It has a dual blood supply, from the deep layer and from the skin, and it is able to survive on either.
Caution is warranted in patients with large umbilical hernias and previous transections of the umbilicus. In patients who are relatively thin, the two layers of fat are fairly close to each other in thickness. In patients who have a large BMI the superficial fat layer is often much thicker than the deep layer Fig. The superficial fat layer is compact, dense with fat cells contained within well organized fibrous septa, whereas the deep fat is a loose areolar layer.
Regardless of the technique used when performing abdominoplasty, vascular territories are interrupted and should be taken into account especially when upper abdominal scars are present. Huger 28 studied the blood supply to the abdomen and designated three vascular zones Fig. Summary 1. Contraindications include generalized obesity, excessive intra-abdominal content, circumferential lower truncal excess, smoking, and planned pregnancy in the near future.
A subcostal, open cholecystectomy scar is a relitive contraindication for traditional abdominoplasty. Lipoabdominoplasty is an alternative technique to traditional abdominoplasty that may be safer and associated with less complications.
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A high lateral tension abdominoplasty HLTA is fundamentally different from the traditional abdominoplasty in that maximum tension is created laterally, rather than centrally and it attempts to not only improve abdominal contour, but also enhance the appearance of the anterior thighs.
Regardless of the technique used, vascular territories are interrupted and should be taken into account, especially when upper abdominal scars are present. Zone I is supplied by the deep epigastric arcade and these vessels are almost always interrupted by flap elevation. Many abdominoplasty scar patterns have been introduced over the past five decades to accommodate different clothing patterns and potential improvements in contour.
The surgeon has to balance the needs of limiting the width of the scar, eliminating lateral standing cones or dog-ears, and appropriately positioning the mons pubis in the vertical dimension. They are not allowed to straighten up for 1 week after surgery. Abdominoplasty is an extensive operation and complications include wound dehiscence, hematoma, wound infection including toxic shock syndrome , seroma, tissue necrosis, contour irregularity, scarring, umbilical deformity, paresthesia, deep vein thrombosis, and pulmonary embolus.
Introduction The modern history of abdominal contouring began in with Kelly 1, 2 performing an abdominal apronectomy or dermolipectomy to eliminate a large abdominal pannus. Thus it is important to work-up these patients and make sure that they can withstand further pulmonary stress prior to contemplating abdominoplasty surgery. A temporary or traditional Greenfield filter may be considered in this instance in conjunction with a vascular surgery consultation.
Previous abdominal scars Patients with previous abdominal scars may require special considerations if abdominoplasty is contemplated. These vessels are interrupted by a subcostal scar and this can lead to abdominal flap necrosis inferomedial to the scar. Recently created subcostal scars, within the past years, usually contraindicate traditional abdominoplasty. Patients who present with old subcostal scars can sometimes undergo an abdominoplasty, but with techniques that limit flap elevation. If the scar is limited to the infraumbilical level, it will usually be removed with the abdominal panniculus and should not prevent the procedure from creating the best possible abdominal contour.
If the incision is supraumbilical, it usually does not prevent the flap from being advanced appropriately. However in some patients, the scar may be hypertrophic and may restrict abdominal flap advancement during the tailoring process. In these patients resecting the scar only, without the underlying fat layers, will allow the advancement. However, even this maneuver may lead to an increased risk of flap necrosis, because dermal vessels cross over in the midline and can lead to a decrease in blood supply of the inferomedial aspects of the abdominal flap.
A less risky way to attain the desired flap advancement is to create multiple small puncture stab incisions along the hypertrophic scar allowing release of the contracted tissues. If a patient desires a revision of the midline scar, it is generally best to perform that in a subsequent procedure after the flap has had enough time to revitalize its blood supply in its new position. Mini-abdominoplasty Indications for mini-abdominoplasty are limited to patients who present with abdominal laxity restricted to the infraumbilical region. Lipoabdominoplasty Lipoabdominoplasty was introduced and popularized by Saldanha 16 from Brazil.
Also, if lymphatic tissues, especially of the femoral region, are left intact, seromas should be less likely. Preoperative Considerations Preoperative evaluation of potential abdominoplasty patients includes a good history and physical examination, and determination of their primary concerns and expectations. Skin The overall quality of skin, including scars and stretch marks should be noted. Subcutaneous fat The thickness of the subcutaneous fat of the anterior abdomen and the surrounding lateral and posterior lower truncal regions should be determined. In male patients, in particular, who have a fat deposition pattern that predisposes them to large visceral fat deposits, the abdominal panniculus thickness may be minimal despite an extremely protrudent abdomen.
If abdominoplasty surgery is contemplated on a patient with a thick panniculus, it is important to choose a technique that allows for thinning of the flap.
This usually involves liposuction and limited undermining. Abdominal wall laxity A third reason for a protruding abdomen is abdominal wall laxity.source site
Plastic & Reconstructive Surgery
Other features The abdominal physical exam should also include an evaluation of the mons pubis. Counselling Finally the patient is counseled about the risks, benefits, and alternatives to surgery. Preoperative photographs Preoperative photographs are taken in the anterior, posterior, lateral and oblique views to demonstrate the full extent of deformities; they guide surgical planning and serve as an important tool in the post-operative assessment of the results. For information on the full range of library services please see our home page.
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Hustand on RealSelf. Hunstad has given numerous clinical presentations and has been invited to be the featured guest speaker at many conferences both domestically and across the globe sharing his knowledge and expertise by performing live surgeries and presenting on various clinical topics. He was recently invited to lecture as the key note speaker at the 36th Annual International Symposium for Plastic and Aesthetic Surgery in Puerto Vallarta. Course Faculty, Dr.
[فروش کتاب] Atlas of Abdominoplasty
Arm Contouring; from Liposuction through Extended Brachioplasty, the 23rd annual Virgin Islands workshop in plastic surgery, January 26 — 30, , St. Hunstad has published more than forty articles related to plastic surgery. He most recently completed his first full work, Atlas of Abdominoplasty. Rated five stars on Amazon, Atlas of Abdominoplasty, details body contouring and other related ancillary procedures with emphasis on massive weight loss.
With nearly full-color illustrations, photographs and a bonus DVD, this textbook engages readers with details on liposuction and the latest endoscopic surgery techniques. To read the full review in the online version of PRS Journal click here.
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Well written, experienced commentary with detail the best detail of any surgical text and most clinically relevant I have found. This book is mandatory for the fellowship training we provide and I have personally reviewed in over and over again. Hunstad has published more than forty Plastic Surgery articles in the world literature concerning body contouring and facelifting. A complete list of his works can be found in his curriculum vitae.
Click here to read the full article. Dean, M. Louis, Louis Missouri,
Related Atlas of Abdominoplasty (Techniques in Aesthetic Plastic Surgery)
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