Villegas Francisco J
Plastic Surgery, Universidad del Valle, Cali, Colombia,
Aesthetic Plast Surg. 2014 Jun;38(3):511-20. doi: 10.1007/s00266-014-0304-8. Epub 2014 Apr 26.
Lipoabdominoplasty can be associated with complications, particularly tissue necrosis, wound dehiscence, epigastric bulging, high transverse scar, low positioning of the umbilicus, and seroma.
Modified abdominoplasty characterized by (1) transverse elliptical plication of the lower abdominal wall, (2) no undermining of the flap above the navel, (3) unrestricted liposuction, (4) umbilical amputation and neoumbilicoplasty by skin graft, and (5) low transversely placed abdominal scar (TULUA) was performed for 42 patients. These procedures were elective and performed primarily to remedy epigastric skin redundancy associated with obesity or when supraumbilical undermining was considered inappropriate.
The results were objectively scored as excellent for 20 patients, good for 21 patients, and fair for 1 patient. A normal-appearing umbilicus was attained in all cases except one. The lower transverse scars were generally concealable (6.3 ± 1.4 cm from the anterior vulvar commissure), and epigastric bulging was avoided. Although four patients experienced seromas at the tail ends of incisions, no skin necrosis, wound dehiscence, or other major complications such as venothromboembolism occurred, and there were no fatalities. In four patients, postoperative magnetic resonance imaging demonstrated measurable and significant changes attributable to plicature compared with equivalent control points (p < 0.000001), which persisted over time.
The TULUA procedure offers potential advantages in terms of vascular safety, sensory recovery, position and quality of the umbilicus, and transverse scar location, with aesthetic outcomes that generally eliminate epigastric bulging. A sizeable patient population stands to benefit from this approach, especially when obesity, smoking, secondary revisions, umbilical or hypogastric hernias, and massive weight loss are clinical considerations for abdominoplasty.
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腹壁成形术可能会伴有并发症，尤其是组织坏死、伤口裂开、上腹部膨出、高位横行瘢痕、脐部位置过低以及血清肿。
对42例患者实施了改良腹壁成形术，其特点为：（1）下腹部壁横行椭圆形折叠；（2）脐上皮瓣不进行皮下分离；（3）吸脂不受限制；（4）脐部切除并通过植皮进行脐再造；（5）低位横行腹部瘢痕（TULUA）。这些手术均为择期手术，主要用于矫正与肥胖相关的上腹部皮肤冗余，或在认为脐上皮下分离不合适时进行。
客观评分显示，20例患者为优，21例患者为良，1例患者为中。除1例患者外，所有病例的脐部外观均正常。低位横行瘢痕通常可被隐藏（距外阴前联合6.3±1.4厘米），且避免了上腹部膨出。虽然有4例患者在切口末端出现血清肿，但未发生皮肤坏死、伤口裂开或其他严重并发症，如静脉血栓栓塞，也无死亡病例。4例患者术后磁共振成像显示，与相应对照点相比，折叠导致了可测量的显著变化（p<0.000001），且这种变化随时间持续存在。
TULUA手术在血管安全性、感觉恢复、脐部位置和质量以及横行瘢痕位置方面具有潜在优势，美学效果通常可消除上腹部膨出。相当一部分患者可能会从这种方法中受益，尤其是当肥胖、吸烟、二次修复、脐部或下腹疝以及大量体重减轻是腹壁成形术的临床考虑因素时。
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