Plastic Surgery/Tummy tuck

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QUESTION: How would I know if the Scarpa Facsia was/was not sutured as part of the closure procedure of a tummy tuck, and are there any consequences if the Scarpa fascia is not sutured eg seroma formation, wound breakdown, and urinogenital disturbances?

ANSWER: from Dr. Alan Engler
www.bodysculpture.com

Hi Sue,

It's very hard to find that out...it may or may not be noted in the operative report but even if there is no specific mention of it, that doesn't mean it wasn't repaired.  It is not realistic to have every detail of the procedure noted specifically.  In general, terms such as "the tissues were repaired in layers" or something like that is used.  In that case, you can reasonably assume that sutures were placed in any layers that appeared thick enough to hold tension, including Scarpa's.  Aside from that, it is difficult to ascertain.

On the other hand, I don't know of any specific deficits that have been attributed precisely to the LACK of repair of Scarpa's (or the failure of that repair).  If interrupted sutures are used (single sutures, rather than one long one) for this layer, then even if one or more of them failed, one can, similarly, assume that enough tension was maintained, on this and other layers, to prevent deficits associated with lack of repair, or impaired blood flow (which could lead to disruption, wound separation, flap loss, etc).  And seroma can occur regardless of what type of repair, and with or without drains.  Finally, I am not aware of urogenital disturbances (aside from temporary swelling and bruising) being related to this surgery and, particularly, to Scarpa's fascia.

I hope that this helps and good luck,

Dr. E
www.bodysculpture.com

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr E for your response. However, can a surgeon tell if the scarpa fascia was not sutured?

I went in for a revision of scar only but, my surgeon (not the surgeon who did the original surgery) told me that my abdomen was a 'mess' and that there was a lot of scar tissue and that he was forced to lift the flap again, all due to the scarpa fascia not being sutured. He further suggested that, had the scarpa fascia been sutured then a seroma would not have formed or my wound brokedown. Is this true?

Sue

Answer
I would have a hard time looking at tissue during a revision and being able to determine with certainty what was or was not done...in general, it's hard to say something "wasn't done" since even if it were done (ie, repaired) the repair may not have held adequately.  I also would not be comfortable stating that a seroma would not form in the presence of a repaired layer of tissue.  It's just a little too nebulous, in my opinion.

Dr.  E

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Alan M. Engler, MD, FACS

Expertise

Dr. Engler has answered over 6400 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is www.bodysculpture.com. Follow Dr. Engler: @AlanEnglerMD

Experience

Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, as well as EyeScapes - Plastic Surgery of the Eyelids.

Education/Credentials
Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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