Vertical abdominoplasty

General characteristics and indications for operation

With vertical abdominoplasty, the surgeon uses a vertical incision along the midline of the abdomen, in conjunction with horizontal access, typical for classical or stress-side abdominoplasty. The main advantages of vertical plasty of the anterior abdominal wall are:

• the possibility of removing a significant amount of tissue located along the median zone of the anterior abdominal wall;
• the possibility of separating the edges of skin-gingival flaps only within the proximity of the aponeurovaparated abdominal muscles;
• the possibility of a significant reduction in the circumference of the trunk due to the creation of 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 over the entire height of the anterior abdominal wall. With this in mind, vertical abdominoplasty is shown:

• when the hypertrophied fat layer is located mainly along the midline of the abdomen, in connection with which the conduct of other types of abdominoplasty does not give good cosmetic results;
• in the presence of significant transverse overgrowth of the skin and the musculo-aponeurotic system (including in the presence of an umbilical hernia), which requires the duplication of the aponeurosis of the anterior abdominal wall of considerable width (10 cm and more). With other types of abdominoplasty, this leads to the creation of a hardly removable excess of skin in the epigastric region, which persists even when additional deep seams are applied;
• with significant thickness of the subcutaneous fat layer in cases of pronounced obesity, which makes dangerous even a minimal detachment of skin-fat flaps due to the high probability of postoperative complications;
• in the presence of centrally located scars after a medial laparotomy.

Technique of operation

When the patient is in a vertical position, the lining of the median and lower-horizontal accesses, as well as the approximate boundaries of tissue excision, are marked out.

After applying the main incisions, the edges of the skin-fat flaps are separated to the sides to the level of the boundaries of their supposed excision. Throughout the vertical part of the access, the tissue separation boundary extends 2-3 cm to the outside of the line of creation of the aponeurosis duplication of the anterior abdominal wall. Duplicate tissues are created according to the generally accepted pattern, as a result of which the edges of the lateral fatty flaps converge.

After imposing with a moderate tension a deep series of sutures (with the capture of the superficial fascial layer) determine the boundaries of excision of the edges of the flaps, which are then laminated together layerwise with a slight tension.

After bending the operating table, the horizontal wound portion is gradually closed down, using the above described elements of the technique of classical and (or) stress-side abdominoplasty.

One of the features of wound closure with vertical abdominoplasty is the swelling of the skin seam line in the epigastric region, creating a cosmetic defect. For its elimination, limited liposuction of the subcutaneous fat layer can be performed. Another way to solve this problem is to shift the seam line of the subcutaneous fatty tissue by 1-2 cm to the side in relation to the skin seam line. In this case, the line of the skin seam should be located strictly along the midline of the abdomen.