The Effect of Drains and Compressive Garments Versus Progressive Tensioning Sutures on Seroma Formation in Abdominoplasty

The Effect of Drains and Compressive Garments Versus Progressive Tensioning Sutures on Seroma Formation in Abdominoplasty: A New Perspective for Abdominoplasty Procedure?

Authors comment on the paper "The effect of drains and compressive garments versus progressive tensioning sutures on seroma formation in abdominoplasty" written by Brown et al in Aesthetic Plastic Surgery.Although the authors present interesting results on the effectiveness of progressive tensioning sutures proposed originally by Pollok and Pollok, we express some considerations about the analyzed data and patients, hoping in a new research extending these findings to include both aesthetic and post-bariatric abdominoplasty patients, evaluating the effectiveness of these sutures in varied contexts.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

A Systematic Review and Meta-Analysis Evaluating the Surgical Outcomes of Progressive Tension Suturing Compared to Drains in Abdominoplasty Surgery

Closed suction drains are placed to prevent seroma formation after abdominoplasty, but evidence of their effectiveness is limited, and they may increase infection risk and patient discomfort. Previous meta-analyses comparing progressive tension suturing (PTS) to drainage (D) in abdominoplasty have been methodologically weak and small in sample size. In this study we aimed to conduct the first robust systematic review comparing PTS and D outcomes in abdominoplasty. The study was registered on PROSPERO (CRD42022346106). We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Google Scholar, and Web of Science from September 19, 2022, to February 19, 2024. Data were pooled with a random effects Mantel-Haenszel model. Risk of bias was assessed with Cochrane's risk-of-bias tool and the ROBINS-I tool for randomized controlled trials and observational studies, respectively. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system evaluated methodological quality. PTS significantly reduced postoperative seroma rates (relative risk [RR] 0.34; 95% CI 0.15-0.76; P = .001) and reoperation rates (RR = 0.56; 95% CI 0.03-9.77; P = .05) compared to drains, with no significant differences in hematomas, infections, or dehiscence. The review included 24 studies with 750 patients, including 2 randomized controlled trials, and was found to be methodologically superior by AMSTAR 2 criteria. Subgroup analysis indicated that combining liposuction with PTS significantly reduced seromas (RR 0.18; 95%CI 0.00-7.39; P < .00001), infections (RR 0.16; 95% CI 0.03-0.86; P = .03), and dehiscence (RR 0.11; 95% CI 0.01-1.01; P = .05). This robust meta-analysis showed that PTS was more effective than drains in reducing seroma and reoperation rates, with no difference for hematomas or infections. Combining liposuction with PTS may be superior to placing drains. Larger, high-quality studies are needed to further assess the safety and efficacy of drainless abdominoplasty.

LEVEL OF EVIDENCE: 1

Bioglass/ceria nanoparticle hybrids for the treatment of seroma: a comparative long-term study in rats

Background: Seroma formation is a common postoperative complication. Fibrin-based glues are typically employed in an attempt to seal the cavity. Recently, the first nanoparticle (NP)-based treatment approaches have emerged. Nanoparticle dispersions can be used as tissue glues, capitalizing on a phenomenon known as 'nanobridging'. In this process, macromolecules such as proteins physically adsorb onto the NP surface, leading to macroscopic adhesion. Although significant early seroma reduction has been shown, little is known about long-term efficacy of NPs. The aim of this study was to assess the long-term effects of NPs in reducing seroma formation, and to understand their underlying mechanism. Methods: Seroma was surgically induced bilaterally in 20 Lewis rats. On postoperative day (POD) 7, seromas were aspirated on both sides. In 10 rats, one side was treated with NPs, while the contralateral side received only NP carrier solution. In the other 10 rats, one side was treated with fibrin glue, while the other was left untreated. Seroma fluid, blood and tissue samples were obtained at defined time points. Biochemical, histopathological and immunohistochemical assessments were made. Results: NP-treated sides showed no macroscopically visible seroma formation after application on POD 7, in stark contrast to the fibrin-treated sides, where 60% of the rats had seromas on POD 14, and 50% on POD 21. At the endpoint (POD 42), sides treated with nanoparticles (NPs) exhibited significant macroscopic differences compared to other groups, including the absence of a cavity, and increased fibrous adhesions. Histologically, there were more macrophage groupings and collagen type 1 (COL1) deposits in the superficial capsule on NP-treated sides. Conclusion: NPs not only significantly reduced early manifestations of seroma and demonstrated an anti-inflammatory response, but they also led to increased adhesion formation over the long term, suggesting a decreased risk of seroma recurrence. These findings highlight both the adhesive properties of NPs and their potential for clinical therapy.

A Novel Technique for the Permanent Restoration of Pretarsal Fullness of the Lower Eyelids

Background

The presence of static pretarsal fullness is an essential aesthetic feature in Asian culture that endows a youthful and smiling attractive look to the face. The restoration of static pretarsal fullness using acellular dermal matrix implantation or autogenous fascia grafting can result in suboptimal outcomes because of the unpredictable resorption rate. Therefore, a new method is required to achieve a stable, long-term, and natural result.

Objectives

The authors describe a new method to address the deficiency of static pretarsal fullness.

Methods

Sixteen Asian female patients with a deficiency of static pretarsal fullness who received implantation of a bundle of implants consisting of segmented Gore-Tex sutures (W. L. Gore & Associates, Inc., Flagstaff, AZ) overlaid with a mastoid fascia graft were retrospectively evaluated in a 15-year period from July 2007 to July 2022. Patients were assigned to categories based on the pretarsal fullness contour.

Results

Sixteen female patients aged between 22 and 40 years (mean age: 30.375 ± 7.580) underwent the procedure. The mean follow-up period was 52.25 (±33.757) months (range, 6-120 months). Fourteen patients were considered to have satisfactory results. However, 2 patients encountered complications, one of which was a case of infection that was successfully managed through revision and led to an excellent outcome. The other patient experienced malposition, which was also corrected successfully through revision.

Conclusions

Our new method for creating pretarsal fullness using Gore-Tex suture implants overlaid with a retroauricular mastoid fascia graft is effective in achieving aesthetic static pretarsal fullness and obtaining excellent permanent cosmetic outcomes.

Level of Evidence 4