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
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