Progressive Tension Sutures Research Articles

Optimal Use of Drain Tubes for DIEP Flap Breast Reconstruction: Comprehensive Review.

Background: Deep inferior epigastric perforator (DIEP) flap breast reconstruction is an increasingly popular technique, but controversy exists regarding the optimal use of closed suction drains (CSD) at the abdominal donor site. This narrative review synthesizes current evidence on CSD application, criteria for placement/removal, and complications in DIEP flap procedures. Alternative techniques and implications for postoperative care are also discussed. Methods: A systematic search was conducted in August 2024 across several databases to identify English language studies related to CSD use in DIEP flap breast reconstruction. Inclusion criteria consisted of original research on aspects such as CSD volume criteria, timing, complications, alternatives like progressive tension sutures, and impact on showering and patient outcomes. References from relevant papers were hand-searched. Results: The review found a lack of consensus on CSD protocols, with drainage volume triggering removal varying widely from 5 mL to 80 mL daily. While CSD may reduce seroma/hematoma formation, earlier removal (≤3 days) did not increase complications and shortened hospital stay. Progressive tension sutures show promise as an alternative, with evidence of comparable or reduced complications and improved recovery versus CSD. The safety of early showering with drains remains unclear. Conclusions: Although CSD aims to minimize postoperative complications, more rigorous randomized trials are needed to establish evidence-based practices for the timing of removal and demonstrate the efficacy of emerging drain-free techniques on patient-centered outcomes. Standardized criteria could reduce practice variability. Further research should also explore the long-term impact of drainage strategies on aesthetic and functional results.

Progressive Tension Sutures in Fleur de Lis Abdominoplasty: A Case Report

Introduction: As the field of cosmetic and plastic surgery progresses patient safety and comfort remain paramount. Over the past 30 years, multiple studies have demonstrated the effectiveness of progressive tension sutures (PTS) in drainless abdominoplasties and case series have been published evaluating the outcomes of PTS/drainless abdominoplasties in high-volume liposuction cases (liposuction with over 3 L of aspirate). To date, there have been no reports in the literature regarding PTS usage in Fleur de Lis (FDL)-type abdominoplasties. Materials/Methods: We describe our experience using PTS in a patient with a drainless FDL abdominoplasty and several patients in which PTS was used to limit the number of drains needed in an FDL abdominoplasty. Results: In our follow-up with the patient, she had no adverse events or seroma formation. Discussion/conclusion: The cases documented here suggest that FDL abdominoplasty can be performed without the need for drains or with minimal drains.

Evaluating the benefit of progressive tension sutures at the donor site in autologous breast reconstruction – A retrospective comparative cohort study

As seroma formation is a common donor site complication following autologous breast reconstruction, we adapted the surgical protocol by introducing progressive tension sutures (PTS). This study aimed to evaluate the influence of PTS at the donor site in autologous breast reconstruction on seroma formation. Additionally, an exploratory analysis on patient satisfaction and aesthetic outcome was performed. This retrospective cohort study analyzed data of 400 patients who received autologous breast reconstruction between 2018 and 2022. Among them, 204 patients received traditional donor site closure, and 188 patients received PTS with or without drain placement. Proportional incidence of seroma was described and multivariable logistic regression was used to assess the risk factors for seroma formation. At the deep inferior epigastric artery perforator donor site, patient satisfaction was further explored by administering the BREAST-Q and the aesthetic outcome was graded by three blinded participants. Overall, 514 breast reconstructions were performed on 400 patients. The incidence of seroma formation was lower in the PTS group compared with that in the traditional closure group. Multivariable analysis showed that patients who received PTS were 40% less likely to develop seroma. Aesthetic outcome was considered more pleasing objectively and subjectively if PTS were performed. Regarding patient satisfaction, no difference was found in the post-operative physical well-being between the two groups. In this large cohort, we found reduced incidence of seroma when PTS were performed. PTS were also associated with reduced odds of seroma formation and were described to be aesthetically more pleasing. PTS should be considered in autologous breast reconstruction.

The Effect of Combining Progressive Tension Sutures with Autologous Platelet Gel Sealant Effect on Reducing Seroma Incidence after Lipoabdominoplasty

The Effect of Combining Progressive Tension Sutures with Autologous Platelet Gel Sealant Effect on Reducing Seroma Incidence after Lipoabdominoplasty

High volume, drainless lipoabdominoplasty with progressive tension sutures -UK experience.

