One Hundred Consecutive Lipoabdominoplasty Procedures: Modified Avelar Technique for Full Abdominoplasty without Panniculus Undermining—Advances, Morbidity, and Complications

Abstract

Introduction: Abdominoplasty can be limited by preexisting scars and is associated with postoperative drains, seromas, and deep vein thrombosis (DVT). The Avelar technique has been described as an alternative to extensive flap dissection. We adopted this technique in 2007. Materials and Methods: The lower abdomen is marked for planned resection. Liposuction is performed throughout the entire abdomen below Scarpa's fascia and superficially in the lower abdomen to thin the redundant pannus. The skin is sharply incised, and the thinned pannus is bluntly avulsed, leaving the subcutaneous fat and vessels intact. The upper abdominal skin can be slid over the deep fascia, preserving the perforating vessels. A narrow tunnel is dissected from the umbilicus to the xiphoid for rectus plication. The umbilicus is transposed in the usual manner. All patients receive DVT prophylaxis with perioperative heparin, sequential compression devices, and Lovenox. Surgery is ambulatory, and drains are not routinely used. Results: Between April 2007 and December 2010, 100 consecutive lipoabdominoplasty procedures were performed. There were no DVTs and no deaths. One patient sustained small-bowel injury during liposuction, which was immediately recognized and successfully repaired. Five hematomas (28 ± 28 mL) occurred within the early postoperative period, 2 of which became infected. Four hematomas responded to local drainage, but 1 required surgical evacuation 3 months later. The incidence of late seroma was 0%. Two marginal skin necroses occurred in patients with preexisting Kocher and laparotomy scars, which healed without ill effect. Conclusions: The incidence of wound dehiscence, seroma, hematoma, and DVT after lipoabdominoplasty is less than that reported for traditional abdominoplasty.