Kinematic Analysis of Patients before and after Abdominoplasty

Background: Abdominoplasty has consistently been one of the top cosmetic procedures performed each year with a high patient satisfaction rate. Excision of the excess abdominal skin has been shown to reduce low back pain and improve posture. The effects of the excess skin removal would, theoretically, be demonstrated through changes in gait. This study aimed to measure kinematic differences during gait to obtain objective measures for abdominoplasty. Methods: Subjects were recruited from a large, academic plastic surgery clinic. Patients were included if they were 18 years of age, able to walk without an assistive device or any hindrance by any existing medical condition, and were scheduled for abdominoplasty. Kinematic measurements were taken before and after surgery using a plug-in-gait marker set, cameras, and a treadmill. Pre- and postoperative measurements were compared and a post-hoc power analysis was created. Results: Nine total patients were included in the study. Joint angles before and after surgery demonstrated moderate differences. However, analysis revealed few significant differences for spatiotemporal or kinematic variables. The power analysis demonstrated an inadequate number of patients to detect significance. Conclusions: Despite the literature describing subjective and objective improvements following abdominoplasty, we were unable to validate this. Overall, there were noticeable differences in joint angles pre- and postoperatively, though the study is too underpowered to reach statistical significance. This preliminary data shows that if the study was powered through a larger cohort, then more generalizable conclusions could be drawn.

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.

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.

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.

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.

URLD (Ultrarapid Limited Dissection Abdominoplasty) Is Safe with Caesarean Section

Abdominoplasty is not advisable with caesarean section because of high incidence of complications. We have changed the technique of proper abdominoplasty to ultrarapid limited dissection abdominoplasty in 25 women undergoing caesarean section successfully and found that there was no incidence of any complication usually described with proper abdominoplasty,?and?we?recommend that limited dissection abdominoplasty can be combined with caesarean section.

Effect of Rectus Plication during Abdominoplasty on the Mechanical Power and Airway Pressures: Comparison of Two Ventilatory Strategies

Background: Abdominoplasty is a commonly requested procedure for aesthetic improvement of the affected soft tissue layers of skin, fat, and muscle through the slightest incision feasible. The degree of plicature generates an increase in intraabdominal pressure that causes an increase in intrathoracic pressure. Pressure, volume, flow, and respiratory rate are components of a unique physical variable, the mechanical power (MP), and is an integrated variable linked to most factors related to postoperative pulmonary complications. Purpose: To assess the effect of rectus plication (RP) during abdominoplasty on lung pressures and the contribution to increasing the MP. Method: A open-label study was conducted at TJ Plast Advanced Center for Plastic Surgery in Tijuana, México, from September 2021 to May 2022. The study included forty-six female patients subjected to abdominoplasty or liposuction with abdominoplasty. After the induction of general anesthesia and neuromuscular blockade, they were allocated into two groups: Group 1 pressure control ventilation-volume guaranteed (PCV-VG) and Group 2 volume control ventilation (VCV). Respiratory pressures and MP were assessed before and after RP. Results: During VCV, patients had a greater increase in peak pressure (PIP) (P 0.000). Plateau pressure (Pplat) increased 1.78 ± 0.35 cmH2O in group 2 after RP (P = 0.001). MP had a greater increase in group 2 after RP (P 0.01). Conclusion: This prospective study showed that RP is related to an increase in PIP and Pplat and an increase in the MP better controlled with PCV-VG ventilation.

Major and minor risk factors for postoperative abdominoplasty complications:A case series

Background: Although abdominoplasty is a safe and popular surgery, it is associated with a higher complication rate than other body contouring procedures. Therefore, identifying predictive factors of major and minor complications in patients who have undergone abdominoplasty is necessary to achieve better treatment outcomes after major weight loss.Methods: This retrospective study analyzed the medical records of patients who underwent abdominoplasty between January 2016 and December 2019. The inclusion criteria were patients aged >18 years who underwent abdominoplasty as the only surgical procedure and had adequate follow-up. Other patients were excluded from the study. Statistical evaluation was performed using SPSS 20.0;statistical significance was set at a P-value of<0.05.Results: The study included a total of 152 patients, of whom 146(96.1%) were women and 6(3.9%) were men.The mean patient age was 41.1 ± 9.8 years. Comorbidities were reported in 67 patients(44.07%). A direct proportional relationship was observed between the weight of the resected tissue and occurrence of general complications(P=0.01), and the presence of comorbidities increased the occurrence of minor(P=0.04) and major complications(P=0.01).Conclusion: Abdominoplasty is an aesthetic surgical plastic procedure, and its application has increased over the years. Despite its popularity, patient safety requires further attention due to the high risk of complications. It is essential to study all risk factors.

