الفهرس 
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Abstract
Summary
Abdominoplasty is a common procedure within
plastic surgery; it aims to reshape the abdominal wall by
combining skin and subcutaneous tissue resection with
musculoaponeurotic reinforcement. The presence of
infraumbilical scar don’t present a problem as it will be
excised with the excess ellipse, but supraumbilical (vertical,
oblique or transverse) scars must always be considered in
patients for whom an abdominoplasty is planned, and various
techniques are described to treat these cases.
Limited abdominoplasty of the low transverse type with
limited undermining only up to the level of the umbilicus is
performed in order not to compromise blood supply in the
zone between the old transverse and the new transverse scar.
Limited undermined of the flap in an inverted-V fashion,
preserving the intercostals blood supply and elevating the
flap only to the degree necessary to achieve wound closure
without tension and repair of the diastasis. Discontinuous
undermining by dissecting the supraumbilical flap by blunt
dissection is described to improve flap perfusion.
Progressive tension sutures or Quilting sutures better to
performed when there is large dead space or at high risk
patients.
Liposuction is performed away from the zones 1
and 3 of Huger, but liposuction of the hip and lower flanks
is performed freely. It is preferably to perform a second-stage
liposuction.
Summary and Conclusion
99
The blood supply to the abdominal flap can be improved
by selective dissection of perforator vessels in
patients with supraumbilical scars, which enables us to
perform a full abominoplasty with complete flap
undermining.
Most of patients who are candidates for an
abdominoplasty and present supraumbilical median or
paramedian scars, especially in case of concomitant
intraabdominal procedures, an anchor-line abdominoplasty
should always be considered.
Correction of incisional hernia if present is performed
during abdominoplasty. Umbilical reconstruction is done
according to presence or absence of umbilicus and partial or
total loss of the umbilicus.
Conclusion
Abdominoplasty and abdominal contouring procedures
can be safely performed in patients with pre-existing
abdominal scars after proper evaluation, careful planning,
and modification of standard abdominoplasty techniques. An
understanding of the vascular supply to the abdominal soft
tissue and a clear discussion with the patient about risks and
expectations are important to achieve the optimal aesthetic
result and high patient satisfaction. Category I patients who
have scars that will be incorporated into the soft-tissue
resection segment require little modification of the standard
technique. Category IIA and IIB patients require
individualized plans. Category IIA patients are often best
served by a reverse abdominoplasty alone or staged with a
lower abdominoplasty, whereas category IIB patients usually
require the addition of a vertical/oblique anterior resection.
Summary and Conclusion
100
The recommended technique for performing
abdominoplasty in patients with previous supraumbilical
scars is; limited undermining of the abdominal flap in a
triangular shape from the xiphoid to anterior superior iliac
spine with selective dissection and preservation of one or
more of peri-umbilical rectus abdominis perforator
vessels. Progressive tension sutures or Quilting sutures can
be used when indicated. This method leads to safe procedure,
good aesthetic outcomes, and less incidence of postoperative
complications, so it is advised to be performed also at high
risk patients (DM, smokers, hypertension, and morbid
obesity).