The Art of Body Contouring A Comprehensive Approach

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of
Art
The

(Trang không có chữ)

Edited by
Al S. Aly, MD, FACS
Pro essor o Plastic Surgery, Plastic Surgery Consultant
Cleveland Clinic Abu Dhabi
Abu Dhabi, United Arab Emirates
Fabio X. Nahas, MD, PhD, MBA, FACS
Adjunct Pro essor, Division o Plastic Surgery
Federal University o São Paulo
São Paulo, Brazil
Illustrations by
Sarah Taylor ■ Brenda Bunch
Tif any Slaybaugh Davanzo ■ Craig Durant
of
Art
The

Executive Editor: Sue Hodgson
Managing Editor: Nikole Y. Connors
Developmental Editors: Jennifer Gann, Megan Fennell
Project Manager: Glenn Floyd
Director, Editorial Services: Mary Jo Casey
Production Editor: Sean Woznicki
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Senior Vice President and Chief Operating Officer:
Sarah Vanderbilt
President: Brian D. Scanlan
Library of Congress Cataloging-in-Publication Data
Names: Aly, Al S., editor. | Nahas, Fabio X., editor.
Title: The art of body contouring : a comprehensive approach /
[edited by] Al S. Aly, Fabio X. Nahas.
Description: First edition. | New York : Thieme, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2017013062| ISBN 9781626236561 (hardcover
: alk. paper) | ISBN 9781626238855 (eISBN)
Subjects: | MESH: Reconstructive Surgical Procedures--methods
Classification: LCC RD119 | NLM WO 600 | DDC 617.9/52--dc23
LC record available at
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Printed in India by Replika Press Pvt. Ltd.
5 4 3 2 1
ISBN 9781626236561
Also available as an e-book:
eISBN 9781626238855
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I would like to dedicate this book to Hana, Adam, racy, Essam,
and my mother and ather.
Al S. Aly
I would like to dedicate this book to my mother Cledi, my beloved wi e Roberta,
my daughter Marcella Pia, and my son Gianlucca.
Fabio X. Nahas

(Trang không có chữ)

Co n t r ibu t o r s
José Horácio Aboudib, MD
P S g , D . J é H á
A P S g y; M m
h B z S y P S g y;
P h B z S y
P S g y, 2012-2013; C
P S g y D p m , R
J S U v y; D
S , R J S
U v y
Jamil Ahmad, MD, FRCSC
T P S g y C ,
M g , O , C
Gary J. Alter, MD
A C P ,
D p m P S g y, UCLA
S h M , B v y H ,
C
Al S. Aly, MD, FACS
P P S g y, P
S g y C , C v C
A Dh , A Dh , U A
Em
Ricardo Arnt, MD
P S g , P v P , P
A g , R G S , B z
Ricardo Baroudi, MD
C D . R B C g
P á , Sã P , B z
Antonio Roberto Bozola, MD
IMAGEM C g P á , P ,
Sã J é R P , B z
Andrés Fernando Cánchica Cano,
MD
R , D p m P
R v S g y, S v ç
C g P á O v S h ,
S , Sã P , B z
Mauro F.S. Deos, MD
P S g ; F M m , B z
S y P S g y; P
P , B z S y P
S g y, R G S , B z
Sabina Aparecida Alvarez de Paiva,
MD
Ch R , S v ç C g
P á , D . E B v S z
P , S , Sã P , B z
Barry E. DiBernardo, MD
M D , N J y P
S g y; P P , N J y
S y P S g , 2005-2006;
A C P P
R v S g y, U v y
M D y N
J y
Gabriella DiBernardo, BS
R h F , D p m P
S g y, U v y P gh,
P gh, P y v
vii

viii
Cont r ibut or s
Lydia Masako Ferreira, MD, PhD
H F P , D p m
P S g y, F U v y
Sã P , V C m , Sã
P , B z
Osvaldo Saldanha Filho, MD
P O v S h
P S g y S v , y
B z S y P S g y;
C y h B B z
S y P S g y; F
M m B z S y P
S g y
Onelio Garcia, Jr., MD, FACS
V . A P , D v
P S g y, U v y M m
L M. M S h M ,
M m , F
Raul Gonzalez, MD
P , F y M ,
U v y R ã P , R
P , Sã P , B z ; C R
G z z, R P , Sã P ,
B z
David E. Guarin, MD
P S g , U v V ,
C , C m
Eduardo Gus, MD
F , D v P
R v S g y, U v y
, , O , C
Al redo E. Hoyos, MD
P S g , I ASAPS
M m , P v P , B g ,
C m
Kamran Khoobehi, MD, FACS
C P S g y, D
A h S g y g,
L S U v y, N
O , L
Daniel Kushner
M S , FAU Ch E.
S hm C g M , F
A U v y, B R ,
F
Michael R. Lee, MD
P S g , P C C m
S g y, D , x
Frank Lista, MD
A P , D p m
S g y, U v y ,
, O , C
Fabio X. Nahas, MD, PhD, MBA,
FACS
A j P , D v P
S g y, F U v y Sã
P , Sã P , B z
Beatriz Nicaretta, MD
C , D p m P
S g y, IASO G H p ,
A h , G
Luiz Haroldo Pereira, MD
M m , B z S y P
S g y, C p , R J ,
B z
Jason Pozner, MD, FACS
A j C F y, D p m
P S g y, C v C
F , W , F

