Postbariatric patients undergoing body-contouring abdominoplasty: two techniques to raise the flap and their influence on postoperative complications.

摘要

Postbariatric patients undergoing abdominoplasties were retrospectively analyzed to correlate postoperative local complications with the 2 most commonly used techniques of raising the abdominal flap: diathermocoagulation versus scalpel. All patients undergoing body-contouring abdominoplasties were included. Excluded were patients with ongoing clinical infections, those that received a complete course of antibiotic in the 6 months before operation, those requesting steroid therapy, those with systemic diseases that could impair wound repair (arteriosclerosis, diabetes mellitus), and those who had undergone apronectomy. One hundred thirty-seven patients were divided into 2 groups (diathermocoagulation = 90 vs. scalpel = 47). Overall, 7 seromas (5.1%), 7 hematomas (5.1%), and 28 wound infections (20.4%) were detected. A higher occurrence of postoperative hematomas was found after the flap raised using a scalpel (12.8% vs. 1.1%, Fisher exact test, P < 0.05), with a relative risk of 11.6. A significant association existed between postoperative hematomas and wound infections with delayed healing (n = 10, 7.3%): 43% of patients with a hematoma also experienced a wound infection with delayed healing versus 5.4% of those that did not develop hematomas (Fisher exact test; P < 0.01). In patients for whom a scalpel had been used to raise the flap, this correlation persisted (50% of patients with a hematoma had developed a wound infection with delayed healing vs. 7.3% of those that did not develop hematomas; Fisher exact test; P < 0.05).In postbariatric patients, diathermocoagulation reduces the occurrence of postoperative hematomas and wound infections with delayed healing compared with the cold knife.