Lipoabdominoplasty: Liposuction with Reduced Undermining and Traditional Abdominal Skin Flap Resection Ruth Graf, M.D., Ph.D., Luiz Roberto Reis de Araujo, M.D., Ms.C., Ronald Rippel, M.D., Ms.C., Lincoln Grac¸a Neto, M.D., Ms.C., Daniele Tanuri Pace, M.D., Ms.C., and Gilvani Azor Cruz, M.D. Parana´, Brazil Abstract. Abdominoplasty surgery has spread universally, as both an aesthetic and a reconstructive procedure, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. The purpose of this article is to demonstrate that an abdominoplasty technique with limited undermining and preservation of the flap perforator vessels makes it possible to reduce the complication rate attributable to flap necrosis and seroma in abdominoplasty. Doppler flowme- try color study of the abdominal wall was performed before the surgical procedure and on postoperative day 15 after lipoabdominoplasty for a series of 20 patients to evaluate the blood supply of the abdominal wall. This study con- firmed the preservation of perforator arteries in the peri- umbilicus area and right upper quadrant after abdominoplasty with liposuction and reduced undermin- ing. Key words: Abdominoplasty—Lipoabdominoplasty— Liposuction The increasing demand for plastic surgery of the abdomen has also increased the number of compli- cations, some of them very difficult to manage [8]. Among the most dramatic are flap ischemia and necrosis. Different approaches for avoiding these complica- tions [1, 12À14] have been proposed, and adequate flap blood supply is the basis for all these treatments. At the same time, many studies and technical ad- vances have been accomplished with proper knowl- edge of the postoperative flapÕs blood irrigation, which have helped to predict outcomes. Three branches of the femoral artery supply the lower abdominal wall. Cranial-caudally, they are the superficial iliac circumflex artery, the superficial epigastric artery, and the superficial external pudendal artery [6]. The superficial epigastric artery connects to the contralateral branch, and each ar- tery has connections with its deep branches. The deep branches, located between the tranversus ab- dominus muscle and the internal oblique muscle [5,6], are the 10th and 11th posterior intercostal arteries, the anterior branch of the subcostal artery, the anterior branches of the lumbar arteries, and the deep circumflex iliac artery. The rectus abdominus muscle sheath is nourished by the superior epigastric artery, which has its origin in the internal thoracic artery and the inferior epigastric artery that comes in turn from the external iliac artery immediately above the inguinal ligament. The superior epigastric artery penetrates the proximal extremity of the rec- tus sheath in the inner portion of the muscle at the level of the seventh rib cartilage through the ster- nocostal triangle. Myocutaneous branches perforate the anterior rectus sheath to supply the skin above, and they are closer to the lateral edge of the rectus abdominus muscle [10]. The inferior epigastric artery, with its origin in the external iliac artery, is the lateral border of the inguinal triangle. At first, it is within the preperitoneal connective tissue penetrating posteriorly to the rectus sheath at the level of the semilunar line running be- tween the muscle and the posterior rectus sheath. Anastomosis between the superior and inferior epi- Correspondence to Ruth Graf, M.D., Ph.D., Rua Solimo´ es 1184, Curitiba, PR 80810-070, Brazil; email: ruthgraf@ losi.com.br Aesth. Plast. Surg. 30:1À8, 2006 DOI: 10.1007/s00266-004-0084-7 Original Articles