ix
Cont r ibut or s
Rod J. Rohrich, MD, FACS
C P F g
Ch m , D g h h g
P , D p m P
S g y, U v y x
S h M C ;
F g P , D P
S g y I , D , x
Lorne King Rosenf eld, MD
P v P , B g m ,
C ; C P ,
D p m P S g y,
U v y C S
F , S F , C ;
A j C A P ,
D p m P S g y,
S U v y M C ,
S , C
Cristianna Bonetto Saldanha, MD
Sp G S g y, S
C M ó S ,
S , Sã P , B z
Osvaldo Saldanha, MD, PhD
H O v S h P
S g y S v , y
B z S y P S g y;
C y h B B z
S y P S g y; P
B z S y P S g y,
2006-2007; D A
S v P S g y B z
S y P S g y
Paulo R. Sanjuan, MD
Ch R , S v ç C g
P á , D . E B v S z
P , Sã P , B z
Fernando Serra, MD, PhD
P , D p m P
S g y, R J S
U v y; M m , B z S y
P S g y, R J ,
B z
Aris Sterodimas, MD
H , D p m P
R v S g y, IASO G
H p , A h , G
Geo N. Tabbal, MD
A P , D p m
P S g y, U v y x
S h M C , D ,
x
Carlos Oscar Uebel, MD, PhD
P Ch m , D v
P S g y, P C h
U v y R G S , P
A g , R G S , B z
Simeon Wall, Jr., MD, FACS
P S g , P v P ,
T W C P S g y
& J M Sp , Sh v p ,
L ; A C P ,
D p m P S g y,
U v y x S h
M C , D , x ;
A C P , D v
P S g y, L S
U v y H h S C
Sh v p , Sh v p , L
Jules A. Walters III, MD
P S g , Kh h &
A , N O , L

(Trang không có chữ)

xi
Fo r ew o r d
A A y F N h x j g g g h v y mp
h y g y. B z Am h v m
h h q mp v y g v h . I q
xp h v xp h h g h y h y g
h m .
h h p h mp m
v p g y . T m v y mp h m
p v h p h m g z v v
h h h q h p mp h h h q
.
I mp h h v h m m
h h q pp h . I x v h g,
h h p h m m m
pp h p g y, p p , g . T
m y g v h g .
T pp v m h v y h h q y
h . R h v p g pp y h h m ,
p y h h p
h , p y h h h h q h g ’
y .
B y g h m mp h v g y p g y. h
y h h m h h .
H v , h v v p m g m p p , Ch p
12, R L m L p , h v y m . T
h p v y mp h v v p y g,
h h p g m . R m
y p v y g m , m
h p h A y P h m mp v h
h p m m h h m p .

xii
For ewor d
T h gh-q y m h h, p y Ch p
2, A m p y Ov v . I h h p , h h h h v
h q m h h h q mp v
. I g h x v xp v m p y
y D . D Ch p 3, R v A m p y, D . W ’
m g h g. B gm g g y
h g y g h h v v y h
, h p m g g h m p p y.
T v y v v y g y m
m h p h m h .
T h mm h g h mp
j h , h gh x v y y m y h , v y
p h m . g h h mp m h
h v m h h h g h
y y g p y v v h h p y h A A y
F N h .
T , T e Art o Body Contouring: A Comprehensive Approach, mm z h
h . T “ mp h v ” h y h ,
y g p h y mp h v m . I
g y v h h q pp y h h
h mp v h g h j .
Lydia Masako Ferreira, MD, PhD
Head and Full Pro essor, Department o Plastic Surgery
Federal University o São Paulo
Vila Clementino, São Paulo, Brazil
T h p y h h : mp h v
pp h h y g. B y g y h m v
x h g . I h v y h h
g h g gh , gh g , p g y, / h
g v y. O h g g z , h h g p h p y
y h v m p p v , m v y
h gh g y h m m y v h gh g y.