A Comparison between Supra-Scarpa’s Fascia Abdominoplasty and Traditional Abdominoplasty: Effect of Caesarian Section

Background: Abdominoplasty is still among the most popular surgeries in the world of cosmetic surgery, as many modifications have been implemented on this surgery to improve aesthetics and reduce the ratio of complication, especially seroma. Also, the duration to drain removal increases the risk of infection, and this can be avoided by preserving the Scarpa’s fascia. Methods: The study was performed from January 2018 to December 2020. The patients were divided into two groups: group A with patients who were performed in Supra-Scarpa’s fascia abdominoplasty, and group B who were performed in traditional abdominoplasty;then group A was divided into two subgroups (A1 with caesarean history and A2 with no caesarean history) that differ in caesarean history or not, while a comparison was done between the groups regarding early outcomes. Results: A total of 40 full abdominoplasties were preformed (group A, 19 patients;group B, 21 patients);then group A was divided into two subgroups (group A1, 13 patients;A2, 6 patients);we found that the time until drain removal and its drain output in group A is less with a statistical significance, and the seroma was less to happen in group A with no statistical significance. However, the operative time in group A is higher with statistical significance. In the subgroups A1 and A2, there was no statistically significant difference in the results. Conclusion: Preservation of the Scarpa’s fascia reduces the time until drain removal, total drain output and the occurrence of seroma and the caesarean scar doesn’t affect the efficacy of preserving the Scarpa’s fascia.

Abdominoplasty for Patients Who Underwent Surgical Weight Loss:Differences between the Asian and Western Populations and the Associated Controversies

Abdominal contour deformities pose an aesthetic challenge to patients with massive weight loss.This article reviews the similarities and differences in obesity between the Asian and Western populations.A comprehensive classification system combining the objective description of structural deformities with patients’discomfort or physical function is required to classify the abdominal contour deformities.The authors also proposed several controversial issues,including the classification of abdominal deformities,surgical techniques,and complications,providing an evidence-based review for selecting the appropriate surgical method for Asian patients to achieve satisfying clinical outcomes and avoid complications.

Body Contour in the Post-Bariatric Male Patient

Background: Obesity is currently considered a public health problem. Bariatric procedures have become an important part of obesity management and, consequently, the number of male patients seeking post-bariatric reconstructive procedures have increased. Therefore, the clinical approach and understanding of the body contour of this population have become more relevant. The goal of post-bariatric reconstruction is to enhance the male silhouette through removal of skin and adipose tissue excess, and abdominal rectus diastasis repair. Material and Methods: We conducted a retrospective study at the Plastic and Reconstructive Surgery Department of the National Medical Center “20 de Noviembre”. All male patients referred to our department to start a post-bariatric reconstruction protocol from January 2018 to December 2022 were included in this study. Results: In total, 15 patients who underwent corporal contouring procedures were included;median age was 49.2 years with minimum of 33 years, and a maximum of 57 years. Median Body mass index was 28.4 kg/m2 with minimum of 22 kg/m2 and maximum of 38 kg/m2. All patients were treated 18 months after their bariatric surgery. All patients underwent an abdominoplasty as a body contouring procedure. 4 (26.7%) patients presented complications related to the surgery. Conclusion: We described a comprehensive and systematic approach to massive weight loss for male patients, suggesting an abdominal marking based on the patient’s clinical features and the expected results avoiding feminization of the abdominal body contour.

Comment to “Correction of Contour Deformity Using Reverse Abdominoplasty Combined with Mini-Abdominoplasty”

It was a great pleasure to have the opportunity to read the article with title "Correction of Contour Deformity Using Reverse Abdominoplasty Combined with Mini-Abdomi-noplasty"reported by Yang et al[1].

Abdominoplasty with simultaneous liposuction

Abdominoplasty procedures have dramatically increased over the past decade or more.The American Society for Aesthetic Plastic Surgery(ASAPS)Cosmetic Surgery National Data Bank reported in 2005 an increase of 344%[1].Saldanha introduced Lipoabdominoplasty in the early 2000[2].Over the past two decades,Abdominoplasty,a common procedure performed by plastic surgeons worldwide has undergone progressive gradual changes with the inclusion of liposuction contouring of the trunk.The author discusses his experience and technical preferences in the performance and management of complete/full abdominoplasty patients,including the floating umbilicus technique,with simultaneous liposuction obtained over the past 40 years in private practice.

