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Abstract Summary Abdominoplasty is a common procedure within plastic surgery; it aims to reshape the abdominal wall by combining skin and subcutaneous tissue resection with musculoaponeurotic reinforcement. The presence of infraumbilical scar don’t present a problem as it will be excised with the excess ellipse, but supraumbilical (vertical, oblique or transverse) scars must always be considered in patients for whom an abdominoplasty is planned, and various techniques are described to treat these cases. Limited abdominoplasty of the low transverse type with limited undermining only up to the level of the umbilicus is performed in order not to compromise blood supply in the zone between the old transverse and the new transverse scar. Limited undermined of the flap in an inverted-V fashion, preserving the intercostals blood supply and elevating the flap only to the degree necessary to achieve wound closure without tension and repair of the diastasis. Discontinuous undermining by dissecting the supraumbilical flap by blunt dissection is described to improve flap perfusion. Progressive tension sutures or Quilting sutures better to performed when there is large dead space or at high risk patients. Liposuction is performed away from the zones 1 and 3 of Huger, but liposuction of the hip and lower flanks is performed freely. It is preferably to perform a second-stage liposuction. Summary and Conclusion 99 The blood supply to the abdominal flap can be improved by selective dissection of perforator vessels in patients with supraumbilical scars, which enables us to perform a full abominoplasty with complete flap undermining. Most of patients who are candidates for an abdominoplasty and present supraumbilical median or paramedian scars, especially in case of concomitant intraabdominal procedures, an anchor-line abdominoplasty should always be considered. Correction of incisional hernia if present is performed during abdominoplasty. Umbilical reconstruction is done according to presence or absence of umbilicus and partial or total loss of the umbilicus. Conclusion Abdominoplasty and abdominal contouring procedures can be safely performed in patients with pre-existing abdominal scars after proper evaluation, careful planning, and modification of standard abdominoplasty techniques. An understanding of the vascular supply to the abdominal soft tissue and a clear discussion with the patient about risks and expectations are important to achieve the optimal aesthetic result and high patient satisfaction. Category I patients who have scars that will be incorporated into the soft-tissue resection segment require little modification of the standard technique. Category IIA and IIB patients require individualized plans. Category IIA patients are often best served by a reverse abdominoplasty alone or staged with a lower abdominoplasty, whereas category IIB patients usually require the addition of a vertical/oblique anterior resection. Summary and Conclusion 100 The recommended technique for performing abdominoplasty in patients with previous supraumbilical scars is; limited undermining of the abdominal flap in a triangular shape from the xiphoid to anterior superior iliac spine with selective dissection and preservation of one or more of peri-umbilical rectus abdominis perforator vessels. Progressive tension sutures or Quilting sutures can be used when indicated. This method leads to safe procedure, good aesthetic outcomes, and less incidence of postoperative complications, so it is advised to be performed also at high risk patients (DM, smokers, hypertension, and morbid obesity). |