PURPOSE: Residents' duty-hour regulations and the evolution of minimally invasive surgical techniques require more effective and efficient surgical skill teaching models. We used frozen-thawed human tissue remnants harvested during abdominoplasty or abdominal tissue-based breast reconstruction to allow for a medium-sized group workshop program, simulating a realistic surgical environment and visual/haptic feedback. METHODS: Full-thickness abdominal tissue (skin and subcutaneous fat) were donated from patients who underwent autologous breast reconstruction and gave consent to use their tissue for comprehensive research and medical educational purposes. Anonymized tissue was frozen-preserved and then thawed the day of the surgical skills workshop. A total of 53 residents completed 50-minute hands-on training in 3-to-5 person modules in four sessions of the workshop program. RESULTS: Thawed tissue regained almost normal texture and consistency. Structural integrity was also histologically confirmed. All participants were generally satisfied with the program, especially regarding the suture material provided. CONCLUSION: Frozen-thawed tissue remnants from abdominoplasty or autologous breast reconstruction could be preserved and used as a suture education material in medium-group workshops for surgery residents or medical students given anonymity and with proper consent guaranteed. This approach provided an excellent model maintaining relatively real anatomic structure and consistency with minimal cost.
Abdominoplasty ; Anonyms and Pseudonyms ; Education ; Female ; Humans ; Internship and Residency ; Mammaplasty ; Social Control, Formal ; Students, Medical ; Sutures ; Training Support

Abdominoplasty ; Lipectomy

Umbilical preservation can be challenging, particularly in complex cases involving simultaneous ventral hernia repair and abdominoplasty. Although the umbilicus serves no functional purpose, removal of the umbilicus can draw unwanted attention to the abdominal area and can cause emotional distress to patients. There are several well documented options for umbilical reconstruction. We present a new umbilical reconstruction technique relevant for such cases. This neoumbilicoplasty allows for preservation of the original umbilicus with relocation and reconstruction using local flaps. The technique is relatively simple and the time needed is minimal. The result is a natural, well positioned umbilicus using the principles of spare part surgery.
Abdominoplasty ; Hernia, Ventral ; Herniorrhaphy ; Humans ; Umbilicus

Abdominal Wall ; Abdominoplasty ; Humans ; Patient Satisfaction ; Postoperative Complications

BACKGROUND: The donor site of abdominal flaps for breast reconstruction consists of a wide suprafascial cavity that poses a risk of seroma formation. The authors evaluated the efficacy of continuous progressive tension sutures (PTS) using unidirectional barbed absorbable sutures for decreasing the volume of fluid collection and the risk of seroma at the abdominal donor site. METHODS: Between March 2013 and February 2015, 37 consecutive patients underwent breast reconstruction using a deep inferior epigastric artery perforator flap. Two patients who underwent salvage operations were excluded. Ten patients underwent standard abdominal flap donor site closure without PTS. Seven received donor site closure with interrupted Vicryl PTS between the abdominal flap and abdominal muscle fascia. Eighteen patients underwent closure with continuous PTS using unilateral barbed absorbable sutures. Body mass index, the approximate flap area, the duration of drain maintenance, the total drained volume, and the incidence of seroma were compared across these 3 groups. The operative time and subjective difficulty perceived by the surgeon was compared between the 2 PTS groups. RESULTS: The total drained volume was lower and the duration of drain maintenance was shorter in both PTS groups than in the standard closure group. There were no cases of seroma in the PTS groups, and 2 that resolved with conservative care in the standard closure group. More time was required and the subjective difficulty score was significantly higher for interrupted PTS than for continuous PTS. CONCLUSIONS: Continuous PTS effectively reduced the duration of drain insertion, the total volume of drained fluid, and was swifter and easier to perform than interrupted PTS.
Abdominal Muscles ; Abdominoplasty ; Body Mass Index ; Breast ; Epigastric Arteries ; Fascia ; Female ; Free Tissue Flaps ; Humans ; Incidence ; Mammaplasty ; Operative Time ; Perforator Flap ; Polyglactin 910 ; Seroma ; Sutures ; Tissue Donors

