Case 48 Abdominoplasty



Angie M. Paik and Karl H. Breuing

Case 48 Abdominoplasty

Case 48 (a, b) A 46-year-old female with history of two previous pregnancies and a 40-pound weight loss is interested in improving her abdominal contour.



48.1 Description




  • Abdominal skin laxity with periumbilical and lower abdominal striae



  • Central abdominal protuberance



  • Adiposity of bilateral flanks and hips



48.2 Work-Up



48.2.1 History




  • Elicit the patient’s specific concerns regarding the appearance of her abdomen



  • Concomitant medical issues




    • General risk factors for surgery and wound healing




      • Cardiac disease, pulmonary disease, diabetes, obesity, connective tissue disease, and steroid use



    • Risk factors for thrombotic event




      • History of deep venous thrombosis, pulmonary emboli, multiple miscarriages, or known genetic hypercoagulable state



  • Obstetric history: Number of previous pregnancies and plans for future pregnancies



  • Surgical history: Previous abdominal surgery



  • Goal weight and weight stability



  • History of smoking



48.2.2 Physical Examination




  • Calculate body mass index (BMI): Higher incidence of wound complications, deep vein thrombosis (DVT)/pulmonary embolism (PE) in obese patients



  • Examine excess skin and subcutaneous tissue




    • Skin pinch to assess subcutaneous adiposity



    • Note any striae and chest/abdominal scars



  • Examine for hernias or rectus diastasis



48.2.3 Pertinent Imaging or Diagnostic Studies




  • Complete blood count (CBC), basal metabolic profile (BMP), prothrombin time (PT)/international normalized ratio (INR), and activated partial thromboplastin time (aPTT) may be considered depending on medical comorbidities



  • Hematologic testing may be considered if history is consistent with hypercoagulable process



  • Fingerstick glucose on the day of surgery, if diabetic



  • Urine beta human chorionic gonadotropin level on the day of surgery



  • Nutrition labs may be considered for post bariatric surgery patients



  • Urine cotinine level 10 days prior to surgery (to confirm compliance with smoking cessation)



  • Computed tomography (CT) of abdomen/pelvis if there is a questionable hernia that is difficult to characterize on examination

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 48 Abdominoplasty
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