372 Fig. 14 Several adhesion stitches are made to ﬁx the subcutaneous ‘‘dead space,’’ and the inferior scarpa fascia is sutured into the ﬂap to protect the lymphatic vessels and musculocutaneous nerves Aesth Plast Surg (2009) 33:366–376 Subcutaneous Adhesion Stitches and Closing Sutures Approximately 10-12 nonabsorbable 4-0 stitches are placed in the subcutaneous level, ﬁxing the scarpa fascia to the muscle aponeurotic tissue. This procedure was described by Baroudi [21]; a posterior approach was described by Pollok [22] to diminish the ‘‘death space’’ and to avoid ﬂap sliding, preventing hematomas and seromas postopera- tively. The inferior scarpa fascia border is sutured together with the subcutaneous ﬂap to protect the lymphatic vessels and musculocutaneous nerves. Even with these stitches, we maintain a suction drain for 12 h. Subcutaneous and intradermic sutures are made with monocryl 4–0, and micropore sterile strips are attached to the new scar (Fig. 14). Postoperative Remarks Support undergarments are placed on the patient to rein- force and maintain pressure on the abdomen wall. The 123 patient is kept in the hospital overnight; the epidural catheter is kept connected to the pump for 24 h. A solution of sufentanil citrate (100 mg) with saline solution 0.9% (100 ml) is continuously infused only to prevent pain; no other analgesic drugs are administered. The patient can and should move her legs beginning immediately after the surgery this is important to prevent venous thromboem- bolism. Intensive care respiratory procedures are observed and leg massages given. The next day the epidural catheter is removed and the patient may start to walk slowly in a hunched position to avoid stretching the abdomen. The patient can be released if vital signs are normal (Figs. 15, 16, 17). Clinical Dates and Results In the last 8 years we have performed this technique on 326 patients, all with these related improvements. Table 1 gives our data regarding complications. In two patients supra- pubic epidermolyses occurred. Both patients were heavy