Is it Possible to Increase the Survival of the Transverse Rectus Abdominis Musculocutaneous Flap following previous Abdominoplasty Using a Delay Procedure? An Experimental Study in the Rat

TULUA: Effects of Flap Undermining and Type of Wall Plicature in a Rat Model Abdominoplasty

BACKGROUND

TULUA, a transverse plication lipoabdominoplasty, which excludes elevation of the supraumbilical flap and includes a skin graft neoumbilicoplasty, claims greater safety and better results. An animal study was designed to compare it, with two current techniques.

MATERIALS AND METHODS

Three matched groups of 12 rats had combined liposuction and abdominoplasty. Liposuction was extensive and unrestricted. Groups 1 and 2 had vertical plication and transposition umbilicoplasty, and group 3 had transverse plication and neoumbilicoplasty. Flap elevation in the epigastrium was wide to costal margins in group 1, limited to a tunnel in group 2, and no dissection in group 3. The animals were observed for 21 days and then euthanized. Intraoperative, postoperative, and postmortem variables and findings were measured and analyzed to find differences between groups.

RESULTS

Transverse lipoabdominoplasty demonstrated a wider wall plication area, as well as a decrease in tension to close the wound, causing the horizontal scar to remain in a low position. In vertical plication lipoabdominoplasty groups, flap necrosis and seromas were more frequent, and the umbilical position descended due to secondary healing and scar contraction. The scar's scores were better in the transverse group and were confirmed when evaluated by external observers.In postmortem examination, horizontal plication presented less widening; perforator vessels were preserved when surgical undermining of the upper abdomen was not performed, and there were fewer seromas.

CONCLUSION

In a rat model, TULUA demonstrates superior results and a decrease in complications when compared to lipoabdominoplasties with vertical plication and wide or tunneled dissection in the upper abdomen.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of intra-operative abdominal wall perfusion in post-bariatric abdominal dermolipectomy

OBJECTIVE

Abdominal dermolipectomy after massive weight loss has become a standard procedure. However the complication rates such as wound necrosis or secondary healing complications are still high. In this context ischaemia or inadequate micro-perfusion are known as triggers of wound healing complications. Little is known about the regional perfusion patterns before and after post-bariatric abdominal dermolipectomy. This study focuses on assessment of intraoperative micro-perfusion patterns of the abdominal tissue.

METHODS

The perfusion of the abdominal wall flap was monitored intra-operatively in 17 patients with an average BMI of 29.2 ± 3.7 kg/m² after bariatric surgery. All patients underwent abdominal post-bariatric dermolipectomy after massive weight loss while applying the non-invasive O2C laser-spectrophotometer. The micro-perfusion parameters oxygen saturation (SO₂), relative haemoglobin content (rHB) and relative blood flow (BF) were intra-operatively measured.

RESULTS

The results of this study show that the part of the abdominal fat typically resected during dermolipectomy has the lowest SO₂ before surgery. Furthermore, the results demonstrate that previously well oxygenated parts in the median line of the abdominal fat undergo a significant decrease in oxygen saturation upon mobilisation and subsequent suturing, while the caudal wound edges show an increase of micro-perfusion parameters.

CONCLUSION

Data show that micro-perfusion is worst in the median line of the cranial wound edge and is significantly altered after mobilisation. In addition an intra-operative increase of micro-perfusion in the caudal part of the wound edge, especially in the mons pubis area, can be measured.