title: Evaluation of intra-operative abdominal wall perfusion in post-bariatric abdominal dermolipectomy.
abstract: OBJECTIVE
  Abdominal dermolipectomy after massive weight loss has become a standard procedure. However the complication rates such as wound necrosis or secondary healing complications are still high. In this context ischaemia or inadequate micro-perfusion are known as triggers of wound healing complications. Little is known about the regional perfusion patterns before and after post-bariatric abdominal dermolipectomy. This study focuses on assessment of intraoperative micro-perfusion patterns of the abdominal tissue.
  
  
  METHODS
  The perfusion of the abdominal wall flap was monitored intra-operatively in 17 patients with an average BMI of 29.2 ± 3.7 kg/m² after bariatric surgery. All patients underwent abdominal post-bariatric dermolipectomy after massive weight loss while applying the non-invasive O2C laser-spectrophotometer. The micro-perfusion parameters oxygen saturation (SO₂), relative haemoglobin content (rHB) and relative blood flow (BF) were intra-operatively measured.
  
  
  RESULTS
  The results of this study show that the part of the abdominal fat typically resected during dermolipectomy has the lowest SO₂ before surgery. Furthermore, the results demonstrate that previously well oxygenated parts in the median line of the abdominal fat undergo a significant decrease in oxygen saturation upon mobilisation and subsequent suturing, while the caudal wound edges show an increase of micro-perfusion parameters.
  
  
  CONCLUSIONS
  Data show that micro-perfusion is worst in the median line of the cranial wound edge and is significantly altered after mobilisation. In addition an intra-operative increase of micro-perfusion in the caudal part of the wound edge, especially in the mons pubis area, can be measured.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany. adrian.dragu@uk-erlangen.de
authors.forename: Adrian
authors.initials: A
authors.lastname: Dragu
authors.forename: Stefan
authors.initials: S
authors.lastname: Schnürer
authors.forename: Thomas
authors.initials: T
authors.lastname: Horbach
authors.forename: Frank
authors.initials: F
authors.lastname: Unglaub
authors.forename: Andreas
authors.initials: A
authors.lastname: Arkudas
authors.forename: Justus P
authors.initials: JP
authors.lastname: Beier
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D050153:Abdominal Fat / Q000601:surgery*; D034861:Abdominal Wall / Q000098:blood supply*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009767:Obesity, Morbid / Q000601:surgery*; D010100:Oxygen / Q000378:metabolism; D055420:Perfusion Imaging; D019651:Plastic Surgery Procedures; D013053:Spectrophotometry / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D015431:Weight Loss; D014945:Wound Healing; D055815:Young Adult
chemical_list: D010100:Oxygen