xiii
For ewor d
h h , h my m h m xp
y g, h v v g p - h h
g v p y g, m g h
h p x . T , h gh mp m z ,
m h h y h h m , , pp
x m , , v , v g
h m m g . T m m y v ,
h j h .
h x v g h m , h m -
mp g. T p v h mp h v g h
phy g h m , h m p p m
my, h my v x m . T
hy h p h h D . N h z C v h
m p y mp h p p v m g g. D . O v S h ’
h p p m p y h p . W h m g,
h v pp y h m , p h v
p h , v m z g ; h , p m p y
h y h p y h m m , p , h m
p m y m . Ch p h gh- m p y
m - m p y , g h h p h
m p y. I h h p y yp -
m p y, D . N h m h x v xp h ,
g m p h , p g m , v
h . E h v h
p v h h gh h v m g m h
pp p m .
L p , xp , h gh y v . Ag , h mph y.
T p h p m p m
v - y p . F j v
p p v . I p h m v
m h , h h v y h h . I , h
h p m h j p v v j y
h , p y h .
B gm , h h h g g g p p y h U
S , v . T mph h h
mp . O h h , D . F S , h h PhD h
gm , h h v h my

xiv
For ewor d
h p h , h p h p h mp ,
p p v . B gm h j v
Ch p 16, L p p : F I j h q h B y.
I mm y, h p- - m g h h , h v y h
h q p , h mph g y, h h h
h h D . A y N h , m h q
g. T x p h h y g
m y h v xp p g
h v p g .
Luis O. Vasconez, MD
Pro essor o Plastic Surgery (Emeritus)
University o Alabama-Birmingham
Birmingham, Alabama

xv
Pr eFa Ce
T g h m g y g ymp m h
h Ch g y g . T A A y’ p v
y g , Body Contouring A er Massive Weight Loss, g
g z h m , h gh h g h p h
y g g y x , p y
m m h p g y: Am B z .
I h p g z g m h m m p j , z h
h gh h v m y , h y h h .
T , g h p h v Body Contouring
A er Massive Weight Loss. W g h g h , h
h Body Contouring A er Massive Weight Loss p h h
m g m h . I h m h 10 y h p h ,
h h h v m v h y h mph z
h h pp h h v h g h p h
h v h h y h v m .
T , p g g h h j h T e Art o Body Contouring:
A Comprehensive Approach, h v v g g h m h
m m N h Am , B z , h . W p p y v
xp h g p v h h ’ g
g h h v y y g p m
p g ’ p .
O h m p g y h y m g
h p . T , h v p h h p ,
h h h j v . A x g C
D Op v N q h . I m h
g h h p h q h g
h h p .

xvi
Pr eface
M y h v p v v h g y h h ’ p
mp h v g xp . N m , m
h h y , h g h m h
.
T e Art o Body Contouring: A Comprehensive Approach h g h h
v m h y g . I
h g h v m h q p m ,
g m . H p y, h p v y , h ,
h h g h h v xp h v g g h p .
Al S. Aly, MD
Fabio X. Nahas, MD

xvii
a Ckn o w l ed g men t s
S h h p h m h 10 y g , h
h g my . I h p v p h A C m I , v
m p h U v y C I v (UCI). A h gh I
h m v y g h UCI, I g y m g h
A C m. h y, h v I p m m v - gh - y g
p , I h . A I h m pp y g h
v g y h g v g my m I v . Op g h A
g p , m h m h I m
. B A I v p h p g h , h h y
p h I h h I p
mp y. A h h p h g h I h v
h h I h h g, I h mp h p my
h . I m A C m v y y h I m p I y
h m h h p, pp , .
A p g 4 y UCI, I m v x g p j . I 2014 I m v
h C v C A Dh , h I h v v v g p
g y m h g p. I I v p g gh, I h
h h h h x ’ A gm .
T h 20 h y h I h v p m g y g m v -
gh - g y. I v I h v g g h y y v . I m
x m y h h v h h pp y p , ,
p m v g y m v 30 . I h I p
A C m h I y h h h v v h m h h h p
h g m y h p p g h g . T y
y h v gh m m h y h g I m gh h v gh h m. I
h h m, y h y , y h v m .
I h h p p h h g h h m , my
m y. h h g h , I h h . A v
h h y h , m h mp
. I h v m h g m h , I z

