More Superficial Abdominoplasty in Post–Bariatric Surgery Patients

Sir: As stated by Fang et al.,1 postoperative fluid collections are the most frequent complication following an abdominoplasty procedure. Obese patients significantly differ from nonobese patients for their increased risk of surgical complications2 that persists even after the massive weight loss is obtained.3 The incidence of fluid collections in obese and post–bariatric surgery patients is higher than in normal patients4 and may be explained by the need to elevate a larger flap compared with normal weight patients or by the anatomical differences in the number and distribution of lymphatics following weight loss. Cases of massive collections (also referred as “pseudotumors”) in post–bariatric surgery patients undergoing body contouring abdominoplasty have already been published,5 and we also experienced one of them (Fig. 1).Fig. 1.: A 56-year-old woman underwent body contouring abdominoplasty after massive weight loss (body mass index decreased from 36 to 29.5) (above, left). Drains were removed on the third postoperative day and the patient was sent home with two compressive garments. The outpatient visit on postoperative day 7 was normal. On the postoperative day 14, a massive asymptomatic abdominal lump was detected (above, right). Surgical exploration removed approximately 4000 ml of serosanguineous fluid (below), and no site of active bleeding was found. The abdominal wound was closed directly; two drains were left in situ for 12 hours and two compressive binders were applied. On postoperative visits, the wound had healed, with no complications, and an overall good aesthetic result was obtained.The technique described by the authors is meritorious and could help prevent postoperative seromas. Although the occurrence of seromas and hematomas did not differ significantly between the groups, they found a significant reduction of the postoperative drain duration that could indirectly suggest a reduced amount of fluid formation. However, we would like to ask the authors to comment on its eventual application in post–bariatric surgery patients, because of their peculiar anatomical changes and increased wound risks, and if they can anticipate any specific advice in this setting. Furthermore, is it possible that the more superficial dissection could predispose the flap more frequently to necrosis in the event of a massive seroma or hematoma? The fluid collection could lead to an increase in the tissue pressure until the small vessels of the dermis become compressed, thereby reducing local tissue perfusion, and the reduced flap thickness could act as a predisposing factor. DISCLOSURE No funding was received for this study. The authors have no conflict of interest to declare. Antonino Araco, M.D. Istituto “Ninetta Rosano” Clinica Tricarico Marina di Belvedere Marittimo, Italy Francesco Araco, M.D. Department of Surgery University of Tor Vergata in Rome Rome, Italy Gianpiero Gravante, M.D. Department of Upper Gastrointestinal Surgery Frenchay Hospital Bristol, United Kingdom