Complications Of Abdominoplasty Research Articles

A Meta-Analysis of the Effects of Abdominoplasty Modifications on the Incidence of Postoperative Seroma.

Seroma is the most common complication of abdominoplasty. Certain modifications to abdominoplasty may reduce the risk of seroma. The authors evaluated the incidence of seroma for 3 abdominoplasty techniques: preservation of Scarpa's fascia, placement of progressive tension (or quilting) sutures, and application of fibrin glue. In this systematic review and meta-analysis, the Cochrane Library, MEDLINE, Embase, and the International Clinical Trials Registry Platform (World Health Organization) were searched to identify studies of patients who underwent abdominoplasty with seroma as a potential "outcome." RevMan 5.3 was utilized for data management, statistical analyses, and graph preparation. Fifteen studies (1824 total patients) met the criteria for inclusion in this review. The overall risk of bias was high, mainly owing to the nonrandomized nature of most studies. Abdominoplasty with preservation of Scarpa's fascia or placement of progressive tension sutures was associated with a significantly reduced incidence of seroma compared with that of standard abdominoplasty (P < 0.0001 and P < 0.0002, respectively). Abdominoplasty with application of fibrin glue was similar to standard abdominoplasty in terms of seroma development. Placement of progressive tension sutures or preservation of Scarpa's fascia during abdominoplasty may reduce the likelihood of postoperative seroma. Application of fibrin glue has no impact on seroma formation. 2.

A Personal Approach for Abdominoplasty

Abdominoplasty is a common cosmetic procedure. It addresses skin excess, excess fat, and muscular weakness. Complications of abdominoplasty may include hematoma, seroma, wound dehiscence, abscess, severe cellulitis, and venous thromboembolism. The aim was to perform abdominoplasty with minimal complications and accepted aesthetic results. Twenty-nine women aged between 38 and 59 years underwent full abdominoplasty with umbilical transposition at a single hospital from April 2012 to April 2015. Of the 29 patients, 26 cases showed acceptable results. The average amount of liposuction was 800 cc, the least amount was 400 cc, and the most was 1200 cc. The excised segment weighed between 900 and 2500 g. Umbilicus was viable in all cases. Three of the 29 patients showed partial flap necrosis and wound dehiscence. Complicated cases were treated conservatively. Hypertrophic scar was developed in 1 case. Two patients developed minor seroma that required a single aspiration in the office every week for 2 weeks. Abdominoplasty is a safe and an easy operation to execute by adopting some techniques in carefully selected patients.

Karın Germe Ameliyatı Kontrendikasyonlarının Gözden Geçirilmesi ve Komplike Olmuş Olgu Sunumu

Introduction: Abdominoplasty is the most popular surgical body contouring procedures. The seroma and the wound healing problems are the most common complications. In this study, we aimed to report complication of abdominoplasty followed abdominoplasty. Case Report: A 57 years old female patient appealed with infected abdominal wall wound and revealed diabetes mellitus, hypertension, cholesistectomia scar, and BMI was 37. The abdominal tissue defect was repairedby grafting after regression of enfectious signs. Conclusion: Despite of its popularity, the abdominoplasty is still associated with complications. Thus, we believe that the patient selection must be considered from the individually, as for to determinate the indication borders

Ligating Perforators in Abdominoplasty Reduces the Risk of Seroma

Seroma formation, a common complication of abdominoplasty, can cause patient discomfort and inconvenience. This study aimed to compare seroma rates after ligation and diathermy of large abdominal perforating vessels during abdominoplasty. Consecutive patients undergoing abdominoplasty with epigastric undermining between 2004 and 2011 were studied. Body mass index (BMI), age at operation, smoking history, preoperative weight loss, operative details, perioperative fluid infiltration, concomitant abdominal liposuction, ligation of perforators by clips, suture or diathermy, use of quilting sutures, weight of tissue removed, postoperative drainage, inpatient stay, and seroma rates were recorded. Statistical analysis was undertaken using the unpaired t test, Fisher's exact test, the Mann-Whitney U test, and Kendall's tau-b test. The study included 90 patients. The incidence of seroma was significantly lower among the patients who had perforators ligated (4/60, 6.7%) than among those who had diathermy (10/30, 33%) (p=0.002, Fisher's exact test). Seroma formation was significantly associated with a higher BMI, (27.45 vs. 25.16 kg/m2; p=0.025, t test) but not with preoperative weight loss. Postoperative fluid drainage did not differ significantly between ligated and diathermied perforators (p=0.716 Mann-Whitney U test). Use of ligation by clip or suture rather than by diathermy to ablate large abdominal perforators significantly reduced the incidence of seroma among abdominoplasty patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prospective Clinical Study of 551 Cases of Liposuction and Abdominoplasty Performed Individually and in Combination

