Enhancing abdominal donor site aesthetics: The double diamond drainless closure with barbed progressive tension sutures

Abstract

We present an updated suturing technique for aesthetic abdominal donor site closure following Deep Inferior Epigastric Perforator (DIEP) flap breast reconstructions. Traditional closure methods can struggle with seroma formation and wound dehiscence, resulting in poor aesthetic outcomes. Our "double diamond" pattern uses continuous double-ended barbed sutures for progressive tension closure, ensuring tension-free closure, improved aesthetics, and minimized donor site morbidity.This technique was applied to 94 abdominally based autologous breast reconstructions (114 flaps). The average patient age was 52 years, with a BMI of 28.6. Complications included one case of donor site dehiscence (1.1%) and one hematoma (1.1%), with no seromas or infections. Breast-Q scores for abdominal satisfaction unclothed were significantly higher at 3 months post-operatively (3.15 vs. 2.18, p<0.0001).Building on our experience, this technique provides an efficient, standardized method for continuous progressive tension suture closure, improving operative efficiency and enhancing patient outcomes by minimizing complications and achieving superior aesthetic results.