I had a patient visit recently who had really done her research on abdominoplasty. She had seen a multitude of doctors here and was talking to me about the actual inside the body surgery techniques. She focused on this because one of my colleagues in the Bay Area does what is called the progressive tension suture technique, where he puts in a lot of quilting sutures. Because of this, he said, his patients don’t need to have any drains following surgery. His surgery also takes about 2 hours longer.
So she was perplexed. What should she do? Is one technique better?
I like to apply science when possible. A journal article came out in the recent Plastic & Reconstructive Surgery Journal, “Is the High Superior Tension Technique an Equivalent Substitute for Progressive Tension sutures in Postbariatric Abdominoplasty? A Comparison Prospective Study.” In this study, which was a prospective study, they looked at the 2 techniques and their affect on
- duration of procedure
- hopsitalization time,
- rate of complications (hematoma, seroma, dog ear, dehiscence, dvt, secondary corrections)
- drained volume,
- patient and doctor satisfaction
The difference in the techniques is something you won’t see as a patient. In the progressive tension technique, an assistant holds the skin flap under traction as the surgeon makes many sutures to quilt the abdominal skin down to the underlying rectus fascia, to close off the open space. These step by step sutures are done in 1 cm steps centrally down to the wound edge, and less concentrated done out laterally. In the high superior tension technique, a total of 2 quilting sutures are done just along the midline at the level of the umbilicus.
Findings?
There was no overall benefit. Interestingly in their study, the operative times were close (one criticism of the progressive tension extensive quilting sutures is the time it takes). Also of interest they did drain both groups and found no difference in the drain output (indicating multiple quilting sutures did not get rid of the need for drains). The complication rates (seroma, hematoma, wound dehiscence, etc) were also found similar.
They argue you don’t need a lot of quilting sutures, just a few well placed ones to achieve the same affect.