Despite the popularity of these procedures, there are limited published prospective studies evaluating liposuction and abdominoplasty. Lipoabdominoplasty is a subject of recent attention. Several investigators have recommended alternative techniques that preserve the Scarpa fascia in an effort to reduce complications, particularly the risk of seromas. Over a 5-year period, 551 consecutive patients were treated with ultrasonic liposuction alone (n = 384), liposuction/abdominoplasty (n = 150), or abdominoplasty alone (n = 17). In lipoabdominoplasties, the abdomen and flanks were first treated with liposuction. A traditional flap dissection was used for all abdominoplasties. Scalpel dissection was used rather than electrodissection. A supine "jackknife" position was used in surgery to provide maximum hip flexion, allowing a secure deep fascial repair. The complication rate after liposuction was 4.2% vs 50% for patients treated with an abdominoplasty. Approximately half of the abdominoplasty complications were minor scar deformities, including widened umbilical scars (17.3%) that were revised. The seroma rate after abdominoplasties was 5.4%; there were no seromas after liposuction alone. Lipoabdominoplasty may be performed safely, so that patients may benefit from both modalities. The seroma rate is reduced by avoiding electrodissection, making Scarpa fascia preservation a moot point. A deep fascial repair keeps the abdominoplasty scar within the bikini line. Deep venous thrombosis and other complications may be minimized with precautions that do not include anticoagulation.

Acute Upper Gastrointestinal Tract Obstruction: A Complication of Abdominoplasty following Adjustable Gastric Banding

Abdominoplasty performed after bariatric surgery has become an integral part of the surgical treatment of morbidly obese patients. A 45-year-old woman underwent abdominoplasty 2 years after placement of a gastric band, following massive weight loss. Two days after the procedure, she developed signs and symptoms suggestive of acute abdomen. An abdominal X-ray showed dilation above the level of the stomach antrum and distal esophagus. CT scan revealed complete migration of the gastric band below the junction between the body and antrum of the stomach. Three hypotheses were formulated as potential explanations for the cause of malposition of the gastric band. We report a case of acute upper gastrointestinal tract obstruction following abdominoplasty secondary to gastric band malposition. This complication has only rarely been reported in the literature.

Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps

Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author's own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.

Tension Suture Technique Combined with Lidocain-Adrenalin-Saline-Infiltration Decreases Complications in Abdominoplasty

Due to growing interest into body contouring has abdominoplasty become one of the most common aesthetic operations. New techniques have appeared to reduce the relatively high incidence of complications in abdominplasty. One technique is the tension suture technique, which can be combined with lidocain-adrenalin-saline-infiltration. Our aim was to analyse the results of this combined technique. This retrospective study consisted of 95 women operated on in a private hospital by one senior plastic surgeon between years 2004 and 2009. Sixty patients had other operations in addition to abdominoplasty: 49 liposuctions, six breast reductions or mastopexies, three umbilical hernioplasties, one brachioplasty, one partial excision of labias, and one blepharoplasty. The operative time was 82 minutes ranging from 45 to 173 minutes. Peroperative bleeding was a mean of 196 ml in abdominoplasty only and 254 ml when combined with additional operation. Patients did not have any major complications and the total incidence of minor--not clinically significant--complications was 12.6%. Obesity, smoking, comorbidities, previous operations on belly area or additional operations did not affect the complication rates. Our study supports the view that the tension suture technique combined with lidocain-adrenalin-saline-infiltration decrease the formation of seroma and wound complications in abdominoplasty. Lidocain-adrenalin-saline-infiltration also fastens and eases the operation without increasing the risk of bleeding in experienced hands.

Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/postpregnancy

It is well known that the risk of complications after abdominal contouring surgery is high. Sparse data in published reports exist, suggesting that complication rates are higher in postbariatric patients compared with patients who have lost weight by dieting. The aim of this study was to analyse the incidence of complications after abdominoplasty in postbariatric patients compared with in patients who have not had weight loss surgery. The aim was also to identify predictive factors associated with the development of postoperative complications. This study retrospectively analysed 190 consecutive patients operated on with abdominoplasty due to abdominal tissue excess from January 2006 to December 2008 at Sahlgrenska University Hospital. Variables analysed were sex, age, max body mass index (BMI), delta BMI (max BMI minus preoperative BMI), preoperative BMI, method of weight reduction, resection weight, and complications. The early complication rates were significantly higher in postbariatric patients (48%) than in patients who had not had weight loss surgery (29%). Resection weight was significantly higher for patients with early local complications compared with patients without early local complications. Max BMI, delta BMI, or preoperative BMI had no influence on the incidence of complications. In conclusion, this study confirms in a fairly large sample that the complication rate after abdominoplasty seems to be higher in postbariatric patients compared with patients who have not had weight loss surgery. However, no predictive factors could be identified explaining these differences. Further studies need to be conducted to identify predictive factors for the occurrence of complications after abdominal contouring surgery.

