Classic abdominoplasty

The technique of classical abdominoplasty was developed in North America in the 1960s. Although various modifications of this operation have been proposed over the past 30 years, its principles have remained the same. These include:

• transverse incision in the lower abdomen;
• wide allocation of the skin-fat flap to the level of the edge of the costal arch;
• strengthening the muscular wall by creating a duplication of the aponeurosis;
• resection of the excess part of the flap with maximum removal of tissue in the central zone;
• navel transposition;
• suturing a wound with the hips bent.

This technique is quite simple, relatively safe and usually produces good results.

The main conditions necessary for performing classical abdominoplasty are considered to be: 1) a significant excess of soft tissue in the hypogastric region with the presence of a sagging skin-fat fold ("apron") and 2) sufficient mobility of the navel and skin of the anterior abdominal wall with an average or significant thickness of the subcutaneous fat layer.

Marking the surgical field

With the patient in an upright position, a midline is drawn from the xiphoid process through the umbilicus to the pubic symphysis. The anterior superior iliac spines are connected by a transverse line. The access line is located approximately 1.5-2 cm above the pubic level within the "swimsuit" zone. In most cases, the incision line is W-shaped with a small protrusion located along the midline. This protrusion relieves the suture line and is not needed only if the excess soft tissue in the upper sections of the anterior abdominal wall is significant and the edge of the flap at the level of the umbilicus can be freely shifted caudally until it touches the opposite edge of the wound.

The surgeon defines and marks the expected boundaries of tissue excision, creating a skin-fat fold on the anterior abdominal wall with his fingers. At the end of the marking, the symmetry of the applied lines is determined. With greater ptosis of soft tissues, the incision can be easily placed in the hairy part of the pubis and inguinal fold. With less mobile skin, the incision can be made higher.

Technique of operation

In the midline area, the incision is made with an upward bevel, which allows the wound edges to be precisely aligned along the entire depth when closed, thereby reducing the likelihood of painful retraction above the pubis.

The superficial inferior epigastric vessels are transected and ligated. The skin-fat flap is detached over the aponeurosis of the abdominal wall, leaving a thin layer of fatty tissue on its surface.

The umbilicus is mobilized by a circular incision and isolated on a pedicle. The skin-fat flap is then dissected to the umbilicus and gradually separated to the level of the xiphoid process and the edges of the costal arch. Large perforating vessels are ligated and transected. In classical abdominoplasty, a wide separation of the flap to the level of the anterior axillary line is necessary to move the umbilicus to the suprapubic line if there is no true vertical excess skin. In this case, relaxed tissues from the lateral sections are moved in the central-caudal direction, ensuring the movement of the skin along the midline.

After preparing the flap, the midline is marked on the aponeurosis, after which its duplication is created from the xiphoid process to the pubic bone. In this case, interrupted reverse sutures are applied (with a knot deep, so that they are not subsequently palpable under the skin) or/and a continuous wrap suture. A strong non-absorbable suture material (prolene No. 1-2/0) or a material that is absorbed over a long period of time (maxon No. 0) is used.

One of the reliable options for performing the operation is the application of two sections of continuous suture (from the xiphoid process to the navel and from the navel to the pubic symphysis) with the addition of several interrupted sutures that relieve and strengthen the continuous suture. When applying a wraparound suture, in addition to reducing the waist circumference, the vertical size of the anterior abdominal wall is shortened.

The next step is to remove the excess skin-fat flap. To do this, the flap is moved with a certain force in the distal-medial direction and a central fixing suture is applied.

Then, using a marking clamp, mark the line of flap excision (with the patient in a horizontal position), excise excess tissue, bend the operating table to an angle of 25-30°, apply layer-by-layer sutures, and actively drain the wound.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]