Isoflurane - The surgeon will typically use epinephrine infiltration to prevent blood loss, so if available, use isoflurane, as it is the least dysrhythmogenic of the inhaled anesthetics in the presence of epinephrine. Antibiotic - Typically cefazolin Extubation - Recommended deep extubation to prevent bucking. Postop Positioning - Maintenance of the flexed position (semi-fowlers) post-op will minimize tension on the suture line.
Indications for this procedure include abdominal wall laxity, diastasis of rectus muscles, excess skin, or a loose and sagging abdomen.
The surgeon will mark the patient in the upright position preoperatively. An incision is made above the pubic hair line and extended out to the anterior-superior iliac spine. The surgeon will then raise a flap of skin, subcutaneous tissue, and fat at the abdominal wall fascia. This dissection will extend up to the costal margin. The OR table will then be positioned so the patient is in the semi-fowler position and the flap of skin will be pulled down to overlap the incision. The redundant soft tissue will be excised. The wound will then be closed with drains and the belly button will be brought out through a new incision. An abdominal binder may be applied. The patient will remain in the semi-Fowler position during transfer from the OR table back to the stretcher.
