Defining the Sub-Scarpal Lipo-Aponeurotic System: Anatomical, Histopathological and Biomechanical Analysis

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Abstract Background As previously reported on the sub-scarpal lipo-aponeurotic system (SLAS), the authors describe their experience with bi-planar lipo-abdominoplasty. The SLAS was found to serve as an excellent flap for tightening the abdominal wall and improving the abdominal contour. Objectives The purpose of this study was to explore the anatomy of the SLAS, its biomechanical properties, and its microscopic composition using tissue analysis and morphometric quantification. Methods Cadaver dissections were performed on preserved cadavers in the faculty of medicine’s anatomic labs. Tissue samples were also obtained from abdominoplasty procedures conducted on living patients. These tissues then underwent mechanical analyses and pathological characterization. Results Average nominal stress-strain curves demonstrated that for each given strain measurement, SLAS samples exhibited significantly higher stress than the subcutaneous samples, at a statistically significant level (P < 0.001). Average collagen area percent per 100 microscopic field was found to be 12 ± 1.4 in the subcutaneous fields and 19.7 ± 2.4 in the corresponding SLAS fields (P-value = 0.013). Individual variation on information entropy in the tissue samples demonstrated a statistically significant increase in the SLAS sample when compared to the corresponding subcutaneous tissue, with an average of 1.59 ± 0.27 and 1.46 ± 0.25, respectively (P-value < 0.0001) Conclusions SLAS exhibited unique biomechanical, histopathological, and anatomical properties in our studies. The unique anatomical qualities of SLAS are important to consider in abdominal wall surgeries