Lipoabdominoplasty is an established technique, however outcomes for high lipoaspirate volumes in large series are lacking. We present the UK experience of high-volume, drainless lipoabdominoplasty using progressive deep tension sutures. 286 consecutive patients at a single centre underwent drainless lipoabdominoplasty with a lipoaspirate volume of 500 ml or greater between 2017 and 2023. Surgery was performed under total intravenous anaesthesia with SAFELipo©, MicroAire® and a superwet technique. Abdominoplasty was commenced via a low convex abdominal incision with multilayer rectus plication, and abdominal closure undertaken with progressive tension sutures. Logistic regression was used to determine the relationship between lipoaspirate volume and four primary outcomes - all complications, delayed healing, seroma, and need for revision. The mean lipoaspirate volume was 2392.4 ml (500-5900), and abdominal tissue resection weight 1392.0 g (346-3802). One third of patients had local complications - minor irregularities (14.0%), abdominal scar problems (12.9%), umbilical shape/scar (4.5%), localised infection (4.2%) and delayed healing (3.8%). One (0.3%) had a small area of localised necrosis successfully managed by further tissue advancement. There was one abdominal haematoma, and two systemic complications- venous thromboembolism (0.3%) and drug-induced hepatitis. Seroma rate was 3.1%. 16.0% of patients required revision under general anaesthesia, and 6.6% under local anaesthetic. There was no significant relationship between the lipoaspirate volume and any of the four primary outcome measures. High-volume liposuction can safely be performed simultaneously with abdominoplasty. Our complication rates are equivalent to, or lower than other published data on lipoabdominoplasy, challenging current concepts in body sculpting.

"The Effect of Combining Progressive Tension Sutures with Autologous Platelet Gel Sealant Effect on Reducing Seroma Incidence After lipoabdominoplasty "

"The Effect of Combining Progressive Tension Sutures with Autologous Platelet Gel Sealant Effect on Reducing Seroma Incidence After lipoabdominoplasty "

Safety of Drainless Donor Closure in DIEP Flap-Based Breast Reconstruction: A Prospective Analysis Using Ultrasound.

Although drainless donor closure with progressive tension suture (PTS) technique has been attempted to further reduce donor morbidity in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, its clinical safety has not yet been fully elucidated. This study prospectively investigated donor morbidity after DIEP flap elevation and drain-free donor closure. A prospective cohort study was performed on 125 patients who underwent DIEP flap-based breast reconstruction and drainless donor closure. Postoperatively, the donor site was evaluated repetitively using ultrasonography. Development of donor complications, including any fluid accumulation and seroma (defined as detection of fluid accumulation after postoperative one month), was prospectively noted, and independent predictors for the adverse events were evaluated. On ultrasound examination conducted within postoperative 2 weeks, 48 patients were detected to have fluid accumulation at the donor site, which were more frequently detected in cases of delayed reconstruction and those with lesser number of PTS conducted. The majority of those events (95.8%) were resolved with one- or two-times ultrasound-guided aspirations. Five patients (4.0%) showed persistent fluid accumulation after postoperative 1 month, which were successfully treated with repetitive aspiration without requiring reoperation. No other abdominal complications developed except for three of delayed wound healing. On multivariable analyses, harvesting larger-sized flap and conducting lesser number of PTS were independent predictors for the development of fluid accumulation. The results of this prospective study suggest that drainless donor closure of the DIEP flap with meticulous placement of PTS followed by postoperative ultrasound surveillance appears to be safe and effective.

Reduction in Seroma Rate Following Deep Inferior Epigastric Perforator Flap with Umbilectomy Utilizing Progressive Tension Sutures.

Umbilectomy has been implemented in both abdominoplasties and deep inferior epigastric perforator (DIEP) flaps to improve abdominal wound healing and better control the location of the neoumbilicus; however, seroma rates are increased. The objective of this study is to compare the seroma rate following DIEP flap reconstruction with umbilectomy when progressive tension sutures (PTS) are implemented. A retrospective chart review was performed to evaluate postoperative seroma rates in patients undergoing DIEP flap breast reconstruction at a single academic institution between January 2015 and September 2022. All procedures were performed by two senior surgeons. Patients were included if their umbilicus was removed intraoperatively. PTS were utilized in all abdominal closures beginning in late February 2022. Demographics, comorbidities, and postoperative complications were evaluated. A total of 241 patients underwent DIEP flap breast reconstruction with intraoperative umbilectomy. Forty-three consecutive patients received PTS. Overall complications were significantly lower in those who received PTS (p = 0.007). There were no abdominal seromas (0%) in patients who received PTS, whereas 14 (7.1%) occurred without PTS. The use of PTS conferred a decreased likelihood of abdominal seroma (5.687× lower risk, p = 0.017). Additionally, wound formation was significantly lower in those who received PTS (p = 0.031). The use of PTS in the abdominal closure during DIEP flap reconstruction addresses the previously seen rise in seroma rates when concomitant umbilectomy is performed. Decrease in both donor-site wounds and now seroma rates reaffirm the efficacy of removing the umbilicus to improve patient outcomes.

