RESUMO
While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.
Assuntos
Lipoabdominoplastia , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Lipoabdominoplastia/métodos , Abdominoplastia/métodos , Laparoscopia/métodosRESUMO
Existe en la práctica diaria de los cirujanos plásticos una búsqueda continua de mejores alternativas técnicas para el tratamiento de las deformidades del contorno abdominal. La LADE (Lipoabdominoplastia con defi nición anatómica) da un paso más adelante de la técnica LAP tradicional. Esta técnica incorpora los principios de resaltar la defi nición de la musculatura abdominal, consiguiendo resultados más naturales y con menos estigmas de una intervención quirúrgica. Los resultados estéticos son mucho más armoniosos, con un verdadero aspecto abdominal rejuvenecido. Logramos reducir la morbilidad preservando los vasos sanguíneos perforantes y suspendiendo la fascia de Scarpa. Una correcta selección del paciente asociado a la estandarización de esta técnica hace que el procedimiento sea seguro y reproducible
There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE Lipoabdominoplasty with Anatomical Defi nition is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the defi nition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The aesthetic results are much harmonious, with a true abdominal rejuvenated appearance. We can reduce morbidity by preservation of perforating blood vessels and suspension of Scarpa's fascia. The correct selection of the patient associated with the standardization of this technique makes the procedure safe and reproducible
Assuntos
Lipectomia/métodos , Fáscia , Contorno Corporal/métodos , Lipoabdominoplastia/métodosRESUMO
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 .
Assuntos
Parede Abdominal , Abdominoplastia , Lipectomia , Lipoabdominoplastia , Parede Abdominal/cirurgia , Abdominoplastia/métodos , Animais , Lipoabdominoplastia/métodos , Ratos , Resultado do TratamentoRESUMO
Introdução: A importância da fáscia de Scarpa, tanto na diminuição da tensão da sutura da pele quando na diminuição do seroma, são assuntos de grande discussão sobre a lipoabdominoplastia. Este estudo tem o objetivo de avaliar o débito nos drenos, nos 1º, 3º, 5º e 7º dias de pós-operatórios, em procedimentos de lipoabdominoplastias com e sem preservação da fáscia de Scarpa. Métodos: Estudo prospectivo, randomizado e consecutivo, analizando 24 pacientes submetidas à lipo abdominoplastia por sete cirurgiões (residentes) diferentes, no período de agosto-dezembro de 2013. As pacientes foram divididos em 2 grupos, um com manutenção da fáscia de Scarpa e outro onde ela foi removida. Foi pesquisado o débito no dreno nos 1°, 3°, 5° e 7º dias de PO, assim como as complicações nos dois grupos. Resultado: Três pacientes do grupo apresentaram epiteliólise na cicatriz umbilical, sendo duas delas tabagistas. Houve menor quantidade de líquido drenado no grupo 1 do que no grupo 2, sendo significância menor no 1º pós-operatório. Um paciente do grupo 2 apresentou seroma (40 ml), aspirado com seringa no 10º PO, sem recidiva. Conclusão: Ficou demonstrado que a lipoabdominoplastia com preservação da fáscia de Scarpa apresentou diminuição de drenagem sero-sanguinolenta, tanto nas medições como um todo (182,09 ml a menos na somatória dos sete dias) quanto na medição de cada dia isoladamente.
