Commentary on: Lipoabdominoplasty Without Drains or Progressive Tension Sutures: An Analysis of 100 Consecutive Patients.

Abstract

In general, abdominoplasty is a conceptually simple procedure with consistent aesthetic improvement of the abdomen from its preoperative appearance. However, until recently, abdominoplasty has been plagued with an unacceptably high complication rate, with seromas reported in a consistently high percentage of cases. This has been accepted because it was generally easy to treat, reasonably well tolerated by the patient, and had only uncommon long-term sequelae. Drains, compression, and immobilization were the mainstays of prevention. These techniques alone are clearly inadequate in seroma prevention, and there are significant negatives of the preventative measures themselves. Immobilization slows recovery and places the patient at risk of a far worse complication: venous thrombosis. Compression places the vulnerable flap at risk of vascular compromise and can be restrictive to patient mobility. Drains are uncomfortable, poorly tolerated, and dreaded by the patient. More recently, several techniques for decreasing the incidence of seromas have been described, including quilting or progressive tension sutures, avoiding lymphatic disruption by altering the plane of dissection, and lipoabdominoplasty using discontinuous undermining through liposuction, as in this study. All have been shown to be successful at decreasing seroma rates and allowing drains to be safely eliminated. Regardless of which technique is used, inclusion of a seroma reduction technique should be included in the current-day abdominoplasty. The specific method selected by the …