Safety and Efficacy of Outpatient Drainless Abdominoplasty: A Single-Surgeon Experience of 454 Consecutive Patients.

The incidence of seroma after abdominoplasty is accepted as approximately 10% (with a range) in the literature. Progressive tension sutures (PTS) have arisen as a means of reducing seroma, however there are conflicting data regarding their efficacy. The primary aim of this study was to describe the incidence of postabdominoplasty seroma in the setting of drainless abdominoplasty with PTS. A retrospective chart review was performed of all abdominoplasties (n = 454) during a 20-year period. At approximately the halfway point of this time frame, the abdominoplasty technique was changed from the use of 2 drains to the use of PTS without drains. Additionally, pulsed electromagnetic field therapy (PEMF) and liposomal bupivacaine (Exparel, Pacira Pharmaceuticals, Inc., Parsippany, NJ) were added as pain control adjuncts. There were 194 patients in the drain group and 260 patients in the PTS/no drains group. The group without drains contained a significantly higher proportion of massive weight loss patients (4.1% vs 9.2%, P = .041). The majority of the group without drains underwent outpatient surgery (89.7% vs 98.8%, P < .001). The overall complication rate was significantly lower in the no drains group (31.4% vs 13.8%, P < .001). The incidence of seroma was dramatically reduced in the group without drains (24.7% vs 0.0%, P < .001). PTS are highly effective in preventing seroma and can be safely employed as an alternative to drains in abdominoplasty. PEMF may play a role in seroma prevention and is also helpful for pain control. With these techniques to mitigate complications and minimize postoperative pain, abdominoplasty can be performed safely and effectively in a purely outpatient setting.

Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level.

Most published studies on abdominoplasty focus on methods to reduce the risk of seromas. These methods include limited dissection (lipoabdominoplasty), quilting sutures, and preservation of the Scarpa fascia. Quantitative evaluation of the aesthetic result has been lacking. A retrospective study was undertaken of all patients undergoing abdominoplasty in the author's practice from 2016 to 2022. A full abdominoplasty was performed, usually with liposuction (87%). All patients were treated under total intravenous anesthesia without paralysis or prone positioning. A single closed suction drain was removed 3 or 4 days after surgery. All procedures were performed as outpatients. Ultrasound surveillance was used to detect any deep venous thromboses. No patient received chemoprophylaxis. The operating table was flexed, often to 90°. Deep fascial anchoring sutures were used to attach the Scarpa fascia of the flap to the deep muscle fascia. Measurements of the scar level were made at intervals after surgery up to 1 year. Three hundred ten patients were evaluated, including 300 women. The mean follow-up time was 1 year. The overall complication rate, which included minor scar deformities, was 35.8%. Five deep venous thromboses were detected. There were no hematomas. Fifteen patients (4.8%) developed seromas that were successfully treated by aspiration. The mean vertical scar level 1 month after surgery was 9.9 cm (range, 6.1-12.9 cm). There was no significant change in scar level at subsequent follow-up times up to 1 year. By comparison, the scar level in published studies ranged from 8.6 to 14.1 cm. Avoidance of electrodissection reduces tissue trauma that causes seromas. Flexed patient positioning during surgery and deep fascial anchoring sutures are effective in keeping the scar low. By avoiding chemoprophylaxis, hematomas can be avoided. Limiting the dissection (lipoabdominoplasty), preserving the Scarpa fascia, and adding quilting (progressive tension) sutures are unnecessary. Total intravenous anesthesia offers important safety advantages. Avoiding electrodissection is effective in keeping seroma rates at a tolerable level (5%), and the scar low and more easily concealed. Alternative methods present disadvantages that may contribute to a suboptimal aesthetic result and require additional operating time.

