Purpose: Abdominoplasty is the third most popular surgical procedure performed in plastic surgery, and one of the fastest rising in prevalence, partly due to the growing number of massive weight loss patients. Pre-existing abdominal scars, particularly the right subcostal (Kocher) scar used for open gallbladder removal, may threaten healing after abdominoplasty due to decreased blood supply. We aimed to determine if patients with pre-existing Kocher scars or upper midline scars from open gastric bypass surgery (gbs) had actually experienced increased risk of complications, and specifically, wound healing problems.

Methods and Materials: Review of operative and clinic notes of all patients who had abdominoplasty from March 1998 to February 2008 was performed.  Variables studied included age, gender, BMI, medical and surgical history, and postoperative complications. The most frequent complications were wound healing problems and seromas, but other complications included postoperative bleeding and venous thromboembolism, for example. Statistical analysis to assess outcomes was performed in Stata SE, version 9.

Results: 420 abdominoplasty procedures took place. The patient population was comprised of 88.6% women, and shared an average age of 42 years. Within the overall group, 62.2% had open gbs and 19% had laparascopic gbs.  Seven percent (n=29) of the patients had a Kocher scar. Mean BMI at the time of abdominoplasty was 33 (range: 19.5 to 88).  Overall risk of any complication was 32.9%, with risk of wound healing problem, 18.3% and seroma, 14.9%. Chi square analysis revealed significance in the relationships between any abdominal scar and any complication (p=0.001) and wound healing problem as a specific complication (p=0.009). The Kocher scar was significantly associated with wound healing problems (=0.003), but not seromas. The upper midline incision also had a higher association with any complication, but not with wound healing or seroma complication.  Multivariate analysis, controlling for age, gender, medical comorbidities, smoking history and BMI, indicated no significant relationship existed between abdominal scars and postoperative complications. While this relationship dropped out in the adjusted analysis, BMI revealed itself to be the variable providing the greatest detriment to successful wound healing. With every unit increase in BMI, a 5% increase in risk of any complication and a 6% increased risk in wound healing was calculated (p=0.001). There was no difference in complications between the open and laparascopic gbs groups, indicating the upper midline incision did not pose a threat to wound healing, whereas BMI did.

Conclusions: While the Kocher scar seems to pose a threat to wound healing in abdominoplasty, this analysis reveals that it is BMI, not the Kocher scar, that poses the greater threat. Upper midline incisions also do not present a risk to wound healing in abdominoplasty.  While caution is recommended in undermining toward the right upper quadrant when a Kocher scar exists, we find that including BMI in the analysis disabled the risk of Kocher scar in causing wound healing problems.