Progressive Tension Sutures Research Articles

Does the Addition of Progressive Tension Sutures to Drains Reduce Seroma Incidence After Abdominoplasty? A Systematic Review and Meta-Analysis.

Progressive tension sutures (PTS) are commonly utilized to reduce postoperative seroma in abdominoplasty. However, current evidence regarding PTS in abdominoplasty is limited to small series and the findings of single institutions. The authors reviewed the available literature concerning the effects of PTS and drains on seroma formation following abdominoplasty, and summarized the different techniques that have been described to date. We conducted a systematic review of the Medline, Embase, and Cochrane databases. We identified randomized controlled trials (RCTs) and observational studies in which the numbers of patients who had postoperative seroma were indicated. We applied the Cochrane Collaboration's tool for assessing the risk of bias. Seven studies were included (three RCTs and four retrospective studies). Patients who had PTS and drains following abdominoplasty had a significantly lower rate of postoperative seroma than those who had drains only. The mean surgical time difference between the two groups was 23 minutes. There was no difference in postoperative seroma rate in patients who had PTS and drains placed following abdominoplasty compared to those who had PTS only. Addition of PTS to drains reduces the risk of postoperative seroma in standard abdominoplasty. More RCTs with larger sample sizes and better comparability are warranted to confirm with more confidence the impact of PTS in abdominoplasty.

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

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 …

No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures.

The use of progressive tension sutures has been shown to be comparable to the use of abdominal drains in abdominoplasty. However, the use of barbed progressive tension sutures (B-PTSs) in deep inferior epigastric artery perforator (DIEP) flap donor-site closure has not been investigated. A retrospective chart review was performed on patients with DIEP flap reconstruction in a 3-year period at 2 institutions by 2 surgeons. Patients were compared by method of DIEP donor-site closure. Group 1 had barbed running progressive tension sutures without drain placement. Group 2 had interrupted progressive tension closure with abdominal drain placement (PTS-AD). Group 3 had closure with only abdominal drain placement (AD). Data collected included demographics, perioperative data, and postoperative outcomes. Seventy-five patients underwent DIEP reconstruction (25 B-PTS, 25 PTS-AD, and 25 AD). Patient characteristics-age, body mass index, comorbidities, smoking status, and chemotherapy-were not significantly different between groups. Rate of seroma was 1.3% (B-PTS = 0%, PTS-AD = 4%, AD = 0%), wound dehiscence 16% (B-PTS = 8%, PTS-AD = 16%, AD = 24%), and umbilical necrosis 5.3% (B-PTS = 0%, PTS-AD = 0%, AD = 16%). No hematomas were observed in any patients. No statistically significant difference was found between complication rates across groups. Use of B-PTSs for abdominal closure after DIEP flap harvest can obviate the need for abdominal drains. Complication rates following this technique are not significantly different from closure using progressive tension suture and abdominal drain placement. This practice can prevent the use of abdominal drains, which can promote patient mobility, increase independence upon discharge, and contribute to patient satisfaction.

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

Abdominoplasty is a common aesthetic procedure in the United States. Pollock and Pollock described their progressive tension technique in 2000 and published a series of 597 patients in 2012 of their experience. The reported seroma rate in the literature ranges from 2% to 26% with drains and 0.1% to 4% with progressive tension sutures (PTS) without drains. Given these data, we decided to use PTS and forego drains in abdominoplasty. Here we present our experience with the transition. This is a retrospective chart review of 451 abdominoplasties performed at our outpatient surgery center over a 7-year period (2009-2015). We gathered data on patient demographics, concomitant liposuction, and complications and length of follow up. Five main differences were examined in PTS vs traditional abdominoplasty using drains groups. These included rate of seroma, wound complication, scar revision, hematoma, and follow up. We found a decreased rate of seroma in the PTS group, 2% vs 9%. Wound complications were similar. Scar revision was slightly higher in the PTS group at 17% vs 10% in traditional abdominoplasty, this association had a P value of .048. The rates of hematoma were similar (0% vs 1%). The mean follow up was 6 months in PTS and 9 months in traditional abdominoplasty. Addition of liposuction did not increase the rate of seroma. PTS without drains significantly decreased the seroma rate in our practice. Our experience adds to the mounting evidence that surgeons should consider using the PTS technique and abandon the use of drains in abdominoplasty. A well powered, multicenter, randomized controlled study is needed in order to definitively lay this question to rest. 4 Therapeutic.

Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial.

To evaluate the occurrence of seroma and surgical wound infection after surgery. A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.

Redefining abdominal anatomy: 10 key elements for restoring form in abdominoplasty.

While traditional abdominoplasty methods can successfully achieve the objective of restoring a flat appearance, the results can be artificially board-like, lacking the subtle anatomical features of a three-dimensional abdomen, thus creating the potential for patient dissatisfaction. While often difficult to articulate, patient criticism is almost always distilled to the ubiquitous concern that the surgical abdomen lacks the natural features of an authentic, youthful abdomen. In an effort to provide a more anatomically accurate outcome and improve patient satisfaction, I have made a series of technical modifications to the abdominoplasty that I now perform. Ten key technical refinements, including a modified "Anatomy Defining" Progressive Tension Suture technique, were successively incorporated in 177 patients during the first 5 years of 2000-2014. All have been applied consistently in 961 abdominoplasty procedures during the subsequent 10 years, often accompanied by liposuction of adjacent lateral (non-abdominal) areas to ensure harmonious proportion. This series of refinements adds precision and detail by redefining the native anatomical nuances of the abdomen, an aesthetic objective that has been consistently achieved in BMI ranges between 20 and 35. Overall satisfaction with results was high (94%). The 10 elements described are safe, effective, and lasting.

Running barbed suture quilting reduces abdominal drainage in perforator-based breast reconstruction

Prolonged abdominal drainage after perforator-based breast reconstruction is a common problem that can result in seroma formation, patient morbidity, and increased duration of hospital stay. Abdominal quilting with progressive tension sutures has been effective in reducing abdominal drainage in abdominoplasty patients prompting a change of practice in our unit. We studied consecutive unilateral mastectomy patients undergoing breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap. The initial 27 patients underwent breast reconstruction without any form of abdominal flap plication. The subsequent 26 patients underwent an identical DIEP flap raise procedure after which the abdominal flap was progressively tensioned using a running barbed suture quilting technique. All patients had closed suction drains inserted bilaterally until daily drain output was <40 ml in 2 consecutive days. Primary outcome measures were total volume of abdominal drainage and length of hospital stay. Independent statistical analyses were performed using Welch's t-test. There were no demographic differences between the two groups. A statistically significant decrease in the mean total abdominal drainage was found after quilting (238 ml vs. 528 ml; p = 0.0005). Patients in the quilting group also showed a reduction in mean duration of hospital stay. Quilting of the abdominal flap helps to reduce abdominal drainage not only in abdominoplasty patients but also in patients undergoing breast reconstruction with DIEP flap.

Commentary on: Use of Quilting Sutures During Abdominoplasty to Prevent Seroma Formation: Are They Really Effective?

Of the many methods described to reduce seroma formation after abdominoplasty, the use of internal suture techniques to secure the deep surface of the abdominoplasty flap to the superficial fascia of the abdominal wall seems to have the best track record. Although somewhat different in actual technique, both quilting sutures and progressive tension sutures appear to have the same result: no increase in seroma rates while allowing for shorter times to drain removal or even the elimination of drains altogether. This retrospective study by Sforza et al was able to show that among the three groups studied, quilting sutures dramatically reduced clinically detectable seroma formation.1 Unfortunately, the author's hospital policy required placement of at …

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

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 …

Lipoabdominoplasty without drains or progressive tension sutures: an analysis of 100 consecutive patients.

