Abdominal Anatomy of Stomach Wall

Tummy Tuck Surgery 01 Dividing Scarpa Fascia.
Tummy Tuck Surgery 01 Dividing Scarpa Fascia.
After cutting through the skin and Camper's Fascia, the white fibers of Scarpa Fascia show under tension of fingers of my left hand.
  • Tummy Tuck Surgery 01 Dividing Scarpa Fascia.
    After cutting through the skin and Camper's Fascia, the white fibers of Scarpa Fascia show under tension of fingers of my left hand.
  • Tummy Tuck Anatomy 02 Relaxed Scarpa Fascia in Fat.
    Relaxed Scarpa's Fascia Appears as a white line. This structural support varies in thickness and strength throughout the body.
  • Tummy Tuck Surgery 03 Tensing Scarpa Fascia to Define Tissue Below.
    Here my thumb is under the Scarpa Fascia tensing it to define the tissue planes below.
  • Tummy Tuck Surgery 04 Superficial Suspenstion System Below Scarpa Fascia.
    Below are the fine fibers of the Superficial Suspension System (SFS) supporting system connections to the abdominal wall.
  • Tummy Tuck Anatomy 05 Dissecting SFS From External Oblique Fascia.
    Dissecting the fine fibers of the SFS and fat off of the Aponeurotic portions of the External Oblique muscle.
  • Tummy Tuck Surgery 06 Plan for New Belly Button Base.
    Marking the plan for the base of the new belly button. This base will form the floor and tethering anchor for the skin above.
  • Tummy Tuck Surgery 07 Defining Base of New Belly Button.
    Cutting in a hole can be a challenge. The new belly button base incision is carefully performed perpendicular to the skin for better structure to repair.
  • Tummy Tuck Surgery 08 Belly Button Base Drops Free From Surface Skin.
    Belly button skin divided, the new base falls below. The surface hole became bigger as tethering tension was released.
  • Tummy Tuck Anatomy 09 Fascia Tethered to Belly Button Stalk.
    Left hand pulls on the remaining attachments of belly button to Linea Alba component of abdominal fascia.
  • Tummy Tuck Surgery 10 Belly Button Stalk Refinement.
    This central component being defined encloses the umbilical stalk. I define the stalk carefully to preserve blood supply, but minimize bulk for the new belly button base reconstruction.
  • Tummy Tuck Surgery 11 Dividing SFS Near Old Belly Button Hole.
    Fine filaments of Campers fascia layer of the SFS divided near old belly button hole.
  • Tummy Tuck Surgery 12 Dividing Excess Skin Improves Exposure.
    Dividing skin from the lower incision to the old belly button hole, helps visualize repair once I have proven there is enough excess tissue.
  • Tummy Tuck Surgery 13 Deep Dissection Protecting Nerves and Vessels.
    Coarse fibers of the SFS, nerves, and vessels are exposed during finger dissection exposing the rectus sheath for repair above the belly button.
  • Tummy Tuck Anatomy 14 Wide Diastasis Recti Muscles.
    Here there is a Diastasis Recti, the Rectus muscles are separated here with a thick fascia layer in between.
  • Tummy Tuck Anatomy 15 Separation of Rectus Abdominis Muscles.
    Diastasis Rectus muscles are stretched apart resulting in a wide Linea alba fascia plane separation. I was always careful during this dissection a patient history of popping or tearing experience looking for a thin scar from torn fascia.
  • Tummy Tuck Anatomy 16 Belly Button Base Between Diastasis Recti.
    Here the belly button base sits between the diastasis recti stretched apart rectus muscles. Under tension, the stalk is gone.
  • Tummy Tuck Surgery 17 Diastasis Dissection to Xyphoid and Rib Attachments.
    Exposure of the rectus muscles fascia sheaths must continue to the Xyphoid process of the rib cage to prevent bulges in the repair. I preferred to limit dissection to what needed to be repaired preserving blood supply and sensation.
  • Tummy Tuck Surgery 18 Planning Fascia Repair - Diastasis Relaxed.
    Now to plan the fascia repair. With an sedated, not paralyzed patient, tension adjustment is a ballet between breathing tightening relaxing muscles. Here the fascia and Diastasis Recti are not fully relaxed.
  • Tummy Tuck Surgery 19 Fascia Repair - Testing Tightness For Suture Placement.
    When the rectus muscles relax, I approximate them with forceps so they can be marked for repair tension.
  • Tummy Tuck Surgery 20 Marking Fascia Repair Plan with Pen.
    Here the tension adjusted tentative repair plan is marked with surgical pen.
  • Tummy Tuck Operation 21 Fascia Repair Plan Below Belly Button.
    Width of repair plan varies depending on the laxity of that tissue.
  • Tummy Tuck Surgery 22 Fascia Repair Plan - Belly Button On Excess Fascia.
    Here the belly button lays between the tentative markings which will then be adjusted for symmetry.
  • Tummy Tuck Surgery 23 Fascia Repair - Breathing Ballet.
    Here an initial suture approximates the lax fascia. Suture tying is also a ballet with the patient's breathing.
