TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

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Abstrakt

Tytuł:: TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.
Autorzy:: Villegas-Alzate FJ; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Blugerman G; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Vera-Cucchiaro J; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Cárdenas-Camarena L; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Uebel CO; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Schavelzon D; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Moretti E; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Elena E; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Elmeligy A; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Danilla S; From the Plastic Surgery Department, Universidad del Valle Cali; UCEVA, Central Unit of Valle del Cauca Tuluá; Centro B&S Plastic Surgery; Aesthetic and Laser Surgery Clinic; Innovare, Specialized Plastic Surgery Clinic; Division Plastic Surgery, Pontifical Catholic University of Rio Grande do Sul; Gamma Health Group, Hospital Privado Rosario; Centro de Medicina y Cirugía Plástica Esteban Elena; Plastic Surgery Department, Ain Shams University; and Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital.
Źródło:: Plastic and reconstructive surgery [Plast Reconstr Surg] 2021 Dec 01; Vol. 148 (6), pp. 1248-1261.
Typ publikacji:: Journal Article; Multicenter Study
Język:: English
Imprint Name(s):: Publication: : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore : Williams & Wilkins,
MeSH Terms:: Cicatrix/*epidemiology
Lipoabdominoplasty/*methods
Postoperative Complications/*epidemiology
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cicatrix/etiology ; Cicatrix/prevention & control ; Esthetics ; Female ; Follow-Up Studies ; Humans ; Lipoabdominoplasty/adverse effects ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Reproducibility of Results ; Retrospective Studies ; Treatment Outcome ; Young Adult
References:: Mayr M, Holm C, Höfter E, Becker A, Pfeiffer U, Mühlbauer W. Effects of aesthetic abdominoplasty on abdominal wall perfusion: A quantitative evaluation. Plast Reconstr Surg. 2004;114:1586–1594.
Matarasso A, Matarasso DM, Matarasso EJ. Abdominoplasty: Classic principles and technique. Clin Plast Surg. 2014;41:655–672.
Lockwood T. High-lateral-tension abdominoplasty with superficial fascial system suspension. Plast Reconstr Surg. 1995;96:603–615.
Illouz YG. En bloc abdominoplasty: A new, safer and more esthetic technique (in French). Ann Chir Plast Esthet. 1990;35:233–242.
Avelar JM. Abdominoplasty combined with lipoplasty without panniculus undermining: Abdominolipoplasty. A safe technique. Clin Plast Surg. 2006;33:79–90, vii.
Graf R, de Araujo LR, Rippel R, Neto LG, Pace DT, Cruz GA. Lipoabdominoplasty: Liposuction with reduced undermining and traditional abdominal skin flap resection. Aesthetic Plast Surg. 2006;30:1–8.
Saldanha OR, Pinto EB, Matos WN Jr, Lucon RL, Magalhães F, Bello EM. Lipoabdominoplasty without undermining. Aesthet Surg J. 2001;21:518–526.
Villegas-Alzate FJ. Murillo W, ed. Umbilicus and scar positioning during abdominoplasty: Main determinants of results. In: Omphaloplasty. A Surgical Guide to the Umbilicus. 2018:Cham, Switzerland: Springer; 41–70.
Caldeira AML, Carrión K, Jaulis J. Focus on the importance of lipomid-abdominoplasty in the body contouring surgery. Aesthetic Plast Surg. 2019;43:718–725.
Villegas FJ. A novel approach to abdominoplasty: TULUA modifications (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar). Aesthetic Plast Surg. 2014;38:511–520.
Villegas F. Google forms, Patients - TULUA abdominoplasty. Available at: https://goo.gl/forms/wbN1z6pdwtWGTAvB2 . Accessed March 21, 2020.
Villegas F. Google forms, Pacientes - TULUA abdominoplastia. Available at: https://goo.gl/forms/L1l7MxxgmIIuXiTv1 . Accessed March 21, 2020.
Salles AG, Ferreira MC, do Nascimento Remigio AF, Gemperli R. Evaluation of aesthetic abdominal surgery using a new clinical scale. Aesthetic Plast Surg. 2012;36:49–53.
Villegas-Alzate FJ. Di Giuseppe A, Shiffman MA, eds. A paradigm shift for abdominoplasty: Transverse hypogastric plication without supraumbilical dissection, unrestricted liposuction, neoumbilicoplasty, and low placement of the scar (TULUA). In: Aesthetic Plastic Surgery of the Abdomen. 2016:Cham, Switzerland: Springer; 171–193.
Villegas F. TULUA lipoabdominoplasty: No supraumbilical elevation combined with transverse infraumbilical plication, video description, and experience with 164 patients. Aesthet Surg J. 2021;41:577–594.
