Morphometric Study (Macroscopic and Microscopic) of the Lower Abdominal Wall

Costa‐Ferreira, António; Rodrigues-Pereira, Pedro; Rebelo, Marco; Vásconez, Luis O.; Amarante, José

doi:10.1097/prs.0000000000000732

Cited by 22 publications

(13 citation statements)

References 27 publications

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“…[35][36][37][38][39]46 This is probably unnecessary as the deep fat compartment is usually thin in comparison to the fat superficial to it, rendering it inconsequential to the final abdominal contour. 32 This was one of the conclusions of an anatomical study done in the surgical specimens of 41 female patients submitted to a full abdominoplasty. 32 The authors verified that most of the fat is located above Scarpa fascia.…”

Section: Discussionmentioning

confidence: 96%

“…This is an important point as the contribution of the deep fat compartment to the total thickness of the abdominal wall decreases from the umbilical level to the mons pubis level, from 43% to 19%. 27,32 A flexed position of the operating table is essential for wound closure because it should be performed with the patient flexed at the level of the hips. Two closed-suction drains are used in all patients.…”

Section: Techniquementioning

confidence: 99%

“…[21][22][23][24][25][26][27][28][29][30][31][32] There is considerable scientific data to validate this concept. [21][22][23]28,[32][33][34] We can speak of a trilaminar structure with superficial compartment dominance and a minor contribution of the deep fat compartment to the total thickness (less than 25%). 32 The superficial fat compartment is always the thickest regardless of the adiposity degree.…”

mentioning

confidence: 92%

“…[21][22][23]28,[32][33][34] We can speak of a trilaminar structure with superficial compartment dominance and a minor contribution of the deep fat compartment to the total thickness (less than 25%). 32 The superficial fat compartment is always the thickest regardless of the adiposity degree. 32 Scarpa fascia is usually ignored in the classic descriptions of the abdominoplasty surgical technique but it has been suggested that it may have an important role in this type of surgery, namely, by reducing the most frequent complication: seroma.…”

mentioning

confidence: 99%

“…32 The superficial fat compartment is always the thickest regardless of the adiposity degree. 32 Scarpa fascia is usually ignored in the classic descriptions of the abdominoplasty surgical technique but it has been suggested that it may have an important role in this type of surgery, namely, by reducing the most frequent complication: seroma. 35,36 The classic technique of abdominoplasty is performed using a premuscular plane of dissection.…”

mentioning

confidence: 99%

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Abdominoplasty With Scarpa Fascia Preservation

Costa‐Ferreira

Rebelo

Vásconez

et al. 2016

Annals of Plastic Surgery

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The plane of dissection used during a full abdominoplasty has been implicated on the seroma rate. Avoiding the classic plane of dissection on top of the rectus fascia and using a more superficial plane of dissection has been suggested as a strategy to improve recovery and lower the complication rate. The authors have been applying this principle in their practice for more than a decade, and they performed 2 prospective comparative studies to evaluate the clinical effects of using a more superficial plane of dissection (with Scarpa fascia preservation) during a full abdominoplasty.The technique is presented and explained along with the results of both comparative studies.The results of both studies are discussed particularly the effects on drain volume (total and daily), the duration of drain usage and the avoidance of "long drainers." These are very relevant advantages of the technique that have not been discussed in the literature. The results and surgical strategies used by other authors which apply a more superficial plane of dissection are presented.Controversy still exits on the manipulation of the deep fat compartment by liposuction or direct fat excision. No manipulation is another option which should be considered but it has been questioned due to the risk of aesthetic compromise. A morphometric study performed on the surgical specimens of 41 female patients submitted to a full abdominoplasty validates that option.Based on this evidence, the authors recommend that surgeons consider performing abdominoplasties using a more superficial plane of dissection in the infraumbilical area with total preservation of Scarpa fascia and the deep fat compartment. The classic plane of dissection, on top of the deep fascia, should be avoided in the lower abdomen.

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Section: Discussionmentioning

confidence: 96%

Section: Techniquementioning

confidence: 99%

mentioning

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Abdominoplasty With Scarpa Fascia Preservation

Costa‐Ferreira

Rebelo

Vásconez

et al. 2016

Annals of Plastic Surgery

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Physical properties of Scarpa's fascia

et al. 2023

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Preservation of Scarpa's fascia has improved clinical outcomes in abdominoplasty procedures and in other body contour surgeries. However, the physical properties of Scarpa's fascia have not yet been described, and grafts are still underexplored. Fresh surgical specimens from five female patients subjected to classical abdominoplasty were dissected and analyzed. A grid was drawn on the fascia surface, dividing it into equal upper and lower halves; four Scarpa's fascia samples (30 × 10 mm) were collected from each half, 40 mm apart. The thickness was measured with a caliper. A strain/stress universal testing machine was used for mechanical tests. Twenty‐five samples were obtained (nine from the upper half, 16 from the lower). The average thickness was 0.56 ± 0.11 mm. The average values for stretch, stress, strain, and Young's Modulus were, respectively, 1.436, 4.198 MPa, 43.6%, and 23.14 MPa. The upper half showed significantly greater thickness and strain values (p = 0.020 and p = 0.048; Student's t‐test). The physical and biomechanical properties of Scarpa's fascia can make it a donor area for fascial grafts as an alternative to fascia lata, as it is always available and has minimal donor‐site morbidity. Further studies are needed to validate this statement. It seems advantageous to use the lower half of the abdomen instead of the upper part as a donor site.

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