Subcutaneous surgical drains are commonly used in abdominoplasties to prevent seromas but are not tolerated well by patients and add additional discomfort after the procedure. The lipoabdominoplasty modification may create a more favorable surgical field to reduce the need for surgical drains without increasing seroma formation. The goal of this review was to determine if surgical drains can be completely eliminated in lipoabdominoplasty procedures without an increased risk of seromas. The authors conducted a retrospective chart review of 100 consecutive standard, extended, and circumferential lipoabdominoplasty patients done by a single surgeon with at least a 3-month follow-up period. Seroma was identified in 5% of patients, hematoma and abscess each in 2% of patients, and granuloma, cellulitis, and delayed wound healing each in 1% of patients. The use of discontinuous undermining with liposuction, limited direct undermining in the midline, preservation of a thin layer of fibrofatty tissue on the superficial abdominal wall fascia, and targeted surgical site compression can eliminate the need for surgical drains without increasing seroma rates.

Modified aesthetic abdominoplasty approach in perforator free-flap breast reconstruction: Impact of drain free donor site on patient outcomes

The use of progressive tension sutures alone has been shown to be comparable to using abdominal drains in aesthetic abdominoplasty. This study reviews outcomes with the use of barbed progressive tension suture technique without drains in DIEP donor site closure compared to standard closure with drains. A two year retrospective review was conducted of DIEP flap reconstructions in the enhanced recovery program at Mayo Clinic, Rochester (USA). Donor site closure was divided into barbed progressive tension sutures (B-PTS) without drains, and standard abdominal closure with drains(S-AD). Demographics, perioperative data and donor site complications were documented. 93 patients were included in the study, 42 in the B-PTS no drain group and 51 in the S-AD with drains. 81% of all procedures were bilateral and 39% were immediate. Patients were discharged faster to the ward postoperatively and total hospital admission was reduced in the B-PTS group, 3.7 (SD=1.4) days versus 4.7 (SD=2.1) days in the standard group (P=0<0.001 and 0.004 respectively). Less morphine was required postoperative day (POD) 1, 2 and 3 (P=0.04, 0.03, 0.02 respectively), and time to mobilize was quicker but not statistically significant (P=0.09) in the B-PTS group. Overall there were 18 patients in the S-AD group who had complications versus 9 in the B-PTS group (P=0.14). The incidence of complications occurring within 30 days were lower in the B-PTS group (P=0.05). The overall seroma rate was 5.4% and rates in the B-PTS group was 2.4% versus 7.8% in the S-AD group, P=0.37. Use of barbed progressive tension sutures for abdominal closure after DIEP flap harvest can obviate the need for abdominal drains, reduce postoperative pain and encourage early discharge from the hospital without an increased risk in complications. III.

Consecutive 75 cases of mastectomy for breast cancer using ultrasonic dissection and without drain: Quilting reduces seroma formation

Introduction: Seroma is a common occurrence after mastectomy and repeated aspiration of it is associated with infection and financial implication for the NHS and negatively affects the patient experience. Various strategies are described to reduce seroma including quilting, ultrasonic dissectors and fibrin glue. This study was performed to assess whether quilting (progressive tension sutures) reduces seroma rate after mastectomy.

Is the High Superior Tension Technique an Equivalent Substitute for Progressive Tension Sutures in Postbariatric Abdominoplasty? A Comparison Prospective Study

The addition of progressive tension sutures to the abdominoplasty technique is advocated to reduce the risk of several complications. High superior tension abdominoplasty is another technique aimed at reducing tension at the prepubic suture line and improving cosmesis of the umbilical area. A cohort of massive weight loss patients undergoing abdominoplasty, treated with the progressive tension suture technique in association with the high superior tension technique (group A), was followed up and compared to a cohort of patients who underwent high superior tension abdominoplasty (group B). Several variables including rate of complications and patient satisfaction were explored to determine any possible benefit deriving from the combination of progressive tension suture and high superior tension techniques in the abdominoplasty. A total of 90 patients were included in the study, of whom 34 were in group A and 56 were in group B. No statistically significant difference was found between the two groups in terms of duration of the procedure, hospitalization time, rate of complications, drained volume, and patient or physician satisfaction. No beneficial effect appears to derive from the progressive tension suture technique in massive weight loss patients undergoing abdominoplasty, provided that the high superior tension technique is performed as an adjunct to the traditional method.

