Scarpa Sparing Abdominoplasty with Concomitant Liposuction. No Drains Needed

Purpose:

Abdominoplasty is a fundamental treatment for improving body contour. Complication rates have historically been very low and the scars are well tolerated. Possible seroma complications force surgeons to counter the physiologic response of the soft tissue disruption with closed suction drains. The lymphatic anatomy of the abdomen in the area inferior to the umbilicus drains to the inquinal region. Preservation of Scarpa’s fascia may reduce the need for closed suction drains. Reduction in the thickness of fat deep to Scarpa’s fascia may be performed by simultaneous liposuction.

Methods:

130 cases were retrospectively reviewed over a 8 year period. The patients had an average age of 41.8, a BMI of 26.3 with 15% having a BMI over 30, and an average weight of 157 pounds. 33% of the patients had prior abdominal surgery. The patients were grouped by their physical classification of the American Society of Anesthesiologists (ASA). 45 % were ASA 1, 55% were ASA 2. Patients were operated on at a surgery center under general anesthesia or IV sedation. All were treated with antibiotics and venodyne boots. On average, surgery time was 113.7 minutes. Tumescent fluid which contained lactated ringers with 20 mg of lidocaine and 1 ampule of epinephrine per liter were infiltrated into the abdomen. Volume infused was, on average, 1500cc.  Liposuction was performed deep to Scarpa’s fascia, in addition to liposuction of the flanks and the upper abdominoplasty flap. Fat removed by liposuction was 551cc ± 443cc. The largest volume removed was 2050cc. All patients underwent standard skin incision with umbilical transposition. Dissection went only to the level of Scarpa’s fascia and the fascia was left intact. Rectus diastasis repair was performed with 0-PDS in 85% of the patients from the xiphoid to the pubis. The wounds were closed with 2-0 Monoderm suture in the subcutaneous fascia and with  0-PDS Quill suture at the subcuticular dermis. No drains were used.

Results:

7% had a seroma, as determined by drainage lasting more than a week. None of these patients experienced a clinical seroma with a fluid wave or fullness. 8% of the patients underwent dog ear excision or scar revision at 6 to 8 months post abdominoplasty and 2% of patients underwent revision liposuction to the lower abdomen.

Discussion:

Lymphatic drainage from the abdominal wall inferior to the umbilicus is largely carried to the inquinal region via the lymphatic network deep to Scarpa’s fascia. Preservation of these lympatics allows for absorption of the exudative fluid created from the trauma of surgical dissection eliminating the need for drains. Simultaneous liposuction can be effectively used to thin the fat deep to Scarpa’s fascia, thereby improving the abdominal contour.