Swanson Eric
From Private Practice, Leawood, Kansas.
Ann Plast Surg. 2025 Mar 1;94(3):378-383. doi: 10.1097/SAP.0000000000004149. Epub 2024 Nov 6.
Repair of the abdominal fascia at the time of abdominoplasty is a valuable method to improve the contour of the abdomen. However, this maneuver has been linked to an increased risk of venous thromboembolism (VTE). This review was undertaken to evaluate the evidence.
An electronic literature review was conducted to identify publications on the subject of abdominal fascial repair during abdominoplasty and VTE risk. Key words included abdominoplasty, fascial plication, intra-abdominal pressure, and venous thrombosis.
Three large clinical studies were identified. One retrospective study using matched comparisons reported nearly identical VTE rates for patients treated with and without abdominal fascial plication (1.5% vs 1.7%). Another retrospective study reported significantly more VTEs (2.3%) in abdominoplasty patients undergoing fascial repair compared with panniculectomy patients who did not undergo fascial plication (0.36%). The author also recommended a modified Caprini score, adding fascial repair as a risk factor. Only 1 prospective study reported a large number of consecutive plastic surgery outpatients evaluated with Doppler ultrasound. This group included 188 abdominoplasty patients, all treated with fascial plication and without muscle paralysis. Only 1 VTE was diagnosed on the day after abdominoplasty (0.5%).
Retrospective studies are susceptible to confounders and confirmation bias. Caprini scores do not have a scientific foundation. Chemoprophylaxis increases the risk of bleeding without reducing the risk of VTE.
The best available evidence supports performing a fascial repair. An effective and safe alternative to Caprini scores and chemoprophylaxis is avoidance of muscle paralysis and early detection of VTEs using ultrasound screening.
腹壁成形术时修复腹部筋膜是改善腹部外形的一种有效方法。然而，这种操作与静脉血栓栓塞（VTE）风险增加有关。本综述旨在评估相关证据。
进行电子文献检索，以确定关于腹壁成形术期间腹部筋膜修复及VTE风险的相关出版物。关键词包括腹壁成形术、筋膜折叠、腹内压和静脉血栓形成。
共确定了三项大型临床研究。一项采用配对比较的回顾性研究报告，接受和未接受腹部筋膜折叠治疗的患者VTE发生率几乎相同（1.5%对1.7%）。另一项回顾性研究报告，与未进行筋膜折叠的腹壁成形术患者（0.36%）相比，接受筋膜修复的腹壁成形术患者发生VTE的比例显著更高（2.3%）。作者还推荐了改良的Caprini评分，将筋膜修复作为一个风险因素。仅有一项前瞻性研究报告了大量连续接受多普勒超声评估的整形手术门诊患者。该组包括188例腹壁成形术患者，均接受了筋膜折叠且未使用肌肉麻痹。腹壁成形术后仅1例患者被诊断为VTE（0.5%）。
回顾性研究易受混杂因素和确认偏倚的影响。Caprini评分缺乏科学依据。化学预防增加了出血风险，却未降低VTE风险。
现有最佳证据支持进行筋膜修复。避免肌肉麻痹并使用超声筛查早期发现VTE是Caprini评分和化学预防的一种有效且安全的替代方法。
