The presence of scars on the anterior abdominal wall significantly affects the planners and the technique of performing the operation, since the existence of "avascular" zones of scar tissue within the cut out flaps can significantly worsen their blood supply and lead to the development of severe complications. Most often the surgeon meets with the arrangement of scars along the median line, horizontal scars in the suprapubic zone, as well as obliquely arranged scars in the right ileal region (after appendectomy) and in the right hypochondrium (after cholecystectomy).
Vertical scars located below the navel, as well as scars localized in the right ileal region, are usually removed along with excised tissues during classical or stress-side abdominoplasty. The arrangement of the scar on the front line above the navel is the basis for vertical abdominoplasty.
The greatest difficulties are caused by the surgeon's relatively long scars, left after cholecystectomy, as well as atypically located scars in the perepump zone. In some cases, they can be included without special difficulty in the tissue complex being removed. In others, this may require atypical access, in which sufficient blood supply to the created flaps is maintained.
Important is also the length of the scar and its location in relation to the main direction of blood flow to the peripheral part of the formed skin-fat flap. Thus, the blood supply of the flap can not practically change under the influence of the cicatricial barrier with small size of the rumen and (or) its location parallel to the main direction of the blood flow. With a transverse arrangement of a sufficiently long scar, forming a flap is dangerous.
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