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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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9 Abdominoplasty
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Results
ab
Fig. 9.28
a Preoperative; b Postoperative
Patient I (Fig. 9.28): This is a 46-year-old female patient after three
pregnancies with divarification of the recti and fat flap. Doubling of the
fascia was carried out in addition to the skin/fat resection and repositioning of the navel.
Twelve months after the operation. Normal wound healing,
good contouring of the abdomen and hips.
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cd
Fig. 9.29
a, b Preoperative; c, d Postoperative
Patient II (Fig. 9.29): This is a 49-year-old female patient following
substantial weight loss (40 kg).
Twelve months after the operation. Healthy scar.
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Mini Abdominoplasty
Modified lower abdominoplasty according to Ribeiro without navel
transposition. In the case of mild cutaneous laxity mainly in the lower
abdomen, for example, following pregnancies and successive musculoaponeurotic insufficiency, a mini abdominoplasty without navel transposition can be carried out, during which only the lower abdominal tissue is lifted. If necessary , this procedure may be combined with liposuction of the flanks/upper abdominal region.
This procedur e can be performed under general anaesthesia, as well as
under local tumescent anaesthesia.
Here we present the mini abdominoplasty procedure with lipoaspiration in the upper abdominal region.
1. Marking of the incision lines 1 day prior to the operation with the
patient standing. Disinfection of the surgical area with Cutasept®,
infiltration anaesthesia along all incision lines and tumescence in
the region to be aspirated. Subsequently, the surgical area is covered
(same procedure aswith the normal abdominoplasty).
(Fig. 9.30)
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Fig. 9.30
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2. Incision: distal incision of a cap-shaped cutaneous form in the
suprasymphyseal region, extending up to the anterior superior iliac
spine. Here the scalpel is angled (30°) in order to leave a widened
dermal edge in the caudal region to facilitate woundclosure later.
(Fig. 9.31)
3. Dissection: in a similar manner to normal abdominoplasty, dissec-
tion is now performed obliquely and at a 30° angle in order to avoid
step formation and additionally to leave a fatty layer on the rectus
fascia which will help lymphatic drainage.
(Fig. 9.32)
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Fig. 9.31
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Fig. 9.32
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4. The inferior superficial epigastric artery and vein are visualized and
ligated at the lateral edge of the pubic region on both sides. The
cutaneous/fatty flap to be removed is dissected in a cranial direction
with the Scarpa ’s fascia while the fatty tissue is left on the autochthonous abdominal musculature. During this, the flap is held up with a
sharp multi-pronged retractor. (Fig. 9.33)
5. A change in fatty tissue consistency and whitish connective tissue
septa are noticed in the umbilical region. Careful dissection should
be carried out herein order to prevent displacement ofthe navel.
(Fig. 9.34)
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Fig. 9.33
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Fig. 9.34
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6. Subsequently, fan-shaped lipoaspiration should be carried out in the
upper abdominal region. Extreme care should be exercised here,
as pronounced aspiration can lead to local disturbances in blood
supply to the cranial flap. It is recommended that the subcutaneous
fatty tissue in the flank region is tunnelled (not aspirated) with the
aid of liposuction cannulas to achieve improved mobility of the soft
tissue. (Fig. 9.35)
7. The patient should then be moved into the ‘beach chair’ position
(flexion at the hips) to enable tension-free mobilization of the
cranial flap. Following a renewed check of the area to be resected,
this is divided at the midline. (Fig. 9.36)
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Fig. 9.35
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Fig. 9.36
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