ULTRASLIM 3D ABDOMINOPLASTY: Combination of Techniques in Dermolipectomy: Integration of the Saldanha Technique, Extended Plication and Tuluá Abdominoplasty in a Primary Clinical Case

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Abstract

A clinical case of primary abdominoplasty is presented in a patient with no medical or surgical history, in whom an unprecedented combination of three surgical techniques was implemented: Saldanha’s technique, extended rectus muscle plication, and the Tuluá abdominoplasty. Preoperative planning was focused on optimizing aesthetic outcomes without compromising the vascular safety of the abdominal flap. The integration of these techniques allowed simultaneous correction of rectus diastasis, enhanced abdominal contouring with greater waist definition compared to conventional abdominoplasty, and facilitated a tension-free wound closure. Additionally, a modification to the neo-umbilicoplasty technique using four dermocutaneous flaps is introduced, avoiding the need for a full-thickness skin graft.

Introduction

Abdominoplasty is a widely performed procedure with multiple technical variations aimed at optimizing both aesthetic outcomes and surgical safety. The combination of previously described techniques has mostly been reported in secondary or tertiary surgeries, generally as a rescue strategy for intraoperative difficulties. However, in this case, the combination is proposed as a primary approach to achieve a predictable, reproducible, and aesthetically superior result.

Case Report

A normoweight female patient with no relevant clinical history consulted for abdominoplasty to improve abdominal contour aesthetics. Preoperative evaluation revealed rectus diastasis, moderate skin–fat redundancy, and no ventral hernias. The procedure was planned using a combination of three techniques:

Saldanha Technique: Allowing assisted liposuction to enhance contour definition while crucially preserving musculocutaneous perforator vessels that ensure adequate vascularization of the abdominal flap. A supraumbilical linea alba plication was performed to correct the diastasis without compromising blood supply.
Extended Plication: An expanded infraumbilical plication was performed, achieving an additional 16 cm of waist reduction compared to conventional abdominoplasty. This is a key advantage since standard abdominoplasty often provides limited waist definition.
Tuluá Abdominoplasty: A horizontal infraumbilical plication was performed to facilitate tension-free approximation of the wound edges, minimizing the risk of complications such as dehiscence, marginal necrosis, or infection.

Additionally, a novel neo-umbilicoplasty technique was implemented using four defatted dermocutaneous flaps anchored to the rectus aponeurosis. This modification avoids the full-thickness skin graft used in the traditional Tuluá technique, thereby eliminating raw areas requiring additional coverage.

Discussion

Conventional abdominoplasty focuses on improving abdominal wall aesthetics and function but has limitations regarding waist contouring and flap vascular safety. The combination of techniques used in this case allowed the following:

Correction of rectus diastasis while preserving flap vascularity (Saldanha technique).
Superior waist definition thanks to the extended plication.
Reduced tension on wound closure with the Tuluá technique, decreasing postoperative complications.
Introduction of a neo-umbilicoplasty technique without the need for a full-thickness skin graft, reducing tissue trauma and favoring healing.

Unlike previous reports in which the combination of Saldanha and Tuluá was employed as a salvage strategy for complex cases, here it was used as a first-line approach in a patient without prior surgeries, demonstrating its applicability in primary abdominoplasty without compromising aesthetic outcomes.

Conclusion

The combination of Saldanha’s technique, extended plication, and Tuluá abdominoplasty in primary dermolipectomy represents a viable and reproducible alternative to optimize safety and aesthetic outcomes in selected patients. The modification introduced in the neo-umbilicoplasty technique, avoiding a full-thickness skin graft, adds a new variant that reduces local morbidity. Further studies with larger sample sizes are needed to validate the applicability of this combined technique and its impact on reducing postoperative complications.

References

(All references were translated and preserved exactly as provided, maintaining original citation formatting.)

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