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BACKGROUND:
Abdominoplasty is a commonly performed cosmetic procedure, spurring the study of its risks and morbidities. Nerve injury is an underexplored risk of the procedure, despite several nerves within the surgical field and reports of injury after abdominoplasty. Our objective is to provide evidence-based information on the risk of nerve injury after abdominoplasty, and an algorithm for its management.
METHODS:
A broad literature search of Medline, Embase, and the Cochrane Database of Systematic Reviews was undertaken. Selected studies were narrowed by three independent reviewers using specific inclusion and exclusion criteria to locate articles that report nerve injury after abdominoplasty.
RESULTS:
The initial 4,806 citations were narrowed by topic, title, and abstract to 42 articles. After full text review and extensive hand-searching, 23 citations were included into this systematic review. From pooling the articles’ data, we calculate that 1.94% of patients sustain specific nerve injury and that 1.02% of patients have permanent injury. We calculate that 7.67% of abdominoplasty patients have decreased sensation, 1.07% report chronic pain, and 0.44% suffer temporary weakness or paralysis. Specific nerves injured from the surgical incision were the lateral femoral cutaneous (1.36% of patients), and the iliohypogastric (0.10%). Nerves injured from surgical positioning were the brachial plexus (0.10% of patients), the musculocutaneous (0.10%), the radial (0.05%), the sciatic (0.19%), and the common peroneal (0.05%).
CONCLUSIONS:
There is a definite risk of lasting nerve injury or nerve deficits after abdominoplasty. Although the number of patients affected is small, the lasting effect on their quality of life may be significant. Appropriate and timely treatment by a multidisciplinary team including peripheral nerve surgery is critical to optimize patient outcomes after such injuries. While this review estimates a low incidence of abdominoplasty-related nerve injuries, a more accurate incidence can only be obtained through better reporting of nerve injuries in future studies of abdominoplasty.

Table 1: Pooled Total Risk of Nerve Injury After Abdominoplasty

	Number of Patients Injured	Pooled Risk
Any Nerve Injury	40	1.94% (40/2061)
Incisional Nerve Injury	30	1.46% (30/2061)
Positional Nerve Injury	10	0.49% (10/2061)

Table 2: Pooled Risk of Specific Nerve Injury After Abdominoplasty

	Nerve	Number Nerves Injured	Percent Patients Injured	Number Not Recovered	Percent Not Recovered
Incisional Injuries	Lateral Femoral Cutaneous	28	1.36%	21	1.02%
	Iliohypogastric	2	0.10%	0	0%
Positional Injuries	Brachial Plexus	2	0.10%	0	0%
	Musculocutaneous	2	0.10%	0	0%
	Radial	1	0.05%	0	0%
	Sciatic	4	0.19%	2	0.10%
	Common Peroneal	1	0.05%	0	0%

Table 3: Pooled Risk of Deficits After Abdominoplasty

Deficit	Number of Patients with Deficit	Percent of Patients with Deficit	Number of Patients with Deficits at Abdominal Wall	Percent of Patients with Deficit at Abdominal Wall
Decreased Sensation	158	7.67%	128	6.21%
Pain/Neuroma/Entrapment	22	1.07%	21	1.02%
Weakness	6	0.29%	0	0.00%
Paralysis	3	0.15%	0	0.00%