Commentary on: Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years.

Abstract

Congratulations to the authors1 on contributing further evidence supporting the use of progressive tension sutures (PTS) in abdominoplasty. Since we initially introduced the concept of advancement and fixation of the abdominal flap to the abdominal wall in abdominoplasty into the literature in 20002 we have been surprised at how slow it has been for, what we believed to be a very empirically logical idea, to disseminate into common use. However, it became clear that simply being “empirically logical” was not adequate and that more clinical data were needed. Over the subsequent years, many contributions to the body of data on progressive tension suture in abdominoplasty have accumulated in the literature. First, we should point out that Baroudi3 independently preceded our paper publishing a hundred cases of “Quilting sutures” in abdominoplasty which is essentially the same concept and gives the same results. Additionally, Mladick,4 in a brief communication, pointed out that his mentor, Nicholas Georgiade, taught a similar technique at Duke and it was included in a chapter of his textbook. This goes to show that good ideas are rarely of one source. Since then, many articles have addressed the progressive tension suture/quilting suture concept from a variety of perspectives. Nahas et al5 used ultrasound to assess volumes of fluid that accumulated when PTS are used. He looked at 21 consecutive abdominoplasties between postoperative day 15 and 18 finding an average fluid volume of 8.2 cc. Only two patients had more than 20 cc (25 and 47 …