Quilting the Tummy Tuck?
For decades, a standard tummy tuck involved lifting up the loose abdominal skin, repairing relaxed muscles, then pulling down and cutting off the extra skin. The analogy is much like pulling a sheet tight on a bed and cutting off the extra. The tightened skin was left to stick to the abdominal wall with gentle pressure from wearing a compressive binder as the patient healed. A drain was placed so that fluid would not accumulate under the healing skin and keep it from sticking to the abdominal wall. Fluid collections are known as seromas. Recently two surgeons, brothers, in the Midwest began sewing the skin down to the abdominal wall, quilting it so to speak. They have popularized the idea as a way to make the skin adhere faster, and minimize fluid collections under the skin. In fact they routinely do not use drains. The sutures are placed in such a way that the upper abdomen is pulled downwards taking tension off the incision. They argue that removing the tension makes for less healing problems and better scars. I could not ignore the logic of their approach and I began quilting my tummy tucks. I have been very pleased so far. All the patients I have quilted have healed uneventfully and I have seen far fewer fluid collections. Drains have been coming out more quickly as well. While some doctors quilt and do not leave a drain I still prefer to have a route for additional fluid to exit. I include liposuction of the hips with many of my abdominoplasties and this often adds additional fluid to the mix- better out than in. The only downside is that early on patients may see little dimples under the skin where the sutures have been placed. Because the sutures all absorb they go away in about six weeks. Less seroma, quicker healing drains out earlier is better for my patients. October 30, 2014 7:12 pm
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