Abstract
Background
Seroma formation has become the most reported complication after abdominoplasties. In 2000, progressive tension sutures (PTS) were described and reported to be associated with a seroma rate of 0.1%. Surgeons worldwide use PTS to prevent seroma; however, there are discrepancies in the number of PTS commonly used, starting from five up to 35 sutures. The absence of standardization may cause a lack of seroma prevention, increased surgical time, and general hesitation to perform the technique.
Objective
To determine whether 11 PTS are sufficient to prevent seroma in abdominoplasties.
Methods
We performed a single-blind, prospective, comparative, randomized clinical trial of 63 healthy patients from January to December 2017. Patients were divided into groups: group 1, classic abdominoplasty without the use of PTS and drains; group 2, abdominoplasty with the use of 11 PTS and drains; and group 3, abdominoplasty with the use of 22 PTS and drains. The duration of the surgical technique, presence of clinical seroma, number of aspirations, and days to drain removal were evaluated. The Cochran–Armitage, Fisher exact, Kruskal–Wallis, and t tests were used in the statistical analyses.
Results
PTS reduced the rate of seroma formation to 3.5%. Results showed that there is a benefit in using 11 PTS instead of 22 PTS because using more sutures led to an increased surgical time (30 min vs. 13 min) and possible complications. Compared to patients with PTS, those without PTS underwent more seroma aspirations and delayed drain removal.
Conclusions
Eleven PTS should be used in classic abdominoplasties.
Level of Evidence I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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References
Matarasso A (1995) Liposuction as an adjunct to a full abdominoplasty. Plast Reconstr Surg 95:829–836
Zimman OA, Butto CD, Ahualli PE (2001) Frequency of seroma in abdominal lipectomies. Plast Reconstr Surg 108:1449–1451
Pollock TA, Pollock H (2010) No drain abdominoplasty with progressive tension sutures. Clin Plast Surg 37(3):515–524
Hester TR Jr, Baird W, Bostwick J, Nahai F, Cukic J (1989) Abdominoplasty combined with other major surgical procedures: safe or sorry? Plast Reconstr Surg 83:997–1004
Kargi E, Akduman D, Dokuzoguz B (2003) Late complication of abdominoplasty in an obese patient: systemic inflammatory response syndrome and seroma. Plast Reconstr Surg 111:1568–1571
Zecha PJ, Missotten FE (1999) Pseudocyst formation after abdominoplasty: extravasations of Morel-Lavallee. Br J Plast Surg 52:500–502
Jabbour S, Awaida C, Mhawej R, Bassilios Habre S, Nasr M (2017) Does the addition of progressive tension sutures to drains reduce seroma incidence after abdominoplasty? A systematic review and meta-analysis. Aesthet Surg J 37(4):440–447
Chaouat M, Levan P, Lalanne B, Buisson T, Nicolau P, Mimoun M (2000) Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results. Plast Reconstr Surg 106:1614–1618
Baroudi R, Ferreira C (1998) Seroma: how to avoid it and how to treat it. Aesthet Surg J 18(6):439–441
Sforza M, Jonavonic M (2015) Use of quilting sutures during abdominoplasty to prevent seroma formation: Are they really effective? Aesthet Surg J 35(5):574–580
Arantes HL, Rosique RG, Rosique MJ, Melega JM (2010) The use of quilting sutures in abdominoplasty does not require aspiration drainage for prevention of seroma. Aesthet Plast Surg 34(1):102–104
Pollock H, Pollock T (2000) Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg 1057:2583–2586
Pollock T, Pollock H (2012) Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. Aesthet Surg J 326:729–742
