Lipoabdominoplasty: Revisiting the Superior Pull-Down Abdominal Flap and New Approaches

Abstract

Abdominoplasty is a very common procedure, especially for patients with abdominal laxness, striaes, and muscle rectus diastases. With the advent of liposuction 28 years ago, we can improve body contouring by treating lipodystrophies in the epigastric, flank, trochanteric, and buttocks areas. With the patient in a sitting position, we estimate the amount of skin to be resected and outline the extension of the inferior suprapubic incision by the inguinal groove extremities. Epidural anesthesia via catheter is usually used, with bandage compression on the legs to prevent thrombovenous embolism. The first surgical step consists of releasing the superior abdomen wall with an assisted mechanical cannula liposuction procedure, originally described by Saldanha [19] and Avelar [20]. The incision starts in the supraumbilical area and goes to the xiphoid appendix through a narrow tunnel. The patient is placed in a Fowler position, and the superior flap is pulled down to assess whether it will reach the suprapubic line. This maneuver is important to ensure an accurate estimate of the amount of skin needed to be resected without stretching. We then trim the umbilical stack and a block resection of the entire infra-abdominal flap is done. Demarcation of the new umbilicus orifice is done and adhesions stitches, as described by Baroudi [21] and Pollock [22], are placed. Intradermic sutures with longterm absorbable sutures and a compression garment finalize the surgery. Materials and MethodsThis surgery is indicated in patients with abdominal laxness, extensive striaes, rectus muscle diastases, and localized lipodystrophy, a very common pathology after pregnancy and also in postbariatric surgical patients (Fig. 1).

Lipoabdominoplasty: An exponential advantage for a consistently safe and aesthetic outcome

“…[17] Due to the poor quality of skin if it failed to redrape later, the excess fold would appear ugly. This excessive excision prevented this possible unfavourable result.…”

A Case of Obesity Hypoventilation Syndrome with Respiratory Failure that Improved with Abdominoplasty

“…Epidermolysis might have been caused by the blood flow and abdominal tension. Uebel has reported that epidermolysis occurs most commonly in patients with a history of smoking 5 . We believe that epidermolysis can be prevented by undermining the lower flap as little as possible.…”

“…Oxygenation postoperatively, and lung compliance markedly improved. tus muscle diastases and for women in the postpartum period 5,6 . In this report, we describe our performing ab- It is important to be aware of potential postoperative complications, including infection, skin!…”

“…flap necrosis, seroma, scar, sensory disturbance, hematoma, gas! air embolism, and epidermolysis of the suprapubic region 5,14 .…”

The High-Superior-Tension Technique: Evolution of Lipoabdominoplasty

“…In 2009, Uebel [ 28 ] reported a revision of the superior pull-down abdominal flap described in 1975 by Sinder [ 29 ]. This revision added tunnel dissection, preservation of the inguinal and axillary lymphatic trunks, and paraumbilical high-tension sutures, as we describe in our reports of HSTA [ 16 – 20 ] and in this article.…”