Abdominoplasty in patients with and without pre-existing scars: a retrospective comparison

Over the past decade, abdominoplasty has become an increasingly popular aesthetic procedure both in improving anterior abdominal contour and scar revisions. The associated post-operative complications have been widely reported. Many factors such as obesity, smoking and pre-existing abdominal wall scars are hypothesised to increase the risk of these problems. However, there are no published data analysing the effect of segmental interruption to the blood supply that may have been caused by pre-existing scars. This study attempted to quantify the effect of pre-existing scars on the incidence of complications after abdominoplasty.

All 123 abdominoplasties under the care of a single surgeon (2000-2007) were reviewed retrospectively with respect to indications, presence of abdominal scars, and post-operative complications. Patients with pre-existing scars were compared with unmatched 'controls' (no scars) by univariate analysis using the Student's t-tests, Mann-Whitney U, and Fisher's Exact tests and by multivariate analysis employing a simple logistic regression.

One hundred and twenty-three patients (97% female, median age=40 years) underwent abdominoplasties for abdominal laxity (46%), multiple scars (22%) and 'diastasis recti' (11%). Seventy per cent (87/123) had pre-existing scars (29% single, 71% multiple) of which 32 patients have supraumbilical scars, fifty-five patients with infraumbilical scars and 36 patients with no pre-existing scar. A quarter of patients developed complications such as: infection (14.6%), delayed wound healing (8.1%) and wound dehiscence (4.9%). Smoking and diabetes were the only independent risk factors for complications following an abdominoplasty.

Our study suggests that pre-existing scars, both supra-umbilical and infraumbilical, did not significantly predispose to abdominoplasty complications. Smoking and diabetes were independent risk factors, a finding of clinical importance.