Matarasso A. Reply: Secondary abdominoplasty: Management of the umbilicus after prior stalk transection. Plast Reconstr Surg. 2020;145:654e–655e.
Cucchiaro JV. Secondary abdominoplasty: Management of the umbilicus after prior stalk transection. Plast Reconstr Surg. 2020;145:654e.
Cucchiaro JV. High definition liposuction classification. Plast Reconstr Surg Glob Open 2019;7:e2440.
Avelar JM. Opinion. TULUA: In search of excellence, simplicity and safety in abdominoplasty (in Portuguese). Available at: http://boletim.med.br/en/2018/07/26/parecer-sobre-o-artigo-tulua-em-busca-da-excelencia-simplicidade-e-seguranca-em-abdominoplastia/ . Accessed April 18, 2020.
Villegas F. TULUA: In search of excellence, simplicity and safety in abdominoplasty (in Portuguese). Available at: http://boletim.med.br/cirurgia-estetica-do-corpo/tulua-em-busca-da-excelencia-simplicidade-e-seguranca-em-abdominoplastia/ . Accessed March 21, 2020.
Vila-Rovira R. Commentary on the article “TULUA: Transverse plication lipoabdominoplasty without supraumbilical detachment. Series of 176 cases” (in Spanish). Cir Plast Iberolatinoam. 2020;46:7–24.
Rosenfield LK. Commentary on: TULUA lipoabdominoplasty: No supraumbilical elevation combined with transverse infraumbilical plication: Video description and experience with 164 patients. Aesthet Surg J. 2020;41:598–602.
Nahas FX. Commentary on: TULUA lipoabdominoplasty: No supraumbilical elevation combined with transverse infraumbilical plication, video description, and experience with 164 patients. Aesthet Surg J. 2020;41:595–597.
Villegas F, Caycedo D, Meza L, Malaver J, Hidalgo S, Cardona V. Transverse and vertical plication lipoabdominoplasty. An experimental study in rats (in Spanish). Rev Col Cir Plast Rec. 2017;23:9–32. Available at: http://www.ciplastica.com/ojs/index.php/rccp/article/view/50 . Accessed April 8, 2020.
Vila-Rovira R, Serra-Renom JR, Guinot-Madridejos ALiposucción abdominal asociada a abdominoplastia. Cir Plast Iberolatinoam. 1985;11:301–307.
Avelar JM. Fat-suction versus abdominoplasty. Aesthetic Plast Surg. 1985;9:265–276.
Cárdenas-Camarena L, González LE. Large-volume liposuction and extensive abdominoplasty: A feasible alternative for improving body shape. Plast Reconstr Surg. 1998;102:1698–1707.
Avelar JM. A new technique for abdominoplasty: Closed vascular system of subdermal flap folded over itself combined to liposuction (in Portuguese). Rev Bras Cir. 1999;6:3–20.
Illouz YG. A new safe and aesthetic approach to suction abdominoplasty. Aesthetic Plast Surg. 1992;16:237–245.
Saldanha OR, De Souza Pinto EB, Mattos WN Jr, et al. Lipoabdominoplasty with selective and safe undermining. Aesthetic Plast Surg. 2003;27:322–327.
Saldanha OR, Federico R, Daher PF, et al. Lipoabdominoplasty. Plast Reconstr Surg. 2009;124:934–942.
Saldanha OR, Azevedo SF, Delboni PS, Saldanha Filho OR, Saldanha CB, Uribe LH. Lipoabdominoplasty: The Saldanha technique. Clin Plast Surg. 2010;37:469–481.
Nahas FX. Advancement of the external oblique muscle flap to improve the waistline: A study in cadavers. Plast Reconstr Surg. 2001;108:550–555.
Veríssimo P, Nahas FX, Barbosa MV, de Carvalho Gomes HF, Ferreira LM. Is it possible to repair diastasis recti and shorten the aponeurosis at the same time? Aesthetic Plast Surg. 2014;38:379–386.
Nahas FX. An aesthetic classification of the abdomen based on the myoaponeurotic layer. Plast Reconstr Surg. 2001;108:1787–1795; discussion 1796–1797.
Abramo AC, Casas SG, Oliveira VR, Marques A. H-shaped, double-contour plication in abdominoplasty. Aesthetic Plast Surg. 1999;23:260–266.
Cárdenas Restrepo JC, García Gutiérrez MM. Abdominoplasty with anchor plication and complete lipoplasty. Aesthet Surg J. 2004;24:418–422.
Marques A, Brenda E, Ishizuka MA, Abramo AC, Andrews JM. Abdominoplasty: Modified plication. Br J Plast Surg. 1990;43:473–475.
Serra-Renom JM, Martinez-Teixido L, Serra-Mestre JM. Abdominoplasty with customized transverse musculoaponeurotic plications. Plast Reconstr Surg. 2015;136:741e–749e.
