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Abdominoplasty-Related Nerve Injuries: Systematic Review and Treatment Options
John M. Felder, III1, Hesham Zakaria, M.D.2, Sarah A. Arnspiger, B.S.1, Ivica Ducic, MD, PhD1.
1Georgetown University Hospital, Washington, DC, USA, 2George Washington University School of Medicine, Washington, DC, USA.

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 InjuredPooled Risk
Any Nerve Injury401.94% (40/2061)
Incisional Nerve Injury301.46% (30/2061)
Positional Nerve Injury100.49% (10/2061)


Table 2: Pooled Risk of Specific Nerve Injury After Abdominoplasty
NerveNumber Nerves InjuredPercent Patients InjuredNumber Not RecoveredPercent Not Recovered
Incisional InjuriesLateral Femoral Cutaneous281.36%211.02%
Iliohypogastric20.10%00%
Positional InjuriesBrachial Plexus20.10%00%
Musculocutaneous20.10%00%
Radial10.05%00%
Sciatic40.19%20.10%
Common Peroneal10.05%00%


Table 3: Pooled Risk of Deficits After Abdominoplasty
DeficitNumber of Patients with DeficitPercent of Patients with DeficitNumber of Patients with Deficits at Abdominal WallPercent of Patients with Deficit at Abdominal Wall
Decreased Sensation1587.67%1286.21%
Pain/Neuroma/Entrapment221.07%211.02%
Weakness60.29%00.00%
Paralysis30.15%00.00%


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