Drainless Abdominoplasty with Concomitant Liposuction: How Sparing Scarpa's Fascia Enables Drain Free Body Contouring
Vinod K. Chopra, Sr., MD1, Brannon Claytor, Sr., MD2, Lawrence Gray, Sr., MD3.
1Cooper University Healthcare, Camden, NJ, USA, 2Claytor Noone Plastic Surgery, Bryn Mawr, PA, USA, 3Atlantic Plastic Surgery, Portsmouth, NH, USA.
Abdominoplasty results in significant open cavity, and seromas following surgery drives most surgeons to utilize drains post-op. This does not reduce the incidence of post-operative seromas to zero, nor does it make for a positive patient experience. Maintaining the lymphatic drainage within Scarpa's Fascia allows for autogenous fluid management following surgery.
A retrospective review of the data was performed on 179 patients that underwent Scarpa's sparing abdominoplasty with concomitant liposuction over a 6-year period. Post operatively, chemoprophylaxis was given for DVT prophylaxis of indicated per the Caprini scale. The Scarpa's fascia is spared on the inferolateral aspect on both sides. The dissection is carried down to the rectus fascia centrally, to allow for full rectus plication. Surgical dissection is done after liposuction and preferentially the cut function of the cautery is employed. Coag is only used at blood vessels. The entire flap is removed as a single unit from preoperative markings. The upper flap is dissected with discontinuous undermining, thus maximally preserving rectus perforators.
Data analysis showed that the average age was 44 years (SD=11). Average patient weight was 76.43 kg (SD=7.4). Average BMI was 28.4 kg/m2 (SD=0.85) Average operative time was 165 minutes (SD=24.75). The average amount of fat liposuctioned was 702 g (SD=628) with average flap resection weighing 1.68 kg (SD=1.75). Complication rates were as follows: overall 16.8%, seroma 4.5%, hematoma 0.5%, dehiscence 2.2%, PE 0.5%, suture granuloma 5.1%, UTI 0.5%, and erythema 1.1%
CONCLUSIONS:Concomitant liposuction with abdominoplasty allows for discontinuous undermining enabling direct skin excision and preservation of Scarpa's fascia. This preserves blood flow and innervation to the abdominal wall, which improves autoregulatory homeostasis. Minimizing cautery dissection and preserving the Scarpal layer minimizes serous fluid production, thus obviating the need for surgical drains. Doing so allows earlier mobilization and showering, eliminates complications from the drain itself, and dramatically improves patient satisfaction. The incidence of complications in this study is comparable to patients who are treated with drains.
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