  • Tummy Tuck Surgery 24 Fascia Repair Progresses Below Belly Button.
    The deep layer of the repair progresses up to the belly button. Suture spaces to evenly spread tension without gaps to let deeper tissues herniate or come through.
  • Tummy Tuck Surgery 25 Fascia Repair - Excess Folded Inside.
    The extra fascia is folded inside the abdominal wall during this deeper of at least a two layer permanent suture repair.
  • Tummy Tuck Anatomy 26 Belly Button Stalk From Fascia Excess.
    The belly button stalk frees up as the rectus fascia sheaths are approximated.
  • Tummy Tuck Surgery 27 Fascia Repair Near Navel Stalk
    Fascia repair continues to the belly button adjusting navel position. Repair has to be tight enough not to herniate and loose enough to permit blood flow.
  • Tummy Tuck Surgery 28 Securing Stalk to Fascia.
    The stalk now is repaired with strong sutures to the fascia anchoring the base of belly button.
  • Tummy Tuck Surgery 29 Deeper Belly Button Stalk Secured to Deeper Fascia.
    Here the belly button base sits on top of the deep fascia repair.
  • Tummy Tuck Anatomy 30 Red Laser Light Confirming Belly Button Is Midline.
    Laser Light Leveler confirms central alignment of the belly button. The repair was adjusted if the navel was off center.
  • Tummy Tuck Surgery 31 Testing Fascia Repair for Space Between Sutures.
    I used my finger to test the fascia repair for defects needing deep layer sutures. Then a running layer of permanent suture material refines and reinforces this repair.
  • Tummy Tuck Surgery 32 Repair Belly Button Dermis to Fascia.
    Belly button base dermis repaired to fascia refining the deeper sutures. This controls the shape of the deep belly button skin.
  • Tummy Tuck Abdominoplasty 33 Fat Gap Above Old Belly Button Hole.
    Repair of abdominal SFS Camper's Fascia tissue above old belly button hole. This anatomic region is often thinner than surrounding tissue.
  • Tummy Tuck Anatomy 34 Camper's Fibrous Fat Repaired Under Dermis.
    Unless eliminated when removing excess, the typically thinner Camper's Fibrous Fat above the old belly button must be sculpted to match thickness to the groin repair site.
  • Tummy Tuck Surgery 35 Beginning SFS Scarpa Fascia Repair.
    Scarpa's Fascia Repair starts centrally after flexing the operating table to lessen tension. Typically two sutures are needed to distribute the load before the assistant can relax the support.
  • Tummy Tuck Surgery 36 Repair of Central Dermis.
    Central Dermal Repair to judge what excess tissue should be removed on each side.
  • Tummy Tuck Surgery 37 Dermis Sutures Reinforce Repair.
    Central Dermal Repair reinforced to deal with structural stress during surgery.
  • Tummy Tuck Surgery 38 Measure Excess Skin High Lateral Tension Repair.
    High Lateral Tension Tummy Tuck excess skin planning with Lockwood's Forceps. Markings are based on actual in operating room tensions, often coming close to the before surgery markings.
  • Tummy Tuck Surgery 39 Removing Excess Tissue.
    Excess skin removed. Even hours after Tumescent Anesthesia, the incisions are nearly bloodless. Deeper division is with cautery.
  • Tummy Tuck Anatomy 40 SFS Scarpa Fascia Repair Continues.
    Notice the well defined white Scarpa's Fascia being repaired. Closure starts laterally moving the excess tissue centrally to prevent a "Dog Ear" deformity. I preferred a heavy dissolvable suture.
  • Tummy Tuck Surgery 41 Removing Excess Tissue - Deep SFS Division
    Other side excess removed after marking tension. Here the deep SFS fibers are divided with gentle cautery. Low settings minimize tissue burn throughout the operation.
  • Tummy Tuck Surgery 42 SFS Repair - Distributing Excess Tissue.
    In the High Lateral Tension Tummy Tuck there is a longer upper wound to appropriate to the lower wound. Here the tissue is distributed to even out the excess during the SFS repair.
  • Tummy Tuck Surgery 43 Deep Fat Liposuction.
    Deep plane liposuction for coarse refinement of transition zone front to back.
  • Tummy Tuck Surgery 44 Superficial Fat Liposuction.
    Superficial liposuction can help with remaining Dog Ear minimization if still a factor. Microliposuction cannula offered fine control.
  • Tummy Tuck Surgery 45 Plan New Belly Button Hole.
    Plan for new belly button hole must match the location of sutured base inside.
  • Tummy Tuck Surgery 46 Fat Removed to Shape Belly Button Internal Wall.
    Fat removed to form shape of new belly button. This fat configuration influences internal navel geometry.
  • Tummy Tuck Surgery 47 New Belly Button Fat Wall.
    Fat wall of new belly button also factors into the shape of the internal walls.
  • Tummy Tuck Surgery 48 Depth Depends on Prior Repair Belly Button Base to Fascia.
