Ultrasound and seromas

Defining Internal Tissue Closure: High-Resolution Ultrasound Evaluation of Interi-A Novel Internal Tissue Closure System

Background

Seroma remains a leading postsurgical complication in plastic surgery. Conventional drains are ineffective in clearing blood and fluid and closing down surgical spaces. The Interi (Internal Closure System, IC Surgical, Grand Rapids, MI) is comprised of a novel branching internal manifold attached to a self-contained portable pump with a higher, consistent, continuous negative pressure, may reduce this long-standing issue. In addition, high-resolution ultrasound (HRUS) has emerged as an ideal tool to visualize structures, fluid collections, and seromas internally.

Objectives

This study evaluates Interi in full abdominoplasty patients utilizing HRUS to evaluate Interi's ability to evacuate blood and fluid, hold internal tissues together and document, for the first time, what internal tissue healing actually looks like radiographically.

Methods

An IRB approved, Contract Research Organization reviewed retrospective study evaluated consecutive patients undergoing full abdominoplasty utilizing Interi from July 2020 through March 2021 by three plastic surgeons. HRUS visualized and confirmed the presence or absence of fluid collections and healing tissue planes during the postoperative process. Study data and all adverse events were recorded, with HRUS images reviewed by investigators and confirmed by an independent radiologist.

Results

Seventy-one Interi patients were enrolled. Mean age was 43 (range: 21-74) and BMI was 28. Seroma was confirmed clinically and through HRUS in 3/71 patients, and was associated with either clot (2) or failure to activate system (1). Interi's ability to eliminate fluid and approximate/hold surgical tissue planes together was confirmed with HRUS. No other major complications, including abscess, hematomas, or flap necrosis were observed.

Conclusions

This novel Internal Tissue Closure System effectively evacuated blood and fluid, approximated and maintained closure of internal tissue planes in abdominoplasty patients, allowing for primary tissue healing and internal wound closure to occur. Healing tissue planes and any fluid present are easily identified on HRUS visualizing actual internal tissue healing with a simple, widely available radiographic scan.

Level of Evidence 3

The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis.

METHODS

In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I² index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2).

RESULTS

In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05).

CONCLUSIONS

This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously.

LEVEL OF EVIDENCE III

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 .

Anchor-Line Abdominoplasty with Scarpa Fascia Preservation in Postbariatric Patients: A Comparative Randomized Study

BACKGROUND

The number of bariatric surgeries for the treatment of morbid obesity has increased, and there is growing demand for postbariatric abdominoplasty. The aim of this study was to evaluate the impacts of Scarpa's fascia preservation on total drainage volume, time to drain removal, and seroma formation in anchor-line abdominoplasty.

METHODS

A total of 42 postbariatric patients were randomly assigned to two groups and underwent anchor-line abdominoplasty. Scarpa's fascia was not preserved during abdominoplasty in one group (n = 21) but was preserved in the other group (n = 21). A suction drain was left in place until the drainage volume was less than 30 ml/24 h. Seroma formation was assessed by abdominal ultrasound on the twentieth postoperative day; only fluid collections greater than 30 ml were considered seromas.

RESULTS

The time to drain removal was shorter, and the total drainage volume was lower in the fascial preservation group than in the fascial dissection group. However, no difference in the seroma formation rate was observed between the groups.

CONCLUSION

Scarpa's fascia preservation decreased the drainage volume and the time to drain removal but not the rate of seroma formation.

LEVEL OF EVIDENCE II

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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Lipoabdominoplasty with Progressive Traction Sutures

BACKGROUND

Proactively preserving Scarpa's fascia and thus its intrinsic lymphatic drainage and tensile strength for suture placement can eliminate the need for drains after lipoabdominoplasty and therefore reduce the rate of seroma development. In this article, we describe the effectiveness of a modified progressive traction suture (PTS) technique, which enables us to lessen the most common complications and avoid hospital readmission; these sutures take 3-5 minutes of additional surgery time.

METHODS

Two hundred seventy-six patients (mean age, 38 years; range, 19-67 years), with a mean body mass index of 25 were included in this study. All patients underwent complete lipoabdominoplasty with ultrasound-assisted liposuction (VASER) throughout the abdomen and flanks. Abdominal rectus plication was performed in 100% of cases. All patients were operated on under spinal anesthesia and stayed overnight in hospital.

RESULTS

Of the 276 patients, 1.8% developed postoperative seromas. No patients developed hematomas. New wound closure was needed in 1.4% of patients, performed within 7-10 days of surgery, scar revision in 4.7%, residual liposuction under local anesthesia in 9.7%, and liposuction under sedation in 1%; deep vein thrombosis without thromboembolic phenomenon developed in 1%, none resulting in death. In addition, the use of a PTS technique is a time-saving procedure because it takes the surgeons between 3-5 minutes of operative time, unlike that of adhesion and/or separate traction, which takes between 30 and 45 minutes.

CONCLUSIONS

The use of PTSs helped diminish complications such as seroma and hematoma and prevent additional cost involving hospital readmission and/or further surgery. Furthermore, use of these sutures required only 3-5 minutes of additional operative time.