xviii
Acknowl ed ent s
h I my m h , h , h ,
. D p h j m I h v m , I h v h m y m
my m y h h p j , I m h y h I pp
v h m v y m h.
L , , I h F N h . F -
g h g h , h h v y m
p . F y v y h g h h . H h g
, h h v v mp h h ,
p , pp . T y , my , I v y v y m h.
Al S. Aly
Wh g , h m h v m p p m . T
mm g h A A y v m p p h . O
v v y m . W h y g h
mp h v pp h h g h m h
v h m h p h q . W g
h g p h p p m , h h mp
p g y . T h v m h
y g m m - gh p m g x
h j , m y p p h m y
pp h p h m y m v gh
. T m h v y mp p . W h h m ,
v p h p , h h v y h xp .
E h h h y g y g. M g
h I g my y B z . My h , p p gy
g y h S U v y Sã P , m y p h
. P h m y v p m m ,
h q g m . H m h p h m h
h , I y g h h q h m y. H

xix
Acknowl ed ent s
gh m h p h h v h p m m . T ,
I x h m xp v m g h . Wh I
my h p h U v y A m B m gh m, I h h q
pp y m v y p m , D . L O. V z. I h 1 0 , h
g m RAM p. I m
h m h “ mp p h q ” m .
F h m , I h h p v g j h p p g y h m
h U v y A m , h h h y D . V z. O h m, I
p v p g h h g
p py. I h B z , h I my PhD h m
.
P Ly M F v m p h p g y y
h F U v y Sã P , I g my g g m
h y g g y, h v y pp y v p my h
h . I h p , I h v p p pp x m y 250 p , m
h h y g g y, I h h pp y p my
p m p 26 .
I h v m y h m y g h g z h .
My m y h h p , I h v xp
my g .
Wh A v m p p h h m h , I p v y
x . I mm h g g h p
. I h p , I h v h h pp y g y g
g , h m g, m v h g h .
A v v mp h h q , h h g ,
h h v y g mm . I mm y, h y
h v . A I m h v h p v g .
T , A , h xp .
Fabio X. Nahas

(Trang không có chữ)

xxi
Co n t en t s
A m Phy g Ch g h A m W 1
Fabio X. Nahas
A m p y Ov v 15
Fabio X. Nahas, Al S. Aly
R v A m p y 65
Mauro F.S. Deos, Ricardo Arnt, Eduardo Gus
L p m p y: T S h h q 5
Osvaldo Saldanha, Osvaldo Saldanha Filho, Cristianna Bonetto Saldanha, Sabina
Aparecida Alvarez de Paiva, Paulo R. Sanjuan, Andrés Fernando Cánchica Cano
L p m p y A W h M mm p y 10
Carlos Oscar Uebel
F A m p y W h C m SAFEL p
S p F Ex 137
Simeon Wall, Jr., Michael R. Lee
H gh- A m p y 1 5
Lorne King Rosen eld
M -A m p y: C m 225
Antonio Roberto Bozola
S y A yp C A m p y 253
Fabio X. Nahas
App h B h p y 275
Ricardo Baroudi
P p L p 2 7
Geo N. abbal, Jamil Ahmad, Frank Lista, Rod J. Rohrich

xxii

Cont ent s
R L m L p 323
Fabio X. Nahas, Lydia Masako Ferreira
L p h T gh 341
Luiz Haroldo Pereira, Beatriz Nicaretta, Aris Sterodimas
L p h Upp L Ex m 361
Onelio Garcia, Jr.
A v App h R p L p 3 7
Simeon Wall, Jr.
L p p : F I j h q h B y 42
Kamran Khoobehi, Jules A. Walters III
N h gy L p 445
Jason Pozner, Barry E. DiBernardo, Gabriella DiBernardo, Daniel Kushner
B A gm W h Imp 45
José Horácio Aboudib, Fernando Serra
C Imp 475
Raul Gonzalez
H gh-D L p p h A m 4 3
Al redo E. Hoyos, David E. Guarin
L p p h Ch A m 521
Al redo E. Hoyos, David E. Guarin
C g h F m Ex G 555
Gary J. Alter
C g h M G 5 1
Gary J. Alter
C 601
I x 603

xxiii
Vid eo s
-1 A m p y Ov v
Fabio X. Nahas
-1 RA yp 1
Mauro F.S. Deos
-2 RA yp 2
Mauro F.S. Deos
-1 L p m p y: T S h h q
Osvaldo Saldanha
-1 L p m p y
Carlos Oscar Uebel
-1 H gh L M g
Lorne King Rosen eld
-2 H gh L S g y
Lorne King Rosen eld
-1 M -A m p y
Antonio Roberto Bozola
-1 App h B h p y
Ricardo Baroudi
-1 L p h T gh
Luiz Haroldo Pereira, Beatriz Nicaretta, Aris Sterodimas
-1 L p h Upp L Ex m
Onelio Garcia, Jr.
-1 L p F G g
Kamran Khoobehi, Jules A. Walters III
-1 G p y
José Horácio Aboudib
-2 G p y S m C v
José Horácio Aboudib