Cardenas Restrepo JC, Munoz Ahmed JA. New technique of plication for miniabdominoplasty. Plast Reconstr Surg. 2002;109:1170–1177; discussion 1178–1190.
Yousif NJ, Lifchez SD, Nguyen HH. Transverse rectus sheath plication in abdominoplasty. Plast Reconstr Surg. 2004;114:778–784.
Villegas Alzate F. TULUA: Transverse plication lipoabdominoplasty without supra-umbilical flap detachment. A series of 176 patients (in Spanish). Cir Plast Iberolatinoam. 2020;46:7–24. Available at: https://ciplaslatin.com/descargas/item/46-1-tulua-lipoabdominoplastia-de-plicatura-transversa-sin-despegamiento-supraumbilical-serie-de-176-pacientes . Accessed April 8, 2020.
Nahas FX, Faustino LD, Ferreira LM. Abdominal wall plication and correction of deformities of the myoaponeurotic layer: Focusing on materials and techniques used for synthesis. Aesthet Surg J. 2019;39(Suppl 2):S78–S84.
Xia Y, Zhao J, Cao DS. Safety of lipoabdominoplasty versus abdominoplasty: A systematic review and meta-analysis. Aesthetic Plast Surg. 2019;43:167–174.
Dutot MC, Serror K, Al Ameri O, Chaouat M, Mimoun M, Boccara D. Improving safety after abdominoplasty: A retrospective review of 1128 cases. Plast Reconstr Surg. 2018;142:355–362.
Seth AK, Lin AM, Austen WG Jr, Gilman RH, Gallico GG III, Colwell AS. Impact of patient subtype and surgical variables on abdominoplasty outcomes: A 12-year Massachusetts General Hospital experience. Plast Reconstr Surg. 2017;140:899–908.
Uebel CO. Lipoabdominoplasty: Revisiting the superior pull-down abdominal flap and new approaches. Aesthetic Plast Surg. 2009;33:366–376.
Ribeiro RC, Matos WN Jr, Cruz PFS. Modified lipoabdominoplasty: Updating concepts. Plast Reconstr Surg. 2016;138:38e–47e.
Hoyos A, Perez ME, Guarin DE, Montenegro A. A report of 736 high-definition lipoabdominoplasties performed in conjunction with circumferential VASER liposuction. Plast Reconstr Surg. 2018;142:662–675.
Martinez-Teixido L, Serra-Mestre JM, Serra-Renom JM. A new technique for creating a neo-umbilicus in abdominoplasty. J Plast Reconstr Aesthet Surg. 2017;70:1760–1767.
Danilla S, Bonasic S. Anatomical localization of the umbilicus: A statistical analysis. Plast Reconstr Surg. 2007;119:1123–1124.
Villegas F. Secondary surgical times after abdominoplasty and liposuction. Rev Col Cir Plast Reconstr. 2011;17:47–58.
Visconti G, Salgarello M. The divine proportion “ace of spades” umbilicoplasty: A new method of navel positioning and plasty in abdominoplasty. Ann Plast Surg. 2016;76:265–269.
Moretti E, Gómez García F, Monti J, Vázquez G. Investigación de seromas postliposucción y dermolipectomía abdominal (Investigation of seromas postliposuction and abdominal dermolipectomy). Cir Plást Iberolatinoam. 2006;32:151–160.
Andrades P, Prado A, Danilla S, et al. Progressive tension sutures in the prevention of postabdominoplasty seroma: A prospective, randomized, double-blind clinical trial. Plast Reconstr Surg. 2007;120:935–946.
Babaitis R. High definition tummy tuck. Paper presented at: Plastic Surgery The Meeting 2019, 88th Annual Meeting of the American Society of Plastic Surgeons; September 20–24, 2019; San Diego, Calif.
Villegas F, Sanabria V, Mera J. Banco hemiabdominal, preservación de medio colgajo para segundo uso en reconstrucción mamaria microquirúrgica (Hemi-abdominal flap banking, preservation of a half abdomen for second use in microsurgical breast reconstruction). Rev Col Cir Plást Rec. 2017;23:66–76Available at: https://www.ciplastica.com/ojs/index.php/rccp/article/view/55/pdf . Accessed April 18, 2020.
Entry Date(s):: Date Created: 20211013 Date Completed: 20220120 Latest Revision: 20230717
Update Code:: 20240104
DOI:: 10.1097/PRS.0000000000008577
PMID:: 34644270
: Czasopismo naukowe

Background: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience.
Methods: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics.
Results: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded.
Conclusion: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate.
Clinical Question/level of Evidence: Therapeutic, IV.
(Copyright © 2021 by the American Society of Plastic Surgeons.)

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