Introduction
Orlando Tummy Tuck (Abdominoplasty) Anatomy
The abdominoplasty, commonly known as a tummy tuck, is a versatile reconstructive surgical procedure designed to rejuvenate the appearance of the anterior abdominal wall. It primarily involves the removal or repositioning of excess adipose tissue, often encompassing both gynoid (hip) and infraumbilical (lower abdominal) subcutaneous layers.
Indications and Contraindications
This procedure is indicated for patients possessing significant, grade III or IV skin laxity, particularly in the lower abdominal and groin areas, often accompanied by attendant issues such as urinary incontinence or poor posture. Conversely, patients displaying grade I or II dermal layer turgor, minimal fat reaccumulation, or a relatively youthful, lean body type may not be optimal candidates for abdominoplasty.
Surgical Approaches
Abdominoplasties are typically divided into two categories: the high-transverse abdominoplasty (HTA) and the complete or extended abdominoplasty. The HTA entails a transverse incision through one or both rectus muscles (rectus vertical muscle division), allowing for removal and plication of redundant skin and fascia. The extended abdominoplasty, also known as the high lateral tension abdominoplasty, entails a horizontal incision extending from the xiphoid to the pubis, incorporating a lateral retraction of each rectus abdominis muscle for the repositioning of the anterior sheath and the enhancement of wound closure tension.
Technical Considerations and Operative Techniques
The operative approach necessitates meticulous dissection of the fascial and dermal layers, with particular attention to the release of rectus sheath adhesions, if present. A thorough ligation of the medial umbilical ligaments will facilitate reduction of lower abdominal skin redundancy. In patients displaying compromised infra-umbilical dermal layers, a segmental excision will facilitate improved wound healing.
Post-operative Management and Complications
Post-operative treatment involves the implementation of meticulous wound dressings, proper patient positioning during the immediate recovery period to prevent hematoma accumulation and seroma development, and the mandatory use of compression bandages. Notable complications which may necessitate reoperation include wound dehiscence, partial or complete loss of skin grafts, infection, seroma formation or recurrent skin redundancy.