Incorporating Barbed Sutures in Abdominoplasty

Barbed sutures can be used in body contouring procedures to close long incisions better than conventional sutures. The results of a literature review focusing on the use of barbed sutures in abdominal contouring procedures suggest that they are safe and effective in wound closure with complication rates similar to conventional sutures but with possibly faster incision-closure times. An update on one author's (K.A.G.) personal experience with barbed progressive tension sutures in abdominoplasty procedures is presented, along with practical technique recommendations for barbed suture use.

Seroma suppression using TissuGlu® in a high risk mastectomy patients

Introduction: Post mastectomy seroma is a common problem in modern oncological surgery. Occurrence rates of up to 59% are reported in literature. High risk patients, having received previous surgeries, radiation or chemotherapy present a particular challenge. Several surgical techniques, including progressive tension suture application have shown promise. Non-invasive measures such as fibrin based adhesives have thus far not been able to prevent seroma occurrence effectively. A recent study using a lysine-derived urethane adhesive named TissuGlu® however, showed promising results in abdominoplasty patients.

Seroma suppression using TissuGlu® in a high-risk patient post-mastectomy: a case report

IntroductionPost-mastectomy seromas are a common problem in modern oncological surgery. Occurrence rates of up to 59% have been reported in the literature. High-risk patients, that is, those who have received previous surgeries, radiation or chemotherapy, present a particular challenge. Several surgical techniques, including progressive tension suture application, have shown promise. Noninvasive measures such as fibrin-based adhesives have thus far not been able to prevent seroma occurrence effectively. A recent study using a lysine-derived urethane adhesive named TissuGlu®, however, showed promising results in patients after abdominoplasty.Case presentationWe used TissuGlu® to treat a high-risk 64-year-old female patient with a history of breast cancer and severe post-mastectomy seroma. The postsurgical period showed successful seroma suppression, without any adverse effects or complications.ConclusionsThis type of adhesive should be evaluated as an alternative, less-invasive option for preventing seroma in patients after a mastectomy.

Our Experience in Progressive Tension Sutures in Abdominoplasty

Amac : Abdominoplasti sonrasi en sik gorulen lokal komplikasyonlar, flep nekrozu, hipertrofik skar gelisimi, seroma ve hematom olusumudur. Gerginlik azaltici dikisler, abdominoplasti sonrasi lokal komplikasyonlarin azaltilmasi icin tanimlanmistir. Bu calismada, abdominoplasti uygulamalarinda gerginlik azaltici dikislerin kullanimi ile ilgili deneyimlerimizi aktarmayi amacladik. Yontemler : Calismaya abdominoplasti ameliyati uygulanan 19 kadin hasta dahil edildi. Hastalarin ortalama yasi 42 (35-59) idi. Tum olgularda, abdominoplasti flebi ilerletilirken derin ve yuzeysel fasya arasina gerginlik azaltici dikisler uygulandi. Bulgular : Ortalama takip suresi 11 (6-26) aydi. Hastalarin hicbirinde hipertrofik skar, flep nekrozu, enfeksiyon, seroma veya hematom gelismedi. Bir hastada (%5) orta hatta lokalize minimal yag nekrozu, bir baska hastada (%5) ise pulmoner emboli meydana geldi. Her iki hasta da sorunsuz olarak iyilesti. Sonuc : Gerginlik azaltici dikisler, flep distalinde olusabilecek iskemiyi azaltarak flep nekrozu ve hipertrofik skar olusumunu azaltmaktadir. Ayrica olu bosluk miktarini azaltarak, seroma veya hematom olusma riskini azaltmaktadir. Sonuc olarak, ameliyatin normal suresinde bir miktar uzamaya neden olsa da, abdominoplasti olgularinda lokal komplikasyonlari azaltmak icin kullanilabilecek bir yontemdir. Anahtar Kelimeler: Gerginlik azaltici dikisler, abdominoplasti, komplikasyon Our Experience in Progressive Tension Sutures in Abdominoplasty Objective: The most common local complications following abdominoplasty are flap necrosis, hypertrophic scar formation, seroma, and hematoma. Progressive tension sutures were introduced in order to decrease the local complications. In this study, we present our experience in progressive tension sutures in abdominoplasty patients. Methods: Nineteen female abdominoplasty patients were included in this study. The mean age was 42 years (35-59). The progressive tension sutures were placed from the superficial fascia to the deep fascia as the flap was advanced. Results: The mean follow-up was 11 (6-26) months. No hypertrophic scar formation, flap necrosis, infection, seroma, or hematoma developed. Minimal localized fat necrosis in 1 patient (5%) and pulmonary embolus in 1 patient (5%) occurred. Both patients healed uneventfully. Conclusion: The progressive tension sutures decrease flap necrosis and hypertrophic scarring by preserving the distal flap perfusion. Additionally, it reduces seroma and hematoma formation by reducing the dead space volume. In conclusion, although increasing the operation time, it may be a useful method for decreasing local complications. Key Words: Progressive tension sutures, abdominoplasty, complication

