Note: This video contains footage of a live surgical procedure at the 3:24 mark, when I warn you I’m going to show a surgical clip. If you are sensitive to graphic medical procedures, please skip ahead or close your eyes to the 4:33 mark of the video.
The Lockwood technique is superior to traditional tummy tuck dissection. It preserves the blood and nerve supply much better than the traditional abdominoplasty technique by undermining less tissue, which has several benefits:
- Better blood supply means more oxygen to the wound, so less chance of infection, wound separation, or other healing problems.
- Preservation of nerve supply means there no loss of sensation in the belly skin after surgery.
- Undermining less tissue means less chance of fluid accumulations (hematoma, seromas) which means drains can be removed after a few days instead of weeks!
Technically, the Lockwood technique is more difficult to do because the surgeon must operate in a narrow tunnel (hard on my back) and it takes longer. Perhaps that explains why it is not more popular among surgeons.
Transcript
Hi, I’m Dr. Ricardo Rodriguez, and today I want to talk to you about tummy tucks.
Right, so the whole trick with a tummy tuck is to get this piece of skin here over the bellybutton to reach down here. Now, in order to do that right, you just can’t pull on it, you’ve got to separate it from the tissues and the problem is that when you separate it from the tissues underneath, you’re also eliminating some of its blood supply. So the trick is to get it down there with a maximum amount of blood supply.
So let’s say we cut out the skin here, right, because we want it, that’s just excess skin, you might have stretch marks whatever there, you want to get rid of that extra skin. So, underneath underneath all of that, you have the muscles those rectus muscles that you want to fix when you’re going to do the tummy tuck, but those muscles without blood supply that goes up to the skin so I’m just gonna show this is just showing like a transparency overlay or something and then you also have the external obliques you also have nerves and blood vessels coming in too then some blood vessels from the chest and some blood vessels here from the growing that are coming up so those are your sources of blood supply. Now, depending depending on how much tissue you separate you eliminate more or less blood supply.
So we cut out the skin in here right and we see the muscle and now let’s get this from here to down here well to do that now we got a deal with a blood supply right so what are we gonna do with all this blood supply well with a traditional cut up technique what you do is you undermine all this so you can take this skin here and bring it down like a curtain right and close it with a single line down in here so now your only sources of blood supply are from the sides coming in from the side or coming in from the chest that means you can’t get very aggressive liposuction down here on the sides because if you like oh suctioning to aggressively they’re your only blood supply is this and that’s really not that great now you go in and you saw the muscle and then you bring the skin down on your closer right but there’s a problem with that and the problem is that you have not all the same tea space and in all this empty space has been detached you can get blood collections and that’s what’s called seroma or hematomas.
Now, my favorite technique is called a Lockwood technique and what you do with a Lockwood technique is that instead of undermining all of that, you just undermine in between here, in the space where you want to show the muscle, and you leave all of this attached. And, you know, if you stand up and you grab your belly here on the side, you know, you can make a pinch and make it reach.
Now, if you try to do it in the center you can’t so that’s why we mobilize and we mobilize only from here and down that means that all this face stays attached and because it stays attached all that blood supply and even the nerves stay intact okay now compare the amount of dissection with a regular tummy tuck where all of this is empty and you eliminate all that supply with a lock with technique where you have more blood supply more nerves so after surgery your skin has a lot better sensation now you fix the muscle in both but the other one is a lot better.
Now I’m going to play you a little video in here of how the whole dissection goes. And if you can see here is the belly, right, and then here’s the skin and I have a retractor there. And see, those are the edges of the muscle that we’re going to sew up. We’re gonna sew that to that, right. And then what I’m pointing at in there is, do you see these little things going on the side and I’m pointing out they’re right there, I’m pointing out vessels and nerves, okay, that are going to supply this tissue here and the tissue up there.
So all of that tissue, we don’t separate, so the blood supply there is going into it instantaneously. And then, when we bring the skin down, as you can see here, all that skin, we’re gonna be getting rid of all that skin. Okay, so then, the only space that’s going to be left, you know, empty, is here and that narrow tunnel.
So here’s the thing, you correct the muscle, we close it, and then we close it with a single line. So the scar for the Lockwood looks pretty much the same as the other techniques. The nice thing about it is that because you have better blood supply and less empty space, you get less complications and, as a bonus, the scar tends to stick down here a lot better because of the way we close it – and we can talk about that other time, but anyways, I love the Lockwood technique, and it’s my favorite.
See you later.