Esthetic and functional evaluation of abdominal contouring using lipoabdominoplasty versus lipoabdominoplasty with TULUA procedure: a comparative clinical study

Background
Lipoabdominoplasty techniques may be followed by a wide range of complications such as flap necrosis, wound dehiscence, surgical site infection, epigastric bulging, malpositioned umbilicus, high transverse scar, and seroma formation. Villegas in 2014 introduced Transverse Plication, No Undermining, Full Liposuction, Neoumbilicoplasty, and Low Transverse Abdominal Scar (TULUA) abdominoplasty to improve the esthetic outcome and to avoid the many associated complications mentioned. The aim of this study was to compare the esthetic and functional outcomes between the traditional lipoabdominoplasty and TULUA abdominoplasty.
Patients and methods
In this prospective comparative clinical study, 60 adult women with excess subcutaneous abdominal fat and skin laxity after repeated pregnancies with mild to moderate degree of diastasis of recti were included. The patients’ ages ranged between 28 and 55 years, and their BMI scores were 25–35 kg/m. Group A (30 patients) underwent lipoabdominoplasty, whereas group B (30 patients) underwent TULUA abdominoplasty. The patients were followed up for a minimum of 6 months, where the comparative study included esthetic results regarding the abdominal contouring using clinical outcome scaling system in addition to functional aspects assessing anatomical features, changes in anterior abdominal wall, and finally, the complication rates between both techniques.
Results
The average volume of liposuction of the abdomen was 2400 ml in group A, whereas in group B, the average volume was 3500 ml. The mean surface area of vertical plicature measured intraoperatively was 211.93±54.66 cm in group A, whereas in group B, the mean transverse plicature surface area was 369.47±84.22 cm. The increase in intra-abdominal pressure after plication and skin closure in group A was 7.93±1.26 cmHO, whereas in group B was 9.87±1.01 cmHO, being higher, with a highly significant difference. Flap sloughing was seen in four cases (13.3%), wound dehiscence in two cases (6.6%), and seroma in three cases (10%) for group A, whereas no cases reported flap necrosis, wound dehiscence, or seroma that need to be aspired in group B. The esthetic outcomes were evaluated using a five-point Likert scale system through three indicators. For group A, the overall result was 4.50±0.87, umbilical appearance was 4.61±0.73, and scar quality was 4.35±0.82. On the contrary, group B showed overall result of 4.53±0.71, umbilical appearance of 4.52±0.82, and scar quality of 4.43±0.87.
Conclusions
TULUA procedure is a safe, reproducible shift in abdominoplasty and is associated with fewer complications.