TULUA Abdominoplasty the new modified technique for pendulous abdomen

A free fibula flap is a type of microsurgical reconstruction technique that involves transferring a section of the fibula bone, along with its surrounding tissue and blood vessels, to another part of the body ¹ ² ³. Here are some key points about free fibula flaps:

*Key characteristics:*
- The fibula bone is harvested from the lower leg, along with its surrounding skin, muscle, and blood vessels.
- The bone can be used to reconstruct defects in the upper or lower jaw, or in other long bones.
- The flap is transferred to the recipient site and reattached using microsurgical techniques.

*Advantages:*
- The fibula flap is a reliable and versatile option for reconstructive surgery.
- It can be used to reconstruct complex defects, including those involving bone, skin, and soft tissue.
- The flap can be innervated, allowing for sensory function in the reconstructed area.

*Common applications:*
- Reconstruction of the jaw or face after trauma or cancer resection.
- Reconstruction of long bones in the upper or lower extremities.
- Reconstruction of the orbit or skull base.

*Surgical procedure:*
- The surgery involves harvesting the fibula flap from the lower leg.
- The flap is then transferred to the recipient site and reattached using microsurgical techniques.
- The surgery requires careful planning and execution to ensure success.

*Post-operative care:*
- The patient will typically require a hospital stay for several days after surgery.
- Pain management and wound care are critical components of post-operative care.
- The patient will need to follow a rehabilitation program to restore function and mobility in the reconstructed area.

1. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
TULUA
Abdominoplasty
Author:Francisco Villegas MD.
Institutions:
ClínicaSan Francisco, Tuluá.
Universidad del Valle Cali.
UcevaTuluá.
Colombia.
Nothing to disclose

2. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
Objective of the study
Describe a modified
lipoabdominoplasty
techique:
Modifications
Results
Complications

3. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
Materials and methods: 100 patients 2005-2017
CONVENTIONAL ABDOMINOPLASTY TULUAMODIFICATIONS
Vertical plicature
T
Transverse(plicature)
Tunnelorwide
dissection U
Undermining halted at
umbilicus
(Nodetachment )
Without liposuction or
limited (danger zones)
L
Liposuction
(without restrictions)
Umbilicoplastyby
stump exteriorization
U
Umbilicoplastywith a
skin graft
Abdominoplasty
Random scar location
A
Abdominoplasty
lowscar localization
Villegas F : A Novel Approachtoabdominoplasty: TULUA modifications(transverseplication, no
undermining, full liposuction, neoumbilicoplasty, and lowtransverseabdominal scar).
AestheticPlastSurg2014; 38(3):511-20

4. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
T
Transverse(plicature)
U
Undermining halted at
umbilicus
(Nodetachment )
L
Liposuction
(without restrictions)
U
Umbilicoplastywith a
skin graft
A
Abdominoplasty
lowscar localization
Transverse plicature
•30 by 12 cm
umbilicus to pubis
•Polipropilene0
•2 layers
•Flexed surgical
table
•Wider than
vertical
•Diminish dead
space
•Less tension
wound closure

5. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
No undermining
•No flap
detachment
•Dissection stops
at umbilicus level
T
Transverse(plicature)
U
Undermining halted at
umbilicus
(Nodetachment )
L
Liposuction
(without restrictions)
U
Umbilicoplastywith a
skin graft
A
Abdominoplasty
lowscar localization
•Mesh
dissection
(cannula)
•Preserves
perforators

6. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
T
Transverse(plicature)
U
Undermining halted at
umbilicus
(Nodetachment )
L
Liposuction
(without restrictions)
U
Umbilicoplastywith a
skin graft
A
Abdominoplasty
lowscar localization
Flap liposuction
(without restrictions)
•Tumescent
•Superficial and
deep planes
•Suction of the flap
•No restrictions
•Flap thinning
•Flap molding
•Flap sliding down
•Improves contour

7. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
T
Transverse(plicature)
U
Undermining halted at
umbilicus
(Nodetachment )
L
Liposuction
(without restrictions)
U
Umbilicoplastywith a
skin graft
A
Abdominoplasty
lowscar localization
Neo-umbilicoplasty
•Stalk amputation
•Ring closure
•Neo-umbilicus
•Inverted U
•Skin graft
•Good position
•Proportionality
•Aesthetic result

8. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
T
Transverse(plicature)
U
Undermining halted at
umbilicus
(Nodetachment )
L
Liposuction
(without restrictions)
U
Umbilicoplastywith a
skin graft
A
Abdominoplasty
lowscar localization
Low scar placement
•5-6 cm from
vulvar
commissure
•Proportionality
•Aesthetic result
•Less tension
•Better scar

9. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
Clinical outcome scoring of
100 TULUA abdominoplasty patients
Score indices
0
Excellent
1
Good
2
Fair
3
Revision
required
Epigastricbulging(wall) 93 7 0 0
Epigastricredundancy(skin)
90 10 0 0
Hypogastrium/ Veneris(H/V) Ratio 48 - 50 2
Umbilical shape 98 1 0 1
Transverse scar position 52 40 4 4
Aesthetic appearance global 61 37 2 0
Excellent (0 points), 48 cases;
Good (1-5 points), 50 cases;
Fair (6-9 points), 2 cases;
Poor (10 or more points), 0 cases.
48
50
2
0

10. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
Results : Primary case
TULUA in as a combined procedure

11. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
TULUA in a patient with previous abdominoplasty, skin and umbilical necrosis.
Note extent of the new resection, no supraumbilical detachment and low scar
placement
.
Results : secondary case

12. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
Results : Hernia repair
Villegas F. A paradigmshiftforabdominoplasty: transversehypogastricplicationwithout
supraumbilicaldissection, unrestrictedliposuction, neoumbilicoplasty, and lowplacementof the
scar(TULUA). In: Di Giuseppe A, ShiffmanAM, editors. AestheticPlasticSurgeryof theAbdomen.
Springer. 2016: p 171-193

13. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
COMPLICATIONS
•No flap necrosis
•No fatal cases
•No deep vein thrombosis
•No Pulmonary embolism
•14 umbilical skin graft loss
(evolution to good umbilicus)
•8 seromas (syringe drained)
Results : Male abdominoplasty

14. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
Conclusions:TULUA
FULL liposuction with vascular safety
•Can be indicated
in ALMOSTevery
abdominoplasty.
•Widens
indications to
more difficult
cases.
•Advantages
-flap vascularity
-scar positioning
-umbilicus
placement.
-less seromas
-aesthetic results
TULUA in a patient with umbilical hernia

15. TULUA
Abdominoplasty
Francisco Villegas MD.
Tuluá-Colombia
A nametotheprocedure
•Tuluá-Colombia
Transverse plication
(Hypogastrium)
Umbilicoplasty(Skin graft)
Liposuction, Full
(Epigastrium, flanks…)
Undermining ( No up to the
umbilicus)
Abdominoplasty
-Villegas F.: Abdominoplasty withoutflapdissection, full liposuction,
transverseinfraumbilical plication and neoumbilicoplasty withskingraft.
(T.U.L.U.A). Canadian J. Plast Surg. 2011, 19 (A): 95