Two-Year Experience with the Avelar Abdominoplasty

Abstract

Objective: To evaluate our 2-year experience with a modified Avelar abdominoplasty in an outpatient office surgery center setting and to compare our complication rate with other studies reported in the literature. Methods: A retrospective review of the medical charts of 80 patients who underwent a modified Avelar abdominoplasty between June 2005 and June 2007. Seventy-seven patients underwent full abdominoplasties and 3 patients had mini abdominoplasties. Patients included 79 women and 1 man. Their ages ranged from 24 to 76 years. Mean age was 44 years. Of the patients, 47 (59%) had tumescent local anesthesia with conscious sedation. The remaining 33 (41%) patients had tumescent infiltration with general anesthesia. Surgical Technique: The technique presented modifies the Avelar technique by using tumescent anesthesia infiltration and conscious sedation, the Mangubat disruptor, less aggressive liposuction in the lower abdomen, subcutaneous excision of the lower flap down to the fascia in larger patients, a different technique for umbilical transposition, and platelet-rich plasma is sprayed in the flap closure and on the incision to promote healing. With liposuction to help mobilize the skin, the upper flap undermining can be limited to the midline, and blood vessels in the area can be preserved. Results: Most patients were happy with their results, and they especially liked the body sculpting with additional liposuction of their flanks. In the 80 patients who underwent the modified Avelar abdominoplasty, there were 3 cases of skin necrosis (3.7% incidence), 10 seromas (12.5 % incidence), 1 episode of aspiration of gastric contents, and 1 episode of postoperative urinary retention requiring Foley catheter placement for 2 days. There were no cases of significant blood loss and no incidence of deep vein thrombosis. Most patients had significantly less pain than occurred with traditional abdominoplasty and most returned to work in 10 to 14 days. Discussion: The Avelar abdominoplasty is touted as a safe procedure with fewer complications than the traditional abdominoplasty because the perforator vessels, nerves, and lymphatics are not damaged during the operation. The few published studies using only the Avelar technique or a modification of it have demonstrated a low complication rate. The seroma rate found in this study of 12.5% falls within the reported rates of 0 to 32%. Skin necrosis is caused by profound devascularization in the area between the umbilicus and the horizontal scar. Even with sparing of the superior axial vasculature, this area is susceptible to skin necrosis. In the current study 3 patients developed skin necrosis in this area. One patient was a heavy smoker. The second patient was exposed to significant secondhand smoke; and the third patient was obese and had chronic hypertension. All patients had limited dissection in the midline. Conclusion: In the current study, where modifications of the Avelar technique was used, the complication rate was in the low range compared with the complication rates reported in the literature.