Drainless Abdominoplasty Using Barbed Progressive Tension Sutures

Isaac, Kathryn V; Lista, Frank; McIsaac, Mark; Ahmad, Jamil

doi:10.1093/asj/sjw241

Cited by 21 publications

(10 citation statements)

References 40 publications

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“…Subsequently, the umbilical region is located where 4 points are made at 12, 3, 6 and 9 o'clock to finally perform an additional progressive tension suture 2 centimeters away from the midline with greater spacing and in a more random manner to achieve tissue adaptation to the degree of undermining obtained. Once the lower edge of the wound is reached, excess skin is removed, closing the dermis and skin in the usual way [8][9][10][11][12][13]. According to Pollock [1], the modification of the surgical technique, specifically the use of PTS in the abdominal flap, has shown a low incidence of complications since, in their study carried out in 2012 with 597 cases, reported a seroma occurrence rate of 0.1% with overall local complications of 4.2%, which represented a significant decrease from the figures obtained after switching from abdominoplasty with drains to the PTS technique.…”

Section: Discussion and Resultsmentioning

confidence: 99%

“…Maclas et. al [2] state that they agree with this, however they comment that one of the important limitations for the reproduction of the process is the time necessary to complete the technique, since approximately 20 to 50 minutes are required to perform 30 o 40 sutures that allow the abdominoplasty flap to be effectively attached to the abdominal wall, a situation that has sought to be corrected through the implementation of techniques such as the "padded" and "barbado" suture, among others [12,14,15]. On the other hand, Bromley [5] highlights the importance of remembering that regardless of the suture technique (continuous or interrupted), PTS placement is a technique that can be easily adapted to the different influencing factors.…”

Section: Discussion and Resultsmentioning

confidence: 99%

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Progressive Tension Suture in Abdominal Flap

Puentes¹

2023

OAJBS

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Abdominoplasty, known as the procedure through which an abdominal skin flap resection is performed by removing remnants of fat and skin, is considered one of the four most frequently performed medical-surgical interventions in the United States. Over the years, for the development of the process, it has been decided to carry out the original technique implemented by the plastic surgeon Ivo Pitanguy, however, due to the frequency of associated complications and the report of unsatisfactory results, Various authors have generated a series of modifications to the surgical technique, among which the performance of progressive tension sutures stands out, the objective of which is to guarantee adequate adhesion of the flap with the deep layers of the abdominal part and prevent the development of two of the main factors related to complications of the procedure, which are the displacement of the tissue and the formation of free space. In this document you will find a systematic review of specific data on the performance of progressive tension sutures for abdominal flap fixation in order to broaden the associated knowledge and promote the optimization of the results achieved.

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Section: Discussion and Resultsmentioning

confidence: 99%

Section: Discussion and Resultsmentioning

confidence: 99%

Progressive Tension Suture in Abdominal Flap

Puentes¹

2023

OAJBS

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“…1,2,11,13 In 15 publications, suitable photographs were available (Table 4). 3,15,19,22,[24][25][26][27][28]33,36,40,48,49,60 The scar level ranged from 8.6 to 14.1 cm.…”

Section: Measurementsmentioning

confidence: 99%

“…65 A major focus has been on the elimination of drains. 13,14,29,36,37 The author uses a single suction drain, which is removed 3 or 4 days after surgery regardless of drainage volume. In some cases, when there has been very little bleeding at surgery and minimal fluid accumulation in the suction bulb, the drain is removed earlier.…”

Section: Seromasmentioning

confidence: 99%

“…10,23,33,34,44,[47][48][49]54 Many surgeons have adopted quilting (or progression tension) sutures. 1,6,7,12,22,36,37,39,52,53,55 A largely overlooked alternative approach is to avoid electrodissection and reduce the potential for an inflammatory exudate to collect and create a seroma. 25 This study was undertaken to evaluate the clinical outcome of a full abdominoplasty, in combination with liposuction and other procedures, including the seroma rate.…”

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Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level

Swanson¹

2023

Ann Plast Surg

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Background Most published studies on abdominoplasty focus on methods to reduce the risk of seromas. These methods include limited dissection (lipoabdominoplasty), quilting sutures, and preservation of the Scarpa fascia. Quantitative evaluation of the aesthetic result has been lacking. Methods A retrospective study was undertaken of all patients undergoing abdominoplasty in the author's practice from 2016 to 2022. A full abdominoplasty was performed, usually with liposuction (87%). All patients were treated under total intravenous anesthesia without paralysis or prone positioning. A single closed suction drain was removed 3 or 4 days after surgery. All procedures were performed as outpatients. Ultrasound surveillance was used to detect any deep venous thromboses. No patient received chemoprophylaxis. The operating table was flexed, often to 90°. Deep fascial anchoring sutures were used to attach the Scarpa fascia of the flap to the deep muscle fascia. Measurements of the scar level were made at intervals after surgery up to 1 year. Results Three hundred ten patients were evaluated, including 300 women. The mean follow-up time was 1 year. The overall complication rate, which included minor scar deformities, was 35.8%. Five deep venous thromboses were detected. There were no hematomas. Fifteen patients (4.8%) developed seromas that were successfully treated by aspiration. The mean vertical scar level 1 month after surgery was 9.9 cm (range, 6.1–12.9 cm). There was no significant change in scar level at subsequent follow-up times up to 1 year. By comparison, the scar level in published studies ranged from 8.6 to 14.1 cm. Discussion Avoidance of electrodissection reduces tissue trauma that causes seromas. Flexed patient positioning during surgery and deep fascial anchoring sutures are effective in keeping the scar low. By avoiding chemoprophylaxis, hematomas can be avoided. Limiting the dissection (lipoabdominoplasty), preserving the Scarpa fascia, and adding quilting (progressive tension) sutures are unnecessary. Conclusions Total intravenous anesthesia offers important safety advantages. Avoiding electrodissection is effective in keeping seroma rates at a tolerable level (5%), and the scar low and more easily concealed. Alternative methods present disadvantages that may contribute to a suboptimal aesthetic result and require additional operating time.

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