Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_591_Библиотеки_им_академика_М_И_Перельмана

using the superior curved incision with convexity downward (Fig.8.3a). Also the incisions are extended beyond the pubis on the lower abdominal sulcus according to the amount of skin to be resected in each case, without umbilical incisions (Fig.8.3a). The superior markings are curved in direction to the ank regions to permit more skin resection (Fig.8.3a). The supercial fascia and the most important anatomical structures will be preserved in the two lateral regions, and in the central area, the skin will be resected up to the rectus fascia muscle, permitting safe plication and reducing the amount of tissue to be preserved in the lower abdomen, improving the aesthetic results (Fig.8.8). In most of the cases, one transversal strip of the pubis is resected to maintain its length to about 6 to 7cm (transversal pubectomy), avoiding higher scars. The navel is dissected from the abdominal wall as performed in mini­lipoabdominoplasty. Plication on the superior abdominal muscle fascia is performed with reduced undermining preserving the abdominal myocutaneous perforating vessels and continues up to the pubis approaching the two preserved supercial fascia segments (Erfon and Mauricio 2016). After the muscle plication, both lateral segments of the preserved supercial fascia (Scarpa’s fascia) are sutured together with 3-0 colorless mono-nylon in the lower abdomen. After this suture, there is no dead space and there is no necessity of drains. Liposuction in the ank areas can be performed as the same surgery using a special position described by the senior author, avoiding prone position. After the nal sutures, a complementary liposuc­tion is carried out to improve the aesthetic results.

Avelar (1999) described the use of liposuction associated with mini­abdominoplasty on the whole abdominal wall and anks, with skin resection on the pubis and on the sub-mammary groove, preserving the abdominal muscle cutaneous perforating vessels in the upper abdomen and the supercial fascia in the whole lower abdomen without panicle undermining. Joining two great techniques in one new idea publishing new concepts to the classical abdominoplasty, starting a new era in the abdominoplasty approach (Avelar 1999).

Illouz (1980) described the possibility of treatment of lipodystrophies in the body contour using the technique named liposuction, changing concepts about aes­thetic plastic surgery in the whole body regions (Illouz 1980). Illouz (1992) also published a technique of abdominoplasty without undermining and liposuction in the upper abdomen with skin resection in the lower area to be used on obese patients (Illouz 1992).

Uebel (1994) recommended a smaller detachment of the tunnel for plication, reducing the complications such as seromas and preserving nerves and vasculariza­tion from the anks (Uebel 1994). The same author (2009) published that the inci­sions start in the supra-umbilical area and go to the xiphoid appendix through a narrow tunnel for plication and also recommends to place the patient in the Fowler position to pull down the superior abdominal ap and test the appropriate skin resection before the inferior incisions are carried out (Uebel 2009).

Faria-Correa (1992) published the possibility of a video-endoscopic approach to perform muscle plication, reducing the scars in cases of mini-abdominoplasty (Faria-Corrêa 1992). This was also suggested late by Avelar (1999).

Bozolla (Bozolla and Psillakis 1988) published important new classication of abdominoplasty deformities in ve types and indication of surgery for each type (Bozolla and Psillakis 1988). The senior author classied his patients into four groups with his respective surgical indications.