Treatment of retracted, postsurgical scars and reduction of locoregional edema using a combined three-dimensional approach of liposuction lipofilling, dissecting cannulas, and suspension sutures

Background: Post-surgical abdominal and inguinal scars are a frequent challenge in plastic surgery. There are limited non-invasive alternatives to address depressed and retracted scars. The associated retraction and fibrosis might cause lymphatic dysfunction with subsequent regional edema. The authors describe a combined surgical approach of liposuction, the use of dissecting cannulas, lipofilling, and Scarpa’s fascia suspension sutures in a prospective case series. Methods: The proposed procedure was performed in 22 consecutive patients between November 2012 and May 2015. Complications were assessed according to the Clavien-Dindo scale. Postoperative psychosocial, edema reduction, and patient satisfaction outcomes were gathered and analyzed based on blinded questionaries (Rosenberg Self-Esteem scale and a Cosmetic Procedures Screening Questionnaire (COPS)). Results: At 6 months, no major complications and 27.2% minor complications (Clavien-Dindo 1) were recorded. Four patients had superficial infections that settled with oral antibiotics and two patients developed a seroma. A significant improvement in self-esteem, aesthetic satisfaction, and social competence was found postoperatively in all patients. The novel technique reduced regional edema and scar-related self-consciousness. Patient satisfaction was rated very high, and all patients would recommend this surgery for abdominal or inguinal retracted scars. Conclusions: This study shows that the proposed technique is a safe minimally invasive alternative for the treatment of abdominal and inguinal retracted scars. The relatively high rate of minor complications is mainly due to the strict definition of the scale used. The results showed an improvement of local edema and high patient satisfaction.