Does the tumescent infiltration have an adverse effect on the full abdominoplasty flap?

Abstract

Aim. Abdominoplasty is one of the most common aesthetic surgical procedures, which restores abdominal contour and shape in patients who have significant abdominal deformations involving musculofacial laxicity and sagged abdominal wall. Besides its benefits, procedure has some complications such as seroma, hematoma, fat necrosis, wound dehiscense, skin necrosis and flap necrosis. All of which seems to be related either directly or indirectly with the blood perfusion of the abdominal flap. Methods. Presented here, is a patient who underwent full abdominoplasty with tumescent infiltration under conscious sedation after which a severe complication, flap necrosis developed in zone 1, suggesting that it was related with the full abdominoplasty technique combined with adrenaline. Results. In the follow-up examinations, wound care, antibiotic treatment, and debridment of the necrotic tissues under local anesthesia were performed during 6 months. Finally wound closed itself, leaving significant lower abdominal scar which needed a major revisional surgery. Conclusion. In full abdominoplasty procedure, when combined with tumescent anesthesia adrenaline content of the tumescent may compromise blood perfusion of the zone 1, so preventive procedures such as limited lateral dissection of the flap, protection of the some musculocutaneous perforators and short transverse incision, should be kept in mind to avoid ischemia of the flap.