Introduction: The importance of Scarpa's fascia in reducing both skin suture tension and seroma is a subject of great discussion in lipoabdominoplasty. This study evaluates drain flow in lipoabdominoplasty, with and without preservation of Scarpa's fascia, on postoperative days 1º, 3º, 5º, and 7º. Methods: This was a prospective, randomized, and serial study of 24 patients who underwent lipoabdominoplasty; procedures performed by seven different surgeons (residents) were evaluated between August and December 2013. The patients were divided into two groups according to whether Scarpa's fascia was preserved or removed. Drain flow was evaluated on postoperative days 1º, 3º, 5º, and 7º, and complications were assessed in the two groups. Results: Three patients developed epitheliosis on the umbilical scar, and two were smokers. There was less fluid drainage in Group 1 patients compared to Group 2, and this was less significant on postoperative day 1. One patient in Group 2 developed a seroma (40 ml), which was aspirated with a syringe on postoperative day 10, with no recurrence. Conclusion: Lipoabdominoplasty with Scarpa's fascia preservation resulted in reduced serosanguinous drainage, both when taken as a whole (182.09 ml less for the seven day total), or measured daily.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Pacientes , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Estudo Comparativo , Lipectomia , Distribuição Aleatória , Estudos Prospectivos , Canal de Drenagem do Solo , Estudo de Avaliação , Parede Abdominal , Seroma , Abdome , Gordura Subcutânea , Abdominoplastia , Lipoabdominoplastia , Pacientes/classificação , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Lipectomia/métodos , Parede Abdominal/cirurgia , Seroma/cirurgia , Gordura Subcutânea/cirurgia , Abdominoplastia/métodos , Lipoabdominoplastia/métodos , Abdome/cirurgiaRESUMO
Introdução: A abdominoplastia e a lipoaspiração estão entre as cirurgias plásticas estéticas mais realizadas em nosso país, inúmeros cirurgiões plásticos brasileiros contribuíram para o seu aperfeiçoamento, sempre visando um melhor resultado ao paciente. Devemos sempre estar atentos aos fenômenos tromboembólicos que podem ter um desfecho dramático. Métodos: Foram operadas 20 pacientes, com idade variando de 29 a 63 anos, idade média de 43 anos, todas do sexo feminino. As pacientes passaram por consulta pré-anestésica, onde foram classificadas segundo o risco cirúrgico utilizando tabela da ASA (American Society of Anesthesiologists), realizaram os exames de rotina, Ultrassonografia de parede abdominal, avaliação cardiológica e avaliação psicológica. Resultados: Em nossa casuística de 20 pacientes, tivemos um caso de seroma persistente, um caso de "dog ear" e um caso de deiscência de cicatriz umbilical, as complicações encontradas não influenciaram o resultado final da cirurgia e 15 pacientes se disseram muito satisfeitos após 6 meses de operados. Conclusão: A lipoabdominoplastia demonstrou ser uma técnica segura e que traz bons resultados ao paciente, aspectos psicológicos devem ser avaliados e uma rotina criteriosa desde o pré-operatório visa diminuir possíveis intercorrências.
Introduction: Abdominoplasty and liposuction are two of the most frequently performed plastic surgeries in Brazil. Many Brazilian plastic surgeons have contributed to their improvement and constantly seek the best result for their patients. Surgeons also must always be attentive to thromboembolic events that may have a tragic outcome. Methods: Twenty (20) female patients, aged 29 to 63 years, with a mean age of 43 years, underwent surgery. The patients attended a pre-anesthetic visit, where they were classified according to surgical risk using the American Society of Anesthesiologists classification, underwent routine testing, abdominal wall ultrasonography, cardiovascular assessment, and psychological assessment. Results: Among the 20 cases, there was one case of persistent seroma, one case of "dog-ear," and one case of umbilical wound dehiscence. The complications that occurred did not influence the final surgical outcome and 15 patients were very satisfied 6 months post-surgery. Conclusion: Lipoabdominoplasty proved to be a safe technique with good results. Psychological factors must be assessed and a necessarily rigorous routine starting from the preoperative period allows a reduction in the risk of complications.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Relatos de Casos , Estudos Retrospectivos , Ultrassonografia , Estudo de Avaliação , Parede Abdominal , Abdome , Lipoabdominoplastia , Complicações Pós-Operatórias/cirurgia , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Parede Abdominal/cirurgia , Lipoabdominoplastia/efeitos adversos , Lipoabdominoplastia/métodos , Abdome/cirurgiaRESUMO
La abdominoplastia moderna está apoyada en el trípode formado por una dermolipectomia horizontal con transposición del ombligo; plicatura de las aponeurosis de la pared abdominal; y lipoaspiración del abdomen y de zonas vecinas. Se presenta un nuevo diseño en la marcación previa para la resección del excedente dermo-graso, que junto a otras maniobras durante el cierre de la herida quirúrgica, se obtienen los siguientes benefi cios: evita las orejas de perro; previene la redundancia (rollitos) en fl ancos; evita una cicatriz elevada, por tracción superior, en la línea media supra-púbica e involucra a la suspensión superior por la tensión latera
The modern abdominoplasty technique included a horizontal dermolipectomy with umbilical transposition, abdominal wall fascia plication and suction-assisted lipectomy of the abdomen and neighboring areas. We present a new mark for removal of excess fat and skin and add others procedure than bring following benefi t: avoid the dog-ears, prevent a redundant "roll" in fl anks, avoid a superior traction midline scar at supra-pubis and involve the high lateral tension suspension.