Photographic Documentation

■ Patient in standing position from the front

■ Patient in standing position from two sides

■ Patient in standing position from behind

Surgical Planning jg

Tightening of the abdominal wall is indicated if the skin no longer |

shrinks following substantial weight loss, or after a pregnancy that has §

overstretched the abdominal skin and, as a result of this, the elastic fibers 2

of the skin have been destroyed (cellulite) or the abdominal muscles have been strained and have moved away from one another in the center, which has resulted in divarification with a midline hernia. Retracted and painful scars following a gynecological operation (caesarian section) can also be a reason for tightening the abdominal wall.

If the patient is severely overweight, weight loss before the operation is necessary. In rare cases, tightening of the abdominal wall may be combined with liposuction.

The operation is performed under general anesthesia. The type of incision depends on the type and amount of surplus skin.

On the day before the operation, the surgeon has a discussion with the patient about the changes requested by him/her and the performance of the operation itself.

The incision is marked precisely on the patient, who should be in a standing position. When doing this, it should be ensured that a median line runs from the xiphoid process over the navel to the mons pubis and that there are no differences in the sides when drawing the line. A vertical incision is to be avoided. If there is not too much surplus skin, it is better to site the incision slightly more cranially.

The incision line is usually to be marked through the layer of fat and the surplus skin. A good estimation of how high the incision must be to avoid the necessity of a vertical incision can be made before the operation. This is the surgeon's art.

Whether the incision line is horizontal or W-shaped is not important. The important factor is the patient's individual anatomical characteristics, and the individual incision line should be adapted to these.

Thrombosis prophylaxis with s. c. fractionated heparin given once daily should be started the day before the operation. This thrombosis prophylaxis should be continued for 10 days after the operation, as one of the main risks in tightening of the abdominal wall is the danger of thrombosis and embolism.

Intraoperative infection prophylaxis with cefaclor 2 g.

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