Global Prevalence and Preferences of Progressive Tension Suture Usage in Abdominoplasties.

BACKGROUND: Abdominoplasty is one of the most popular esthetic procedures. Seroma is the most frequent postoperative complication. Two decades of literature have described benefits of quilting sutures/progressive tension sutures (PTS) in reducing seroma rates and other complications in abdominoplasties. Despite this, PTS have not been universally adopted by plastic surgeons (ISAPS international survey on aesthetic/cosmetic procedures performed in 2020, 2021) Furthermore, PTS techniques and preferences vary widely. OBJECTIVE: The aim of this study is to determine the prevalence of PTS use, reasons for reluctance to utilize them, and variety of techniques utilized by plastic surgeons performing abdominoplasties internationally. METHODS: A 13-question survey was emailed via ISAPS to 3842 plastic surgeons internationally. Responses were collected and analyzed. RESULTS: Of the 272 respondents, the majority, 58%, currently use PTS. 46% were introduced to PTS during training. Only PTS training exposure was found to significantly correlate with current usage. Only 22% of North American trainees were exposed to PTS compared to 40-62% of trainees from other geographies. Of respondents who utilize PTS, most, 74%, combine them with drains. The majority use interrupted sutures, 65%, while 19% utilize a running suture, and the remaining 16% combine interrupted and running sutures. Of respondents who do not currently utilize PTS, the most common reason stated is that the surgeon's technique works well without them, 73%, which was significantly correlated with years in practice. CONCLUSION: Globally, most plastic surgeons currently utilize PTS (typically with drains) with training exposure being a significant predictor. There are still areas to address reluctance to implement them and use them without drains. LEVEL OF EVIDENCE III: 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 .

Drainless Abdominoplasty Using Progressive Tension Sutures.

Drain-free abdominoplasty using progressive tension sutures (PTS) was initially described in 2000 in a small retrospective series. However, the authors' experience with this technique spans well over 3 decades, and their technique has evolved to simplify the procedure to make it easier and more reproducible by the surgeon and improve the patient's recovery and overall experience. This article provides in-depth technical details on the authors' no-drain abdominoplasty technique. The authors also address through recent literature some of the commonly stated barriers to surgeons instituting this technique into their abdominoplasty procedure, including excessive time of placement, dimpling, and effectiveness.

Evidenced-Based Approach to Abdominoplasty Update.

The following publication was compiled as an evidence-based update for plastic surgeons performing abdominoplasty from a review of the published literature on that subject between January 2014 and February 2017. It is an overview of various aspects of abdominoplasty including preoperative patient assessment, variations and advances in both surgical and anesthetic technique, patient safety, and outcomes. It is intended to serve as an adjunct to previously published evidence-based reviews of abdominoplasty.

Conscious sedation/local anesthesia in the office-based surgical and procedural facility.

The safety, efficacy, and rapid recovery of conscious sedation/local anesthesia make this anesthetic technique useful in the ambulatory setting. The care of the sedated patient requires a team effort. The individual role and responsibility of patient, surgeon, anesthesia provider, and nursing staff are discussed. Using data obtained from a series of 1400 consecutive cases, the authors' experience with conscious sedation/local anesthesia is presented. The current technique, using low-dose propofol, is described in detail. Using conscious sedation, the patient's level of consciousness is depressed, but respiratory drive and airway reflexes are maintained and anesthesia is provided by infiltration of local anesthetic.

Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases.

BACKGROUND: Although abdominoplasty and other body-contouring procedures are being performed more frequently, the incidence of seroma and other complications has remained relatively unchanged. In 2000, a small retrospective series introduced progressive tension sutures (PTS) in abdominoplasty to reduce seroma without the use of drains. OBJECTIVES: The authors review the PTS technique and their experience with the procedure. METHODS: A retrospective chart review of 597 consecutive abdominoplasty patients treated over 12 years was performed. Collected data included surgical setting, concomitant procedures, and complications. RESULTS: Of the 597 abdominoplasties, 52.4% were performed in the hospital and 47.6% in an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited facility. In 63.7% of cases, abdominoplasty was combined with another procedure(s). Liposuction was performed on the abdominoplasty flap or an adjacent area to the abdominoplasty dissection in 67% of patients. The average amount fat aspirate from these areas was 953 mL. No drains were placed. The rate of local complications was 4.2%; all but one of these complications (seroma; 0.1%) were minor. There were no systemic complications related to PTS and no venous thromboembolisms. CONCLUSIONS: PTS are an adjunct to abdominoplasty that can minimize seroma and potentially decrease other local complications. They provide secure fixation of the flap to eliminate motion and broadly transfer tension to the superficial fascial system. Drains can safely be eliminated from abdominoplasty, even when liposuction is performed. Systemic complications may be avoided and patient recovery expedited.

