Quilting Sutures Versus Suprascarpa’s Dissection in Reduction of Seroma Formation Following Abdominoplasty

Document Type : Original Article

Authors

1 Plastic Surgery Unit, General Surgery Department, Faculty of Medicine, Benha University

2 Plastic Surgery Unit, General Surgery Department, Faculty of Medicine, Benha UniversityPlastic Surgery Unit, General Surgery Department, Faculty of Medicine, Benha University

Abstract

Background: Abdominoplasty surgery is used to enhance
body quality and shaping body contours. Massive weight reduction
causes an overabundance of superfluous skin that
causes additional psychological and functional issues. The
most frequent post-abdominoplasty consequence is seroma,
which often develops in the second postoperative week in areas
where the skin of the trunk is compromised or dead space is
produced. Several prophylactic measures have been proposed
to reduce the prevalence of postoperative seroma, including
drains, the use of compression garments, tissue adhesives,
quilting Sutures and Suprascarpa’s fascia preservation.
Objectives: The purpose of this study is to assess the efficacy
of Suprascarpa’s dissection and quilting sutures in reducing
seroma production after abdominoplasty in regarding the
quantity of seroma, duration of drain, length of hospital stay,
patient satisfaction, and ultimate cosmetic result.
Patients and Methods: This study includes 30 female patients
at the Plastic Surgery Unit. All of the patients met the
following criteria: All patients had a BMI of less than 30, all
patients have excess abdominal skin and fat tissue, and all patients
exhibit musculoaponeurotic laxity. Between June 2022
and June 2023, our prospective study was carried out at the
Benha University Hospital’s Plastic Surgery Unit. 15 patients
had abdominoplasty using the quilting suture technique, while
15 others had them using Scarpa’s fascia preservation.
Results: 8 patients had pendulous abdomen post weight
gain, 7 patients presented with redundant skin following dietary
weight loss, 8 patients presented with abdominal deformities
post bariatric surgery and 7 patients presented with skin
laxity following multiple pregnancies. Regarding the complications,
14 patients had no complications, 8 patients with seroma,
6 patients with hematoma and 2 patients with wound
dehiscence.
Conclusion: Suprascarpa’s fascia preservation and quilting
sutures are effective in preserving abdominal wall lymphatics
and decreasing postoperative complications especially;
decreasing seroma rates, reducing drain duration and hospital
stays.

Keywords

Main Subjects


Taman N., Buchman A. and Muehlberger T.: Fibrin glue
and seroma formation following abdominoplasty. Chirurg,
78: 531-535, 2007.
2- Neaman K.C., Armstrong S.D., Baca M.E., Albert M.,
Woude D.L.V. and Renucci J.D.: Outcomes of traditional
cosmetic abdominoplasty in a community setting: A retrospective
analysis of 1008 patients. Plast. Reconstr. Surg.,
131 (3): 403-410, 2013.
3- Costa-Ferreira A. and Rebelo M.: Scarpa fascia preservation
during abdominoplasty: Randomized clinical study of
efficacy and safety. Plast. Reconstr. Surg., 131 (3): 644-
654, 2013.
4- Wijaya W.A., Liu Y., He Y., Qing Y. and Li Z.: Abdominoplasty
with Scarpa Fascia Preservation: A Systematic
Review and Meta-analysis. Aesthetic Plast. Surg., 46 (6):
2841-2852, 2022.
5- Saldanha O.R., De Souza Pinto E.B., Mottos W.N. Jr., Pazetti
C.E., Lopes Bello E.M., Rojas Y., dos Santos M.R., de
Carvalho A.C. and Filho O.R.: Lipoabdominoplasty with
selective and safe undermining. Aesthetic Plast. Surg., 27
(4): 322-7, 2003.
6- Elwakeel H., Abouarab M.H. and Kholosy H.M.: Scarpa
fascia versus rectus sheath plane in lipoabdominoplasty
flap dissection: Comparative study. Egypt. J. Plast. Reconstr.
Surg., 45 (3): 113-119, 2021 .
7- Costa-Ferreira A., Rebelo M., Vásconez L. and Amarante
J.: Scarpa fascia preservation during abdominoplasty.
In: Di Giuseppe A., Shiffman M.A., eds. Aesthetic Plast.
Surg. Abdomen. Cham, Switzerland: Springer, pp. 59-73,
2015.
8- Repo O., Oranges C.M., di Summa P.G., Uusalo P., Anttinen
M. and Giordano S.: Scarpa fascia preservation to
reduce seroma rate on massive weight loss patients undergoing
abdominoplasty: A comparative study. J. Clin.
Med., 12: 636, 2023.
9- Novais C.S., Carvalho J., Valença-Filipe R., Rebelo M.,
Peres H. and Costa-Ferreira A.: Abdominoplasty with
scarpa fascia preservation: Randomized controlled trial
with assessment of scar quality and cutaneous sensibility.
Plast. Reconstr. Surg., 146 (2): 156-164, 2020.
10- Rahal A.A., Alboudi S., Alhilbawi M.H. and Alhassanieh
A.: A comparison between supra Scarpa’s fascia abdomiVol.
48, No. 1 / Quilting Sutures Vs Suprascarpa’s Dissection i 40 n Reduction of Seroma
noplasty and traditional abdominoplasty: Effect of caesarean
section. Modern Plast. Surg., 11 (2): 37-48, 2021.
11- Iannelli A., Ciancio F., Annoscia P., Vestita M., Perrotta R.
E., Giudice G. and De Robertis M. Abdominoplasty with
“scarpa fascia” preservation: Case report. Int. J. Surg.
Case. Rep. 47:100-103. 2018.
12- Helmy Y., Wael Ayad W., Al-Refai A. and Taha A.: Minimized
dead space (Abdominopexy) plus tension free
wound edges abdominoplasty. Al-Azhar Assiut Med. J., l8
(3): 268-282, 2010.
13- Rodrigo Gouvea, Henrique Lopes, et al.: The use of quilting
sutures in abdominoplasty doesn’t require aspiratory
drainage for prevention of seroma. Aesth. Plast. Surg., 34:
102-104, 2010.
14- Epstein S., Epstein M.A. and Gutowski K.A.: Lipoabdominoplasty
without drains or progressive tension sutures:
An analysis of 100 consecutive patients. Aesthet. Surg. J.,
35 (4): 434-40, 2015.
15- Sforza M., Husein R., Andjelkov K., Rozental-Fernandes
P. C., Zaccheddu R. and Jovanovic M.: Use of quilting sutures
during abdominoplasty to prevent seroma formation:
are they really effective? Aesthet. Surg. J., 35 (5): 574-80,
2015.
16- El-Shaer W.M., El-Noamani S. and Hosni H.: Bilateral
Scarpa’s Fascia Advancement J. Plast. Reconstr. Surg.,
Vol. 35, No. 1.: 133-140, 2011. Citated from Santos E. and
Muraira J.: The Waist and Abdominoplasty. Aesth. Plast.
Surg., 22: 225-227, 1998.