(Trang không có chữ)

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C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
2
Th m p g m h g p -
h h v h p v p g h h v gh . I
h p g h mp x my h g h h -
h q h m . K g h m
my m y h h h m
v -m g g g h mp v h m -
p y. B p ’ my v , h yp
q g m v m h .
Surgical Anatomy
LANDMARKS AND ANA OMIC UNI S OF HE ABDOMEN
Anatomic units h m p g m p y. T -
m h m h m y p
. O h m h , h hm , p , p j -
, m h h p v h gh gh g -
g y. T m v g h g g h
, g h p h h h m.
I h p m h gh m p v h
, h m . T x h x
p j h m h hm h h -
Rectus abdominis
muscle
Linea alba
Paramedian fold
External oblique
muscle
Fig. 1-1

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
3
p m m . T m v h h hyp ph
m m m h m . I h p m
, h m hm h x h h z
h m h h h
p . T m h h z p h .
F h , m g h p m g m p y
m mp h m g h m .
p m h g h m , h h m
v m p . T h p j h m
, h m p j m m m h m
h . T y x m h pp m v -
h m . T v x p y yp . T
m h v y h p . T
m y g p m .
I h p m g h m g , h h mp
p j . T pp m h m h m mm y , h
h h m y p v m p y p . T
h y 3 4 m v h v h m , h p j
h h g y h h p j
h p .
I mp v h m v h m . T
h p x m y v . U y p h v g m h
x ph p h m h h m h m h p .
Waist/costal margin
Iliac spine
Fig. 1-2

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
4
T v h yp x m -
p y. Sh p p m h -
.
T p j h m mp h h p m -
. T g h m h gh p j g m p y.
SKIN AND SUBCU ANEOUS ANA OMY
I h m h v p m h . T -
m m p g v y h h p m . T h -
h h m v g v .
U y h x m m h m . T p j
h p m m gh h h x m .
T h m v y :
h p , h h mp h , h p y , h h
h m h . T p v y
g h m . I h m h g v -
h h p , p g p ’ gh . T
y v y , h h m y y . S p
p h y . T h h m
Fig. 1-3
Areolar fat
Scarpa fascia
Skin
Lamellar fat
Muscle

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
5
p g h p m , h
p h . T -
h m h m . I h m
h h h h p
h h m . I h , m v h m
y p h S p . T m v p m p
h v h m h gh h x h m p.
BLOOD SUPPLY
T m p x h m pp y h m . I
mp x p v h p h m . T
v pp y h p p g y, p m x
y, y p h p p g . S p
h h m h p h -
pp y.
T z pp y ( h , g H g ) h v mp
p v . T h pp y, h h h v -
g y p p v . I mp h ,
h y h p g g h g g h m p m -
g. Z I h p m g h h h m
m m h p h p p p g y. T z h
2
1
3
3
Fig. 1-4

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
6
m mp h p v m h p g p -
m g. T g p v m h y p m g m
z m g.
SENSI IVE INNERVA ION
T v v h m gm m m p -
. T , , hyp g , g v p -
h v y v h m . T
v h g g m 7 11. T v g m
12, h h hyp g v g m 12 L1, h g -
v g m L1. B h m 7 v h p m
, 10 v h p m , h h g g m 12
L1 p v v h m .
Fig. 1-5
T7
T12
T11
T10
T8
T9
Eighth
intercostal nerve
Anterior
cutaneous nerves
(T10-T12)
L1
Anterolateral
cutaneous nerves
Anterior
cutaneous nerves
Ilioinguinal nerve
Iliohypogastric
nerve

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
7
LYMPHA IC SYS EM
A h gh h h ymph y m h h
p m h x y ymph , h h m
y m h p g ymph , y m
h h m m y h p ymph
h m v y. T p h m m ,
m y h v v g m p y. T p m
m y h p m p ymph .
MYOAPONEURO IC ANA OMY
T m mp m h -
p v y mp x my. m x m
h v p m h p.
T m m h g h p . I g -
y h h p p y h g h h
h gh h v h , h p h m.
Fig. 1-6
Drainage pattern preabdominoplasty
Drainage pattern postabdominoplasty
Lymphatics
stretched
Lymphatics
removed