Análise comparativa da evolução e das complicações pós-operatórias nas cirurgias plásticas do contorno corporal em pacientes idosos e jovens com perda ponderal maciça

INTRODUÇÃO: Os procedimentos aplicados a pacientes ex-obesos idosos após terapêuticas bariátricas estão em ascensão. Dados fidedignos quanto à evolução e às complicações nesse grupo populacional ainda são escassos na literatura. O objetivo do presente estudo é analisar a evolução e as complicações em abdominoplastias realizadas em pacientes com idade mais avançada após perda ponderal maciça, e compará-las às de pacientes mais jovens. MÉTODO: Foram analisados, retrospectivamente, pacientes com perda ponderal maciça submetidos a cirurgia para contorno da região abdominal, entre julho de 2005 e julho de 2011, no Hospital Estadual Sapopemba (HESAP). Como critério para divisão dos grupos, a fim de analisar o período pós-operatório e as complicações das abdominoplastias realizadas após perda ponderal maciça, foi estabelecida idade > 60 anos. RESULTADOS: Foram analisados 264 pacientes, 19 deles com idade entre 60 anos e 75 anos (grupo I) e 245 entre 22 anos e 59 anos (grupo J). O grupo I apresentou 10,5% de complicações maiores (P > 0,999) e 41,1% de complicações menores (P = 0,280), enquanto o grupo J obteve 10,6% de complicações maiores (P > 0,999) e 30,2% de complicações menores (P = 0,280). CONCLUSÕES: Os pacientes com > 60 anos de idade não apresentaram maior número de complicações que o grupo mais jovem.

Multiple Pseudocysts. A Potential Complication Following Progressive Tension Sutures.

Pseudocyst formation after abdominoplasty is a rare complication. The pathogenesis of these cysts is due to theencapsulation of the potential dead space resulting after undermining of the abdominal flap. The potential incidence of these cysts is likely to be enhanced if liposuction is performed together wit abdominoplasty. Lymphaticdraining system is overwhelmed with the overload of lymph, blood, fat, extravasated fluid and wetting solutionused as infiltrate. Two raw surfaces created as a direct result of undermining result in shearing and rubbing, theprocess further exacerbates extravasation of fluid. To reduce friction between two raw surfaces of abdominoplasty flap and anterior abdominal musculature, progressive tension sutures are used. These sutures compartmentalized and stabilized the raw surfaces. Progressively enlarging multiple pseudo cysts arising from these compartments following the use of progressive tension is described as a case report.Key Words: Seroma, Progressive tension sutures, Abdominoplasty complications, Pseudo cyst, Quilting, Liposuction.

Massive pulmonary thromboembolism after abdominoplasty and liposuction

Pulmonary embolism is a rare complication of abdominoplasty and liposuction that may result in a fatal consequence. A 65-year-old obese woman presented with complaints of shortness of breath, palpitation, and hypotension (90/60 mmHg) seven weeks after abdominoplasty and liposuction. The electrocardiogram showed sinus tachycardia, right axis deviation, and right bundle branch block. The chest X-ray showed atelectatic and focally infiltrated areas, and minimal bilateral pleural effusion. Laboratory findings were normal except for D-dimer level (3500 ng/ml). Echocardiography revealed dilated right heart chambers and a thrombus in the left ventricle. Ejection fraction was normal and pulmonary artery pressure was 50 mmHg. Doppler ultrasound showed no signs of thrombosis. Following the diagnosis of pulmonary thromboembolism, the patient received oxygen therapy and heparin infusion. However, the clinical course did not improve, hemodynamic deterioration continued, and the echocardiographic appearance of the thrombus persisted, so thrombolytic therapy with tissue plasminogen activator was administered, which also resulted in no response. In the end, pulmonary embolectomy was performed and the thrombus was successfully extracted. The patient had an uneventful postoperative course and was discharged on the seventh postoperative day.

