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Using Fillers in the Abdomen and Buttocks
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Rosemarie Mazzuco, Taciana Dal’Forno Dini
The human abdomen is defined as incorporating the anterior region of the trunk between the thoracic diaphragm superiorly and the pelvic brim inferiorly (1). The anterior wall of the abdomen has nine layers. From outermost to innermost, they are skin, subcutaneous tissue, superficial fascia, external obliques, internal obliques, transversus abdominis, transversalis fascia, preperitoneal adipose and areolar tissue, and the peritoneum. The subcutaneous tissue of the anterior abdominal wall below the umbilicus is also separated into two distinct layers: the superficial fatty layer known as Camper’s fascia, and the deeper membranous layer known as Scarpa’s fascia. This membranous layer is continuous with Colles’ fascia within the perineal region inferiorly (2).
Advanced autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
Regarding the donor site, the “boomerang” skin paddle allows for easy re-approximation of the skin allowing for a tension free closure. Harvesting of additional tissue beyond the skin margins below the level of Scarpa’s fascia preserves the subcutaneous fat which minimizes the contour deformity of the donor site. The final position of the donor site scar is easily concealed in clothing, while the traditional SGAP flap may have a scar that becomes apparent in bathing suits or other apparel.
The use of Fat-Augmented Latissimus Dorsi (FALD) flap for male Poland Syndrome correction: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Fabio Santanelli di Pompeo, Michail Sorotos, Guido Paolini, Gennaro D’Orsi, Guido Firmani
The reconstructive process consisted of a pedicled FALD flap. The preoperative markings were performed the day prior to surgery, with the patient in the upright position. The largest possible transverse skin paddle was drawn on the back (19.0 cm × 8.0 cm) using the pinch test. The major axis of the skin paddle was drawn slightly tilted compared to an imaginary transverse horizontal line, which allowed an easy closure of the donor site. The surgery started with the patient in right lateral decubitus position and with the left upper limb suspended at a right angle, to provide adequate axillary access. The skin paddle was first de-epithelialized, then its edges were incised perpendicularly through the Scarpa’s fascia and down to the muscle fascia. The LD muscle was then harvested in its entirety, dissecting proximally up to the insertion tendon on to the intertubercular groove of the humerus, keeping the thoracolumbar fascia intact on the back. The thoracodorsal pedicle was identified from below, isolated and dissected proximally, until reaching the required length for tension-free flap transposition. The thoracodorsal nerve was not sectioned to avoid late muscle atrophy, in order to perform a functional reconstruction of the left thoracic wall. A suction drain was placed at the donor-site, which was closed in two layers. An incision was performed on the left thoracic wall to provide an adequate view of the recipient site and avoid pneumothorax or pericardial injury. The recipient area was prepared, extending dissection from the anterior axillary line to the left parasternal line and from the manubrium to the xiphisternal line.
Objective evaluation of fat tissue induration after breast reconstruction using a deep inferior epigastric perforator (DIEP) flap
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Yoshihiro Sowa, Isao Yokota, Kei Fujikawa, Daiki Morita, Tetsuya Taguchi, Toshiaki Numajiri
Zones I–III were further classified into proximal, middle and distal parts to measure fat stiffness objectively in nine regions in total, using ultrasound SWE (LOGIQ E9; GE Healthcare) with real-time SWE and a 9 L linear (4–9MHz) probe according to with the procedure we previously reported (Figure 1) [16]. In brief, the circular quantitative sampling frame was initiated to measure fat tissue centering on Scarpa fascia in a region of interest (ROI) with a diameter of 5 cm. The system then automatically calculated the elastic modulus mean (in kPa) within the ROI. Data obtained by the same device operator were recorded on the same day three times for the same subject.
Corset trunkoplasty is able to preserve postoperative abdominal skin sensation in massive weight loss patients
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Kathrin Bachleitner, Maximilian Mahrhofer, Friedrich Knam, Thomas Schoeller, Laurenz Weitgasser
Farah et al. report a statistically significant number of patients with decreased sensibility in various sensibility modalities in the hypogastric area, inferior to the umbilicus, after conventional abdominoplasty surgery. Decreased sensibility to hot and cold temperature was observed in the pubic area, and the sensibility to pressure decreased significantly in all areas of the abdomen when compared with a control group [20]. These results were confirmed by various other studies. Fels et al. report a significant difference (p < 0.05) between people without surgery and those who had undergone a classic abdominoplasty for all regions tested. The regions of the abdominal skin surrounding the umbilicus presented the highest index of analgesia and thermal anesthesia, as well as higher cutaneous pressure thresholds. This significant reduction in all qualities of sensation are still present up to an average of 6.8 months after surgery [19]. Novais et al. report that at 3.5 years after surgery, a high percentage of patients still did not recover touch (26%), pain (44%) or sensibility tested by the Semmes-Weinstein 5.07/10-g monofilament (68%). A considerable proportion of patients (68%) still presented sensibility alterations in the infraumbilical area 3.5 years after the abdominoplasty operation [17]. Presman et al. report abnormal abdominal skin sensation in 81% of patients, including hyposensitivity and hypersensitivity. Many patients were not (32%) or only minimally (44%) affected by sensory abnormalities, but (24%) were at least moderately bothered of which 7% were bothered a lot [24]. Even if an abdominoplasty with preservation of scarpa’s fascia was performed, no significant difference of sensation in the lower abdomen could be found compared to conventional abdominoplasty techniques [18].