To Ablate or Not to Ablate: Does Umbilectomy Decrease Donor-Site Complications in DIEP Flap Breast Reconstruction?

Improving outcomes for deep inferior epigastric perforator (DIEP) flap breast reconstruction is an evolving area of interest. The aim of this study was to evaluate the effect of umbilectomy in abdominally based breast reconstruction. This retrospective study evaluated postoperative outcomes of patients who underwent autologous DIEP flap breast reconstruction at an academic center between January of 2015 and December of 2021 performed by one of two reconstructive surgeons. The primary outcome variable was abdominal donor-site complications. A secondary outcome variable was treatment outcomes for complications. Covariates included demographic information, comorbidities, cancer treatment, and smoking. A total of 408 patients underwent DIEP flap breast reconstruction, with 194 (47.5%) undergoing umbilectomy. Umbilectomy resulted in decreased number of total wounds per patient (0.35 ± 0.795) compared with umbilical preservation (0.75 ± 1.322; P < 0.001), as well as decreased associated risk of any reported wounds (OR, 0.530; P = 0.009). Associations that trended toward significance occurred between umbilectomy and minor wound separation and partial necrosis, with both showing decreased risk. A significant association was noted between umbilectomy and donor-site seroma [χ 2 (1) = 6.348; P = 0.016], showing an increased risk (OR, 5.761). Umbilectomy should be discussed with patients and considered as a part of DIEP flap breast reconstruction given the reduction in the risk of abdominal donor-site wounds. Although umbilectomy decreases the rate of wounds, it can increase the risk of seroma; therefore, other interventions, such as progressive tension sutures, may be explored to aid in reducing seroma and improving wound healing. Therapeutic, III.

Ultrasound-Guided Transversus Abdominis Plane (TAP) Blocks Vs. Local Infiltration Anesthesia on Post Anesthesia Care Unit (PACU) Pain Control

Abstract Goals/Purpose Ultrasound-guided regional field blocks are not widely used in outpatient plastic surgery.1 These blocks have been shown to significantly decrease the number of prescribed opioids in patients who underwent abdominoplasty, liposuction, and primary submuscular breast operations. 2,3 The goal of this study is to compare ultrasound-guided TAP blocks to local infiltration anesthesia with or without blind rectus sheath blocks in patients undergoing abdominoplasty. Methods/Technique A retrospective review was conducted of patients undergoing outpatient abdominoplasty performed by the senior surgeon. Group 1 (Local) received local infiltration anesthesia with or without blind rectus sheath blocks between April 2009 and December 2013. Group 2 (TAP) received surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks between January 2014 and December 2021. Outcomes measured included opioid utilization, morphine milligram equivalents (MME) and pain level at discharge (scale from 1 to 10). All abdominoplasties were performed using the same suture materials and techniques by the senior surgeon in the same accredited outpatient surgical facility. Abdominoplasty technique included supraumbilical undermining, umbilical transposition, rectus abdominis fascial plication, progressive tension sutures, and liposuction of the flanks. Patients were excluded if other procedures were performed at the time of abdominoplasty. Results/Complications 60 patients in each of the two study groups met the study criteria for a total of 120 patients. The study groups were similar except for a lower average age in group 1 (Table 1). Patients receiving TAP blocks (group 2) had significantly lower MME requirements in the PACU (3.48 v 2.21, p=0.005). There was no difference in pain level at discharge between the two groups (2.35 v 2.17, p=0.624), (Table 1). Conclusion Surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks statistically significantly reduced opioid utilization by 36.5% in the PACU while achieving comparable patient pain scores.

Modified Progressive Tension Sutures for Closing the Wounds of Large Subcutaneous Tumor in Upper Back.

Large subcutaneous tumor removal in the upper back could leave "dead space" and increase postoperative complications. The progressive tension suture (PTS) has long been used in abdominoplasty to close dead space and reduce the complications rate. We aimed to explore the effectiveness of the modified PTS to reduce the complication of the large subcutaneous tumor removal in the upper back. Fity-nine patients with large subcutaneous upper back tumors (maximal length over 5 cm) were included in our prospective study and were randomly divided into the PTS group (n = 32) and the non-PTS group (n = 27). Based on the exposure of the deep fascia and the thickness of the flap, we modified the PTS technique and compared the outcomes (including necrosis, hematoma, and seroma) between the two groups. The tumor size, flap thickness, and the total surgical duration were comparable between the two groups. The incidence of flap necrosis (6.30% versus 25.90%, P = 0.0659) and seroma (0.00% versus 33.30%, P = 0.004) in the PTS group was lower than that in the non-PTS group. The length of hospital stay in the PTS group was shorter than that in the non-PTS group (6.4 ± 1.3 versus 9.4 ± 2.1 days, P < 0.0001). The modified PTS technique can effectively close the dead space after surgical removal of large upper back tumor and reduce the complications compared to the conventional approach.

