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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