Lockwood Technique Tummy Tuck

Hi, I’m Doctor Ricardo Rodriguez, and today we’re going to talk about tummy tucks. Tummy tuck is a great procedure, but everybody knows tummy tucks have, you know, two or three complications. Some of them are like, you know, the wound margins can have a little bit of skin death in the wound margins or you can have fluid accumulations, what they call seromas, or you can have problems with the wounds separating and all of those have to do with two or three factors.

One of them is blood supply. The more blood supply your abdominal skin has, the better it’s going to heal, and the less problems it’s going to have.

And secondly, the less tissue we mobilize – in other words, the more the tissue is still stuck down that you haven’t separated – the better you’re going to heal and the less complications you’re going to have.

So for all those reasons, I prefer this technique called the Lockwood technique, because it preserves blood supply better, and it diminishes the amount of tissue that you have to move around to get done what you want to get done.

So let’s take a look at this diagram of the way the procedure is done now. So this is pretty standard. This is the skin we take out, and it’s the skin between your belly button and your pubis, and you make a cut in here like this, and you take out all that skin.

Now, the next thing you have to do is you have to reach over here to sew the muscle. Women’s muscles get separated after pregnancy, so you want to sew them together so that their belly doesn’t bulge out.

OK, now, in order to accomplish those things, what surgeons do nowadays is they undermine the skin, all the way up to the side, all the way up to the ribs and all the way up to the side. So what they’re doing essentially is they’re sort of taking the skin and moving, dissecting under it, so they can pull it like a curtain. So we’re going to pull this down, like a curtain. But that creates a bunch of problems.

Number one is that you’re creating all of this space that has to stick down later, OK. And that’s why you have to leave drains in there for two to three weeks so that you want to leave the drains to squeeze out any fluid while all of that is sticking together.

The other problem that you have is with blood supply, and that’s what can cause the skin at times, you know, not doing well or the wound edges separating or wound breakdown. So, the reason is that you have several sources of blood supply. OK? One is from down below. Now, the minute you make your cut, you eliminated those. OK, then you have blood supply coming from up above. And that one will stay because that’s beyond where you make your repair, so that stays. Then you have a little bit of blood flow from the back, but not that much. But then you also have a third source of blood supply, which comes from deep to the surface, and this is the blood supply that we’re concerned about. And it comes from the sides of the muscle. And it comes in two rows like this. And those are called perforators, they come from inside the muscles and they supply the skin.

Now if you notice, since you undermined from here to here, you got rid of all that. That means that now, the only sources of blood supply you have are this and this. So you’re not going to want to be too aggressive with liposuction here on the sides, because you’re counting on that blood supply. I mean, you can do it, but you’re increasing your risk. So it’s a riskier maneuver when you’re liposuctioning a lot here on the sides.

So what Lockwood found out, and it was a brilliant insight, is that if you pinch your skin here to here, you see the skin can reach pretty easily. So he said, well, if I can make it reach from here to here, why do I need to undermine all the way out here to the sides? Why don’t I just come undermine here in the middle, just to get my work done, you know, because all he wants to do is sew the muscle. So, I’m just going to undermine here the through the middle just to get enough room to sew my muscles. I’ll be able to pull the skin down to here, and then I’m saving all that blood supply.

So what happens when you save all that blood supply, now the skin will heal better? There’s going to be much less chance of wound separating or skin death because of not enough blood supply. All those problems get practically eliminated.

And then I can also liposuction a lot more aggressively down on the sides because I’m not depending on this blood flow.

Now I have all this blood flow here supplying my tissue, so I can be very aggressive in my liposuction laterally.

And then finally, as to the problem with the seromas, the fluid accumulations, and the tissues sticking together, well guess what?

Now all this tissue is stuck together, already, I never separated it. So there’s very little tissue that has to stick together after surgery. That improves your healing time, because you just don’t have that much more healing to do. But more importantly, there’s not all that empty space to stick out. I just put in a drain here and a drain here, and like at five to seven days, I can take those drains out.

So for all those reasons: the better blood supply, the less healing (time) because there’s been less separation. I like the Lockwood technique for abdominoplasty.

Thanks a lot.