Abdominoplasty and abdominal wall innervation

Abdominoplasty which requires undermining of a mobilised skin flap in the procedure, sometimes results in troublesome anaesthesia of the skin post-operatively and vascular problems as well, on occasion. It has not been clear what nerve branches and companion vessels of the abdominal wall are damaged and whether attention to their detailed anatomy may help to avoid these problems by modifying surgical procedure.Thirty-six lower intercostal nerves (in the region T6 to T12) were dissected in cadavers in order to examine the relevant anatomy of intercostal nerves. In the light of the literature and our findings, the method that spares the nerves where possible is described. In abdominoplasty, if the area of undermining is limited to a triangular area formed by the xiphoid and the anterior superior iliac spines, the main lateral branches of the intercostal nerves are spared, and cutaneous denervation minimized in this procedure.