Expander removal of scar excision Abdominoplasty

PREOPERATIVE DIAGNOSES:                          Abdominal pannus, abdominal scarring, arm

                                                                        scarring.

POSTOPERATIVE DIAGNOSES:           Abdominal pannus, abdominal scarring, arm

                                                                        scarring.

OPERATION PERFORMED:                    Expander removal of scar excision,

Abdominoplasty, arm scar revision, liposuction of flanks of 800 mL.

anesthesia:                                             General.

PROCEDURE IN DETAIL:                        The patient was brought to the operating room and placed supine on the operating table. General anesthesia was administered and patient was prepped and draped.

Next, a small incision was made around the umbilicus. Small incisions were made in the previous scars which were then tumescenced with fluid. One liter of lactated Ringer mixed with 30 mL of 1% lidocaine and 1 amp of epinephrine was then infiltrated. 

A lower abdominal incision was made. Bovie cautery was then used to elevate the previous skin graft off the abdominal fascia. Care was taken to preserve as much of the tissue and fascia on the abdomen as possible. Once the dissection of the skin graft was performed, undermining was then performed underneath the expanders as well as laterally. Liposuction with ultrasound and conventional liposuction was then performed.  Eight hundred mL was liposuctioned in all. The expanders were then removed in total, including the ports. Undermining was performed up to the rib border. Hemostasis was obtained.

The fascia was repaired in some areas with 3-0 Vicryl suture. The umbilicus was sutured with a small umbilical fascial defect with 3-0 Vicryl suture. The lower abdomen was plicated with #1 Nurolon suture.

Next, the table was flexed and the entire scar was removed. Multiple-layer closure was performed after some excess skin was excised. A small incision was made in the abdominal flap of the umbilicus. This was then sutured to the abdominal flap with 3-0 Monocryl and 3-0 chromic gut. Two round Blake drains were brought out through lateral stab incisions. The mons was also undermined and the closure was performed with 3-0 Vicryl, 3-0 Monocryl, and running 4-0 Monocryl. Mastisol and Steri-Strips were applied. The drains were sutured in place with 2-0 silk suture.

Attention was then drawn to the arms where tumescent fluid was infiltrated. The skin was then excised. Multiple-layer closure was then performed with 4-0 and 5-0 Monocryl suture. Dermabond was applied.

The patient was then awakened and taken to recovery in stable condition.abdominoplasty