Abdominal wall endometriosis is a condition in which functioning endometrial tissue is present outside the uterine cavity, and the standard treatment is extensive surgical excision. A 46-year-old woman presented with an irregular lower abdominal mass measuring 8.5×4.5 cm. The patient had a history of a cesarean delivery 15 years previously. For treatment, a mini-abdominoplasty was designed to avoid possible wound complications and to optimize the cosmetic outcomes. The lesion was excised with an adequate margin because of the possibility of recurrence. The resected structures were the lower mid-abdominal skin, subcutaneous fat, anterior and posterior rectus sheath, and rectus abdominis muscle. The incisional wound was closed layer by layer, including abdominal fascia repair with acellular dermal matrix. At a 3-month postoperative outpatient follow-up visit, the patient was highly satisfied with the cosmetic results and reported no complications. Optimal oncological, functional, and cosmetic surgical outcomes can be achieved by complete excision followed by mini-abdominoplasty.
Abdominal Wall* ; Abdominoplasty ; Acellular Dermis ; Endometriosis* ; Fascia ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Outpatients ; Rectus Abdominis ; Recurrence ; Skin ; Subcutaneous Fat ; Wounds and Injuries

BACKGROUND: The effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser–Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik). METHODS: Nine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively. RESULTS: The measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures. CONCLUSIONS: The liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.
Abdominal Wall ; Abdominoplasty ; Capillaries ; Epigastric Arteries ; Female ; Humans ; Lipectomy* ; Oxygen ; Perforator Flap ; Perfusion* ; Spectrophotometry

BACKGROUND: Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. METHODS: A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. RESULTS: According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. CONCLUSIONS: The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
Abdominoplasty* ; Cicatrix, Hypertrophic ; Cosmetic Techniques ; Humans ; Lipectomy ; Medical Subject Headings ; Necrosis ; Observer Variation ; Postoperative Complications ; Pulmonary Embolism ; Reconstructive Surgical Procedures ; Seroma ; Skin ; Surgery, Plastic ; Sutures ; Venous Thrombosis

BACKGROUND: Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. METHODS: A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. RESULTS: According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. CONCLUSIONS: The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
Abdominoplasty* ; Cicatrix, Hypertrophic ; Cosmetic Techniques ; Humans ; Lipectomy ; Medical Subject Headings ; Necrosis ; Observer Variation ; Postoperative Complications ; Pulmonary Embolism ; Reconstructive Surgical Procedures ; Seroma ; Skin ; Surgery, Plastic ; Sutures ; Venous Thrombosis

BACKGROUND: Creating a natural-looking umbilicus during closure of the donor-site in abdominally based free flap breast reconstruction is a factor of satisfaction for both the patient and surgeon. We present a simple method of umbilical transposition that results in an aesthetic, natural-looking umbilicus. METHODS: From March 2011 to November 2014, fifty three consecutive female patients received abdominal flap breast reconstruction. Twenty patients (from March 2011 to February 2013) underwent umbilical transposition through a cross like incision in the abdominal flap, with fascial fixation sutures but no dermal flaps. Thirty three patients (March 2013 to November 2014) received umbilical transposition in the following method. An oval-shaped incision is made at the location of the new umbilicus on the abdominal flap. This oval is deepithelialized, and full-thickness incisions are made at the 2, 6, and 10 o'clock directions to create three triangular dermal flaps. These are pulled down to the abdominal fascia using sutures that pass through the umbilical stalk and the abdominal fascia at the 3, 9, and 12 o'clock directions. This results in an umbilical stalk lined with dermal flaps, creates a natural periumbilical concavity, and anchors the abdominal flap inward to minimize tension. The cranial flap enhances superior hooding. RESULTS: Patient and surgeon satisfaction, surveyed 2 months after surgery with a satisfaction scoring system, were higher in the dermal flap group. CONCLUSIONS: The technique using three dermal flaps in an oval skin incision is simple, relatively easy to learn, and results in an aesthetic, natural-looking umbilicus.
Abdominoplasty ; Fascia ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty ; Methods* ; Skin ; Surgical Flaps ; Sutures ; Umbilicus