Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps

Abstract

Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author's own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.

Keywords: Abdominoplasty; complications; diastasis recti; haematoma; lipoabdominoplasty; necrosis; seroma; venous thromboembolism; ventral hernia; wound dehiscence.

Figure 1

Ischaemic and wound healing complications. (a) Necrosis of the skin edge with much bigger volume of fat necrosis and seroma, note necrosis of umbilicus as well, (b) Dehiscence of inverted T junction with evident tension in closure and unsatisfactory umbilicoplasty

Figure 2

Schematic diagrams of rectus sheath turn-over and external oblique aponeurosis release techniques. Upper left panel: Cross sections, upper showing diastasis recti and lower showing incisions for rectus sheath turn-over (thin arrow) and external oblique release (thick arrow). Upper right panel: Front view of the same; solid red line depicts rectus sheath turn-over and broken red line the external oblique release. Lower left panel: Cross sections, upper showing rectus sheath turn-over flaps sutured and lower showing the reinforcement of the tendinous intersections. Lower right panel: Frontal view of the same

Figure 3

Wound healing complication in a post weight-loss surgery patient who underwent mastopexy and abdominoplasty as a medical tourist. Note dehiscence of breast and abdominal wounds, umbilical malposition, fat necrosis and infection around? Drain sites. Midline scar revision wound is also infected

Figure 4

Extended scar lipoabdominoplasty and 3D liposculpture. Upper panel front, side and back views before surgery. Lower panel front, oblique and back views 1 month post-operative, a small area of skin overlap has been revised on the right lateral extreme. Note the pleasing features of the abdomen and improvements in waist and back

Figure 5

Stretched depressed unsightly scar: The net result of poor planning, not performing a deep closure and insufficient separation of umbilicus and scar