How Do We Raise the Bar in Autologous Breast Reconstruction? The Use of Progressive Tension Sutures for Donor Site Closure

Abstract

BACKGROUND: The abdomen is the most common location from which tissue is harvested for autologous breast reconstruction.1 The evolution from musculocutaneous flaps to muscle-sparring perforators flaps has decreased donor site complications such as abdominal bulge and hernia; however, complications remain. The development of progressive tension suture placement for donor site closure has the potential to decrease complications and increase the esthetics of the abdomen after breast reconstruction.2 PURPOSE: To present our institutional experience using progressive tension sutures for a tensionless closure of the donor site to improve outcomes and optimize abdominal donor site esthetics. METHODS: A retrospective cohort study was conducted over a 2-year period. Sixty-six consecutive patients who underwent abdominally based autologous breast reconstruction were divided into an experimental group (36 patients), in which the donor site was closed using progressive tension sutures, and a control group (31 patients), in which the donor site was closed without the use of this technique. A comparison between both groups was conducted in terms of demographic characteristics, perioperative variables, and donor site–related postoperative complications. RESULTS: No significant differences were found between the 2 groups in terms of demographic characteristics including age, body mass index, smoking status, comorbidities, and previous abdominal surgery (P > 0.05). No significant differences were noted with respect to unilateral versus bilateral donor sites, operative times, and length of hospital stay (P > 0.05). With regard to donor site complications, the wound dehiscence rate was significantly higher for the control group (27.8% versus 6.5; P = 0.023). No differences were noted in terms of infection, seroma formation, hematoma formation, abdominal bulge, or abdominal hernia rates between the 2 groups. CONCLUSION: In the cohorts of patients analyzed, the use of a tensionless technique for the closure of the donor site after an abdominally based autologous breast reconstruction decreased the rates of donor site wound dehiscence. Seroma and hematoma formation rates remained the same across both groups. REFERENCES: 1. Agarwal J, Tatro E, Kwok A, et al. Immediate unilateral breast reconstruction using abdominally based flaps: analysis of 3,310 cases. J Reconstr Microsurg. 2018. 2. Lee BT, Agarwal JP, Ascherman JA, et al. Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg. 2017;140:651e–664e.