Evaluation of Reducing the Excess Abdominal Skin, Subcutaneous Tissue and Anterior Abdominal Wall Laxity: A Prospective Observational Study at

ABSTRACT


INTRODUCTION
The reconstruction of the anterior abdominal wall is a difficult reconstructive technique that tries to preserve the abdominal contents and restore functional support and structural integrity.[1] Abdominal wall abnormalities may be the consequence of prior surgery, removal of malignancies, trauma, or serious infections.Contamination, loss of domain, scarring from earlier surgeries or radiation, and the unavailability of local tissues for restoration may exacerbate such instances.Numerous treatments have been explored in an attempt to restore the integrity of the anterior abdominal wall so that it can tolerate the dynamic loads exerted on it.There have been several descriptions of autologous tissue procedures, such as component separation, local flap, and free tissue transfer.[2] Kelly invented abdominoplasty in 1910.By removing excess lower abdominal tissue using a minimally invasive wedge excision [3].Later, Babcock added a vertical component to the abdominal incision.Pitanguy published a series in 1967 showing the effectiveness of a low transverse incision with extensive undermining.[4]Grazer modified the Pitanguy approach by pliating the rectus diastasis without incising the anterior rectus sheath.[5] Abdominoplasty has gained popularity since it was originally done.According to the American Society of Plastic Surgeons, abdominoplasty is a common cosmetic procedure.Bozola and Psillakis [6] classified abdominal deformities.Abdominoplasty might be modest, modified, or extensive, says Matarasso.[7] The patient's abdominal wall, fat, and skin before surgery determined the operation.Many plastic surgeons now perform comprehensive abdominoplasty as a solo treatment or in combination with other operations [8].The increased number of patients desiring aesthetic full abdominoplasty highlights the hazards.Seroma, hematoma, wound dehiscence, and infection are prevalent.Seroma is the most common abdominoplasty complication, with a 30-37.3%frequency.[11][12][13][14][15][16][17][18][19] Lack of large-scale research makes it hard to estimate cosmetic abdominoplasty complications.Surveybased research, which influence a large number of highpower studies, have statistical constraints.In this research, we examined the early outcomes of complete cosmetic abdominoplasty in a private clinic.

OBJECTIVE
The purpose of the study was to reduce the excess abdominal skin, subcutaneous tissue and anterior abdominal wall laxity.

METHODS
The observational was performed over the period from July 2014 to April 2015.The research population consisted of patients hospitalized to the Plastic Surgery Department of Dhaka Medical College Hospital and numerous private hospitals in Dhaka with extra abdominal skin and abdominal wall laxity owing to various causes, such as past pregnancy or severe weight loss.From the study population, 30 instances that satisfied the enrollment requirements were chosen.

Inclusion Criteria:
1. Skin and subcutaneous tissue excess and/or laxity limited to anterior abdomen.2. Abdominal wall laxity.
Exclusion Criteria: 1. Unrealistic expectations 2. Psychiatric instability 3. Being a current smoker.4. Plan for pregnancy in the near future 5. Patients with unoptimized co-morbid medical conditions like COPD, DM, Malignancy, jaundice, uremia, as it may influence the outcome by increased chance of infection and decreased healing capacity of the body.6. Patients denying surgery or unwilling to take part in the study.

Data Collection and Analysis
After hospitalization, the researcher addressed himself to the patient or the patient's guardian, described the goal of the study, and requested participation.The patient's information, physical examination, and local examination results were documented.In addition to the results of the local examination, the records contained pre-operative, intraoperative, and post-operative photographs.Prior to the procedure, informed written permission was acquired from all patients or their parents.On the 14th, 28th, and 42nd days after hospital discharge, follow-up care was administered.In every follow-up, photographs were taken.The researcher thanked the responder at the conclusion of the study.Microsoft Excel 2013 was used to combine and organize the collected data.All data were first compiled in a single table.Standard statistical formulas and Statistical Package for Social Science (SPSS) 23 were utilized for analysis.

RESULTS
The age range was from 24 to 59.They averaged 41 years of age.Twelve out of forty (40% of the total) of the incidents occurred among people aged 25 to 39.The ratio of females to males was calculated to be 6.5:1.Women made up 26 (or 86.7%) of the total, while men accounted for just 4 (13.87%).A statistical examination of the patients' marital statuses showed that 96.7% of them were married and only 3.3% were single.Patients were most likely to be stay-at-home mothers (50%), followed by professionals (33.3%), and then businesspeople (16.7%).There is no causal link between these demographic variables and the results of the study.The majority of abdominoplasty procedures (43.33%) were performed owing to extra abdominal tissue from a prior pregnancy.(Figure 1).This table indicates that the majority of patients were overweight (36.7%).(Table 2) Table 2. Distribution of the patients according to BMI: BMI Percentage (%) Underweight (<18.5)0 Normal weight (18.5 to 24.9) 30 Overweight (25.0 to 29.9) 36.7 Obese (30.0 to 39.9) 26.7 Morbidly obese (>40.0) 2 6.7 Total 30 100.0 Distribution of patients according to previous abdominal surgeries shows most of the patients underwent caesarean section (46.67%).
(Table 3) According to the data, sarcomas accounted for 10% of the problems (figure 3).welcome to receive this therapy.The ratio of females to males, which is 6.5 to 1, is imbalanced.Participation was made up of 86.7% women and 4% males (13.87% total).Related to pregnancy and detrimental to a woman's sense of self-esteem The next most prevalent group was professionals (33.3%), followed by proprietors of their own businesses (16%).16.7%The patient had an abdominoplasty to get rid of extra abdominal tissue (43.33%), improve their body image (23.33%), lose weight (20%), and get rid of a stretch mark (3.33%).Abdominoplasty candidates had abdominal wall laxity due to pregnancy.Hensel JM, Lehman Jr JA, Tantri MP, et al.(2001)[20] discovered that the most prevalent reasons for abdominoplasty were to remove excess abdominal tissue following weight loss (26%), to remove stretch marks from pregnancy (25%), to remove an abdominal scar (18%), or for other reasons (8%

CONCLUSION
Abdominoplasty is safe and pleasant.Patients are happy with the result, and there are little hazards.In obese people, problems increased.In this research, most individuals with complications recovered.Very happy patients.The degree of unhappiness is largely due to post-operative issues, not the cosmetic effect.In most instances, problems were minimal and treated in an office setting.

Figure 1 .
Figure 1.Pie chart of marital status among the patients.

Figure 2 .
Figure 2. Pie chart of occupational distribution among the patients.

Figure 3 .
Figure 3. Bar chart Distribution of patients according to complications

of patients according to complications Corresponding Author: Dr. Iqbal Ahmed
Problems kept coming up.A total of 13 people (40.33%) reported some sort of problem, with 9 (30%) only having minor problems and 4 (13.3%)having moderate to severe ones.At least once for seroma, hematoma, infection, and dehiscence.Two seromas, one hematoma, one wound infection, one wound dehiscence, one epidermolysis, and one deep vein thrombosis were rare.In this study, drains and intravenous antibiotics were used to treat infected wounds.Antimicrobial wound swabs that have been cultured to detect certain microorganisms.Escherichia coli and pseudomonas were cultured in one flask.
).The replication of study findings revealed that five