Recently, abdominoplasty flap elevation in a more superficial plane has been a frequently discussed topic.1,2 As we have been using this method for more than 2 years, we would now like to share our experiences.
Fifty patients who were scheduled for primary abdominoplasty at our department between February of 2008 and February of 2010 were included in a prospective randomized study. Patients were randomized to preparation on either the Scarpa fascia or the rectus fascia. Inclusion criteria were no previous surgery on the abdominal wall and a body mass index below 28.
The purpose of this study was to evaluate seroma reduction when using the Scarpa fascia for a more superficial preparation. A full abdominoplasty was performed using the harmonic scalpel for preparation. In one group, we stayed above the Scarpa fascia infraumbilical and used the rectus fascia for further preparation. In the other group, preparation was done at the level of the rectus fascia from the very beginning. In the case of the Scarpa fascia group, we suspended the Scarpa fascia onto the rectus fascia after flap resection with absorbable sutures to use it as an excellent lifting layer for the pubic area.
The mean weight of resected tissue was 968 g in the Scarpa fascia group and 1378 g in the rectus group. The explanation for the minor resection in one group is the thinner flap as a result of more superficial preparation.
Two closed suction drains were removed with a drain output less or equal to 30 cc collected within 24 hours. Most patients in both groups (Scarpa fascia group, n = 12 patients; rectus group, n = 13 patients) had their drains removed on the third day postoperatively.
Two weeks after surgery, 18 patients in each group underwent an ultrasound examination of the abdominal wall performed by a radiologist. The purpose was to evaluate whether there were differences in asymptomatic fluid collection among these groups. Twelve patients each had an asymptomatic fluid collection that did not differ in volume (mean, 20 ml). Six patients in the Scarpa fascia group and two patients in the rectus group showed no fluid collection at all.
The rate of seroma formation was significantly higher in the rectus group. Whereas four patients in this group had symptomatic fluid collections, there were none in the Scarpa fascia group. Seromas were treated with one to three punctures in the ambulatory setting.
Because of our experience with this small prospective study, we conclude that preparation more superficially might reduce seroma formation after abdominoplasty procedures. In the future, more prospective studies with larger patient cohorts are necessary to gain more evidence regarding this.
Matthias Koller, M.D.
Thomas Hintringer, M.D.
Department of Plastic and Reconstructive Surgery
Sisters of Mercy Hospital Linz
1. Costa-Ferreira A, Rebelo M, Vásconez LO, Amarante J. Scarpa fascia preservation during abdominoplasty: A prospective study. Plast Reconstr Surg
2. Fang RC, Lin SJ, Mustoe TA. Abdominoplasty flap elevation in a more superficial plane: Decreasing the need for drains. Plast Reconstr Surg
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