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Abdominoplasty technique choice is key in minimizing tissue necrosis complications

Article-Abdominoplasty technique choice is key in minimizing tissue necrosis complications

Key iconKey Points

  • An ongoing study measures skin perfusion using laser Doppler in patients receiving bipolar radiofrequency-assisted liposuction
  • Avelar technique avoids wide undermining, preserving critical vasculature of tissues

Maintaining a good perfusion and level of hyperemia of the tissues both during and after an abdominoplasty procedure is key in minimizing adverse events, one of the most common of which is tissue necrosis.

Many surgical techniques can be used, but the use of tumescent fluid appears to be instrumental in increasing the blood supply in the surgical site, according to one expert. This can, in turn, help to maintain the tissues and minimize tissue necrosis.

TISSUE NECROSIS Tissue necrosis is one of the feared complications following abdominoplasty, and avoiding this complication can be challenging.

Dr. Lisborg
"Maintaining a good tissue perfusion and eliciting a good hyperemia in the tissues is crucial in helping to avoid post-abdominoplasty tissue necrosis," says Peter H. Lisborg, M.D., medical director of Privatklinik Dr. Lisborg & Partner, Klagenfurt, Austria. "Though this is a very logical conclusion, it has never been studied before. Not all abdominoplasty approaches can achieve the same tissue perfusion post-procedure, and choosing the right technique and using tumescence are critical in keeping this complication to a minimum."

There are many techniques used in abdominoplasty, including liposuction. However, using bipolar radiofrequency-assisted liposuction appears to be advantageous in maintaining this much-needed tissue perfusion, particularly when performed with tumescent fluid.

In an ongoing study, Dr. Lisborg measured skin perfusion using laser Doppler in 12 patients receiving bipolar radiofrequency-assisted liposuction with BodyTite (Invasix). In the study, normal skin perfusion, perfusion following tumescent local anesthesia (TLA), perfusion following conventional liposuction and perfusion following Invasix liposuction were measured.

STUDY RESULTS Results showed a significant reduction of skin perfusion following the application of tumescent fluid reaching a maximum within five to six minutes. Within 18 to 24 hours after tumescence, the hypoperfusion changed to a transient hyperemic response. Hyperemia following Invasix was also seen, but was found to be substantially lower than after conventional liposuction.

According to Dr. Lisborg, it is the tumescent fluid that is key in causing a hyperemia of the tissues. Soon after injection of tumescent fluid, ischemia occurs in the target tissues. The body reacts to this ischemia with a vasodilatation and a reactive hyperemia, he says.

"Less perfusion may possibly translate into a higher chance of necrosis. Though Invasix-treated patients did demonstrate a hyperemia, it was not as distinctive in comparison to those patients who received classic liposuction. However, there is a give-and-take with all procedures, as less hyperemia will likely also result in less bruising and quicker downtimes," Dr. Lisborg says.

The reduction of hyperemia following Invasix corresponds to the reduction of bruising and therefore speeds up reconvalescence and reduces downtime. According to Dr. Lisborg, the perfusion seen with Invasix patients is good and comparable to the perfusion achievable with other liposuction procedures, but using the Avelar surgical technique is superior in maintaining tissue perfusion, which is, again, crucial in minimizing tissue necrosis.

ADDITIONAL STUDY In another tissue-perfusion study using laser Doppler in the same 12 patients, normal skin perfusion, perfusion following TLA alone, perfusion following TLA and power-assisted liposuction (PAL), perfusion following TLA and the Avelar technique and perfusion following abdominoplasty with conventional undermining were measured. Perfusion measurements were taken on the normal skin (reference) and on the skin just above the original umbilicus 30 minutes after TLA, after the procedures, 24 hours after infiltration and 48 hours after TLA.

Interim results of the ongoing study showed only a slight reduction in perfusion in the patients receiving the Avelar technique, whereas patients undergoing conventional abdominoplasty showed a drastic reduction in perfusion. A return to normal perfusion was seen at 24 hours and at 18 to 24 hours in those patients undergoing TLA alone and TLA with PAL, respectively. Dr. Lisborg says he expects to present the final results of this study at the World Academy of Cosmetic Surgery meeting in September in Vienna.

According to Dr. Lisborg, a significant reduction of skin perfusion following the application of tumescent fluid is expected due to the effects of adrenalin, and normal perfusion is expected to return within 18 to 24 hours after tumescence. Liposuction may shorten this vasoconstriction effect due to suction removal of adrenalin, therefore speeding up the return to normal perfusion. In addition, the perfusion following conventional abdominoplasty should be drastically reduced, but it should not be reduced after the Avelar technique.

"The major advantage of the Avelar technique is that it avoids wide undermining and therefore preserves the critical vasculature of the tissues. This subsequently drastically reduces the complications of tissue necrosis and will lead to more optimal outcomes, particularly when used together with tumescent fluid," Dr. Lisborg says.

In a conventional abdominoplasty, much of the circulation from the inferior epigastric vessels is severed. According to Dr. Lisborg, the Avelar technique does not involve such wide undermining and spares the vasculature in the subcutaneous flap, and the preservation of these vessels is critical in avoiding potential tissue necrosis.

"The Avelar technique is a new concept and is not readily performed by many surgeons yet. Surgeons should reconsider wide undermining in abdominoplasties, because they are putting their patients at a greater risk of complications. The Avelar or less undermining techniques reduce this risk and can still achieve good aesthetic outcomes," Dr. Lisborg says.

Disclosures: Dr. Lisborg reports no relevant financial interests.

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