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

Egrari, Sepehr

doi:10.1093/asj/sjab418

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…As might be expected from the name, quilting sutures can produce dimpling 37 . Some plastic surgeons believe the evidence for their efficacy is irrefutable 53,55,79 …”

Section: Discussionmentioning

confidence: 99%

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Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level

Swanson¹

2023

Ann Plast Surg

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Background Most published studies on abdominoplasty focus on methods to reduce the risk of seromas. These methods include limited dissection (lipoabdominoplasty), quilting sutures, and preservation of the Scarpa fascia. Quantitative evaluation of the aesthetic result has been lacking. Methods A retrospective study was undertaken of all patients undergoing abdominoplasty in the author's practice from 2016 to 2022. A full abdominoplasty was performed, usually with liposuction (87%). All patients were treated under total intravenous anesthesia without paralysis or prone positioning. A single closed suction drain was removed 3 or 4 days after surgery. All procedures were performed as outpatients. Ultrasound surveillance was used to detect any deep venous thromboses. No patient received chemoprophylaxis. The operating table was flexed, often to 90°. Deep fascial anchoring sutures were used to attach the Scarpa fascia of the flap to the deep muscle fascia. Measurements of the scar level were made at intervals after surgery up to 1 year. Results Three hundred ten patients were evaluated, including 300 women. The mean follow-up time was 1 year. The overall complication rate, which included minor scar deformities, was 35.8%. Five deep venous thromboses were detected. There were no hematomas. Fifteen patients (4.8%) developed seromas that were successfully treated by aspiration. The mean vertical scar level 1 month after surgery was 9.9 cm (range, 6.1–12.9 cm). There was no significant change in scar level at subsequent follow-up times up to 1 year. By comparison, the scar level in published studies ranged from 8.6 to 14.1 cm. Discussion Avoidance of electrodissection reduces tissue trauma that causes seromas. Flexed patient positioning during surgery and deep fascial anchoring sutures are effective in keeping the scar low. By avoiding chemoprophylaxis, hematomas can be avoided. Limiting the dissection (lipoabdominoplasty), preserving the Scarpa fascia, and adding quilting (progressive tension) sutures are unnecessary. Conclusions Total intravenous anesthesia offers important safety advantages. Avoiding electrodissection is effective in keeping seroma rates at a tolerable level (5%), and the scar low and more easily concealed. Alternative methods present disadvantages that may contribute to a suboptimal aesthetic result and require additional operating time.

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“…As might be expected from the name, quilting sutures can produce dimpling 37 . Some plastic surgeons believe the evidence for their efficacy is irrefutable 53,55,79 …”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Quilting Suturesmentioning

confidence: 99%