Discussion: Corset Trunkplasty

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Excerpt

“Corset Trunkplasty: Recommended with Abdominal Skin Laxity and Open Cholecystectomy Scar,” by Acevedo, Nadhan, Everett, Moya, and Bradley, retrospectively analyzes consecutive abdominoplasty cases performed through corset or traditional transverse technique, with or without right subcostal scar. The analysis compares each technique with or without scar with regard to procedural time, complications, readmission rates, and risk of return to the operating room. Videos of the corset technique are provided by Dr. Moya, who innovated this approach to abdominoplasty. Findings demonstrate that the corset technique trumps the traditional transverse abdominoplasty approach, with or without scar, for the outcomes analyzed.
The technique of corset trunkplasty presents a novel approach to abdominal contouring. Midline vertical resection of skin redundancy is determined on the operating room table, and symmetry along the midline is measured before resection. The skin is excised as a vertical ellipse full thickness; there is no abdominal wall plication; and dog-ears are worked out superiorly with notable skin removal along the inframammary fold to the back, and inferiorly, also with significant skin removal along the pubis and groin to the back after flexing the patient on the table. The umbilicus is inset in the middle of the vertical excision. One drain is placed. Resultant scars are significant in exchange for impactful waist contouring and significant skin removal.
This article particularly advocates for the corset technique because it results in better healing outcome in the presence of subcostal scars that fall within the skin resection, and there are significantly fewer issues with regard to length of stay, reoperation, and complications relative to their traditional abdominoplasty study groups. Although the findings are statistically significant, the question arises with regard to real-world significance. Operative times for corset trunkplasty and transverse abdominoplasty differed by 15 to 20 minutes as performed by the senior author, which is not practically significant. With plastic surgeons new to this technique and with surgeons who work with residents, it is likely that the savings in time with the corset technique might be lost relative to surgical time with traditional abdominoplasty technique, even with abdominal wall plication, which I believe is critical to optimal outcomes in women presenting for postpartum repair of diastasis recti or for individuals seeking improvement after significant weight loss. Beyond the time saved, patients undergoing contemporary abdominal contouring by any surgical technique are typically treated as outpatients, and even in those undergoing surgery in a hospital, only a subset take advantage of a 24- to 48-hour observation stay. Length of stay is a nonissue for abdominal contouring procedures, as plastic surgeons aim to treat medically optimal patients; provide more thoughtful, improved pain management; and encourage early ambulation, which necessarily means the patients more often than not go home the day of surgery. Similarly, very few abdominoplasty patients require reoperation or readmission. Typically, if complicated outcomes arise, they can be managed in office visits. Realistically, surgical time, length of stay, and reoperation are not important issues in abdominoplasty treatment, despite the finding of statistically significant differences in outcomes in this study.
Much of the focus of the article is on the effect of the presence of subcostal scar on outcome comparing corset and traditional abdominoplasty techniques, with outcome statistically better with the corset technique. Although my article studying standard abdominoplasty technique for massive weight loss patients found a higher risk of complicated outcomes with subcostal scars, the analysis was performed at a time when subcostal scars from cholecystectomy surgery were more of an issue.1 Over the past 20 years, open cholecystectomy procedures are increasingly only rarely performed.
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