Abdominal Wall Anatomy and Physical Exam in the Tummy Tuck Patient

The Vascular Territories of the Tummy Tuck

The abdomen is divided into three vascular zones. The midabdomen is supplied by the deep epigastric arcade (zone I). The lower abdomen is supplied by the external iliac artery (zone II). The lateral abdomen is supplied by the intercostal and subcostal arteries (zone III). A neurovascular plane exists between the internal oblique and the transversus abdominis muscles. Through this plane pass the nerves as well as the blood vessels that supply the abdominal wall.

The Nerve Supply of the Abdominal Wall

The motor nerve supply of the abdominal obliques and transversalis muscles is from the lower thoracic and lumbar dorsal rami. The motor nerve supply to the rectus abdominis is the 5th through 12th intercostal nerves. The ilioinguinal and iliohypogastric nerves pass between the internal oblique and the transversus abdominis muscles as they extend from the lateral costal margin to the pubic area. Their course can be disrupted with dissection, particularly in the lateral abdomen. Loss of function results in a sensory defect in the medial thigh and the groin. Dr. Hughes has never encountered any of these nerve issues following a tummy tuck.

Physical Exam for the Tummy Tuck Patient

Dr. Hughes will note skin laxity, striae, and scars. He will point out any irregularities or asymmetries such as an umbilicus that is not midline. Vertical midline scars will decrease the amount of flap advancement possible. Dr. Hughes will determine whether scars are mobile or fixed to the underlying fascia — fixed scars are more likely to reflect interrupted flap circulation. If the skin appears of good quality with minimal or no laxity and the defect appears to be excess adipose tissue or musculoaponeurotic laxity, a minimal scar procedure may be appropriate. Dr. Hughes performs many short scar tummy tucks or mini tummy tucks, and he will determine if these are appropriate for you during your consultation. He will also determine if liposuction or liposculpture will be appropriate or beneficial.

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