No-drain abdominoplasty with progressive tension sutures.

Seroma formation is one of the major postoperative complications of abdominoplasty. Progressive tension sutures have been proposed as an adjunct procedure to combat this problem. Apart from being a simple addition to abdominoplasty, the sutures also eliminate other complications, such as postoperative drains, and increase the patient's mobility.

Subcutaneous brow lift with precise suture fixation and advancement.

BACKGROUND: Current aesthetic literature reflects a renewed interest in the subcutaneous brow lift. The authors believe that this trend is based on the principle that the most direct approach to elevating the brows is subcutaneous dissection with skin advancement. Furthermore, the addition of progressive tension sutures (PTSs) to the subcutaneous brow lift permits precise fixation of brow position, controlled advancement of the forehead flap, and elimination of dead space. OBJECTIVE: The authors report on the use of active suture fixation of the brow and advancement of the forehead flap to accomplish a precise, effective, and sustained brow elevation. METHODS: Dissection was carried down to the frontalis muscle with a reversed bevel incision. Corrugator resection was performed by incising the galea transversely in the glabellar region and then identifying, isolating, and resecting the muscle. The first PTS was placed to secure the midline subcutaneous tissue to the superior edge of the transected galea. Then a PTS was placed from the subcutaneous tissue or deep dermis of the flap deep to the anticipated brow peak. The brow was anchored in an elevated position with additional PTS placed medially and laterally. RESULTS: A consecutive series of 80 patients underwent the described procedure, with average follow-up of 13.5 months. One case of transient epidermolysis occurred, resulting in a small area of partial alopecia. Three patients had extruding sutures. Upper eyelid excision was required in 5 patients, and in 1 patient unilateral revision was performed to improve symmetry. CONCLUSIONS: This approach simplifies the forehead lift and allows the surgeon to directly and precisely control the position of the brows, while shortening convalescence and reducing complications.

Progressive tension sutures in abdominoplasty.

The authors describe a simple, safe, and effective way to reduce complications related to abdominoplasty. By using progressive tension sutures, a suture technique to advance and anchor the abdominal flap, they have routinely combined abdominal liposuction and abdominoplasty, with no resulting seroma formation or distal flap necrosis. No drains are used in this technique, and early ambulation in an upright posture is encouraged.

Progressive tension sutures to prevent seroma formation after latissimus dorsi harvest.

The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The major complication reported with its use is donor-site seroma, reported to occur in 20 to 79 percent of cases. A retrospective review of 47 patients undergoing latissimus dorsi muscle harvest from April of 1998 through May of 2002 was performed. Progressive tension sutures were used during donor-site closure in 22 patients from March of 2000 through May of 2002. This group was compared with historical controls from April of 1998 through March of 2000 (n = 23) who underwent latissimus dorsi harvest without use of the technique. Seven of 23 controls (30 percent) developed seromas at the donor site, compared with 0 of 22 (Fisher's exact text, p = 0.0092). The authors conclude that use of progressive tension sutures placed at the time of donor-site closure is an effective method to reduce or eliminate the most common complication associated with latissimus dorsi harvest. Technique recommendations are reviewed.

Management of face lifts with progressive tension sutures.

BACKGROUND: Performance of deeper and more extensive dissections in face lift procedures has led to more complex procedures, a higher rate of reported complications, and more prolonged convalescence. OBJECTIVE: We investigated the use of progressive tension sutures (PTSs) to achieve more controlled, safe, and secure skin flap management and improved aesthetic results. METHODS: Defatting of the neck was performed by lipoplasty or direct excision. The face was dissected in a subcutaneous plane to enable individualized management of the deeper tissues. After employment of appropriate face lift techniques, the skin flaps were advanced and PTSs were placed from the deep surface of the skin flap to the underlying superficial musculoaponeurotic system and were also used to advance the lateral neck and postauricular skin flap. RESULTS: Early findings in a series of 10 patients followed up for at least 1 year showed excellent aesthetic results with no cases of skin flap necrosis or widening of scars, minimal swelling and ecchymosis, and no long-term complications. CONCLUSIONS: The use of PTSs, in combination with individualized management of the deep tissues, can reduce wound complications, decrease postoperative edema, and promote shorter recovery.

Reducing abdominoplasty complications.

The authors recommend using progressive tension sutures in abdominoplasty procedures. This suture technique not only eliminates dead space but also securely advances the flap with incremental tension transferred from the skin closure incision to the superficial fascial system. (Aesthetic Surg J 2002;22:475-476.).