The grid/staple adjunct to abdominoplasty

A variety of designs have been described for skin resection in abdominoplasty, but all have in common the need for intraoperative modification. Comparison of the different techniques is problematic because the actual skin resection may differ from the preoperative design. In addition, it may be difficult to achieve a symmetrical result, given the shifting bulk of the skin and soft tissue and the differences between the upright and supine patient.

This article describes a standardized grid pattern drawn on the abdomen preoperatively that promotes symmetry and allows postoperative determination of the exact extent of skin resection. Preliminary stapling fundamentally changes the sequence of the procedure by eliminating the conventional first step of flap elevation.

The technique was used on 31 patients from January of 2004 through May of 2005. Body mass index ranged from 19.1 to 33.1, with an average of 24.4. All procedures were performed under general anesthesia in an accredited office operating facility on an outpatient basis. Details of the technique and representative cases are shown.

Use of the grid pattern allows more meaningful comparison of different techniques and gives the surgeon more insight into his or her own technique. When combined with temporary intraoperative skin stapling, it maximizes symmetry of the results, facilitates precise scar placement, and minimizes the need for modifications such as chasing dog-ears. Stapling also allows identification of the proper amount of safe tissue resection at the beginning of the procedure, allowing the redundant tissue to be removed without first being elevated as a cumbersome flap.