Complications of abdominoplasty

Plastic surgery 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, are usually divided into general and local.

General complications

The most dangerous general complication of abdominoplasty is the development of overload of the pulmonary circulation and, as a consequence, pulmonary edema as a result of a significant increase in intra-abdominal pressure after excessively wide suturing 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 be extended with the development of local complications, which ultimately may lead to the development of hypostatic pneumonia and even pulmonary embolism.

The main method of preventing these complications is early activation of patients, which is ensured by the appropriate technique of abdominoplasty, relatively early getting out of bed with sufficient immobilization of tissues in the area of the surgical wound.

In patients with accelerated blood clotting rates, it is necessary to carry out specific therapy aimed at preventing thromboembolic complications.

Local complications

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

Seroma. The main cause of seroma development is the formation during surgery of extensive wound surfaces that are loosely adjacent to each other and shift during movements. Constant movements of the abdominal wall play an important role in the pathogenesis of seromas. Despite the fact that the abdominal component of respiration is most pronounced in men, it is also important for women. With loose contact of wound surfaces, inflammatory exudate, the formation of which increases with movement, 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 area, swelling and fluctuation begin to be determined.

The probability of seroma development increases significantly in patients with a significant thickness of subcutaneous fat. An important role in the development of seroma can also be played by performing liposuction through the wall of the main wound (during abdominoplasty). Thus, during liposuction in the lateral parts of the abdomen and the flank area, pressure on these areas leads to a clear movement of wound exudate into the main wound through the channels formed by the cannula.

Diagnosis of seroma is based on clinical signs (swelling in the sloping areas of the abdomen, fluctuation of the anterior abdominal wall, increased body temperature of the patient) and in doubtful cases can be clarified using sonography.

Seroma treatment is usually carried out in two ways. The simplest solution is periodic punctures of the cavity with removal of excess serous fluid. In combination with a pressure bandage, this can be effective, although repeated punctures may be required for a long time (3-5 weeks). However, this approach may be ineffective in relatively large seromas. In these cases, constant drainage of the cavity through the site of the main wound is often necessary.

Since the wound surfaces separated by fluid remain mobile and do not fuse with each other, the drained cavity slowly fills with granulations. Ultimately, the wound can be closed with secondary sutures, but patients are forced to visit the surgeon regularly for a long time (up to 2-6 months), which, combined with a significant deterioration in the quality of scars, determines the patient's negative assessment of the treatment outcome. Over time, this assessment can significantly improve, including after corrective surgeries. With late diagnosis of seroma, wound suppuration may develop.

The main areas of seroma prevention are:

• the use of those methods of abdominoplasty that are not associated with significant detachment of skin and fat flaps on the anterior abdominal wall (tension-ocular or vertical abdominoplasty);
• application of additional sutures during the operation to fix the deep surface of the skin-fat flap to the surface of the aponeurosis;
• refusal of extensive liposuction through the wall of the main wound;
• sufficient postoperative tissue immobilization, which is ensured by:
  • by applying a special compression bandage on the operating table, which ensures relative immobilization of the tissues of the anterior abdominal wall;
  • bed rest during the first day after surgery and limited movement during the next 2 weeks;
  • maintaining the position of the flaps during movements and the vertical position of the patient's body due to the semi-bent position of the body.

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

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

• formation of too large a flap on the anterior abdominal wall, as a result of which the blood supply to its edge may be insufficient;
• suturing the skin with tension, which can further reduce the nutrition of the flap edge below a critical level;
• the presence of postoperative scars on the anterior abdominal wall, which impair blood flow to the edge of the formed flap.

The main directions of prevention of necrosis of tissues forming wound walls are obvious and are discussed in the relevant sections of this chapter.

One of the variants of postoperative tissue necrosis is necrosis of the subcutaneous fat along the edge of the opening used for umbilical plastic surgery after transposition of the skin-fat flap. The reason for this may be excessive tightening of the skin sutures fixing the edges of the umbilicus to the edges of the skin wound and to the aponeurosis of the abdominal wall, as a result of which the edges of the skin of the abdominal wall wound are displaced inward. With a significant thickness of the subcutaneous fat and (or) its insufficient excision (around the umbilical opening), compression of the fat may lead to its necrosis and subsequent suppuration of the wound.

Wound suppuration is usually a consequence of the development of one of the complications described above (seroma, hematoma, soft tissue necrosis), if the latter were diagnosed late and their causes were not eliminated actively enough. Patients are treated according to generally accepted surgical rules (wide drainage of the suppuration site, excision of necrotic tissue, general and local drug treatment, etc.).

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