The experience performing extended abdominoplasty in massive weight loss patients

Aim: The post-bariatric patients who undergo torsoplasty often incur postoperative complications that dilate their recovery time. The authors propose the technique of extended abdominoplasty, described in 2012 for aesthetic torso remodeling, in post-bariatric patients in order to reduce complications and hospitalization time. Methods: The authors performed 21 extended abdominoplasties and compared them with 21 torsoplasties in post-bariatric patients during a 1-year period. Data studied was age, gender, duration of the procedure, blood loss, complications and hospitalization duration. Results: Peri and postoperative bleeding led to 3 cases of anemia necessitating blood transfusions in 14.3% of the second group;no blood transfusion was needed in the first group. No other major complications occurred during the postoperative period in both groups. Conclusion: The authors believe that extended abdominoplasty is a viable alternative to the torsoplasty in selected patients presenting a severe adipocutaneous circumferential laxity, as occurs in post-bariatric patients with a significant weight loss.

A Proposed Mesh Placement for Repair of Ventral Hernia and Contouring of the Abdomen

Introduction: Abdominal wall defects and muscle redundancy in the form of protruded abdomen still represent a challenging problem. The aim of this article is to reconstruct the abdominal wall and regain the abdominal contour through the application of biosynthetic meshes in certain fashion. Patients and Methods: this is a prospective study done 25 patients with long standing ventral hernia and lax abdominal muscle wall. All patients were performed at Zagazig university hospitals in the period between September 2011 and November 2013. Polypropylene mesh is used for every patient after anatomical hernia repair for hernioplasty and then shaping like outstretched hand (fingers processes). The aim is to reinforce the abdominal wall and reshape the abdomen. Results: regarding to the aesthetic aspect and success rate of the abdominal wall reconstruction, we have a good satisfactory results without recurrence in a period of 2 years follow up. Three patients are suffered from wound infection and partial edge ischemia in two patients. Bleeding and delayed wound healing in ten patients and persistent seroma are occurred in fife patients. Conclusion: It is safe with a good patient satisfaction to combine ventral hernia repair and abdominoplasty in cases with excess skin and musculofascial laxity of the abdominal wall (pendulous abdomen) with application of this finger processes mesh, after following the proper technique and precautions.

Effects of Cryofrequence on Localized Adiposity: Case Study

Cryofrequence is the combination of cryotherapy with radiofrequency, which promotes a “thermal shock” to the tissue, working simultaneously to skin flaccidity and localized adiposity. The efficacy of dermatological and hypodermic cryofrequency treatment was evaluated. This study reports the case of a 45-year-old woman with complaints of flaccidity and fat located in the infra-umbilical region in the preoperative period of abdominoplasty. The evaluation was performed before and after treatment through evaluation protocols, ultrasound examinations and histological findings through optic microscopy, microfocal and immunohistochemical analysis. The treatment was performed in 4 sessions, with a weekly application, using the BHS 156 FULL&reg;—BODY HEALTH BRASIL&reg;apparatus, the parameters were temperature of -10&deg;C, power in 70%, duration of 8 minutes. After the surgical procedure, parts of treated and untreated abdominal tissues were removed for evaluation. In the tests performed, significant destruction of adipocytes was detected, with consequent reduction of fat and greater expression of caspase-3 in the treated tissue, being constated the macrophage increase by CD68 expression. There was improvement in flaccidity, evidenced by the significant increase in the number of fibroblasts and inflammatory cells positive for Ki67, bringing more quantity and better quality to the collagen.

Resection and repair of large abdominal wall lesions in gynecologic patients

Background The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology. We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients. Methods Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010. Results All patients had a history of cesarean section. One patient had an infected sinus tract after cesarean section, one patient had an inflammatory nodule, and the others had lesions of endometriosis, including one cancer. The average largest lesion diameter was （4.79 ± 4.18） cm according to the ultrasonography results. The lesions of all patients were completely resected with pretty abdominal contour. A polypropylene biological mesh was added to the fascia in 20 patients. One patient underwent groin flap repair, and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension. Conclusions Multi-department cooperation involving the gynecology and plastic surgery departments, and even the general surgery department, is essential for patients with large lesions in the abdominal wall. This cooperative effort enabled surgeons to completely resect large lesions. Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall.

Surgical circumferential contouring:lower body,upper body,and in-between

Deformities in the body contouring population are rarely isolated to one area,and procedures can be combined to achieve more substantial results.While there is no formula for optimal surgical sequencing and timing,there are certain principles which-when applied appropriately-can yield results that are reliable,aesthetically pleasing,and aligned with the patient’s desires and preferences.In this article,we outline our latest thinking in circumferential body contouring and how to integrate the lower body lift with procedures of the abdomen,upper body,breasts,back,and arms to achieve the complete 360°look.