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
8
T m m p h
y p : h h p h h. T
p m y p g h v , , x
q m .
T h h v h h h m
m . I mp p g v . A v h ,
h h h m y p h g m h x
q m . B h , h x q -
q m h v p m h
h h. T h h m p g v y h m
h m g . T v p
Fig. 1-7
Arcuate
line
ABOVE THE ARCUATE LINE
Linea alba
Transversus
abdominis muscle
Internal oblique muscle
External oblique muscle
Rectus
abdominis muscle
Peritoneum
Transversalis
fascia
BELOW THE ARCUATE LINE
Linea alba
Rectus
abdominis muscle
Peritoneum
Transversalis
fascia
Transversus
abdominis muscle
Internal oblique muscle
External oblique muscle

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
9
h m h p . I y h m
ph h h h m h p .
T p h h v h p h
m , x h . A v h v , h h h
m y p h q v m . B
h , h m p m h p m y h v
, h h mp v .
T v y g hm h h h h -
m , p y h m g m h . T h
m hy p h p h
. Wh h h h p , h m v m
h m g h h h p , h g h
m p . O h h h , h v y hm h
m h p p . H v , h m
m p h g , h p m y ,
p m m y p h pp m .
T pp y h m m m m m -
, h p h p g . T p g y
g m h x y. I h p m, h p -
h m p h m h v h -
. Wh g h m m p h h, mp
v j y h y h m ym v . T m g-
m h y p h p h m .
O h p h m , h h m :
h x q , q , h v m . T h
q m p p h q m . T
v h m . T h hy h p
h x q p , h h
g h p . T p m
m h m p v m , p y

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
10
h . T pp y h x q m v
p h m y h x y . T h m h -
h x q m h v m p m
v j y v pp y.
T hm h q m h v m
v y g. T gm g v h m
h p h m ; h h h y v y
. I mp h h v m g h h -
p h y m h v v h m v y; h h y h v
mp h m .
HE UMBILICUS
T m p m y v y g m h p . I -
y m m h h v v h
. A m y v m h h v p ,
h p h , h v y h p . M y m -
p y h q h v h m h p
h p . R g h h q , mp q
- m h z m v h p m -
, h h g y h.
Fig. 1-8

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
11
Anatomic Danger Zones

■Wh p m g m p y, h g h v gg v m -
g h p m . T m g h m p
h m g h m p v m y p p .

■Wh m v g m h p, S p h h h p, -
m y ymph v h .

■T m m p m h p h m g .

■Sm h m y h m . I v y mm , m g h
h , m h h .
Physiologic Changes
EX RACELLULAR MA RIX AND DEFORMI IES
OF HE ABDOMINAL WALL
T q y h my p m y m y m y q ,
g , g h m y h v m y h
y . C m h m h p v -
, h h m y m g h p . I m
, h p h g h h
m y p .
T x m x p h g h x y h .
C g h h x m x. T m m-
p x m mp y p m . W h
h p h yp g , yp I III. yp I g p -
v p g h, h yp III p h x y -
. T h p h m yp I yp III g q
h v ( g ) h q y h p .
P h g h h v m m -
v g m p q y. I h p
h v y v yp III g m y v p
g h . T p h yp III yp I -
g m y h v m x v m my p m . I h
h h h yp III yp I g y p ;
h , p v p g - m m h g .

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
12
T yp I, III, IV, V g h m . T yp g
h p my m, p my m, my m. A h gh j -
h yp III yp I h g , h g
g I III h m , m y C v .
T h x y h my p y p g .
L x y g y p ’ . P h g x y
h v m my p x y. I h m h p h m
mp x yp my p m h v m x . T
h q y h x m x , p , m
m h m v . B m m h h -
h p h h m . T
p y h g yp m g v . F h
, m y m p h h ,
h h h . R g m-
h p h m y h v p p
h m p p h m . T y pp
h g g g h v q y h p .
P g m m h q h m h p -
g m p y. E h p p q m phy g
h .
SELEC ED READINGS
B m D. D : my. P R S g 122:1564, 200 .
C v EN, N h FX, B MV, . C g h m m v
g . H 1 :527, 2014.
D MWB. P â . I P A, . A m C ú g . R J : G -
K g , 1 .
E p FE. I v çã p á m . I P A, . A m C ú g . R
J : G K g , 1 .
F -C MA. E p m p y, m p xy, . C P S g 22:723,
1 5.
G JA, K MJ, R R, . C h m : g- m v
h mp p m h . A P S g 42:3 5, 1 .
G AJ, R g H. P m . I P A, . A m C ú g . R J :
G K g , 1 .
H h WH. L v - x A m H m . Sã P : H p & R B , 1 0.
H g WE J . T m m p my. Am S g 45:612, 1 7 .
L v JP, K p NS. R m g y v g p
m h g m h my . P R S g 107:707, 2001.

