The Use of the Scarpa Fascia as a Lifting Layer in Abdominoplasty Procedures

Abstract

Sir: Preservation of the Scarpa fascia in abdominoplasty flap elevation is not new.1 Its benefits have been described previously.2 Of importance is the minor lymphatic vessel harvest that should lead to minor seroma formation.3 However, empirical evidence regarding this is low. There is room for more prospective studies investigating the benefits of Scarpa fascia preservation in abdominoplasty flap elevation. At our department, we have been performing flap elevation on Scarpa fascia since 2008. The main reason why we preserve it is not concern regarding seroma. Our experience has shown the Scarpa fascia to be an excellent lifting layer in full abdominoplasty. It is part of the superficial fascial system of the trunk, and its function has been described by Lockwood.4 One can lift the superior aspect of the anterior thighs, the sagging skin of the mons pubis, and the lateral gluteal region when pulling the Scarpa fascia upward after abdominal flap resection. One important side effect is the decreased tension on the skin flap after skin wound closure. This technique was presented at the Annual Meeting of the German Society of Plastic Surgery in 2008 by D. Richter5 (Fig. 1).Fig. 1.: Intraoperative view showing the Scarpa fascia flap fixed to the rectus fascia with several sutures.At our department, 50 patients have been treated successfully with Scarpa fascia lifting during abdominoplasty since 2008. Beginning with preparation from the suprapubic incision, we leave the Scarpa fascia approximately 3 cm beneath the umbilicus and use the rectus fascia for further preparation. After tissue resection, the Scarpa fascia is suspended onto the rectus fascia with absorbable sutures. Starting centrally, two sutures suspend the area of the mons pubis, and two others are fixed more lateral in an inner outer direction. These are supposed to suspend the anterior thigh region. To shape the lateral thigh region, we lift the Scarpa fascia in the very lateral aspect of the incision. Pulling the Scarpa fascia flap with the forceps helps to find the proper tension and direction for the lift. This is of course a very individual maneuver, as the amount of sagging skin needing suspension is variable as well. In case of rectus diastasis, we excise the Scarpa fascia in the area of plication. In our opinion, patients with a low body mass index are better candidates for this procedure. These patients present with less subscarpal fatty tissue. If the Scarpa flap remains thick after abdominal flap resection, it could lead to a more bulgy abdominal contour. Patients with a low body mass index benefit most from the lifting effect, not only because of thinner subscarpal fat but also because of thinner subcutaneous tissue. Contouring of the superficial fascial system is more visible in these patients. Matthias Koller, M.D. Thomas Hintringer, M.D. Department of Plastic and Reconstructive Surgery Sisters of Mercy Hospital Linz Linz, Austria