title: Perforator-sparing abdominoplasty technique in the presence of bilateral subcostal scars after gastric bypass.
abstract: BACKGROUND
  The number of patients after gastric bypass being referred to plastic surgery units for secondary plastic surgery procedures is increasing. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars in the upper abdomen. Often a 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.
  
  
  METHODS
  We propose a new, modified and safe surgical technique to perform a complete abdominoplasty with wide undermining up to the xiphoid process in patients with preexisting transverse subcostal scars after gastric bypass surgery, by selectively dissecting and preserving one to three periumbilical abdominal wall perforator vessels to secure flap blood supply. Vessel tunnelling through the rectus sheath and muscle and ligation of the cephalad branch of the perforator provide sufficient flap mobility without perforator tension or traction. Flap undermining is performed around these perforator vessels. To match dissected flap perforators with blood-flow, we performed post-operative color-flow duplex scanning.
  
  
  RESULTS
  We treated two patients according to this new technique. In both cases the postoperative course was uneventful and a good aesthetic result was achieved.
  
  
  CONCLUSIONS
  We conclude from our experience that with this perforator-sparing abdominoplasty technique, safe and complete abdominoplasty can be performed with no additional risk of complications and that a good cosmetic result can be achieved in patients after open gastric bypass surgery.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Division of Angiology, University Hospital of Basel, Basel, Switzerland. riegeru@uhbs.ch
authors.forename: Ulrich M
authors.initials: UM
authors.lastname: Rieger
authors.forename: Markus
authors.initials: M
authors.lastname: Aschwanden
authors.forename: Dominik
authors.initials: D
authors.lastname: Schmid
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pierer
authors.forename: Martin
authors.initials: M
authors.lastname: Haug
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D002921:Cicatrix / Q000209:etiology* / Q000601:surgery; D062109:Dermatologic Surgical Procedures; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D040521:Subcutaneous Tissue / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome