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.

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.

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.

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.).

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.

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.

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.