The Effect of Quilting Sutures on the Tension Required to Advance the Abdominal Flap in Abdominoplasty

Abstract

Background Quilting sutures attaching the abdominal flap to the aponeurosis contribute to the prevention of seroma formation post-abdominoplasty. The sutures distribute the tension over the subcutaneous tissue along the flap length, theoretically decreasing tension at the distal (cutaneous) end of the flap. This is expected to reduce the risks of necrosis, dehiscence, and enlarged or hypertrophic scars. Objectives The study sought to verify whether quilting sutures decrease the tension required to advance the dermal-fat flap in abdominoplasty. Methods Thirty-four women undergoing abdominoplasty with quilting sutures participated in the study. The tensile force required for flap advancement was measured before and after the placement of quilting sutures, using a digital force gauge, and then compared. Differences in tensile force were tested for correlations with body mass index (BMI), age, weight of flap tissue removed, number of previous pregnancies, and postoperative complications, including seroma formation, hematoma, necrosis, dehiscence, and enlarged or hypertrophic scars. Results A mean reduction in tension of 27.7% was observed at the skin suture after the placement of quilting sutures (p < 0.001). No significant correlation was found of reduced flap tension with BMI, age, weight of tissue removed, and number of births. A case of seroma formation and two cases of enlarged scars were observed, but no case of hematoma, necrosis or wound dehiscence was detected. Conclusions The use of quilting sutures to attach the abdominal flap to the aponeurosis of the anterior abdominal wall reduced tension at the advancing edge of the flap in abdominoplasty.

Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level

“…Many publications did not include photographs that allowed measurement of the scar level, because photographs either were missing, [4][5][6][7]9,12,14,17,20,21,23,[29][30][31][32]34,35,[37][38][39]41,42,[44][45][46][47][52][53][54][55][56][57][58][59] were overcropped, 8,10,16,18,51,61 did not show the scar, 50 or were slightly out of focus. 43 Photographs in additional articles by the same authors were not measured.…”

“…Quilting sutures, also called progressive tension sutures, are frequently recommended to reduce the seroma risk. 1,7,8,13,22,[36][37][38][39]53,55 The sutures are used to reduce the dead space and movement of the flap on the aponeurotic layer. 53 As might be expected from the name, quilting sutures can produce dimpling.…”

“…1,7,8,13,22,[36][37][38][39]53,55 The sutures are used to reduce the dead space and movement of the flap on the aponeurotic layer. 53 As might be expected from the name, quilting sutures can produce dimpling. 37 Some plastic surgeons believe the evidence for their efficacy is irrefutable.…”

“…37 Some plastic surgeons believe the evidence for their efficacy is irrefutable. 53,55,79 This method adds approximately 30 minutes to the operating time. 7,37,53 One study reported an extra time commitment of 50 minutes.…”

“…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.…”