Progressive Tension Sutures – Placement Time in Abdominoplasty
Progressive tension sutures are a widely accepted technique used in abdominoplasty to advance and secure the abdominal flap. This technique reduces dead space and distributes tension over a greater surface area, thereby reducing tension on the incisional closure. Progressive tension sutures have many benefits, including but not limited to reduced seroma risk, reduced wound healing complication rate, and elimination of the need for surgical drains. Nevertheless, the progressive tension suture technique is often criticized for adding significant time to the abdominoplasty operation. Other studies have measured total operative times with and without the use of progressive tension sutures but fail to quantify the time required for the progressive tension suture portion of the procedure in isolation.
In an attempt to reduce operative time, some surgeons have used running, bidirectional barbed sutures for progressive tension suture placement in abdominoplasty. Warner et al estimated the time required for the progressive tension suture technique, using a running, bidirectional barbed suture, at about 9 minutes. However, many surgeons are reluctant to use barbed suture due to the increased cost. The amount of time required solely for the progressive tension suture portion of the surgery, using standard non-barbed suture, has not been precisely quantified.
The purpose of this study is to quantify the amount of time placement of progressive tension sutures adds to the abdominoplasty operation by a practiced plastic surgeon.
Methods/Technique
:This is a prospective multicenter study of patients undergoing standard, primary, full abdominoplasty by the senior surgeons. A total of 100 subjects will be included in the study, with 50 consecutive abdominoplasty patients from each senior surgeon. Any other concomitant procedures, including liposuction, will be noted. All patients will have progressive tension sutures placed in the routine manner of each senior surgeon and no surgical drains will be placed. The start and finish times will be recorded for the operation as a whole, the abdominoplasty portion of the operation, the progressive tension suture placement, and umbilical inset. Intraoperatively, the number of progressive tension sutures will be counted. The surface area of the abdomen will be calculated for each subject (xiphoid process to pubic symphysis and ASIS to ASIS).
Any complications in the post-operative period will be documented, including dimpling (from progressive tension suture placement), wound healing problems, seroma, hematoma, and umbilical necrosis. Patients will be monitored for at least 3 months post-operatively.
Results/Complications
:The mean time of progressive tension suture placement is 13.95 minutes for an abdominoplasty by one fo the senior surgeons, according to initial results for 20 patients. This includes placement of a running vertical progressive tension suture (with a mean of 10.6 loops, requiring a mean time of 3.95 minutes to complete) and placement of a mean of 25.3 interrupted sutures, requiring a mean of 10 minutes to complete. For an individual interrupted progressive tension suture, the mean time required is 23.7 seconds. The Spearman rank correlation (rs) calculates the degree of correlation between BMI and progressive tension suture placement time as 0.295, indicating a weakly positive correlation without statistical significance. The degree of correlation between abdominal surface area and progressive tension suture placement time is -0.432 (rs – Spearman rank correlation) and the degree of correlation between abdominal surface area and number of progressive tension sutures required is -0.126 (rs – Spearman rank correlation), indicating a weakly negative correlation for both. No complications have been noted. Ongoing data analysis for abdominoplasty patients of the other senior surgeon is being performed.
Conclusion
:Progressive tension suture placement in abdominoplasty is not time intensive. Our study suggests that the amount of time required to complete progressive tension suture placement is not strongly correlated to abdominal surface area or BMI. This technique can be efficaciously included in abdominoplasty regardless of patient size. Progressive tension suture placement should be strongly considered in abdominoplasty, given the numerous benefits and the short amount of time required for completion.