Due to the increased prevalence of obesity in the last decades, bariatric surgery has been on the rise in recent years. Bariatric surgery is a compelling option for weight loss in obese patients with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. Redundant skin following significant weight loss is a common occurrence affecting up to 96% of patients who undergo bariatric surgery, negatively impacting physical and psychosocial health and detracting from activities of daily living. Statistics of the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report. Abdominoplasty, a well-established cosmetic surgery procedure for improving body contour, is performed by removing excess skin and fat from the abdominal wall and thereby restoring musculofascial integrity and skin elasticity, resulting in a more ideal body shape and increasing quality of life. Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. Technologic advances over the past decade have been developed as non-invasive alternatives or adjunctive tools to surgery to enhance cosmetic results and minimize complications. New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity and/or diminish the extent of surgery and resulting scars. Plastic surgeons play a significant role in improving the quality of life of patients who suffer from obesity and underwent bariatric surgery. We are deeply convinced, however, that the advancement of knowledge and research in this field will determine the introduction of new technologies and custom-made techniques. This advancement will reduce the complication rate with a rapid reintegration of the patient into the world of work and resumption of daily activities.

Introduction: The aim of this study was to evaluate ex vivo perfusion (EVP) for vascularized composite tissue preservation. We hypothesized that EVP could maintain allografts in near‐physiologic conditions for ≥ 24 h. Methods: Twenty superior epigastric artery perforator‐based abdominal flaps were procured from 10 Yorkshire pigs. Flaps were preserved for 12 h ( n = 5) or 24 h ( n = 5) using EVP with an oxygenated colloid solution containing HBOC‐201 oxygen carrier (HbO ₂ Therapeutics, Souderton, PA). Contralateral flaps were cold storage controls (4°C) ( n = 10). Hemodynamics, temperature, gases, metabolites, electrolytes, indocyanine green (ICG) angiography, and weight were analyzed. Biopsies were taken every 6 h for histology. Results: Ischemia time was 16 ± 6 min. There were no significant differences between the 12 h EVP and 24 h EVP groups at perfusion end for the following parameters: MAP ( p = 0.63), pH ( p = 0.77), pO2 ( p = 0.20), venous pCO ₂ ( p = 0.22), lactate ( p = 0.28), creatine kinase ( p = 0.89), or myoglobin ( p = 0.95). Electrolytes were also comparable at perfusion termination: sodium ( p = 0.31), potassium ( p = 0.61), and calcium ( p = 0.29). After 12 h, flaps in the 24 h EVP group demonstrated a significant weight decrease (−4.5% [−4.6%, −4.1%] weight change), compared to the 12 h EVP group (1.2% [−1.1%, 1.6%] weight change) ( p = 0.03). At perfusion end, weight did not differ from baseline between the 24 h EVP (2.3% [0%, 3%]) and 12 h EVP groups ( p = 0.37). SCS flap weight was unchanged from baseline at 12 h ( p = 0.954) and 24 h ( p = 0.616). ICG revealed well‐perfused flaps. H&E staining revealed preserved skin architecture without histopathological changes. Conclusion: EVP preserved flaps for 24 h within physiologic parameters and without development of edema. EVP may extend preservation time for VCAs.