Abdominoplasty with Suction Undermining and Plication of the Superficial Fascia without Drains

Abstract

Postoperative abdominoplasty seromas are a problem. Although drains are still commonly used during the initial postoperative period, this article has demonstrated that the combination of an extended incision, suction undermining, and progressive tension sutures can produce superior results without the need for suction drains. A retrospective review of 113 consecutive abdominoplasty patients operated on between April of 2004 and May of 2010 was carried out and complications were reviewed. There were 109 women and four men, with ages spanning 23 to 76 years (average, 50 years). Complications of the surgery included hematoma (2.7 percent), with one requiring drain placement (0.9 percent) and two treated with needle aspiration (1.8 percent); seroma (8.8 percent), with four requiring closed suction drainage (3.5 percent) and six minimally treated with needle aspiration (5.3 percent); infection (2.7 percent), with one requiring intravenous antibiotics (0.9 percent) and two with minimal local erythema (1.8 percent); and minimal marginal skin necrosis with spontaneous healing (3.5 percent). The technique of abdominoplasty with the addition of an extended incision, liposuction undermining of the deep fatty tissue between the superficial and abdominal muscle fascia, and the use of progressive tension sutures results in a better abdominal wall and waist contour. This decreases the need for dissection of the abdominal panniculus above the umbilicus except for a small tunnel to allow for the suturing of the rectus abdominis muscles. This allows for preservation of the arterial and lymphatic vessels, improving blood flow to the superior flap and decreasing seroma formation to the point where operative drains are not required. Therapeutic, IV.