HOT

WATER

BURN

OF THE

ABDOMEN

AFTER

LIPECTOMY

By D. 0. MAISELS, F.R.C.S. Licwpool

Regional

Burns and Plastic

Unit, Whiston England

Hospital,

Prescot,

Mersqvside

L35 sDR,

AN encounter with an unknown and unexpected complication can be a perplexing and salutory experience. If a short report of the incident helps others avoid a similar pitfall it probably constitutes one of the better reasons for writing a paper. CASE REPORT A 35-year-old lady underwent a routine abdominal lipectomy with dissection of the skin flap to the costal margin. She made an uneventful recovery and when seen I month postoperatively was well healed with a satisfactory result. The same night she had an attack of lower abdominal pain and urinary frequency and went to bed with a hot water bottle. Next morning she noticed an area of blistering on the lower abdomen where the hot water bottle had lain. The burns (Fig. I) were of deep partial thickness and had occurred in an area of complete loss of sensation. The burns healed in 4 weeks but when reviewed 9 months later the scars were still apparent as areas of light depigmentation (Fig. 2). Although she had recovered blunt sensation in the whole area there was still an area of loss of pin-prick sensation though it was much smaller than before. In this narrow central zone loss of ability to distinguish between hot and cold persisted.

FIG.

I.

Deep dermal burn of the lower abdomen.

FIG. 2.

32

I-E

Burns healed.

Dotted line outlines area of loss of sensation Dotted line outlines improved sensation II months postoperatively. 65

BRITISH

66

JOURNAL OF PLASTIC

SURGERY

DISCUSSION The dangers of loss of protective sensation are well recognised but loss of sensation in the abdominal wall following a lipectomy does not appear to have been recognised although, as the above case illustrates, the danger of unfelt trauma is just as real. The area of sensory loss in the patient described above has been observed in others following abdominal lipectomy and corresponds to the territory supplied by the anterior terminal cutaneous branches of the anterior primary divisions of the spinal or intercostal nerves TIO to T12 (Cunningham, Igo6) (Fig. 3, a and b). Daniel and his colleagues (1978) confirmed in their dissections that the anterior branches of the lateral cutaneous branches could not be traced beyond the lateral border of the rectus and that this area was supplied by perforators from the termination of the main nerve trunks deep to the rectus. Nowhere is it suggested that the pattern of nerve supply is different above the umbilicus though clearly it must be so since all the perforating nerves are divided in the undermining of the skin. Can it be that in fact the anterior branches of the lateral cutaneous branches of the main nerve do in fact reach the middle in the zone supplied by T6 to T9?

INTERNAL BRANCH

03a FIK 3. a. Scheme of the distribution

of a typical spinal nerve. b. The distribution of cutaneous nerves on the front of the trunk. From Cunningham’s Text-book of Anatomy, 1906

HOT

WATER

BURN

OF THE

ABDOMEN

AFTER

LIPECTOMY

67

SUMMARY Abdominal mbilicus.

lipectomy

Patients

should

results

in a zone

be warned

of impaired

of the significance

sensation

below

of this sensory

the level loss.

REFERENCES D. J. (1906). Text-book of anatomy. 2nd edition, pp. 615, 635. Edinburgh and London: Young J. Pentland. DANIEL, R. K., KERRIGAN, C. L. and GARD, D. A. (1978). The great potential of the intercostal flap for torso reconstruction. Plastic and Reconstructive Surgery, 61, 653. CUNNINGHAM,

32.1-E”

of the