Does the tumescent infiltration have an adverse effect on the full abdominoplasty flap?

Amaç. Abdominoplasti, kas-fasya gevşekliği ve sarkmış karın duvarını içeren belirgin karın şekilbozukluğu olan hastalarda, karın şekil ve sınırlarını yeniden düzelten en sık estetik cerrahiişlemlerden biridir. Faydalarının yanısıra işlem hematom, yağ nekrozu, yara açılması, cilt nekrozuve flep nekrozu gibi bazı komplikasyonlara sahiptir. Bunların hepsi doğrudan ya da dolaylı olarakabdominal flebin kan dolaşımı ile ilgili görünmektedir. Yöntem. Burada, bilinçli sedasyon altındatümesent infiltrasyon ile tam abdominoplasti geçiren, sonrasında ciddi bir komplikasyon olan zon1 de flep nekrozu gelişen, bunun tam abdominoplasti tekniği ile birleştirilmiş adrenaline ile ilişkiliolduğu düşünülen hasta sunuldu. Bulgular. Takip muayenelerinde yara bakımı, antibiyotiktedavisi ve nekrotik dokuların lokal anestezi altında debritmanı 6 ay süresince yapıldı. Sonuçtayara, ciddi revizyon cerrahisi gerektiren belirgin bir skar bırakarak kendiliğinden kapandı. Sonuç.Tam abdominoplasti işlemi, tümesent anestezi ile birleştirildiğinde, tumesentin adrenalin içeriğizon 1 de kan dolaşımını bozabilir, bu nedenle kısa transvers kesi, kas-deri perforatörlerinkorunması ve sınırlı yan diseksiyon gibi koruyucu işlemler flep iskemisinin önlenmesi için akıldatutulmalıdır.

Tümesent inf iltrasyon tam abdominop lasti f lebinde yan etkiye sahip olabilir mi?

Aim. Abdominoplasty is one of the most common aesthetic surgical procedures, which restoresabdominal contour and shape in patients who have significant abdominal deformations involvingmusculofacial laxicity and sagged abdominal wall. Besides its benefits, procedure has somecomplications such as seroma, hematoma, fat necrosis, wound dehiscense, skin necrosis and flapnecrosis. All of which seems to be related either directly or indirectly with the blood perfusion ofthe abdominal flap. Methods. Presented here, is a patient who underwent full abdominoplasty withtumescent infiltration under conscious sedation after which a severe complication, flap necrosisdeveloped in zone 1, suggesting that it was related with the full abdominoplasty techniquecombined with adrenaline. Results. In the follow-up examinations, wound care, antibiotictreatment, and debridment of the necrotic tissues under local anesthesia were performed during 6months. Finally wound closed itself, leaving significant lower abdominal scar which needed amajor revisional surgery. Conclusion. In full abdominoplasty procedure, when combined withtumescent anesthesia adrenaline content of the tumescent may compromise blood perfusion of thezone 1, so preventive procedures such as limited lateral dissection of the flap, protection of thesome musculocutaneous perforators and short transverse incision, should be kept in mind to avoidischemia of the flap.

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