C a t er 1 Anat o ic and P siol o ic C an es of t e Abdo inal Wal l
13
L JB III, L JB, B y JD, . R h “ mp p ” m-
p x m . P R S g 111:1276, 2003.
M h WS, Kh q A. V h mp h h m h h: y h
m . J A 145:61, 1 6.
N h FX. S h p . Op h P R S g 3:5 ,
1 6.
P h P, S m P, S N. A h - m p y: mp h v pp h m -
y g. P R S g 116:2 , 2005.
P m GH. L p y g. I A SJ, B y RW, T CHM, . G
Sm h’ P S g y, 5. N Y : L pp -R v , 1 7.
R g MA, N h FX, R RP, . D h h v h - m-
p ? A h S g J 35:5 3, 2015.
R h h RJ, L JB, H y FL, . A g hm m . P R
S g 105:202, 2000.
R E. V z çã p m . I P A, . A m C ú g . R
J : G K g , 1 .
S h MB, N h FX. P ã g m á p m m pó -
m p . M ’ g h . Sã P : U v y Sã P , 2013.
Z ML, A h K, Sp D, . E p p m p y: v 5 .
P R S g 102:516, 1 .

(Trang không có chữ)

Ch a pt er 2
Ch a pt er 2
A m p y Ov v
Fabio X. Nahas ■ Al S. Aly
P
i
e
r
r
e

A
u
g
u
s
t
e

R
e
n
o
i
r
:

B
a
t
h
e
r
Ch a Pt er 2

C a t er 2 Abdo ino l ast O er iew
16
D m h m v y mm , p y
p g m v gh (MWL). A m p y g -
g y h h h x m v h my p y
p . T h h p h p g xp g .
A h gh h m h h p h p ’ q -
y , - m, - m g mp v h h x
, h h p- m p h m -
m g p m .
I p m mp h h g h my h -
m g mp . I Ch p 1, g my
h m phy g xp . W g
y h h p g h . T v y h p -
g m h p p h .
Indications and Contraindications
W gh y p g p m m h m . Ex
, my p m y, p m y h . T
p h h p y p h h y h gh g
p v p g .
A m p y, h h v p ,
p h v h h p m . P h xp pp
m y g v p — p y h h y y m ph (BDD). T
v h v y p y h p y h g h p z
h . A g , m h 50% p h p -
m p y h v BDD. T v v -
y BDD, p xh g ymp m h m v v h
g m p y. Y h y y F x pp h h p
h m m m h m y m mp v m BDD
ymp m m p y.
A v h p h pp m . T
h v h x p g y. I p
h h , m v v m g h p m .

C a t er 2 Abdo ino l ast O er iew
17
P h h v p m y (COPD) h v -
y p m g m h h g y ,
p m y h py h p m h p ’ p m y
p m g y. P h m , gh g, h p -
’ p p v p g p m y v . P m y
p y m p h v h p p -
v y , g m h h p p v y, h
p v y.
A m p y v gh ; mp m -
y p h gh p . MWL p m m -
gh p m y y . I mp h h v -
h p mp h h m p .
DIFFERENCES BE WEEN NORMAL-WEIGH PA IEN S AND
MASSIVE-WEIGH -LOSS PA IEN S
O v y, m p MWL p g g m gh . T y -
y m g y gh y h y g y,
h gh h h h y y h v gh . A h -
y gh h g , h h h v xp ( ) m h
m ( ) g m h g . A h g
q y h m v p h p : h y p
, h g g x y. I , h g -
my p h g .
T m MWL p h . T m h p p -
h y Ch , h v h h h m
m MWL p g h p m m h -
, m y m . D p h , h y h h
h g h h m m mp h
h m h g p (p h m BMI h y
gh ). T y v h g h h h
m h h h g p. O ph h mp m
h m g MWL p . T h g m y y
m h m h h h g gh g
m .
T MWL p p p v
m p h g mp h m BMI p MWL p h
h v gh y g y . I p p
h h m y p h p -

C a t er 2 Abdo ino l ast O er iew
18
y m. T m h h h g
h p m y h g y, p y m
p .
T my p y y h xp
MWL p y h . H v , h
h h g m h p p h m m p -
h p . I h h h p
g yp h p pp x m y 20%. T y
h h gh p x y h m h g y,
h h p h v y gh , h p
h p h q y h . B h xp
g gh g , h h m , h p -
m h g .
A m m p m g h h p -
p . T h v y h m h
h p h h h h p m z -
h m . I MWL p , p y v g h m g
h m , h y m p h h m -
j v p . A h y g m v
, h m m x y h , h g h pp x m h
p h m p h x m h h
h . H v , h p MWL, h p
m y . T p h h v h g gh h
h m y. T h my p h
m g , p g h m gh h p ’
BMI h g y. I mp v h h h p
h h .
Patient Evaluation
CLINICAL EVALUA ION OF HE DEFORMI Y
T m h v y ymm , h v h m-
, h p y h , y my p m . B -
m ymm y m y p v , mp p
y ymm p p p v y, h y y
h h y v g y. Sp v h h gh
h g p p , h m h p h
m h p h p p . A h mp
m h m p m mp h h m
h g m p v m .

