Vertical abdominoplasty

General characteristics and indications for surgery

In vertical abdominoplasty, the surgeon uses a vertical incision along the midline of the abdomen, combined with the horizontal approach typical of classic or tension-lateral abdominoplasty. The main advantages of vertical plastic surgery of the anterior abdominal wall are:

• the ability to remove a significant volume of tissue located along the median zone of the anterior abdominal wall;
• the possibility of separating the edges of the skin-fat flaps only within the converging areas of the aponeurotic rectus muscles of the abdomen;
• the possibility of significantly reducing the circumference of the body by creating a wide duplication of the aponeurosis of the anterior abdominal wall with the removal of excess skin in the epigastric region.

The disadvantage of this method of abdominoplasty is the formation of a vertical scar along the entire height of the anterior abdominal wall. Taking this into account, vertical abdominoplasty is indicated:

• when the hypertrophied fat layer is located predominantly along the midline of the abdomen, which is why other types of abdominoplasty do not produce good cosmetic results;
• in the presence of significant transverse overstretching of the skin and muscular-aponeurotic system (including in the presence of an umbilical hernia), which requires the creation of a duplication of the aponeurosis of the anterior abdominal wall of significant width (10 cm or more). With other types of abdominoplasty, this leads to the creation of a difficult-to-remove excess skin in the epigastric region, which remains even with the application of additional deep sutures;
• with a significant thickness of the subcutaneous fat layer in cases of severe obesity, which makes even minimal detachment of skin-fat flaps dangerous due to the high probability of developing postoperative complications;
• in the presence of centrally located scars after midline laparotomy.

Technique of operation

With the patient in a vertical position, the lines of the median and lower-horizontal accesses are marked, as well as the approximate boundaries of the tissue excision.

After the main incisions have been made, the edges of the skin-fat flaps are separated to the sides to the level of the boundaries of their intended excision. Along the vertical part of the access, the tissue separation boundary runs 2-3 cm outward from the line of creation of the duplication of the aponeurosis of the anterior abdominal wall. The tissue duplication is created according to the generally accepted scheme, as a result of which the edges of the lateral fat flaps are brought together.

After applying a deep row of sutures with moderate tension (capturing the superficial fascial layer), the boundaries of the excision of the edges of the flaps are determined, which are then sutured layer by layer with slight tension.

After bending the operating table, the horizontal section of the wound is closed in stages, using the elements of the classical or/and tension-lateral abdominoplasty technique described above.

One of the features of wound closure in vertical abdominoplasty is the bulging of the skin suture line in the epigastric region, which creates a cosmetic defect. To eliminate it, limited-scale liposuction of the subcutaneous fat layer can be performed. Another option for solving this problem is to shift the suture line of the subcutaneous fat tissue by 1-2 cm to the side in relation to the skin suture line. In this case, the skin suture line should be located strictly along the midline of the abdomen.