2000 Winner. Robert F. Jackson, MD, F.A.C.S.

Transcription

1 2000 Winner Robert F. Jackson, MD, F.A.C.S.

2 Contouring The Abdomen Using Liposuction, Rectus Plication,, and Crescent Tuck Abdominoplasty A Ten Year Experience Robert F. Jackson, M.D.,F.A.C.S.

3 Contouring The Abdomen Using Liposuction, Rectus Plication,, And Crescent Tuck Abdominoplasty A Ten Year Experience Robert F. Jackson, MD Edward B. Lack, MD

4 Goal More Scaphoid abdomen with minimal increase in post-operative operative morbidity

5 Patient Evaluation Hx and PE Presence or Absence of Obesity Presence or Absence of Underlying Disease Class I or II Anesthesia Risk

6 Ideal Patient Post Partum - 30 Years Old Minimal Intra-abdominal abdominal (Visceral/Omental Omental) ) Fat Moderate Subcutaneous Fat Below the Umbilicus Moderate Skin Laxity Diastasis Recti Below Umbilicus Moderate Fat and Skin Above Umbilicus Minimal Rectus Laxity Above Umbilicus

7 Presented Technique Modified Mini-Abdominoplasty Yields - Firmer Abdomen - Less Skin Flaccidity - Contours Abdomen - Enhances Appearance of the Waist

8 Patient Examination Examination Should Include: Sitting Supine Diver s Position Supine with Head Elevated 30 Degrees

9 Patient Evaluation Cont. Evaluation of: Amount of Subcutanous Fat Degree of Skin Laxity Quality of the Skin Presence of Striae or Scars Degree of Diastasis Recti (Valsalva maneuver in Diver s Position and with Elevation of Head in Supine Position)

10 Evaluate For Hernias Hernia not a Contra-indication but would need to be Repaired at the time of Surgery

11 Appropriate Candidates Are Chosen by the Matarasso Abdominoplasty Classification System Category Skin Fat Type I Minimal Laxity Variable Minimal Falaccidity Type II Mild Laxity Variable Mild Lower Abdominal Flaccidity Type III Type IV Moderate Laxity Severe Laxity Musculofacial System Variable Modereate Lower and/or Upper Abdominal Variable Significant Lower and/or Upper Abdominal Flaccidity Treatment Liposuction or Ultrasonic Liposuction Liposuction plus Mini Abdominoplasty Modified Abdominoplasty with Rectus Plication Possible Liposuction Standard Abdominoplasty

12 Laboratory Evaluation CBC Chemical Profile Bleeding Profile HIV Screen Hepatitis Screen EKG Over age 45

13 Pre-Operative Instructions Avoidance of Medication that Interferes with Coagulation eg eg. Aspirin, Non-Steroidals Steroidals,, Anti- inflammatory Agents & Many of the Natural Herbs Self Prep Hibielens or Phisohex B.I.D. for 2 days prior to surgery

14 I.V. Sedation Anesthesia General Anesthesia Epidural Block Note: All patients receive Tumescent Infiltration with Saline, with Lidocaine,, 0.05%, 0.075%, 0.1%. Epinephrine 1:1,000,000

15 Setting Outpatient Surgical Facility Can be done in Hospital but Not Necessary

16 Absolute Meticulous Sterile Technique is A Must

17 Post-Operative Care Compression Garments Compression Pad eg. Reston Foam Post-op op Visit Hours Post-op op Visits - Weekly through the 3rd week Pain Medication - Usually Acetaminophen or Hydrocodone Walk 1 mile First Day Post-op op - Increase to 2 miles by 3rd or 4th Day Avoid Lifting or Strenuous Exercise for 6 weeks

18 Complications Identical to Those of Liposuction Seroma/Hematoma - Slightly increased Fascititis Induration Edema Infection Cellulitis Hypertrophic Scars Neuropraxia Contour Irregularities

19 Prevention of Complications Infection Use of meticulous sterile technique Hematoma/Seroma Hemostasis at Time of Surgery

20 Treatment of Complications Infection Usually Staphlococcal or Streptococcal contamination Treatment - Broad spectrum antibiotics modified by culture and sensitivity studies

21 Treatment of Complications Wound Dehiscence Re-excision excision and closure if small and uncontaminated Skin Necrosis Topical antibiotics and healing by secondary intent If significant - Debridement

22 Fascitis/Induration Mild Non-Steroidal Drugs Prednisone Broad spectrum antibiotics if any indication of infection Low amperage electrical stimulation Low voltage ultrasound therapy

23

24 Seromas Require Drainage Usually with aspiration in the office If more than 2 or 3 aspirations Closed system drainage is indicated eg. (Seroma Cath) Seromas MUST BE DRAINED TO PREVENT: Abscess formation Pseudo-bursa Note: Platelet Gel is being studied and may have promise in both treatment and prevention

25

26 Scar Formation Epidermabrasion at 5 weeks and 10 weeks post-op op Silastic Pads Intra-Lesional Triamsinalone Reinforcement of Wound with Steri-Strips Strips

27 100 Patients Chosen by Computer at Random Age # of Patients 70% of Patients Fall Between The Ages of 30-50

28 Complications Total Patients Induration Revised "Dog Ears" "Dog Ears" Persistent Seromas Seromas Patients

29 Results Patients Evaluation - 98% Good to Excellent Independent Nurse Evaluation - 98% Good to Excellent

30 Results Our results have been excellent with minimal complications Pearls of our technique will now be presented

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63 Robert F. Jackson, MD. F. A.C.S.

64 Thank you very much for your attention. Robert F. Jackson, M.D. F.A.C.S.