Seroma em lipoabdominoplastia e abdominoplastia: estudo ultrassonográfico comparativo

INTRODUÇÃO: O seroma é uma das complicações mais frequentes nas abdominoplastias. OBJETIVO: Comparar a incidência de seroma em pacientes submetidos à abdominoplastia convencional e à lipoabdominoplastia. MÉTODO: Foram estudadas 41 pacientes, divididas em dois grupos: Grupo A (21 pacientes submetidas à abdominoplastia convencional e Grupo B (20 pacientes submetidas à lipoabdominoplastia). Para a investigação da formação de seroma foi realizado ultrassonografia de cinco regiões da parede abdominal (epigástrio (EPI), umbilical (UMB), hipogástrio (HIPO), fossa ilíaca direita (FID) e fossa ilíaca esquerda (FIE)) em dois momentos: entre o 11º e o 14º dia de pós-operatório (DPO) (P1) e entre o 18º e 21º DPO (P2). RESULTADOS: A incidência de seroma tanto em P1 quanto em P2 foi significativamente maior no grupo A que no grupo B. Observou-se que no grupo A, no P1, as regiões FID e FIE apresentaram maior incidência de coleções fluidas. No grupo B, houve uma maior incidência de coleções fluidas na região HIPO em P1 e nas regiões UMB e HIPO em P2. CONCLUSÃO: Houve menor incidência de seroma nos pacientes submetidos à lipoabdominoplastia em relação à abdominoplastia convencional nos momentos estudados.

Seroma in Lipoabdominoplasty and Abdominoplasty: A Comparative Study Using Ultrasound

Abdominoplasty is one of the most frequently performed cosmetic procedures, and its combination with liposuction has become more common. Seroma is one of the most common complications in abdominoplasty. The aim of this study was to compare the rate of seroma formation in patients who underwent either abdominoplasty with or without the use of quilting sutures or lipoabdominoplasty. Fifty-eight female patients were divided into three groups and underwent one of the following procedures: group A (n=21), abdominoplasty without quilting sutures; group B (n=17), abdominoplasty with quilting sutures; and group C (n=20), lipoabdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (epigastrium, umbilical, hypogastrium, right iliac fossa, and left iliac fossa) at two postoperative periods (P1, between postoperative days 11 and 14; and P2, between postoperative days 18 and 21). The rate of seroma formation at both P1 and P2 was significantly higher in group A. It was observed that in group A at P1, the regions of right iliac fossa and left iliac fossa developed larger fluid collections. In group B, there were no significant differences with respect to fluid collections among the five study regions at both P1 and P2. In group C, there were significantly larger fluid collections in the hypogastrium region at P1 and in the umbilical and hypogastrium regions at P2. Abdominoplasty with quilting sutures and lipoabdominoplasty are effective techniques for the prevention of seromas compared with abdominoplasty without quilting sutures.

A Rare Complication of Abdominoplasty After Bariatric Surgery

We describe an unusual case of small bowel obstruction as a result of an abdominoplasty performed after bariatric surgery. A 40-year-old man presented with signs and symptoms suggestive of small bowel obstruction, 4 years after he underwent a laparoscopic placement of an adjustable gastric band, and 2 years post abdominoplasty following successful weight loss. Investigations confirmed small bowel obstruction while a computed tomography revealed an odd position of the gastric tubing in the abdomen. At laparotomy it was found that the gastric band was in the correct position and still connected by the tubing to the port chamber. However, the port chamber had been moved distally in the anterior abdominal wall as a consequence of the abdominoplasty. As a result of port dislodgement, the tubing had eroded through the small bowel mesentery and created a volvulus leading to small bowel obstruction. During laparotomy the tubing was cut and removed, the band left in position. Postoperative course was uneventful.This case emphasizes the importance of ensuring that the position of the port in the subcutaneous layer of the anterior abdominal wall is maintained while performing an abdominoplasty.

