Abdominalplasty- Intracostal nerves sewn in permanent sutures creating horrible pain. Is this standard practice?

Question

Post Abdominalplasty-I had terrible pain above my belly button and nobody could figure it out. Dozens of doctors. I became completely incapacitated and disabled in chronic pain . Finally a neurosurgeon did exploratory surgery and found my T8 and T9 nerves sewn in/under permanent sutures. Shouldn’t these nerves be looked out for and avoided during plication? Is it standard practice for plastic surgeons to just plicate with no concern of strangling nerves?

David Janssen, MD, FACS · Answer

I am sorry to hear about this problem, and hope that your pain is relieved with the  abdominal suture removal.  Without being too complex about the anatomy or innervation of the abdominal wall, you should understand that when we tightened the tissue in front of the muscles we are placing blind stitches.  We can't see what's underneath the fascia.  When we sew it,  there is the possibility of grabbing a nerve that can cause long-term and chronic pain.  I have answered several questions about this on real self previously.  This is one of the reasons that we have to reoperate and remove permanent suturing after  formal tummy tuck.  It is also the reason that I frequently offer a moderate abdominoplasty where we simply remove the skin and fat but leave the muscle fascia alone.  That operation as described in the movie below.  It is my belief that we frequently tighten muscles for very minimal improvement and with some danger in patients that don't need it.  This is a known complication of abdominoplasty and your surgeon did what is the standard in tightening your muscle.

Douglas Taranow, DO, FACOS · Answer

I am glad you are finally feeling much better.  I am perplexed as to how the Plastic Surgeon was able to catch these nerves.  I cannot comment without hearing directly from your neurosurgeon (the diagnosis listed is very questionable).  When we plicate or tighten the abdominal muscles during an abdominoplasty, we sew 'blindly' catching only the top layer of tissue called fascia that lays above  the muscle.  It is possible to 'catch' a nerve in a non-absorbable suture, but I have not seen it in over 26 years.  The use of non-absorbable sutures is a standard as well.Hope this answers just a few of your questions.Dr T

Mark Eberbach, MD · Answer

I'm sorry to hear of your problems. Your statement from your neurosurgeon doesn't make a lot of sense to me, however. The nerves are really quite small and are not seen in a typical tummy tuck. The plication per se should have nothing to do with nerve injury. I think something was lost in the translation of your neurosurgeon's statement or something unusual was done at the time of your tummy tuck.I'm glad you are better.

Abdominalplasty- Intracostal nerves sewn in permanent sutures creating horrible pain. Is this standard practice?

Answers (3)

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