Commentary on: Zones of Adhesion of the Abdomen: Implications for Abdominoplasty.

Abstract

The author of “Zones of Adhesion of the Abdomen: Implications for Abdominoplasty” has used an innovative method to evaluate skin mobility of the anterior and posterior abdomen in patients and cadavers.1 Skin mobility, according to the author, will depend on many factors, such as skin elasticity, subcutaneous tissue thickness, and deep tissue attachment. Although innovative, this method used to evaluate skin mobilization in patients could be improved. The author has used hand traction exerted over the skin to evaluate skin mobility. To use a dynamometer2 attached to a skin staple enables the examiner to obtain similar traction to mobilize each site, which could decrease possible measurement errors. The dynamometer could be tractioned in each direction, and a similar round figure could then be created. Another weak point of the method is the use of headless frozen cadavers. Although the author mentioned that he used fresh cadavers, it is at some point described that the cadavers were frozen. With frozen cadavers, skin mobility is limited, especially considering that only two subjects were used. The use of fresh cadavers would be better; however, even in this case, tissues are not as mobile as they are in live human beings. The idea of moving the abdominal skin is of interest for plastic surgeons. With knowledge of the less mobile areas, selective undermining of these areas could be performed, with more skin advancement and consequently less undermining. A good balance of undermining and traction is paramount to avoid ischemic complications. In the more recently described techniques, such as lipoabdominoplasty, undermining is limited and any localized undermining that could lead to more extensive skin advancement is important. It is also interesting to see how massive weight loss patients present …