Comparison of Limited-Undermining Lipoabdominoplasty and Traditional Abdominoplasty Using Laser Fluorescence Imaging
Aesthetic Surgery Journal
Comparison of Limited-Undermining Lipoabdominoplasty and Traditional Abdominoplasty Using Laser Fluorescence Imaging
Jason Roostaeian 0
Ryan Harris 0
Jordan P. Farkas 0
Fritz E. Barton 0
Jeffrey M. Kenkel 0
0 Dr Roostaeian is a clinical instructor at the University of California, Los Angeles Health. Mr Harris is a medical student, Dr Barton is a Clinical Professor, and Dr Kenkel is the Vice Chairman and Program Director of the Department of Plastic Surgery, University of Texas Southwestern, Dallas. Dr Farkas is a plastic surgeon in private practice in Paramus , New Jersey , USA
Background: Body contouring that involves abdominoplasty and/or liposuction is a common cosmetic surgery procedure. Although single-staged lipoabdominoplasty has gained popularity, safety concerns remain. Objectives: The authors compared abdominal flap perfusion and overall complication rates for traditional abdominoplasty and limited-undermining lipoabdominoplasty. Methods: Eighteen abdominoplasty patients were evaluated in a prospective study. All patients were nonsmokers and lacked major comorbidities. The control group (n = 9) underwent traditional abdominoplasty with wide undermining. The study group (n = 9) underwent abdominoplasty with limited undermining as well as liposuction of the abdominal flap. The groups were similar with respect to age and body mass index. Patients received follow-up for an average of 97 days. Fluorescence imaging was utilized for perfusion studies. Results and complications were documented, and statistical significance was ascertained via the Student t test. Results: Neither group had major complications or revisions. Minor complications included an exposed suture, resulting in delayed wound healing, in the control group. A patient in the study group had a small area of fat necrosis and a small seroma, neither of which required further treatment. No significant difference in abdominal flap perfusion was found between the control (57%) and study (50%) groups based on fluorescence levels relative to a designated baseline reference marker. Conclusions: Results of the study indicate that no significant differences exist between the 2 operations with respect to the rates of abdominal flap perfusion or complications.
eol>abdominoplasty; lipoabdominoplasty; laser fluorescence imaging; perfusion; SPY system
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Many studies have shown that, compared with traditional
abdominoplasty alone, combining liposuction and
abdominoplasty into a single procedure may improve aesthetic outcomes
and reduce the indication of secondary procedures, without
increasing complications.1-10 Nevertheless, concerns about
compromised abdominal flap vascularity, which may increase
the incidence of wound dehiscence and skin necrosis, have
prevented many surgeons from adopting the procedure.
Efforts have been directed at improving our
understanding of the abdominal vasculature to minimize the potential
for wound-healing problems and complications. Huger11
described 3 vascular zones of the abdominal wall, and
Matarasso8 outlined safety areas for liposuction combined
with abdominoplasty. Saldanha et al6 later popularized
lipoabdominoplasty by describing a selective undermining
approach and recommended a perforator-sparing
procedure with limited lateral undermining of the abdominal
flap to improve perfusion. The rate of complications was
low in their study, mitigating the stigmas associated with
concurrent liposuction. The safety of lipoabdominoplasty
was further corroborated by a large retrospective study by
Stevens et al,2 who found that the complication rate for the
combined procedure was not higher than that of traditional
abdominoplasty.
Successful clinical results have been reported for
lipoabdominoplasty, but the literature lacks prospective analyses
with objective outcomes. It is likely that the paucity of
quantifiable data has contributed to the procedure’s lack of
overall acceptance in the plastic surgery community.
Our prospective observational study was designed to
compare perfusion rates for lipoabdominoplasty and
traditional abdominoplasty by means of the SPY Elite System
(LifeCell Corp, Bridgewater, New Jersey), a fluorescent
imaging device that quantifies tissue perfusion.
MEthods
Study Design
After obtaining approval from Institutional Review Board at
the University of Texas Southwestern, a prospective,
controlled trial was conducted on 18 patients who underwent
abdominoplasty between October 2012 and June 2013.
Patients satisfied at least 1 of the following inclusion criteria:
abdominal wall laxity, excess skin or subcutaneous tissue,
and/or striae at presentation. Each enrolled patient provided
informed consent for the study, surgical procedure, and
fluorescent imaging with iodinated contrast. Exclusion criteria
included a history of smoking, significant comorbidities, and
any known allergy to iodinated dye.
The control group (n = 9) underwent traditional
abdominoplasty. The study gro (...truncated)