Case 12 (2024): Fleur-de-lis abdominoplasty
Dominika Miklisova (StudMed)1, Ena Sutakova (StudMed)1, Miroslava Verbat (StudMed)1, Zuzana Jelinkova1, Julia Bartkova (MD1, MBA)1
- 1University Hospital Brno, Czech Republic
Abstract
A 53-year old woman presenting with venter pendulus and diastasis of the rectus abdominis muscles was admitted to the Department of Burns and Plastic surgery for fleur-de-lis abdominoplasty. The patient underwent bariatric surgery in June 2021, resulting in significant weight loss causing extensive laxity of the abdominal skin. She decided to have the consultation at our clinic to assess the probl
BeforeAfterA 53-year old woman presenting with venter pendulus and diastasis of the rectus abdominis muscles was admitted to the Department of Burns and Plastic surgery for fleur-de-lis abdominoplasty. The patient underwent bariatric surgery in June 2021, resulting in significant weight loss causing extensive laxity of the abdominal skin. She decided to have the consultation at our clinic to assess the problematic excessive tissue and seek surgical resolution for the unsatisfactory appearance, which has caused her mental and physical distress. In terms of further anamnesis, the patient is being treated for hypertension, depressive disorder and osteoporosis. She is also diagnosed with nephrolithiasis, hypothyreosis sleep apnoea, polytopic vertebrogenic algic syndrome and has an anterolisthesis of lumbosacral spine. Apart from bariatric surgery she underwent an urethral stent placement and the total endoprosthesis of the right knee joint. In terms of gynecological history, the patient has three children, one delivered vaginally and two by cesarean section. Concerning family history, her mother has an ischemic disease of the lower limbs and her father died of myocardial infarction. The patient is on disability pension, formerly a saleswoman. No allergies reported.
The horizontal resection was performed firstly as with a standard transverse abdominoplasty.
2
Sharp dissection was performed to the level of umbilicus. The umbilicus was then preserved on a stalk and transected as the vertical incision continued supraumbilical to the level of xiphoid process.
3
The dissection continued in an inverted V shape. To avoid over resection, sharp towel clips were used to secure the excised tissue edges and the limits of vertical resection were then reassessed. A sharp towel clamp was placed subcutaneously, the mons pubis was pulled upward and the mobilized flaps were pulled inferomedially. The operating table was slightly flexed to decrease the tension of the abdomen. En bloc resection was carried out and hemostasis was achieved by electrocautery. The inferomedial edges of the skin flaps were fixed to the suprapubic skin at the midline with a strong suture. A vertical incision was performed afterwards, with supraumbilical incision extended to a level just caudal to the xiphoid process. Minimal undermining was necessary in this area with an emphasis on the perforator preservation. In the apex of the incision, subcutaneous tissue was debulked to avoid a dog-ear.
4
In conjunction with abdominoplasty, the rectus abdominis muscles were sutured to repair the aforementioned diastasis of the patient. This serves to restore the firmness of the abdominal wall and also contributes to achieving favorable cosmetic results.
5
Post operatively, the patient was kept in bed in the modified Fowler’s position. An abdominal pressure garment and antithrombotic pneumatic compression stockings were placed in the operation theatre. The stockings are kept until the patient is discharged and the abdominal binder is instructed to be worn for a period of 3 to 6 weeks. The drains are routinely removed when less than 20 mL drainage is observed in a 24h period. The Foley catheter is removed the next day after surgery. The patient came for follow ups regularly for wound assessment, 15 days and 3 weeks and 5 weeks post operatively. At the first visit, a hematoma was visible near the umbilicus, a 20 mL puncture was therefore performed. The stitches were consequently removed around the umbilicus and a betadine cream was prescribed to prevent infections. The patient came back for a 3 weeks follow up, the scar was without other complications, a small persistent hematoma was seen on the left side of the umbilicus but signs of resorption were present. An additional 5 mL puncture was done. During the last follow up (5 weeks after the surgery), the haematoma was fully resorbed and the scars healed by primary intention without secretion or dehiscence of the wound. The relocated umbilicus appeared to be vital. The patient is highly satisfied with the aesthetic results and reports experiencing mental and physical relief.
How to cite this article
Dominika Miklisova (StudMed), Ena Sutakova (StudMed), Miroslava Verbat (StudMed), Zuzana Jelinkova, Julia Bartkova (MD, MBA). Case 12 (2024): Fleur-de-lis abdominoplasty. Journal of Plastic, Breast & Reconstructive Surgery. 2024.
Open access. © 2024 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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