Progressive Tension Suture in Abdominal Flap

Progressive Tension Suture in Abdominal Flap

The Effect of Drains and Compressive Garments Versus Progressive Tensioning Sutures on Seroma Formation in Abdominoplasty.

Seroma is a common problem following abdominoplasty surgery. Both compressive garments with drains and progressive tension sutures have their advocates to minimise seroma formation. This is a retrospective study in which patients underwent an identical surgical procedure, except for use of drains and garments in comparison to progressive tension sutures between 2005 and 2020. Two hundred thirty-two patients were included in the study 61 in the drains and garment group (DG group), and 171 with progressive tension sutures (PTS group) alone. There was a lower incidence of seroma formation in the PTS group (X2(1, N = 232) = 6.35, P = .012). The weight of tissue excised in the PTS group was greater than the DG group (P < .001). There was there a significantly higher tissue excision weights for patients who developed a seroma, compared with those who did not (P=.02). Patients, who developed a seroma in the PTS group, had significantly greater excision weights than the DG group. Liposuction did not change the incidence of seroma in each group (X2(4, N = 232) = 6.701, P = .08n/s). This study demonstrates the effectiveness of progressive tension sutures in reducing the incidence of seroma formation following abdominoplasty, particularly when large excision weights are involved. The addition of small volume liposuction distant to the abdominal flap does not increase the incidence of seroma formation.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Global Prevalence and Preferences of Progressive Tension Suture Usage in Abdominoplasties.

Abdominoplasty is one of the most popular esthetic procedures. Seroma is the most frequent postoperative complication. Two decades of literature have described benefits of quilting sutures/progressive tension sutures (PTS) in reducing seroma rates and other complications in abdominoplasties. Despite this, PTS have not been universally adopted by plastic surgeons (ISAPS international survey on aesthetic/cosmetic procedures performed in 2020, 2021) Furthermore, PTS techniques and preferences vary widely. The aim of this study is to determine the prevalence of PTS use, reasons for reluctance to utilize them, and variety of techniques utilized by plastic surgeons performing abdominoplasties internationally. A 13-question survey was emailed via ISAPS to 3842 plastic surgeons internationally. Responses were collected and analyzed. Of the 272 respondents, the majority, 58%, currently use PTS. 46% were introduced to PTS during training. Only PTS training exposure was found to significantly correlate with current usage. Only 22% of North American trainees were exposed to PTS compared to 40-62% of trainees from other geographies. Of respondents who utilize PTS, most, 74%, combine them with drains. The majority use interrupted sutures, 65%, while 19% utilize a running suture, and the remaining 16% combine interrupted and running sutures. Of respondents who do not currently utilize PTS, the most common reason stated is that the surgeon's technique works well without them, 73%, which was significantly correlated with years in practice. Globally, most plastic surgeons currently utilize PTS (typically with drains) with training exposure being a significant predictor. There are still areas to address reluctance to implement them and use them without drains. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Outcomes of progressive tension donor-site closure in abdominal-based autologous breast reconstruction

The use of progressive tension sutures (PTSs) for drain-free abdominoplasty closure has been well published in the esthetic literature and found to be effective at reducing abdominal drainage without a worse complication profile. This research aims to evaluate the outcomes of incorporating PTS into donor-site closures for abdominal-based breast reconstruction. A retrospective chart review was performed evaluating patients at the University of Chicago Medicine, who underwent autologous breast reconstruction and either PTS closure or standard abdominal closure between 2018 and 2021. A total of 100 patients were included with 50 patients receiving PTS closure and 50 with traditional abdominal closures. Patient demographics, including age (p=0.82), body mass index (BMI; p=0.17), diabetes (p=1.00), tobacco use (p=0.15), and chemotherapy (p=1.00) did not significantly differ. Total drain output over the first 72h was significantly lower in the PTS group compared with the standard closure (SC) group (p=0.00005). Mean duration of drain placement was shorter by 2 days in the PTS group, but this did not reach significance (p=0.08). Overall complication rates were lower in the PTS group (p=0.03), however, no difference was appreciated when separately assessing for seromas (p=1.00), hematomas (p=1.00), wound dehiscence (p=0.58), or surgical-site infections (p=1.00). More abdominal revisions were observed in the SC group, however, this did not reach significance (p=0.15) CONCLUSION: The use of PTS with placement of a single drain is a safe option for donor-site closure, and is a compelling technique for patients undergoing abdominal-based breast reconstruction.