    Depth of belly button depends on having a secure base repair to fascia. This includes the Deeper Stalk Repair and the Dermal Base Repair.
  • Tummy Tuck Surgery 49 Belly Button Skin to Base.
    Surface skin repaired to base of belly button with deep dermal dissolvable sutures.
  • Tummy Tuck Surgery 50 Hide Scar Inside Belly Button.
    Repair designed to hide scar inside belly button. This was done during the design of the size of the base and surface skin hole.
  • Tummy Tuck Surgery 51 Deep Fat Liposuction
    Deep liposuction refines the other side transition zone.
  • Tummy Tuck Surgery 52 Superficial Liposuction Fat.
    Superficial liposuction can manage residual Dog Ears if present.
  • Tummy Tuck Anatomy 53 Subdermal SFS Suture Reapair.
    Subdermal repair of the Superficial Fascia Suspension Fibers uses a buried knot to keep mass of dissolving suture away from the surface.
  • Tummy Tuck Surgery 54 Testing Subdermal SFS Repair.
    Finger tests for gaps in the Subdermal SFS repair. This level takes the tension off of the skin repair. Patient sedation now lightened so will be awake at end of surgery.
  • Tummy Tuck Surgery 55 Subcuticular Suture Closure.
    Dissolvable monofilament running subcuticular suture means no sutures to remove. Staples may be faster to apply, but less comfortable for the patient to wear until they need removal.
  • Tummy Tuck Surgery 56 Tummy Tuck Sculpture Before Dressing.
    Finished Tummy Tuck before dressings and Steri-Strip reinforcement. By now patient typically talking with Anesthesia about surgery.
  • Tummy Tuck Surgery 57 Everted Edges Skin Closure.
    Everted skin edges quickens edge to edge healing without a segment of Epidermis outer skin inverted between surfaces. If inverted, healing slowed.
  • Tummy Tuck Surgery 58 Belly Button Non-stick Dressing
    Non-stick dressing Xeroform gauze with Neosporin Ointment packed into new belly button to better conform skin edges to fat wall. Mastisol glue applied to hold tape and Steri-Strips.
  • Tummy Tuck Surgery 59 Applying Steri Strips.
    Steri-Strip paper tape reinforces wound and spreads tension to skin beyond incision line. Length of tape depends on distribution zone needed. I typically used full length for Body Lifts.
  • Tummy Tuck Surgery 60 Distributing Skin Tension.
    Tape tension is important. This is another layer of defensive protection when done right. Too tightly applied, and blistering can occur.
  • Tummy Tuck Surgery 61 Steri-Strips Complete.
    Steri-Strip reinforcement complete. Length used varied on patient size.
  • Tummy Tuck Surgery 62 Belly Button Gauze Pressure Padding.
    Gauze padding to apply central pressure over belly button region.
  • Tummy Tuck Surgery 63 Applying Belly Button Dressing.
    Foam tape applied to put gentle pressure completes the belly button dressing, not including critical garment.
  • Tummy Tuck Surgery 64 Belly Button - Foam Tape Pressure Dressing.
    Here is the foam tape, gauze, non-stick gauze finished belly button dressing.
  • Tummy Tuck Surgery 65 Drain(s) Exit Through Skin.
    Drain(s) exit through skin. I put this wound so that the eventual scar would be hidden in the pubic region, but such that wearing the drain would not compromise comfort.
  • Tummy Tuck Surgery 66 Compression Garment.
    The After Surgery Compression Garment is a key element in comfort and minimizing swelling or bruising. I had a special design adapted for this operation. The Male Compression Garment was customized for this important pressure reducing feature.
  • Tummy Tuck Surgery 67 Front Before, Plan, and 1 Month After.
    Learn more about this patients problem and Tumescent Tummy Tuck.
  • Tummy Tuck Surgery 68 Oblique Before, Plan, and 1 Month After.
    Before and After Tummy Tuck Videos are more critical in evaluating the problem & surgical sculpture.
  • Tummy Tuck Surgery 69 Right Lateral Before, Plan, and 1 Month After.
    Before and After Photographs should at least include my Standard Tummy Tuck Pictures.
  • Tummy Tuck Surgery 70 Left Lateral Before, Plan, and 1 Month After.
    Before and after upright photographs, just do not show skin laxity or excess tissue well.
  • Tummy Tuck Surgery 71 Oblique Before, Plan, and 1 Month After.
    Before and after photograph views should continue around the body to understand transition zones.
  • Tummy Tuck Surgery 72 Extra Tissues Sides and Surgical Plan.
    Excess tissue to be managed. The High Lateral Tension design helped better deal with the lateral laxity.

Tumescent Tummy Tuck Surgery performed under local anesthesia and heavy sedation beautifully demonstrates abdominal anatomy. The tumescent fluid leaves an almost bloodless field showing anatomic structures so more clearly than blood stained surgery. Precise definition and cauterization may be factors in the comfort after surgery we saw with this technique. Check out our Bruising Swelling Photo Gallery. Explore this patient's extensive Before After Photos Videos documenting problem, solution, path to recovery, and emotional experiences.

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