Correlation Between Macroscopic Features of Ischemic Skin Injury and Subdermal Plexus Damage in Lipoabdominoplasty.

Background: Skin necrosis after lipoabdominoplasty occurs in 1%-2.7% of cases. Before tissue necrosis develops, there is a transition period characterized by distinct ischemic injuries triggered by different mechanisms that can be identified macroscopically in the skin. Until now, these ischemic lesions have not been classified from a pathological macroscopic perspective, nor have their distinct patterns of presentation and evolution been described. This lack of classification has made understanding and appropriate management more challenging. This study aimed to classify the patterns of skin ischemic injury analyzing damage to the subdermal plexus, as revealed through macroscopic pathological examination of the skin lesions. Methods: This multicentric, retrospective study included 71 patients who underwent lipoabdominoplasty and developed ischemic lesions postoperatively. The study involved 46 surgeons and 2 hyperbaric oxygen therapy centers, both of which participated by completing a questionnaire that collected information about the associated treatments and lesion features. Skin lesions were classified into 3 groups based on macroscopic pathological criteria: (1) dotted pattern, (2) geometric pattern, and (3) geographic pattern. These classifications were correlated with the treatments performed and lesion locations. Results: The most frequent ischemic lesions were observed in the distal part of the abdominal flap (n = 49, 69%), presenting a dotted pattern and a worse prognosis. Lesions in atypical locations (n = 23, 32%) demonstrated an association with the concomitant use of energy devices, exhibiting a geographic macroscopic pattern. Conclusions: Ischemic lesions exhibit well-defined and distinct macroscopic patterns, which are closely related to their triggering mechanisms.