Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience
Luis H Macias1, Edwin Kwon1, Daniel J Gould1
1Dr Macias is an Associate Clinical Professor of Surgery, Dr Gould is a Resident, and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA. Dr Kwon is a Fellow, USC Aesthetic Surgery Fellowship, Los Angeles, CA. Dr Spring is a plastic surgeon in private practice in Kalispell, MT.
Background:
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.
Objectives:
Given these data, we decided to use PTS and forego drains in abdominoplasty. Here we present our experience with the transition.
Methods:
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.
Results:
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.
Conclusions:
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.
Level Of Evidence:
4 Therapeutic.