Treatment for a Post-Reconstruction Seroma Using Viscum album Extract in a Patient with a Pressure Ulcer: A Case Series

Seromas commonly occur or recur after reconstructive surgery in patients with pressure ulcers, often leading to infection, increasing the risk of wound dehiscence and flap necrosis, and therefore requiring an additional surgical procedure. Various strategies have been employed to treat seroma, such as retaining as much of the fascia as possible, using progressive tension sutures, inserting suction drains, utilizing sclerotherapy, or applying compression via dressings or specialized garments. However, despite these efforts, seroma prevention remains difficult. In the current report, we describe three cases in which we administered Viscum album extract to prevent and treat seromas that developed following pressure ulcer reconstruction. V. album extract sclerotherapy was performed in a patient with a recurrent seroma, a patient with a persistent seroma, and a patient wishing to undergo sclerotherapy immediately postoperatively as a prophylactic treatment. The seromas resolved shortly after initiating treatment, and recurrence was not observed at any of the subsequent outpatient follow-up visits. These cases suggest that sclerotherapy with V. album extract following pressure ulcer reconstruction can suppress development of seromas and lower the risk of recurrence.

Radical Surgery for Successful Management of Axillary Hidradenitis Suppurativa Complicated by Mycobacterial Infections

Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to localised immunosuppression. Sometimes, it causes superadded Non tuberculous mycobacterial infections that require radical surgeries. After an extensive literature search, no Indian case report on this rare topic could be found, and this case report aims to fill up the void. A 28-yearold female presented with recurrent ulcers over her left axilla, which were refractory to medical treatments and surgeries for the last 5 years. Earlier, she had received a 6 month course of antitubercular drugs after Acid-Fast Bacilli (AFB) were found on pus examination. When the ulcers recurred afterward, she was empirically diagnosed as Non tuberculous mycobacterial infection in Thailand and treated with appropriate antibiotics for 3 months. However, multiple ulcers in new areas recurred over her axilla about a month after her treatment schedule was completed. To achieve complete surgical cure, radical excision of all the tracts, fistulae, and sinuses over her axilla was performed under ultrasound guidance. Wide excision resulted in a significant axillary defect that was reconstructed with large advancement flaps aided by progressive tension sutures. Postoperatively, a 7 year follow-up period of the patient was disease-free with the patient taking all necessary precautions. After 7 years, the affected axilla appeared nearnormal with some areas of stretched scars that did not bother the patient. To conclude, HS with Non tuberculous mycobacteria is rare, and a proper antimicrobial therapy with early en bloc excision under ultrasound guidance produced a complete cure.

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery.

BackgroundAbdominal panniculectomy after weight loss is a commonly performed procedure with high patient satisfaction yet continues to have a high post-operative complication profile. Several risk-reducing surgical approaches, such as preservation of Scarpa’s fascia, use of tissue adhesives, and progressive tension suture techniques have been described. However, the use of tranexamic acid (TXA) has not been previously reported in panniculectomy surgery. ObjectivesTo improve the safety and predictability of this procedure, the authors investigate whether the use of topically administered TXA during panniculectomy surgery reduces seroma, hematoma, and drain duration.MethodsConsecutive patients who underwent panniculectomy (January 2010 to January 2022) were retrospectively reviewed. Outcome measures included hematoma requiring surgical evacuation, seroma requiring percutaneous aspiration, and drain duration. Patients with thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared with a historical control group who had not received TXA.ResultsA total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months (3.7 years). The median (range) resection weight was 2.6 kg (0.15-19.96 kg). Regarding seroma and hematoma formation, the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio [OR] = 1.7, 95% CI [0.56- 4.8], P = 0.38 and OR = 2.1, 95% CI [0.4-11.8], P = 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group (18.1 [12.1] days vs 19.8 [13.9] days); however, this difference was not statistically significant, albeit clinically significant.ConclusionsAs the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although previous studies report hematoma and seroma risk reduction, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in body contouring are needed. Level of Evidence: 3