus. A bolster suture was used at 12 o’clock to add a small depression above the hood. This technique gave the umbilicus the vertical “T” triangular shape with hooding. A questionnaire to assess patients’ satisfaction regarding the shape, depth, location, size, scarring and overall result of the umbilicoplasty procedure was conducted. The questionnaire used a five-point Likert-type scale as follows: 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). Results were collected and evaluated. Results: 197 patients underwent full abdominoplasty surgery during this 4 years study. Those who underwent umbilicoplasty during the abdominoplasty procedure were 34 patients. The results of the questionnaire could be obtained from 23 patients of them. Each patient gave a number from 1 - 5 for each aspect of the questionnaire of the umbilicus shape, depth, location, size, scarring and overall result. This resulted in total number of points of 115 for each aspect (23 patients × 5 points). The patients’ satisfaction with the shape of the umbilicus was 78.3% (90 out of the 115 points), 80.9% satisfaction rate with the depth (93 out of 115), 98.3% with the location (113 out of 115), 89.6% with the size (103 out of 115), 82.6% with the scar (95 out of 115) and 86.1% as an overall result (99 out of 115). Conclusion: Shortening of the elongated umbilicus at its caudal part with slanting incision directing to its cephalic part gives it the preferred vertical triangular “T” shape. Utilizing the length of the cephalic part in making the hood of the umbilicus and using a bolster suture to make a depression above the hood adds a shape near to the original natural one. The patients’ satisfaction ranged from “very good” to “excellent” according to the five-point Likert-type scale.

Three Reverse Adipofascial Cross Finger Flaps Used for Coverage of Raw Areas on Two Fingers of a Patient with Blast Injury of the Hand—Case Report

We report a case of blast injury to the left hand which resulted in fractures of the fingers with exposure of bones and joints of the phalanges. We used three reverse adipofascial cross finger flaps raised at the same time from 2 fingers to reconstruct adjacent fingers of the patient. The patient recovered well postoperatively and had good range of movement of the fingers. This avoided the complications of the use of regional or distal flaps. To our knowledge, this is the first case reported in which three reverse adipofascial cross fingers flaps are raised at the same time, two of them from an injured finger, to cover three raw areas on two fingers of a patient.