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Pseudocyst Formation after Abdominoplasty in a Slim Patient

Stavropoulou, Vasso M.D., Ph.D.; Vlachos, Spiros M.D., Ph.D.; Yiacoumettis, Andreas M.D., Ph.D.

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Plastic and Reconstructive Surgery: January 2008 - Volume 121 - Issue 1 - p 356-357
doi: 10.1097/01.prs.0000300300.74804.61
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Sir:

Soft-tissue injury can lead to the formation of a pseudocyst in the subcutaneous adipose tissue, also known as extravasations of Morel-Lavallee, a French physician who first described them in 1853.1

A 37-year-old woman with a normal body mass index presented to our clinic with complaints of postpregnancy abdominal wall laxity. She was subjected to an abdominoplasty procedure with plication of the recti muscles. No additional liposuction was performed. Suction drains were installed and the patient wore a pressure garment for 1 month. During this period, subcutaneous serous collection was performed a week after the drains were removed. This was aspirated five times during the following 20 days.

Two years later, she returned with complaints of lower abdominal fullness (Fig. 1). Ultrasound examination revealed a cystic lesion of 15 cm in diameter, which led to the diagnosis of pseudocyst. The lesion was removed surgically (Fig. 2), and pathologic analysis confirmed the diagnosis of a pseudocyst. The pseudocyst was made of thick collagen and had an acellular lining. In the 14-month follow-up period, there was no recurrence.

Fig. 1.
Fig. 1.:
Infraumbilical swelling. Note the slight puckering and distortion on the right side.
Fig. 2.
Fig. 2.:
The pseudocyst excised and opened, showing hemorrhagic-fibrotic content.

Subcutaneous pseudocysts are known to form after soft-tissue (especially adipose) injury, usually in the lower limbs and buttocks. They have also been described as a result of surgery, usually when an abdominoplasty is performed together with a liposuction, particularly in female patients. Due to this combination, it is believed that the load on the subcutaneous lymphatic system does not allow the traumatic surfaces to juxtapose. As a consequence, fluid accumulates and the pseudocyst forms. Ultrasound examination of the abdominal wall can easily reveal the location, dimensions, and contents of such a cyst.2

Intraoperative (bipolar cautery, leaving a fine layer of tissue to cover the fascia, and suction drains) and postoperative (pressure garments) measures sometimes fail to prevent the accumulation of fluids and the formation of a pseudocyst. It has been suggested that such a complication is more likely to occur when liposuction is combined with abdominoplasty.3 Scoring of the rectus fascia, quilting sutures between the fascia and the subcutaneous fat, prolonged drainage,4 and even partial resection of the fascia in a chessboard pattern5 have been proposed to avoid the formation of a pseudocyst or the recurrence of an excised pseudocyst.

In our case, pseudocyst formation occurred in a slim patient who had undergone an abdominoplasty alone. This case should raise the level of awareness of such a complication even in such instances.

Vasso Stavropoulou, M.D., Ph.D.

Spiros Vlachos, M.D., Ph.D.

Andreas Yiacoumettis, M.D., Ph.D.

Department of Plastic Surgery

Oncological IKA Hospital G. Gennimatas

Athens, Greece

REFERENCES

1. Morel-Lavallee. Epanchements traumatique de serosite. Arch. Gen. Med. Paris: Raige-Delorme M., 1853. Pp. 691– 731.
2. Mohammad, J. A., Warnke, P. H., and Stavraky, W. Ultrasound in the diagnosis and management of fluid collection complications following abdominoplasty. Ann. Plast. Surg. 41: 498, 1998.
3. Ersek, R. A., and Schade, K. Subcutaneous pseudobursa secondary to suction and surgery. Plast. Reconstr. Surg. 85: 442, 1990.
4. Zecha, P. J., and Missotten, F. E. M. Pseudocyst formation after abdominoplasty: Extravasations of Morel-Lavallee. Br. J. Plast. Surg. 52: 500, 1999.
5. Ronceray, J. Drainage actif, par resection aponevrotique partielle, des epanchements de Morel-Lavallee. Nouv. Presse. Med. 5: 1305, 1976.

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