The Application of Hemostatic Net Suturing for Epigastric Skin Laxity
In the past several years, there has been a significant increase in the use of hemostatic net suturing in rhytidectomy surgery. With little variability, the face-lift literature highlights a reduction in the rate of hematoma and seroma formation, and an improvement in skin redraping. Until recently, the use of the technique has been limited to the temporal regions of a face-lift or to enhance a neck-lift. Currently, Dr. Ghorbani has highlighted the utility of hemostatic netting in brachial liposuction. Hoyos et al, have applied the technique as a way to accentuate the abdominal midline as an adjunct to ultrasonic device-assisted high definition liposculpture. Our authors seek to apply hemostatic netting and liposuction as a method for treating isolated skin laxity of the epigastrium. In select patients, this technique can provide a less invasive alternative to a problem that is commonly addressed with surgery.
Methods/Technique:
A prospective study was performed with 10 patient enrolled. All females were between the ages of 21 to 65. Inclusion criteria included patient with a BMI less than 30 with minimal to no pannus. Ideally, the patients were selected who had focal epigastric skin laxity with minimal to no fat excess. The patients were assessed pre-operatively with caliper pinch, and skin distraction of the supraumbilical skin as surrogate determinants of skin laxity. These patients were subsequently treated with suction-assisted liposuction to the epigastrium followed by hemostatic net application with a 4-0 double armed prolene suture. The sutures were removed in 3 days following surgery.
Results/Complications:
In our preliminary evaluation, all patients have demonstrated improvement in their epigastric laxity with tighter adherence of the skin. This was assessed by caliper and skin distraction after treatment. There were no clinically apparent hematomas or seroma. There were no major complications.
Conclusion:
For a specific subset of patients with little lipomatous excess of the abdomen, the conventional abdominoplasty is an excessive approach to address mild to moderate epigastric laxity. Furthermore, it may be exceedingly challenging to perform an abdominoplasty without some component of vertical scar. As a result, many patients forgo procedures altogether. Liposuction with hemostatic net suturing addresses this dilemma in a way that is less invasive, spares undue morbidity, and limits the patient's unnecessary down-time. The application of hemostatic net and liposuction is a viable and cost efficient way to redrape and improve the appearance of redundant epigastric skin.