ABDOMINOPLASTY

Abdominoplasty incision. Abdominoplasty should be designed with an horizontally low  incision from one edge to the other, starting from the part that is formed by the hanging part of the abdomen. The design is being held with the patient in an upright position. While designing the incision in the center, the pubic area should be pulled upwards. Otherwise the pubic’s fall area will not be remedied.

Surgical technique, avoidance of complications and aesthetic deformities. The incision should be made vertically through the revelation of the fascia of the abdominal wall. The preparation of the abdominal flap should be done up to the flank arch and the xiphoid appendix. In patients with an exomorphic body type, the διατιτρώσα artery below the flank arch should be preserved in order to enhance the perfusion of the flap. This happens in order to avoid possible partial necrosis in its final center.

Important for colleagues to know is that patients with a mesomorphic body type are more likely to have postoperative symptoms and the shunts should be removed later. In contrast with an exomorphic body type, the patients show less perfusion with the possibility of partial necrosis in the center. If during the preparation of the flap the surgeon notices a harder texture of the fatty tissue, mainly in the exomorphic body types and in men, he should protect the artery of the flank arch and avoid the wide preparation on the sides. The relaxation of the abdominal wall should be capable and more aggressive in the abdomen, above the navel. And less below it, especially if there is chronic obstructive pulmonary disease. The preparation of the navel should be attentive with maintaining adequate perfusion in order to avoid postoperative necrosis.

The process of removing the excess fatty flap is being achieved by pulling the flap down and marking the center. The procedure continues with each side part being pulled down and inwards with the main purpose to avoid the dog ears on the sides. This is how the excision is being accomplished. This design avoids the frequent aesthetic deformities of the dog ears on the sides and of the pubic’s fallen area. The positioning of the new navel is complete after the wound is sutured and follows the rules of body anatomy. The navel is located in the midline and at the level of the iliac muscle. Two vertical lines intersect and determine its normal position. An inverted V-shaped incision is made at this point, and by preparing in depth you discover the stump of the navel, which you pull out and staple. At the bottom of the navel, remove part of the perimeter where you insert the skin flap of the inverted V. This technique prevents the shrinkness of a round incision while giving a more normal image of the navel.

Postoperative care and prevention. The patient remains in bed for 24 hours in an inclined position. The next day a rubber corset is placed and mobilized. Anticoagulant therapy is given if there is obesity, or venous varicose veins of the lower extremities. The drains are removed on the 4th postoperative day or later if there is a possibility of developing a septum. The elastic corset is removed after a month.