脂肪吸引腹部成形術後の皮膚感覚消失：機能および生活の質との相関を伴う前向き定量的マッピング研究

Abdominoplasty, especially when combined with circumferential liposuction, is a widely performed body contouring procedure with well-established aesthetic and functional benefits. However, postoperative cutaneous sensory loss in the abdominal wall remains a frequent and underexplored complication. This study aimed to prospectively map sensory changes following lipoabdominoplasty and evaluate the influence of Scarpa's fascia preservation on recovery trajectories and quality of life.

A prospective single-center study was conducted on 60 patients (mean age 42.7 years; 93.3% female) undergoing 360-degree liposuction and lipoabdominoplasty. Patients were stratified into two groups: Scarpa-preserved (n = 32) and standard dissection with Scarpa removal (n = 28). Sensory testing included Semmes-Weinstein monofilaments, thermal discrimination, and two-point discrimination across 12 abdominal dermatomal zones (T6-L1), assessed preoperatively and at 1, 3, 6, and 12 months. Patient-reported outcomes were measured using standardized questionnaires (SF-36, VAS, and POSAS). Statistical comparisons and multivariate regression were performed to identify predictors of long-term sensory deficits.

At 1 month, 93.3% of patients exhibited sensory impairment, most pronounced in the infraumbilical medial (Zone 8), suprapubic (Zone 11), and supraumbilical midline (Zone 5) regions. Recovery progressed steadily: residual deficits persisted in 72.5% at 3 months, 55.0% at 6 months, and 21.7% at 12 months. Tactile, thermal, and spatial discrimination showed parallel patterns of recovery, with near-complete restitution in most cases. Preservation of Scarpa's fascia significantly improved sensory outcomes, with better tactile thresholds (Zones 5 and 8 at 6 months, p < 0.05), faster thermal recovery (Zone 11 at 3 months, p = 0.041), and fewer impaired dermatomes at late follow-up (p < 0.05). Multivariate analysis identified higher BMI, standard dissection (Scarpa removal), and greater resection weight (>1000 g) as independent predictors of persistent hypoesthesia. Patient-reported maps correlated strongly with objective findings (r = 0.81, p < 0.001). Quality-of-life scores and scar satisfaction were significantly higher in the Scarpa-preserved group at 12 months.

Cutaneous sensory loss is an almost universal early sequela of lipoabdominoplasty but typically resolves within 12 months. Preservation of Scarpa's fascia confers measurable neuroprotective effects, reducing long-term deficits and enhancing patient satisfaction. Incorporating comprehensive sensory evaluation into surgical planning and patient counseling may improve functional and aesthetic outcomes.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .