Operative Note |
PROCEDURE: Abdominoplasty with fascial plication. |
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SUMMARY: After the induction of general
endotracheal anesthesia, the patient was prepped and draped in the usual sterile fashion. Skin incision had been previously
marked with a marking pen. First, the umbilicus was sharply excised and freed from the dermis. This was then marked with
a 2-0 Vicryl stitch for later use. Next, the lower transverse incision was sharply made and dissection was carried down to the
fascial plane with electrocautery. Hemostasis was achieved with electrocautery throughout the case. The soft tissue was
then elevated off the fascial plane in the cephalad direction up to the costal margin laterally and to the xiphoid process medially. The flap was split up to the level of the umbilicus and dissection was carried around, thus leaving a generous umbilical stock. The abdomen was then irrigated with antibiotic solution and rechecked for hemostasis. Next, approximately 4 cm of fascial plication
were carried out with interrupted figure-of-eight 0 Nurolon followed by running 2-0 Vicryl. The rectus sheath was then injected
with 20 mL of 0.25% Marcaine with 1:200,000 epinephrine on each side for a total of 40 mL. The abdomen was then re irrigated. Two 19 French drains were placed through separate inferolateral stab incisions and secured with 4-0 nylon drain stitches. The
drains were shortened, leaving approximately 20 cm of white drain inside the wound. Next, the table was flexed at the waist
until closure above the level of the umbilicus could be achieved. The amount for excision was then estimated with a marker. The excess tissue was then sharply excised and removed with electrocautery. After achieving hemostasis, the abdomen was re irrigated. The midline was then brought together with the deep dermal 3-0 Polysorb. In addition, a small amount of soft tissue was left
over the mons pubis and this was advanced in the cephalad direction with several 2-0 Polysorb. Scarpa was then closed, tacking
this to the fascial plane with multiple interrupted 2-0 PDS stitches. Next, the dermis was reapproximated with multiple interrupted
deep dermal 3-0 Polysorb followed by running subcuticular 3-0 Monocryl. A small dog ear was excised from the left side. Next, a T-shaped incision was made over the umbilical stock. This was 1.5 by 1.5 cm. Dissection was carried down through
the subcutaneous tissue to reveal the umbilicus which was delivered through the wound. Two small side nicks were placed in the
belly button to match the T-shaped incision. This was then secured with multiple half-buried 4-0 Prolene stitches with knots
on the umbilical side. Prior to complete closure of the bellybutton, additional antibiotic solution was irrigated in the wound. A strip of Xeroform gauze was then placed in the umbilicus. The abdominal closure was dressed with benzoin, Steri-Strips, Hypafix
tape, followed by dry gauze dressing. Abdominal binder was then placed.
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