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.

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.

防己黄芪汤应用于腹壁整形术后效果观察

目的:评估防己黄芪汤应用于腹壁整形术后早期对皮瓣充血消退、减少早期并发症的作用。方法:选取2019年1月-2022年3月就诊于笔者医院需要进行腹壁整形的就医者37例,随机分为实验组和对照组,根据就医者腹壁松弛程度选择对应术式。实验组术后服用防己黄芪汤28 d,对照组术后予以口服等量无任何药理作用的安慰剂。比较两组术前术后腹部轮廓评分、炎性指标变化及并发症发生情况。结果:与实验组相比,实验组就医者术后2个月及术后6个月腹部轮廓评分明显高于对照组(P<0.05)。术后两组并发症发生率比较差异无统计学意义。术后早期实验组中就医者血管内皮生长因子(Vascular endothelial growth factor,VEGF)、肿瘤坏死因子α(TNF-α)水平明显低于对照组(P<0.05),提示防己黄芪汤可以减轻就医者炎性反应水平,从而提高术后早期恢复效果。结论:防己黄芪汤具有益气祛风、健脾利水的作用,在手术初期尽早进行干预可减轻术后就医者炎性反应,改善术区血瘀水肿的状态,提高术后整体效果。

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.

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.

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.

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.

射频辅助腰腹部吸脂联合下腹壁整形术临床效果分析

目的探索运用射频辅助腰腹部吸脂联合下腹壁整形术的效果和适应证。方法回顾性分析自2019年11月至2022年9月,共25例患者施行该术式。吸脂范围包括后腰部、下腹部、侧腰部、上腹季肋区,然后对侧腰部及上腹季肋区进行射频紧肤治疗。最后对下腹部松弛皮肤进行部分切除,同时可收紧腹直肌前鞘及腹外斜肌腱膜。结果共治疗25例,25例均Ⅰ期愈合,2例局部下腹部积液,经1-3次抽吸后加压治愈;无皮瓣坏死发生。随访3~12个月,患者腹壁平坦,瘢痕增生不明显,外形满意。结论射频辅助腰腹部吸脂联合下腹壁整形术是一种有效、安全的体型雕塑方法。不改位肚脐位置,缩小手术范围,对轻度下腹壁松弛患者特别适用。

腹部浅层吸脂术21例

目的 :探讨浅层吸脂技术对腹壁多脂皮肤松垂症的治疗效果。 方法 :在肿胀麻醉下 ,应用深层加浅层吸脂技术治疗 2 1例。 结果 :术后腹围减小 4cm～ 15 cm,皮肤回缩好。 结论 :浅层吸脂技术对腹壁多脂松垂者有明显疗效 ,较腹壁成形术 ,手术简化。

减重手术后的形体雕塑

超重和肥胖逐渐成为全球性问题,减重手术可以改善肥胖带来的生活质量降低和心理压力增加,是一个有效且安全的选择,减重手术后所产生的皮肤冗余问题则需要形体雕塑来解决,本文将就其适应证、重要性和术后并发症做一综述。

双侧臂延长的“W”切口在腹部去脂术中应用

目的:探讨本术式在腹部去脂中的临床效果,分析其适应证及优缺点。方法:“W”切口双侧延长至后上方,与腋中线重叠。腹部皮瓣的剥离在电刀下进行。处理腹部皮瓣过多脂肪时,保留2.0cm正常皮下脂肪。向下拉动腹部皮瓣,切除多余皮肤。在腹部侧方切除多余皮肤脂肪时,应兼顾到臀部及腰部曲线成形。结果:自2000年共治疗12例,手术效果良好,腹部形态改善明显,受术者满意。结论:双侧臂延长的“W”切口对某些人,不失为一种可取的腹部整形手术方法。

内窥镜腹壁整形术

目的:探讨并介绍内窥镜腹壁整形方法。方法:经阴毛上缘和/或脐孔小切口,在内窥镜监视下,分离腹肌筋膜表面,收紧腹直肌前鞘,同时根据需要完成脐成形及切除多余皮肤。结果:完成内窥镜腹壁整形5例,获得良好效果。结论:在掌握手术适应症前提下,内窥镜腹壁整形不仅能获得良好的预期效果,而且较传统手术能明显缩短手术瘢痕,适应于没有或有少量多余皮肤,皮肤弹性质地好,有少量或中等脂肪堆积,伴或不伴有腹肌松弛以及鞘分离的患者。

腹壁子宫内膜异位大病灶切除后的创面修复

目的探讨腹壁子宫内膜异位大病灶切除后创面修复方法。方法应用腹壁成形术、V-Y皮瓣推进术修复我院2003年3月～2004年12月收治的6例腹壁子宫内膜异位大病灶患者切除后的创面。结果腹壁子宫内膜异位大病灶均切除彻底,切除后未见复发,腹壁伤口Ⅰ期愈合,美观,无并发症。结论腹壁成形术及V-Y皮瓣推进术可以为腹壁子宫内膜异位大病灶切除后提供良好的创面修复方法。

减重手术后的整形治疗

减重手术是病理性肥胖治疗的重要手段之一,已被越来越多的肥胖症患者接受,然而手术后继发的皮肤过剩及肌肉软组织松弛同样给患者带来很大困扰,严重影响其生活质量,减重手术后的整形治疗可提高患者对减重手术的满意度和自信心。

内窥镜技术在整形美容外科的应用及展望

内窥镜技术自九十年代应用于整形美容外科领域以来,由于其创伤小、恢复快、可视性好等优点,已广泛应用于整形外科的各类手术,开启了微创整形美容领域的新时代,推动了整形美容外科的发展。本文通过对内窥镜发展历史,内窥镜基本构成,内窥镜技术在乳房整形、腹壁整形、面部整形领域的应用,及内窥镜在整形美容外科领域的前景及展望四部分对内窥镜在整形美容领域的历史及应用前景进行详细的介绍。