Use of Progressive Tension Sutures in Components Separation

Components separation is a widely used technique for defect size reduction in abdominal wall reconstruction, and ultimately helps achieve gold standard primary fascial reapproximation in many cases. Even with perforator-sparing techniques, oftentimes there are undermined skin flaps to varying degrees that can lead to complications such as seromas. In this article, the author describes the previously published technique of "progressive tension sutures" reported in the cosmetic literature and extrapolates it to reconstructive abdominal surgery with statistically significant decreases in drain output. This technique also enables recruitment of skin to the midline to afford tension-free reapproximation and excision of redundancy, thereby discarding the most random portion of the skin flaps.

Progressive Tension Sutures in Abdominoplasty: A Review of 597 Consecutive Cases

Although abdominoplasty and other body-contouring procedures are being performed more frequently, the incidence of seroma and other complications has remained relatively unchanged. In 2000, a small retrospective series introduced progressive tension sutures (PTS) in abdominoplasty to reduce seroma without the use of drains. The authors review the PTS technique and their experience with the procedure. A retrospective chart review of 597 consecutive abdominoplasty patients treated over 12 years was performed. Collected data included surgical setting, concomitant procedures, and complications. Of the 597 abdominoplasties, 52.4% were performed in the hospital and 47.6% in an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited facility. In 63.7% of cases, abdominoplasty was combined with another procedure(s). Liposuction was performed on the abdominoplasty flap or an adjacent area to the abdominoplasty dissection in 67% of patients. The average amount fat aspirate from these areas was 953 mL. No drains were placed. The rate of local complications was 4.2%; all but one of these complications (seroma; 0.1%) were minor. There were no systemic complications related to PTS and no venous thromboembolisms. PTS are an adjunct to abdominoplasty that can minimize seroma and potentially decrease other local complications. They provide secure fixation of the flap to eliminate motion and broadly transfer tension to the superficial fascial system. Drains can safely be eliminated from abdominoplasty, even when liposuction is performed. Systemic complications may be avoided and patient recovery expedited.

Commentary on: Progressive Tension Sutures in Abdominoplasty: A Review of 597 Consecutive Cases

It is uncommon to read a follow-up article by original authors on a surgical technique many years after the initial report. Drs Pollock and Pollock1 provide additional evidence that the progressive tension suture (PTS) technique they presented in 2000 can almost entirely eliminate seroma in abdominoplasty. Although other techniques to prevent seroma have been published—including tissue glues, different dissection planes, new dissection devices, and prolonged patient immobilization2⇓⇓-5—it appears that none has been supported by favorable results published by other authors who treated a large number of patients. The success of the PTS technique has been corroborated by several large series,6⇓-8 including reports with Level 2 and Level 3 evidence.9 …