title: Do preexisting abdominal scars threaten wound healing in abdominoplasty?
abstract: OBJECTIVE
  Abdominal scars may impair healing after abdominoplasty. We aimed to determine whether right subcostal or upper midline scars led to increased wound healing problems.
  
  
  METHODS
  Review of all patients who had abdominoplasty from March 1998 to February 2008 was performed. Variables studied included age, gender, body mass index (BMI), medical history, and postoperative complications. Statistical analysis was performed in Stata SE, version 10.
  
  
  RESULTS
  Of 420 abdominoplasty procedures, 62.2% had open gastric bypass surgery (GBS) and 19% had laparoscopic GBS. Seven percent (n = 29) of the series had a right subcostal scar. Overall risk of any complication was 32.9%, with 18.3% risk of wound healing problem (18.3%) and seroma (14.9%). chi(2)analysis revealed a significant relationship between any abdominal scar and any complication (P = .001), and wound healing problem specifically (P = .009). The subcostal scar was significantly associated with wound healing problems (P = .003). The upper midline scar was not associated with wound healing or seroma complication. While multivariate analysis erased any significant relationship between abdominal scars and complications, elevated BMI presented a significant threat to wound healing. With every unit increase in BMI, a 5% increase in the risk of any complication and a 6% increased risk in wound healing was calculated (P = .001). There was no difference in complications between the open and laparoscopic GBS groups, indicating that the upper midline incision did not pose a threat to wound healing.
  
  
  CONCLUSIONS
  Elevated BMI poses a greater threat to healing than does abdominal scar. Caution is recommended in undermining when the right subcostal scar exists.
authors.affiliation: The Johns Hopkins Medical Institutions, Division of Plastic Surgery and Department of Surgery, Baltimore, MD, USA. masherma@jhmi.edu
authors.forename: Michele A
authors.initials: MA
authors.lastname: Shermak
authors.forename: Jessie
authors.initials: J
authors.lastname: Mallalieu
authors.forename: David
authors.initials: D
authors.lastname: Chang