Complications of abdominoplasty

The plastic of the anterior abdominal wall is a highly effective intervention, but under certain conditions it can lead to the development of dangerous complications. The latter, as always, is divided into general and local.

Common complications

The most dangerous common complication of abdominoplasty is the development of small-circulation overload and, as a consequence, pulmonary edema as a result of a significant increase in intra-abdominal pressure after an excessively wide suture of the aponeurosis of the anterior abdominal wall.

Later general complications are associated with the patient's hypodynamia during the first week after surgery. However, this period may expand with the development of local complications, which ultimately is fraught with the development of hypostatic pneumonia and even thromboembolism of the pulmonary artery.

The main method of preventing these complications is the early activation of patients, which is provided by the appropriate technique of abdominoplasty, relatively early rising from bed with sufficient immobilization of tissues in the area of the operating wound.

In patients with accelerated rates of blood clotting, it is necessary to conduct specific therapy aimed at the prevention of thromboembolic complications.

Local complications

The most frequent local complications are the development of seroma, hematoma, soft tissue necrosis and suppuration of the wound.

Seroma. The main cause of the development of seroma is the formation during the operation of extensive wound surfaces, which loosely adjoin to each other and are displaced during movements. In the pathogenesis of gray, an important role is played by constant movements of the abdominal wall. Despite the fact that the abdominal component of respiration is most pronounced in men, it is also important for women. In the case of loose contact of wound surfaces, inflammatory exudates, the formation of which is intensified during movements, accumulates in the wound and moves under the action of gravity to the lower parts of the wound. With a sufficient volume of fluid in this zone, swelling and fluctuation begin to be determined.

The likelihood of seromy is significantly increased in patients with significant thickness of subcutaneous fat. An important role in the development of seromy can also be played by performing liposuction through the wall of the main wound (during abdominoplasty). Thus, with liposuction in the lateral parts of the abdomen and the flank region, pressing on these zones leads to a distinct movement of the wound exudate into the main wound through the channels formed by the canula.

Diagnosis of seroma is based on clinical signs (swelling in the loins of the abdomen, fluctuating the anterior abdominal wall, increasing the patient's body temperature) and in doubtful cases can be refined by sonography.

Treatment of seroma, as a rule, is carried out in two versions. The simplest solution is the periodic performance of the puncture of the cavity with the removal of excess serous fluid. In combination with a pressure bandage, this can give a result, although repeated punctures may be required for a long time (3-5 weeks). However, such an approach may prove ineffective for relatively large serums. In these cases, it is often necessary to continuously drain the cavity through the main wound site.

Due to the fact that the fluid-separated wound surfaces remain mobile and do not coalesce with each other, the drained cavity is slowly filled with granulations. Eventually, the wound can be closed with secondary seams, but patients have to visit the surgeon for a long time (up to 2-6 months), which, combined with a significant deterioration in the quality of the scars, determines the patient's negative assessment of the outcome of the treatment. Over time, this assessment can significantly improve, including after performing corrective operations. At late diagnostics of a seroma the suppuration of a wound can develop.

The main areas of prevention of gray are:

• the use of those methods of abdominoplasty that are not associated with a significant detachment of skin-fat flaps in front of her abdominal wall (tense-ocular or vertical abdominoplasty);
• superposition during the operation of additional seams fixing the deep surface of the skin-fat flap to the surface of the aponeurosis;
• failure of extensive liposuction through the wall of the main wound;
• sufficient postoperative immobilization of tissues, which is ensured by:
  • superimposition on the operating table of a special compression bandage, providing relative immobilization of the tissues of the anterior abdominal wall;
  • bed rest for the first 24 hours after the operation and limited movement for the next 2 weeks;
  • Preservation of the position of the flaps during movements and vertical position of the patient's body due to the half-bent position of the trunk.

Hematoma is a rare complication, the prevention of which is a careful stop of bleeding, suturing the wound without leaving significant cavities and draining the wounded space.

Necrosis of the edges of the wound. The causes of necrosis of the edges of the operating wound are:

• forming too large a flap on the anterior abdominal wall, as a result of which the blood supply to its edge may not be sufficient;
• Stitching on the skin with tension, which can further reduce the feeding of the flap edge below the critical level;
• presence of postoperative scars on the anterior abdominal wall, worsening the flow of blood to the edge of the formed flap.

The main directions of the prevention of necrosis of tissues that form the walls of the wound are obvious and are considered in the relevant sections of this chapter.

One of the variants of postoperative tissue necrosis is the necrosis of subcutaneous adipose tissue along the edge of the hole used for the plastic of the navel after transposition of the skin-fat flap. The reason for this may be an excessive tightening of the skin seams that fix the edges of the navel to the edges of the cutaneous wound and to the aponeurosis of the abdominal wall, as a result of which the edges of the skin of the wound of the abdominal wall move inward. With a significant thickness of subcutaneous fat and (or) its insufficient excision (around the umbilical orifice) compression of fatty tissue can lead to its necrosis and subsequent suppuration of the wound.

Suppuration of the wound is usually a consequence of the development of one of the complications described above (seroma, hematoma, soft tissue necrosis), if the latter were late diagnosed, and their causes are not actively eliminated. Treatment of patients is carried out according to generally accepted surgical rules (wide drainage of foci of suppuration, excision of necrotic tissues, general and local medication, etc.).

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