Comparison of Limited and Full Dissection Abdominoplasty Using Laser Fluorescence Imaging to Evaluate Perfusion of the Abdominal Skin.

BACKGROUND: In an effort to reduce risk, some surgeons promote a limited dissection abdominoplasty technique. They believe that preserving musculocutaneous perforators improves blood supply to the overlying abdominal tissue and that improved vascularity avoids seromas and reduces wound healing problems. Laser fluorescence imaging is a new method that allows quantitative measurements of perfusion.
METHODS: Twenty-two consecutive women undergoing abdominoplasty agreed to participate in this prospective study. The inclusion rate was 100 percent. The SPY Elite Intraoperative Perfusion Assessment System was used to quantitate flap perfusion. Patients served as their own controls to avoid confounders. All patients received superwet infusions followed by liposuction of the abdomen and flanks. First, a limited dissection was performed, preserving medial musculocutaneous perforating blood vessels and the Scarpa fascia on the lower abdomen. The rectus fascia was repaired in all cases. A temporary superficial fascial wound closure was performed. The patient was imaged after injection of the contrast agent. The dissection was then extended to a full abdominoplasty and the Scarpa fascia was removed from the lower abdomen. The patient was reimaged. Wound tension was also measured.
RESULTS: Complications included one distal deep venous thrombosis, one infection, and one seroma. There were no cases of marginal necrosis or dehiscence. There was no significant difference (p < 0.05) in perfusion measurements comparing the limited and full dissections. Wound tensions were significantly less (p < 0.001) in the full-dissection group.
CONCLUSION: The limited dissection abdominoplasty does not provide a significant improvement in perfusion compared with a full dissection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.