C a t er 2 Abdo ino l ast O er iew
19
Fig. 2-1
T p h m ymm y. N h m v h
h ymm .
Considerations or Correction o Excess Fat
T h m
y , p g h m x . P h x
m y h p , h m x h q p p -
p . D p p h v m h m , h
p m v p m m h
h , m g h h m . U y -
m p p m , g h h p
p h m . F g g m y p m h m-
p v v .
I p h x h m h v h
x p p m v ( h h h y-
g m v g h ). L p m m p
v h h x . I 1 5 M h g
h h m m x p . A p
p h m h m . F v y
, M p h h , g h h p h
p m h p y S p y.
Ex m y m v m m m p y p m g
p my v . T m p m h , h g
h v h h g m v . S p v y -
h m . A h g v h m , h -

C a t er 2 Abdo ino l ast O er iew
20
y h x ph , h g p g h gh h
, h h m h m v h h -
m .
L p m p y v v h q h h h S p -
m v y p , g h . L p p m h
h m , h m p m h h p -
, x p v h h x 1 2 m y h
m g . T p h p h m ,
h y m g. T h q Ch p 4.
Aesthetic Classi cations o Abdominal Wall De ormities
A m m m y v y, h p g pp -
h h m . T m p h h -
, g , p v p g . S h g y
h h h q m p m y, -
h v . O h x
, h h g h yp my p -
m y h h p p . T p . T
m x p h Ch p . F h m y, p
h q gg .
Classi cation Based on the Excess Skin and Subcutaneous issue
P yp 0, I, II, III, g h m x
.
2 cm
Type I
Type II vertical
Type II high
Type III
Fig. 2-2

C a t er 2 Abdo ino l ast O er iew
21
Type 0
yp 0 p h v m x g q y. Ex m y
h p v p g y gh . T p h
p y, p v y .
T 2 -y - p yp 0 m h x p
h p m m h p .
Sh h 6 m h m p h h 3200
m v . H p h m m .
Type I
yp I p h v m x h gh-p m . A
m g h p p h . T x h
y h h h m p . T m p
v , xp g h m h p 2 m h x ph p .
T m p , h m m h h
m p. T m h x
m h h h p I . T m h
Fig. 2-3

C a t er 2 Abdo ino l ast O er iew
22
h p g 4-0 y , h 2 3 m g
p . T h q h g y m h .
T v y mm g m p h g , h h
yp p h yp I m y.
T 43-y - m , g v 2 p 2, mp x v p j
h m . W h yp I m y y m v g x
m g h m 2 m g p . A
m h . Sh h 1 y p p v y.
Type II
yp II p h v m x -p m . P h
m x h - h gh-p m
h g p. I h , h g h h
h m h p g , h gh h
h p v h . I h , g v , -
p g h p ’ h .
Management o ype II Vertical T p yp II p
h y gh , h p h m , p -
h m p m . I h , h p -
m h p , p v g m h m . A ,
m m h m h h h v
m p p . A h m g, h x m v
h p h p q . W h h p ,
h m h v h - h p h m m v . I
h gh h m h ( h h p h h m-
Fig. 2-4

C a t er 2 Abdo ino l ast O er iew
23
) h h , h
g h h pp x m , v m h
m h p .
T 42-y - m , g v 2 p 2, mp h h p h
m . Sh h 6 m h yp II m y h v -
. N h mp v m h m h p h my p -
y .
Management o ype II High T p yp II p h
h v h gh m h h gh h h gh
h v . P h h gh m h v y v p m
. T h p h h
h m . I h p g gh g y, v m y
, h v g h m p j -
. I h , h gh-p p . I p m 2
3 m v h p h , h p ’ m x
Fig. 2-5

C a t er 2 Abdo ino l ast O er iew
24
h m . U m g xp h m 1 2
m h m g h m h pp m , h m -
p h x q m h m , h
m . A h x mm , h m g m p
h y m v g h y h S p h p
h h h p p . T p h h p. I m
p h m v h p m h h p h
g m h .
T 32-y - m , g v 2 p 2, mp x h
p j h m . Sh h h gh m . Sh h
6 m h h yp II m y h h gh-p
h m .
T 26-y - m h h gh-p , 2 y p p v y.
T p y h h m .
Fig. 2-6
Fig. 2-7