Cosmetic Surgery: Promises and Pitfalls™

Progressive Tension Sutures: Our Approach to Reducing Complications and Speeding Recovery

OUR APPROACH:

This technique, which we have originally described, has been used in our practice for approximately 20 years. We have incorporated the progressive tension sutures into our abdominal contouring procedures, facelifts, and our browlifts. In both procedures, we have been impressed with the overall improvement in our patients' recovery. Swelling and bruising is minimal, even though we use no pressure dressings and only occasional drains in our facelifts and no drains in our abdominoplasties.

The most frequent questions from patients about this procedure is: "Why don't all plastic surgeons use this technique?" We must conclude from correspondence we have received that after they tried it most cosmetic surgeons adopted this technique for abdominoplasty (tummy tuck). Many surgeons are reluctant to stop using drains as this is traditionally regarded as mandatory with abdominoplasty. Our experience is to the contrary: there are no ill-effects of eliminating drains.
 

OVERVIEW

Image (Flash movie) above: Illustration of Pressure Tension Suture (PTS) placement under the skin to advance and then anchor the skin flap.   Image to the right: This simple surgical modification is the addition of progressive tension sutures (PTS), which were first described in the Journal of Plastic and Reconstructive Surgery in June 2000 by Drs. Pollock. The basic concept is that of a controlled redraping and advancement of the abdominal skin flap by the placement of multiple sutures from the skin flap to the deep tissues.

The rationale for the use of PTS is based on three surgical principles that promote healing and reduce complications:

• Closure of a Wound with Minimal Tension - PTS spreads the tension of the flap advancement over the surface area of the entire flap. Tension on the healing wound is minimal.
• Elimination of "Dead Space" - that empty space created by a surgical dissection. Dead space permits the accumulation of fluid in the early postoperative period, which results in swelling and bruising, but can also result in a complication: a collection of blood (hematoma) or tissue fluid (seroma). The PTS sutures eliminate this dead space and reduce swelling and bruising, while preventing hematomas and seromas.
• Secure Anchoring of the Tissues Speed Healing - PTS hold the tissues firmly together, prevent disruption of early healing by movement. Healing begins immediately further reducing swelling and other potential problems.
   

SURGICAL TECHNIQUE

Image to the right: The progressive tension sutures are placed from the skin flap to the deep tissues as the flap is advanced.

Image to the right: This progressive advancement is maintained as each suture is placed and tied, hence the name, "progressive tension sutures." In this manner, tension is redistributed over a broad area of the flap, as opposed to the conventional procedure in which all the tension is concentrated on the incision. The PTS technique allows closure of the incision with virtually no tension. This improves the quality of resulting scars and prevents healing problems.

 
The PTS eliminates the dead space under the flap and securely anchors the flap to the deep tissues. This speeds healing and simplifies and shortens convalescence. As previously discussed, no drains are used in tummy tuck, which facilitates early ambulation and speeds convalescence - and early ambulation in an upright posture is possible. In the facelift, no pressure dressings (usually no dressing at all) are used, which actually results in less swelling and bruising. Certainly, patients are more comfortable without tight, bulky and uncomfortable head dressings.

Complications, such as excess scarring, healing delay and fluid accumulation are prevented by this technique. 
 

Publication:

Pollock, H, and Pollock, T. Progressive Tension Sutures: A Technique to Reduce Local Complications in Abdominoplasty. Plastic and Reconstructive Surgery (June) 2000; 105 (7), pp. 2583-2586

 
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