Abstract

to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. according to the algorithm used, the most frequently chosen technique was "Technique IV" (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. "Technique I" (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, "Technique III", dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients' expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature.

Highlights

  • The abdominal wall presents an important aesthetic and functional aspect in the human anatomy, being affected by gestations, obesity, hernias and eventrations

  • The techniques of abdominal dermolipectomy preceded its application in Plastic Surgery, being previously used in General Surgery, in the treatment of great hernias

  • This algorithm was developed for the selection of the procedure among the following five surgical techniques: Technique I – Detachment and dermolipectomy of the lower abdomen with liposuction: known as “Miniabdominoplasty” or “Mini Tummy Tuck”, this procedure is limited to supra pubic dermal resection, with eventual plication of the infraumbilical fascia in the midline, associated with local lipectomy using the liposuction[10]

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Summary

Introduction

The abdominal wall presents an important aesthetic and functional aspect in the human anatomy, being affected by gestations, obesity, hernias and eventrations. The abdominal muscles and the sheath of the rectus abdominis muscle are of great importance in visceral restraint, in the dynamics to efforts and in postural aspects, influenced by aging, reduced local innervation and bariatric procedures[1]. The techniques of abdominal dermolipectomy preceded its application in Plastic Surgery, being previously used in General Surgery, in the treatment of great hernias. Dermolipectomies were performed mainly in obese patients, in order to facilitate the approach to umbilical hernias. With the development and diffusion of the technique, many authors have developed specific instruments to aid in abdominal dermolipectomies, such as the La Roe retractors, the Skoog forceps (1955), the Pitanguy marker clamp and many others[3,4]

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