Deep-Plane Lipoabdominoplasty in East Asians

Abstract

Background: The objective of this study was to develop a new surgical technique by combining traditional abdominoplasty with liposuction. This combination of operations permits simpler and more accurate management of various abdominal deformities. In lipoabdominoplasty, the combination of techniques is of paramount concern. Herein, we introduce a new combination of liposuction and abdominoplasty using deep-plane flap sliding to maximize the benefits of both techniques.

Methods: Deep-plane lipoabdominoplasty was performed in 143 patients between January 2007 and May 2014. We applied extensive liposuction on the entire abdomen followed by a sliding flap through the deep plane after repairing the diastasis recti. The abdominal wound closure was completed with repair of Scarpa's fascia.

Results: The average amount of liposuction aspirate was 1,400 mL (700-3,100 mL), and the size of the average excised skin ellipse was 21.78×12.81 cm (from 15×10 to 25×15 cm). There were no major complications such as deep-vein thrombosis or pulmonary embolism. We encountered 22 cases of minor complications: one wound infection, one case of skin necrosis, two cases of undercorrection, nine hypertrophic scars, and nine seromas. These complications were solved by conservative management or simple revision.

Conclusions: The use of deep-plane lipoabdominoplasty can correct abdominal deformities more effectively and with fewer complications than traditional abdominoplasty.

Keywords: Abdominal wound closure techniques; Abdominoplasty; Lipectomy.

Fig. 1. External laser irradiation

External laser irradiation was performed on the abdominal surface. The immediate effect of the laser is to produce temporary pores in the cell membranes of adipocytes, allowing fat to migrate into the extracellular space. This technique speeds up fat removal.

Fig. 2. Liposuction

Liposuction was performed over both subcostal areas.

Fig. 3. Abdominal tissue removal

The abdominal tissue was removed, including Scarpa's fascia and the deep fat, except over the bilateral inguinal region. Umbilical isolation was also performed.

Fig. 4. Infraumbilical diastasis repair

(A) Infraumbilical diastasis was repaired first, providing a clear visual field in the upper abdomen and making the rectus muscle border more clearly visible. (B) Schematic illustration of this procedure.

Fig. 5. Schematic illustration of deep-plane lipoabdominoplasty

(A) Preoperative status (blue line, Scarpa's fascia). (B) Liposuction was performed over the abdomen. (C) The lower abdominal tissue was removed. (D) Abdominal flap sliding was performed without difficulty.

Fig. 6. Scarpa's fascia repair

The Scarpa's fascia was repaired first. It relieved skin tension and made dermal circulation intact.

Fig. 7. Skin closure using histoacryl

After finishing dermal suture, skin bond (Histoacryl, B. Braun, Aesculap, Germany) was applied along the incisional wounds.

Fig. 8. Case

A 42-year-old woman with bulging and striae gravidarum underwent deep-plane lipoabdominoplasty. (A) Before surgery. (B) After surgery.

Fig. 9. Preservation of the abdominal perforators

(A) We were able to preserve many central perforators (the area marked in green) by dissecting the anterior surface of the rectus abdominis muscle to the minimal extent possible. (B) Intraoperative photographs of the limited dissection of the abdominal flap.