Macias L, Kwon E, Gould DJ, Spring MA, Stevens G (2016) decrease in seroma rate after adopting progressive tension sutures without drains: a single surgery center experience of 451 abdominoplasties over 7 years. Aesthet Surg J 369:1029–1035
Antonetti JW, Antonetti AR (2010) Reducing seroma in outpatient abdominoplasty: analysis of 516 consecutive cases. Aesthet Surg J 303:418–425
Khan UD (2008) Risk of seroma with simultaneous liposuction and abdominoplasty and the role of progressive tension sutures. Aesthet Plast Surg 32(1):93–99 (discussion 100)
Bercial M, Sabino M, Call JA, Rosetto LA, Ferreira LM (2012) Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: Which is the best strategy? Aesthet Plast Surg 36(2):370–373
Pitanguy I (2016) Cirurgia Plastica, Uma Visao de Sua Amplitude. Atheneu, Rio de Janeiro, Brazil, pp 467–470
Matarasso A (1991) Abdominolipoplasty: a system of classification and treatment for combined abdominoplasty and suction assisted lipectomy. Aesthet Plast Surg 15:111–121
Seretis K, Gouilis D, Demiri EC, Lykoudis EG (2017) Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis. Aesthet Surg J 37(3):316–323
Gould DJ, Macias LH, Saeg F, Dauwe P, Hammoudeh Z, Stevens G (2018) Seroma rates are not increased when combining liposuction with progressive tension suture abdominoplasty: a retrospective cohort study of 619 patients. Aesthet Surg J 13(387):763–769
Nahas FX (2007) Does quilting sutures prevent seroma in abdominoplasty. Plast Reconstr Surg 1193:1060–1064
Matarasso A, Swift RW, Rankin M (2006) Abdominoplasty and abdominal contour surgery: a national plastic surgery survey. Plast Reconstr Surg 117:1797–1808
Drapeau CM, D’Aniello C, Brafa A, Nicastri E, Silvestri A, Nisi G, Petrosillo N (2007) Surgical site infections in plastic surgery: an Italian multicenter study. J Surg Res 143:393–397
Coulston JE, Tuff V, Twine CP, Chester JF, Eyers PS, Stewart AH (2012) Surgical factors in the prevention of infection following major lower limb amputation. Eur J Vasc Endovasc Surg 43:556–560
Simchen E, Rozin R, Wax Y (1990) The israeli study of surgical infection of drains and the risk of wound infection in operations for hernia. Surg Gynecol Obstet 170:331–337
Vilar-Compte D, Mohar A, Sandoval S, de la Rosa M, Gordillo P, Volkow P (2000) Surgical site infections at the National Cancer Institute in Mexico: a case–control study. Am J Infect Control 28:14–20
Kim J, Stevenson TR (2006) Abdominoplasty, liposuction of the flanks, and obesity: analyzing risk factors for seroma formation. Plast Reconstr Surg 117:773–779
Fang RC, Lin SJ, Mustoe TA (2010) Abdominoplasty flap elevation in a more superficial plane: decreasing the need for drains. Plast Reconstr Surg 125:677–682
Stoff A, Reichenberger MA, Richter DF (2007) Comparing the ultrasonically activated scalpel (Harmonic) with high-frequency electrocautery for postoperative serous drainage in massive weight loss surgery. Plast Reconstr Surg 120:1092–10933
Dillerud E (1990) Abdominoplasty combined with suction lipoplasty: a study of complications, revision and risk factors in 487 cases. Ann Plast Surg 255:333–338
Najera RM, Asheld W, Sayeed SM, Glickman LT (2011) Comparison of seroma formation following abdominoplasty with or without liposuction. Plast Reconstr Surg 1271:417–422
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Dr. Bromley, Dr. Marrou and Dr. Charles de Sa´ have nothing to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Bromley, M., Marrou, W. & Charles-de-Sa, L. Evaluation of the Number of Progressive Tension Sutures Needed to Prevent Seroma in Abdominoplasty with Drains: A Single-Blind, Prospective, Comparative, Randomized Clinical Trial. Aesth Plast Surg 42, 1600–1608 (2018). https://doi.org/10.1007/s00266-018-1227-6
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DOI: https://doi.org/10.1007/s00266-018-1227-6