Evaluation of Intra-Operative Abdominal Wall Perfusion in Post-Bariatric Abdominal Dermolipectomy
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Abstract
Objective: Abdominal dermolipectomy after massive weight loss has become a standard procedure. However the complication rates such as wound necrosis or secondary healing complications are still high. In this context ischaemia or inadequate micro-perfusion are known as triggers of wound healing complications. Little is known about the regional perfusion patterns before and after post-bariatric abdominal dermolipectomy. This study focuses on assessment of intraoperative micro-perfusion patterns of the abdominal tissue. Methods: The perfusion of the abdominal wall flap was monitored intra-operatively in 17 patients with an average BMI of 29.2 8 3.7 kg/m 2 after bariatric surgery. All patients underwent abdominal post-bariatric dermolipectomy after massive weight loss while applying the non-invasive O2C laser-spectrophotometer. The micro-perfusion parameters oxygen saturation (SO 2 ), relative haemoglobin content (rHB) and relative blood flow (BF) were intra-operatively measured. Results: The results of this study show that the part of the abdominal fat typically resected during dermolipectomy has the lowest SO 2 before surgery. Furthermore, the results demonstrate that previously well oxygenated parts in the median line of the abdominal fat undergo a significant decrease in oxygen saturation upon mobilisation and subsequent suturing, while the caudal wound edges show an increase of micro-perfusion parameters. Conclusion: Data show that micro-perfusion is worst in the median line of the cranial wound edge and is significantly altered after mobilisation. In addition an intra-operative increase of micro-perfusion in the caudal part of the wound edge, especially in the mons pubis area, can be measured.