Risk Factors for Wound Complications Following Abdominoplasty

Problem Statement: Abdominoplasty has become an increasingly popular procedure. Risk factors affecting wound complications of abdominoplasty are not adequately defined in literature. Identification of these risk factors is crucial for better patient’s selection and counseling. The objectives of this study were to determine wound complication rate following abdominoplasty and to examine the relationship of a set of possible risk factors with the incidence of complications. Approach: We studied 116 patients (107 women and 9 men) who underwent abdominoplasty at Jordan University Hospital, between June 1997 and June 2007. Data were collected from patients’ medical records and analyzed to determine types and rates of surgical wound complications. Fourteen possible risk factors were investigated using logistic regression analysis to evaluate their relationship with the occurrence of wound complications. Risk factors examined were: age, sex, body mass index, parity number, smoking history, history of diabetes mellitus, previous gastroplasty for morbid obesity, previous abdominal surgical scars, type of abdominoplasty, plication of recti, hernia repair, operative time and operative blood loss. Results: A total of 29 patients (two males and 27 females) (25%) had wound complications. The most common complication was seroma. It was encountered in 15 cases (12.9%). Six patients (5.2%) had wound infection. Partial skin necrosis was encountered in four cases (3.4 %). Two patients (1.7%) developed wound dehiscence and two patients (1.7%) had hematoma. The only factors significantly increased the complication rate were: increased body mass index (p = 0.002) and history of smoking (p = 0.004). Conclusions and Recommendations: This study confirms the adverse effect of overweight and cigarette smoking on the incidence of wound complication rate following abdominoplasty. We recommend that overweight patients and smokers undergoing abdominoplasty should be adequately counseled and informed about the increased risks. In addition, prophylactic measures should be properly taken to decrease wound complication rate in these groups of patients.

Complications in abdominoplasty: A risk factor analysis

Abdominoplasty is one of the most popular body-contouring procedures. However, it is associated with a significant number of complications, the most common being seroma and wound-healing problems. In this study, we analysed postoperative complications following abdominoplasty and evaluated the presence of statistically significant correlations between pre-existing risk factors and postoperative complications. We carried out a retrospective chart review of all patients who underwent abdominoplasty from June 1994 to April 2004 at our institution. Patient demographics, risk factors (smoking, previous abdominal surgery, obesity, and male gender) and complications (minor and major) were noted from the patient's medical record. In all, 139 patients were included in the study (126 female and 13 male), with a mean age of 42.8 years at the time of surgery. Minor and major complications were seen in 40 (28.8%) and 16 patients (11.5%), respectively. Smoking and previous abdominal surgery were not associated with a significantly increased complication rate. However, patients without previous surgery displayed a significantly increased complication rate (43.2% vs. 22.1% for minor and 25% vs. 5.3% for major complications; p<0.05). Obesity (BMI >30 kg/m(2)) was associated with a significant increase in major complications (20.8% vs. 9.7%; p<0.05). Male gender was predisposed to increased minor and major complications; however, this was not statistically significant. Despite its popularity, abdominoplasty is still associated with a significant rate of complications. In particular, obese patients and those with no previous history of abdominal surgery seem to be at risk for complications. The role of male gender needs to be evaluated further.

Epidermal Inclusion Cyst of the Umbilicus Following Abdominoplasty

The incidence of retained epidermal inclusion cyst at the site of the umbilicus following abdominoplasty has yet to be well documented. Compliant patients who are seen in scheduled follow-up, and who display signs of infection or wound issues at the site of the umbilicus, usually have these factors addressed before inclusion cysts manifest. Here, however, we present a patient who underwent abdominoplasty, lost her surgeon because of geographic relocation, presented to our office 1 year following surgery with a large retained umbilical epidermal inclusion cyst. This case gave us a unique opportunity to observe a well-developed retained umbilical epidermal inclusion cyst. Her evaluation and management are reviewed in an effort to familiarize the practicing plastic surgeon with a rare, but significant potential complication of abdominoplasty.

Do Progressive Tension Sutures Really Decrease Complications in Abdominoplasty?

Do Progressive Tension Sutures Really Decrease Complications in Abdominoplasty?

Abdominoplasty Complications: A Comprehensive Approach for the Treatment of Chronic Seroma with Pseudobursa

Abdominoplasty is an extensive surgical operation, often followed by a significant number of local and general complications. Some studies indicate that the risk of severe complications, including mortality, ranges from 1 in 617 to 1 in 2,320 cases. Seroma is one of the serious consequences that follows each type of abdominal contour surgery, from suction-assisted lipoplasty to standard and limited abdominoplasty. A case of a 46-year-old women who underwent standard abdominoplasty and liposuction during the same procedure is presented. In the follow-up examination, a chronic seroma with pseudobursa was observed. The pseudobursa was evacuated multiple times under ultrasound control. During one evacuation, 2,010 ml of seroma was evacuated. Because of the prolonged Seroma formation, the pseudobursa grew, creating a tumor-like effect in the front abdominal wall. In a second operation (miniabdominoplasty), the pseudobursa was completely excised, and the material was sent for analysis. Progressive tension sutures were placed in additional lines to decrease the dead space, and to decrease movement between the abdominal flap and the musculoaponeurotic layer, as suggested by Saltz and Matarasso. Suction drainage with a compressive girdle was maintained for 2 weeks after the second operation. The follow-up assessment, performed 3 months after the second operation, showed no infection, skin necrosis, hernia formation, or new chronic seroma with pseudobursa.