From the Research
Nerve damage during abdominoplasty and thigh plasty procedures most commonly affects the lateral femoral cutaneous and iliohypogastric nerves, resulting in numbness, tingling, and pain in the affected areas. The incidence of nerve injury after abdominoplasty has been reported to be around 1.94% of patients, with 1.02% experiencing permanent injury 1. The nerves directly injured during these procedures include the lateral femoral cutaneous nerve (1.36% of patients) and iliohypogastric nerve (0.10%) 1.
Nerve Injury Mechanism
Nerve damage occurs due to dissection near superficial nerves, particularly when creating skin flaps or removing excess tissue, making some degree of sensory change almost inevitable after these cosmetic surgeries. The lateral femoral cutaneous nerve is at risk of injury, especially during abdominoplasty, due to its anatomical location near the anterior superior iliac spine and inguinal ligament 2.
Management of Nerve Damage
For management, a multimodal approach starting with conservative treatments is recommended. This includes neuropathic pain medications such as gabapentin or pregabalin, physical therapy focusing on desensitization techniques and nerve gliding exercises, and topical treatments like lidocaine patches or capsaicin cream. Nerve blocks with lidocaine or bupivacaine administered by a pain specialist may be considered for persistent pain. Surgical exploration and nerve repair are rarely needed but may be considered if symptoms are severe and don't improve after 6 months.
Prevention Strategies
Prevention of nerve injury is crucial and can be achieved through a thorough understanding of the course of the nerves in the lower abdomen and careful dissection techniques. Preserving Scarpa's fascia near the inguinal ligament and minimizing dissection in the area around 4 cm of the anterior superior iliac spine may serve as key strategies to avoiding lateral femoral cutaneous nerve injury 2.
Recovery and Outcomes
Most nerve damage symptoms improve within 6-12 months as nerves regenerate at approximately 1mm per day. However, some sensory changes may be permanent. The recovery process can be influenced by the extent of nerve injury and the effectiveness of treatment strategies. Further research is needed to develop new therapeutic strategies to limit nerve scarring and improve outcomes for patients with peripheral nerve injuries 3.