| PRS 0409-992 El-Khatib
El-Khatib HA, Bener A.
Abdominal dermolipectomy in an abdomen with pre-existing scars: a different
concept. Plast Reconstr Surg. 2004 Sep 15;114(4):992-7.
Department of Plastic Surgery, Hamad General Hospital and Hamad Medical
Corporation, Doha, State of Qatar. hamdyel@yahoo.com
Although abdominal dermolipectomy is a frequently performed procedure, few
publications have reported on the safety of the procedure in the scarred
abdomen. The aim of this study was to stress the possibility of performing a
natural-looking abdominoplasty with no complication such as skin necrosis or
liponecrosis in the presence of abdominal scars and to clarify that the scarred
abdomen is not a great limitation for full abdominoplasty as reported in the
literature. Seventy-six abdominoplasties were performed on scarred patients from
July of 1997 to June of 2003. Twenty-five patients had oblique subcostal scars,
six patients had median supraumbilical scars, three patients had median
infraumbilical scars, 10 patients had appendectomy scars, nine patients had
paramedian supraumbilical scars, eight patients had paramedian infraumbilical
scars, seven patients had long transverse scars of repaired ventral hernias, and
eight patients had multiple small scars after laparoscopy. In addition, there
were concomitant transverse cesarean delivery scars in 40 patients. All patients
underwent full abdominoplasties, plication of the musculoaponeurotic system, and
liposuction assistance if required (45 patients). Of 76 subjects, three patients
had very limited liponecrosis at the watershed area. Eleven patients (14.5
percent) were morbidly obese and heavy smokers. In comparisons of
postabdominoplasty complications, such as liponecrosis, wound infection, and
dehiscence with and without liposuction in scarred abdomen, no significant
differences were found. Secondary revision was more common among
abdominoplasties without liposuction [seven of 45 (15.6 percent) versus 12 of 31
(38.7 percent); p = 0.02]. In conclusion, there is no limitation or
contraindication for abdominal dermolipectomy with or without liposuction
assistance on the previously scarred abdomen as long as the vascular zones of
the abdomen are respected. The abdominal wall dissection is limited to allow
only the plication of the musculoaponeurotic system, and aggressive liposuction
is avoided.
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