bdominoplasty is a type of plastic surgery
that has evolved through time. It has undergone
significant refining to meet the growing aesthetic
perception, as well as to address various issues
such as rectus abdominis muscle diastasis, trunk
rejuvenation, and the restoration of a normal defined
waistline [1-4].
The three essential defects of the abdominal
wall (redundant skin with concomitant striae, excess
subcutaneous fat, and musculoaponeurotic laxity)
must always be considered and managed by the
plastic surgeon while performing classic abdominoplasty.
The waist, which is a component of the
trunk's circumferential aesthetic unit, must be
considered similarly as well [5].
As a result, abdominoplasty has evolved from
focusing on the skin flap and underlying rectus
diastasis repair to include liposuction procedures
and minimal undermining to improve the outcome
[6].
Although plication of the midline diastasis
improves antero-posterior diameter, it has a limited
effect on waist definition. Furthermore, as shown
by Nahas and his colleagues in 2001, when the
plication of the anterior rectus sheath is expanded
in width, it might cause deformed abdominal shape,
resulting in undesirable and unnatural contour [6].
Various procedures have been recommended
in order to accomplish reliable waist modification.
Multi-directional abdominal musculature plication,
L-shaped external oblique plication, and muscle
flap advancement have also been documented [7].
Lockwood reported the interconnected fibrous
septa that extend from the dermal layer in different
directions to the Scarpa's fascia, allowing pulling
forces to be directed to the skin even after liposuction,
when tension is applied to the fascial flaps.
It may be modified to meet a variety of aesthetic
purposes, similar to SMAS in the facelifts [8].
The use of bilateral Scarpa advancement flaps
for waist definition during standard abdominoplasty
can alter the waistline and enhance the result of
waist liposuction [9].
When supra-Scarpal dissection was conducted,
roughly 17 percent of the lymph drainage of the
abdominal wall was retained, according to Friedman
and his colleagues [10]. Scarpa's fascia preservation
has also been shown to reduce the risk of
postoperative problems [11].
In comparison to traditional abdominoplasty,
the current study aimed to determine the value of
Scarpa's fascia inferomedial advancement during
abdominoplasty in patients with moderate to severe
actual or potential laxity of the skin, fat, and
muscles of the anterior abdominal wall in terms
of waist definition and seroma rates.
PATIENTS AND METHODS
Between January 2020 and September 2021,
40 female patients were included in the study at
the Plastic Surgery Unit, General Surgery Department,
Faculty of Medicine, Benha University, after
receiving clearance from the Ethics Research Committee.
According to the following criteria, all of
the patients had abdominal deformities indicated
by extra abdominal skin and fat tissue, as well as
musculoaponeurotic laxity.
Inclusion criteria:
• The candidate was not extremely overweight
(BMI 30kg/m2) and remained stable for more
than 6 months if considerable weight loss occurred.
• Females who are very motivated and realistic.
• Major uncontrolled medical conditions such as
labile hypertension, diabetes, coronary disease,
nutritional deficiencies, and bleeding disorders
are not present.
Exclusion criteria:
• BMI >30kg/m2.
• Multiple abdominal scars or a large amount of
abdominal protrusion (secondary to intraabdominal
fat accumulation).
• Females who are completely unrealistic.
• Patients on unreasonable diet, with excessive
smoking or alcohol consumption.
108 Vol. 46, No. 2 / Scarpa's Fascia Advancement in Waist Definition during Abdominoplasty
According to the infraumbilical plane of dissection,
either rectus sheath or Scarpa fascia plane,
they were divided into two equal groups:
- Group A: Abdominoplasty with Scarpa's fascia
inferomedial advancement was performed on
Group A.
- Group B: Traditional abdominoplasty was performed
on Group B.
They were given information regarding the
operation, the type of anesthetic used, the risks,
potential consequences, photos, and their participation
in the research. Before surgery, all patients |
