No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures

Abstract

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Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay

“…Liang et al 12 performed a comparative study of abdominal closure using progressive tensioning with a running barbed suture quilting technique in breast reconstruction with the DIEP flap and reported a reduction in abdominal drainage. Similar results were reported by Nagarkar et al 8 where the use of running barbed progressive tension sutures only was not associated with increased complication rates versus closure with interrupted progressive tension sutures with abdominal drain placement versus closure with abdominal drains only. Quilting sutures have also been shown to be of benefit reducing incidence of donor site seroma formation in TRAM flap breast reconstruction 13 .…”

Modified aesthetic abdominoplasty approach in perforator free-flap breast reconstruction: Impact of drain free donor site on patient outcomes

“…18 The absence of drain use with this technique has not been shown to increase the risk of donor site complications in elective abdominoplasty 6,18 or DIEP donor site closure in the senior author's (M.S.C) preliminary data. 7 The premise of this study was based on lessons learned from aesthetic abdominoplasty and reaffirmed the previous work using progressive tension sutures and applying these principles in breast reconstruction. Drains are known to be cumbersome in the early postoperative period, and often the ongoing source of pain.…”

“…6,7,19 The barbed self-anchoring suture incorporates tiny barbs spaced evenly in a helical array on either side of a nonbarbed mid-segment. Tension is distributed across multiple barbs along the entire length of the suture.…”

“…In aesthetic surgery and from the senior author's (M.S.C) preliminary study in DIEP breast reconstruction this technique has demonstrated no increased abdominal-based complications. 6,7 The primary aim was to compare donor site complications, and secondary outcomes included postoperative recovery, including pain and analgesic requirement, and follow up drain management. The null hypothesis was there was no difference between standard and the new donor site closure technique.…”

The Efficacy of Midline Barbed Absorbable Sutures in Progressive Tension Closure of Abdominal Flap Donor Sites

“…Beginning with facelifts and skin closure, many groups have used this material during abdominal flap closure [14,15]. Nagarkar et al [26] found that the application of running barbed PTS along the entire elevated flap, combined with limited dissection, allowed the surgeon to even obviate the requirement for drain placement at the donor site. The main advantage of this material is the elimination of the knotting process required for interrupted sutures; this innovation reduces the operative time and distributes the wound tension across multiple barbs rather than the knotted end.…”