Ronaldo Pontes block abdominoplasty technique

BRAGA, LEONARDO XAVIER; DAVID, ARTHUR CASOLARI ARAÚJO MANSUR; KAM, RICARDO ARIEL; LOPES, RAFAEL DE OLIVERA; PONTES, GISELA HOBSON

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 34 (4) • Oct-Dec 2019 • https://doi.org/10.5935/2177-1235.2019RBCP0224 copy

Ronaldo Pontes block abdominoplasty technique

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Abdominoplasty involves not only aesthetic characteristics but abdominal wall structural reconstruction. This study aimed to illustrate the authors’ experience with abdominoplasty, focusing on the scar’s aesthetic results and the evolution of application of the block resection technique of Professor Ronaldo Pontes (RP).

Methods:

The study included a series of retrospective cases of 124 patients treated between March 2014 and March 2017 who underwent RP block abdominoplasty.

Results:

In our studies, a minimal incidence of complications and a small number of healing alterations were noted with the RP block technique compared to those found in the literature.

Conclusion:

A técnica descrita e suas variantes atendem a necessidade de diversos tipos de casos e garantem cirurgias seguras e eficazes, com resultados muito satisfatórios, sendo uma técnica reprodutível.

Keywords:
AAbdominoplasty; Seroma; Hematoma; Hypertrophic scar; Keloid

Body mass index (kg/m2)	Frequency	%
20-22 23-25	13 48	10.40 38.80
26-28	35	28.20
29-31	15	12.10
32-34	8	6.50
≥35	5	4.00

Comorbidity	Frequency	%
None (healthy patient)	84	67.74
Diabetes	4	3.22
Hypertension	15	12.09
Hypothyroidism	8	6.45
Other	15	12.09

Age (years)	Frequency	%
18-30	20	16.12
31-45	67	54
46-60	33	27
61-65	4	3

Complication	Frequency (%)	Literature (range, %)
Seroma	1.61 (2 cases)	1.0-4.2
Hematoma	0.80 (1 cases)	5.0-6.1
Surgical site infection	0.00 (0 cases)	2.2-7.3
Flap necrosis or loss	0.80 (1 cases)	4.8-6.0
Deep vein thrombosis	0.00 (0 cases)	1.0-1.1
Pulmonary embolism	0.00 (0 cases)	0.5-0.8

Complication	Frequency (N = 124)	%
Without complications	118	95.18
Wound dehiscence	0	0.00
Hypertrophic scar	2	1.61
Keloid scars	1	0.80

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

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[1] Conflicts of interest: none.

1.	Marking of the block abdominal incision (RP technique) with the patient in the standing and lying positions;
2.	Pneumatic boot placement;
3.	Patient in horizontal dorsal decubitus position with asepsis and antisepsis and placement of sterile fields under general anesthesia;
4.	Local infiltration with anesthetic solution^* * Solution of 1.0 mL of 0.9% saline solution associated with 20 mL of 2% xylocaine, 20 mL of ropivacaine, and 1 mL of 1:000 adrenaline. ;
5.	Incision of excess tissue according to previous and circumferential navel marking;
6.	Resection of excess tissue previously marked, keeping the navel inserted in the aponeurosis^ The technique used the RP1, RP2, and RP4 approaches; in RP3, the navel is removed of aponeurosis. ;
7.	Tunnel flap detachment up to the xiphoid process with plicature marking of the muscle-aponeurotic system of the abdominal rectum;
8.	Plicature according to the marking, with number 0 Prolene thread and navel fixation in the aponeurosis with four cardinal points;
9.	Flap caudal traction to mark the onphaloplasty on the skin as a Y (3-point star);
10.	Review of hemostasis and introduction of a closed suction drain system (exiting in the pubic region);
11.	Confection of Baroudi adhesion points;
12.	Onphaloplasty, resulting in an equilateral triangle (directed to the pubis);
13.	Flap synthesis in three planes; and
14.	Local dressing.

LXB	Conceptualization, Final manuscript approval, Investigation, Realization of operations and/or trials, Resources, Supervision, Writing - Original Draft Preparation
ACAMD	Resources, Supervision
RAK	Analysis and/or data interpretation, Data Curation, Formal Analysis, Investigation, Methodology, Writing - Original Draft Preparation, Writing - Review & Editing
ROL	Analysis and/or data interpretation, Conceptualization, Data Curation, Formal Analysis, Writing - Original Draft Preparation, Writing - Review & Editing
GHP	Final manuscript approval, Supervision, Validation, Writing - Original Draft Preparation

LXB	Aprovação final do manuscrito, Conceitualização, Gerenciamento de Recursos, Investigação, Realização das operações e/ou experimentos, Redação - Preparação do original, Supervisão
ACAMD	Gerenciamento de Recursos, Supervisão
RAK	Análise e/ou interpretação dos dados, Análise estatística, Coleta de Dados, Investigação, Metodologia, Redação - Preparação do original, Redação - Revisão e Edição
ROL	Análise e/ou interpretação dos dados, Análise estatística, Coleta de Dados, Conceitualização, Redação - Preparação do original, Redação - Revisão e Edição
GHP	Aprovação final do manuscrito, Redação - Preparação do original, Supervisão, Validação