Abdominoplasty and Clitoris Evaluation: A Prospective Study on Sexual Pleasure in Women Undergoing Abdominoplasty.

INTRODUCTION: Being one of the most practiced procedures in plastic surgery, it is important to foster a better understanding of the effect of anatomical changes in the pubic area after abdominoplasty on sexuality in women. Since to date no study has been performed with this purpose, our aim is to evaluate the impact of the abdominoplasty on sexual pleasure and to perform an objective evaluation of changes in clitoral position and prepubic fat area after this procedure. MATERIALS AND METHODS: A prospective study has been performed in 50 women who expressed a desire to undergo abdominoplasty from January 2021 to December 2021. The primary endpoint was Sexual pleasure assessed by the "Sexuality Assessment Scale" before and 6 months after abdominoplasty in all patients. Furthermore, we evaluated the physical changes of the clitoris (clito-pubic distance, CP distance) and the prepubic fat area on magnetic resonance imaging before and 3 months after abdominoplasty. RESULTS: Patients mean age was of 42 ± 9 years, and mean body mass index of 26 ± 2 kg/m2. A significant difference (P < 0.0001) between sexual satisfaction before and 6 months after abdominoplasty (mean difference +7.4 ± 6.452) was found. Though there was no significant difference between the clito-pubic distance before and after abdominoplasty (mean difference -3.200 ± 2.499 mm; p= 0.0832), a significant difference was found in the size of the prepubic fat area before compared to after abdominoplasty (mean difference -1.714 ± 1.010 cm2; p = 0.0426). However, no significant relationship between these anatomical changes and sexual satisfaction was found. CONCLUSION: Our results show that abdominoplasty is associated with an increase in sexual satisfaction. The changes in the post-operative position of the clitoris were not statistically significant, contrarily to the size of the prepubic fat area, which was significantly modified and could partially explain the improved sexual pleasure. Authors were unable to statistically demonstrate a correlation between those anatomical modifications and sexual pleasure. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Microvascular assessment of fascio-cutaneous flaps by ultrasound: A large animal study.

Objectives: Blood perfusion quality of a flap is the main prognostic factor for success. Microvascular evaluation remains mostly inaccessible. We aimed to evaluate the microflow imaging mode, MV-Flow, in assessing flap microvascularization in a pig model of the fascio-cutaneous flap. Methods: On five pigs, bilateral saphenous fascio-cutaneous flaps were procured on the superficial femoral vessels. A conventional ultrasound evaluation in pulsed Doppler and color Doppler was conducted on the ten flaps allowing for the calculation of the saphenous artery flow rate. The MV-Flow mode was then applied: for qualitative analysis, with identification of saphenous artery collaterals; then quantitative, with repeated measurements of the Vascularity Index (VI), percentage of pixels where flow is detected relative to the total ultrasound view area. The measurements were then repeated after increasing arterial flow by clamping the distal femoral artery. Results: The MV-Flow mode allowed a better follow-up of the saphenous artery's collaterals and detected microflows not seen with the color Doppler. The VI was correlated to the saphenous artery flow rate (Spearman rho of 0.64; p = 0.002) and allowed to monitor the flap perfusion variations. Conclusion: Ultrasound imaging of microvascularization by MV-Flow mode and its quantification by VI provides valuable information in evaluating the microvascularization of flaps.