A Newly Designed Ruler for Planning Incision Markings in Abdominoplasty Surgery

Abdominoplasty is one of the most common procedures in plastic surgery, and its popularity may be due to the increasing patient search for bariatric and esthetic surgery. The ideal candidate for abdominoplasty has marked skin excess and laxity of the musculoaponeurotic layer.

As an asthetic surgery, scar appearance is an importante outcome, and its asymmetry can have a significant impact on patient and surgeon satisfaction. Complications are frequent after abdominoplasty, and seroma, infection, poor wound healing, or plication rupture can potentially cause scar asymmetry, worsening the esthetic result. These complications have been associated with obesity, male gender, older age, diabetes, cardiovascular comorbidities, smoking habits, previous bariatric surgery, and multiple or combined procedures(eg liposuction and breast surgeries). They may require revision surgery, which is time consuming and entails additional risks andfinancial costs.

The most effective way to reduce complications and a worse esthetic scar outcome consists in prevention. There are some recommendations regarding procedures in the intraoperative period to prevent these complications, but the lower abdominal scar following an abdominoplasty surgery may also be a result of preoperative incision marking. As the skin resection pattern and the planned line suture are the only variables that can be predetermined, a major effort should be made to optimize these factors. By standardizing preoperative incision markings, we may be able to shorten the surgery planning time and reduce deviations from the intended incision lines.

We have recently described (Horta R, Domingues CS; Dias CC; Barreiro D. A newly designed ruler for planning the incision markings in abdominoplasty surgery. Surgical Innovation, 2020 Jun 5:1553350620929303. doi: 10.1177/1553350620929303. Online ahead of print) a newly designed template which we believe can help surgeons plan incision markings and achieve a higher scar symmetry, and patient and surgeon satisfaction. It can be used with 2 options: (1) an angulated upper marking on its superior border—useful for thinner patients and (2) a smooth curve on its inferior border—especially useful for larger patients when circumferential scars are planned.

This tool is convenient, flexible, easily adjustable to the body contour, sterilizable, portable, long-lasting, and inexpensive, and can be easily used by the surgeon to get better results in preoperative incision markings, scar symmetry outcome, and patient satisfaction.

In a pilot study with 42 patients, we found that we could achieve better scar symmetry and more standardized results in patients,as well as a higher satisfaction rate in patients where incision markings were made with this tool.

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