Treatment of Large Skin Necrosis following a Modified Avelar Abdominoplasty with the Erchonia EML 635 nm Laser and Platelet-Rich Plasma

Abstract

Objective:

Skin necrosis of the flap and delayed wound healing are common complications of abdominoplasty surgery. A case report is presented of a patient who was treated with the 635 nm or low-level laser therapy (LLLT) and platelet-rich plasma (PRP). Both of these modalities have been shown to accelerate wound healing and improve the appearance of the scar.

Materials and Methods:

Case report.

Case Presentation:

A 62-year-old female with chronic hypertension underwent a modified Avelar abdominoplasty. She developed skin necrosis at the midline from her umbilicus to the lower horizontal incision. Also, mild necrosis was noted in her upper abdomen in the area of the left superior epigastric vessel. The patient had negative bacterial cultures and was given daily 635 nm laser treatments for the first month. PRP (Smart PReP System, Harvest Technologies Corp, Plymouth, Mass) was used for the early small open wounds and then on the large midline wound after the eschar had lifted.

Discussion:

Skin necrosis is a complication that can occur after abdominoplasty surgery. The area between the umbilicus and the lower incision is the area where profound devascularization occurs, as was demonstrated by Mayr. Despite upper abdominal undermining limited at the midline to 3 cm, skin necrosis still occurred in this patient and was evident 6 days postoperatively. LLLT was started on the first postoperative day to treat surgical pain and inflammation; treatments were provided daily after necrosis was diagnosed on the sixth postoperative day. When the patient developed open wounds near the umbilicus, activated PRP (PRP with calcium chloride and topical thrombin) was placed in the deepithelialized wounds to accelerate healing. The activator was made by combining 5 ml of 10% calcium chloride with 5000 units of bovine thrombin in a PRP-to-activator ratio of 10:1. An increase in tissue exudate was noted with LLLT. When the eschar had lifted, the wound was treated with activated PRP and with daily 635 nm laser treatments. The patient healed within 3 months.

Conclusion:

Ischemic flaps can be treated with LLLT and with PRP. When both modalities are used, the healing is accelerated, and the final aesthetic appearance of the scar is improved, so future corrective surgery is avoided.