Ways to improve the results of reconstructive lipoabdominoplasty

Introduction. Reconstructive lipoabdominoplasty is a surgical technique aimed at restoring the anatomical and aesthetic integrity of the anterior abdominal wall. An important aspect of the effectiveness of the intervention is the choice of the method of electrodissection, which affects the extent of injury, the severity of pain, and the frequency of complications. Materials and methods. A prospective cohort study was conducted involving 90 patients who underwent reconstructive lipoabdominoplasty using three different modes of electrodissection: monopolar coagulation, monopolar cutting, and Valleylab mode. Intraoperative parameters, the frequency of complications according to the Clavien-Dindo scale, the intensity of pain (VAS), and patient satisfaction according to the BODY-Q questionnaire were studied. Results. The best results were achieved when using the Valleylab mode within the proposed step-by-step algorithm, taking into account features of blood supply (location of perforators of the superior and inferior epigastric vessels) to the anterior abdominal wall, local tissue status and concomitant pathology. In this group, the minimum duration of surgery (on average 120 min), the lowest blood loss (150 ml), and the lowest frequency of seromas (6,67 %) and hematomas (3,33 %) were recorded. A lower value of pain syndrome and high satisfaction with the aesthetic results according to the BODY-Q scale were noted. Discussion. The use of the Valleylab mode in combination with an algorithm that includes Doppler assessment of the vascular bed and stratification of patients by risk provides a gentle effect on tissues, reduces the likelihood of thermal damage and helps improve clinical and functional outcomes. The effectiveness is especially pronounced in elderly patients and with comorbid pathology. Conclusion. A comprehensive algorithmic approach to reconstructive lipoabdominoplasty with an individualized choice of the electrodissection method, including the use of the Valleylab mode, allows for increased safety and predictability of the intervention, reduced complication rates, and improved quality of life for patients. The proposed protocol can be recommended as a basis for standardizing surgical tactics in reconstructive surgery of the anterior abdominal wall.