Anamnesis. Carefully collected history allows you to understand the causes of the development of pathological changes in the anterior abdominal wall. To do this, the surgeon finds out the presence of previous pregnancies, changes in body weight and the effect of each pregnancy on the condition of the anterior abdominal wall.
Motivation. Stretching bands on relaxed abdominal skin are a cosmetic defect and prevent many women from appearing on the beach in an open swimsuit. The presence of a crease on the abdomen is emphasized by tight clothing. The existence of an "apron" of soft tissues disrupts a woman's sexual attractiveness and can cause disharmony of family relationships.
Medical examination. Patients are examined in the nude in a standing position, and then lying down. During the examination, there are scars on the anterior abdominal wall, the number, distribution and appearance of the stretch bands, the degree of obesity, the presence of hernial protrusions. Determine the tone of the anterior abdominal wall and the edge of the muscles. Excess skin is evaluated by taking it into the fold and moving this fold to the inguinal level. This test allows you to determine the type and location of the proposed section. Ultimately, the surgeon chooses the final method for correcting the deformation in this patient and informs him of the maintenance of the operation.
Indications and contraindications. The main indications for abdominoplasty are:
- presence of skin stretch bands located mainly in the hypogastric region, combined with flabbiness of the skin;
- presence in the lower abdomen of the skin-fat "apron";
- significant divergence of the rectus abdominis muscles;
- flabbiness of the skin in combination with umbilical hernia;
- extensive postoperative scars.
Many patients, especially those with excessive body weight, want to create a waist and generally improve the figure "at once and as much as possible", not dooming themselves to exercise and dieting. It is understandable that for some patients this intervention seems to be a "simple and reliable measure" that can solve their problems. In these cases, it is advisable to recommend patients to reduce body weight, having previously consulted a nutritionist.
In the presence of obesity with significant adipose tissue deposits in the anterior abdominal wall, surgical methods are often considered as the last hope after unsuccessful shaping and dieting. In these cases, the question of the operation must be solved differentially, depending on the specific conditions.
The most frequent common contraindications are:
- the presence of scars on the anterior abdominal wall located above the navel (for example, after cholecystectomy), with the possibility of their significant influence on the blood supply of the flaps being cut during the operation;
- excessive thickness of the subcutaneous fat layer on the anterior abdominal wall, which increases the likelihood of postoperative complications.
The general factors that make abdomino-plastic surgery unreasonable or premature include:
- the intention of the patient to lose weight later, which will worsen the result of the operation;
- possible pregnancy, which will lead to loss of the achieved result;
- the presence of common diseases (diabetes, heart disease, etc.).
Preoperative preparation. For 2 weeks before surgery, patients should not take drugs containing acetylsalicylic acid. During the last two days before the operation, the patient is transferred to the "water diet". In the evening before the operation and on the morning of the day of intervention, a cleansing enema is put.
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