Effect of Tissue Adhesives on Seroma Incidence After Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Tissue adhesives (TAs) are widely utilized in abdominoplasty to reduce postoperative seroma. However, current literature regarding TAs in abdominoplasty is limited to small studies and the findings of single institutions.

OBJECTIVES

The authors reviewed the current literature regarding the effects of TAs on seroma formation and other endpoints following abdominoplasty, and summarized the types of TAs and application techniques that have been described to date.

METHODS

A systematic review of the Medline, Embase, Web of Science, and Cochrane databases was conducted to identify randomized controlled trials (RCTs) in which the numbers of patients who experienced seroma after abdominoplasty were indicated. The Cochrane Collaboration's tool for assessing risk of bias was applied.

RESULTS

Seven studies were included in a descriptive review, 5 of which were RCTs. Data from the 5 RCTs were pooled for a meta-analysis. Patients who received TAs following abdominoplasty had a similar incidence of seroma compared with patients who did not receive TAs. However, the total drainage volume was significantly lower for patients who received TAs.

CONCLUSIONS

There is a paucity of high-quality evidence to support the delivery of TAs to prevent seroma formation after abdominoplasty. Well-designed RCTs are needed to assess with confidence the overall effects of TAs in abdominoplasty.

LEVEL OF EVIDENCE

2 Therapeutic.

Analysis of Complications in Postbariatric Abdominoplasty: Our Experience

Abdominoplasty is one of the most popular body-contouring procedures. It is associated with a significant number of complications: the most common ones are seroma, hematoma, infection, wound-healing problems, and skin flap necrosis. From January 2012 to December 2014, 25 patients (18 women and 7 men) (mean age: 51 years) underwent abdominoplastic surgery at the Plastic Surgery Section, Department of Surgical Sciences, University of Parma, Italy. All patients reported a weight loss between 15 kg and 47 kg. All of the of 25 patients were included in the study; minor and major complications were seen in 17 (68%) and 8 (32%) patients, respectively. The percentage of complications in our patients was as follows: 9 patients with seroma (36%); 4 patients with wound dehiscence with delayed wound healing (16%); 3 cases with hematoma (12%); 2 patients with postoperative bleeding (8%); 1 patient (4%) with an umbilical necrosis; 1 patient (4%) with a deep vein thrombosis; 3 patients with infected seroma (12%); and 2 patients with wound infection (8%). There were no cases of postoperative mortality. The aim of this study is to analyze our complications in postbariatric abdominoplasty.

Natural evolution of seroma in abdominoplasty

BACKGROUND

Abdominoplasty is one of the most performed aesthetic surgical procedures, and seroma is a common local complication. The aim of this study was to investigate the beginning of seroma formation after abdominoplasty and its progression.

METHODS

Twenty-one female patients underwent standard abdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (i.e., epigastric, umbilical, hypogastric, right iliac fossa, and left iliac fossa regions) at five different time points: postoperative days 4, 11, 18, 25, and 32.

RESULTS

The incidence of seroma was 4.8 percent on postoperative day 4, 38.1 percent on postoperative day 11, 33.3 percent on postoperative day 18, 23.8 percent on postoperative day 25, and 19 percent on postoperative day 32. The left iliac fossa region had the highest relative volume of fluid collection on postoperative day 4, as did both the right iliac fossa and left iliac fossa regions on postoperative day 11. At other time points, the relative volume of fluid collection was significantly higher in the right iliac fossa region.

CONCLUSION

The highest incidence of seroma occurred on postoperative day 11, and the iliac fossae were the most common locations of seroma.

Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy?

BACKGROUND

Seroma is the most common complication in abdominoplasty and abdominal ultrasound is one of the best noninvasive methods for diagnosing seroma formation. The aim of this study was to compare the use of suction drains, quilting sutures, and fibrin sealant in abdominoplasty to determine the best strategy to prevent seroma formation.

METHODS

Forty-three female patients, aged 20-66 years, nonsmokers, with Nahas' type III deformities, and body mass index (BMI) ranging from 18.0 to 24.9 kg/m(2), underwent abdominoplasty between March and October 2008 in a public hospital setting. The patients were randomly allocated to one of three treatment groups: DN group (n = 15), abdominoplasty with suction drains alone; QS group (n = 13), abdominoplasty with quilting suture between the subcutaneous tissue of the flap and musculoaponeurotic layer of the anterior abdominal wall; and FS group (n = 15), abdominoplasty with fibrin sealant. All patients underwent ultrasound examination on postoperative days 15 and 30 for detection of abdominal fluid collections.

RESULTS

The groups were homogeneous for age and BMI. There was a significant reduction in seroma formation between postoperative days 15 and 30 in the three groups (DN group, P = 0.0003; QS group, P = 0.0011; and FS group, P = 0.0003). Seroma formation was significantly higher in the FS group (H = 6.04, P < 0.05) compared with the DN and QS groups on postoperative day 15.

CONCLUSION

Seroma formation was significantly lower in the DN and QS groups compared with the FS group on postoperative day 15.

Seroma in lipoabdominoplasty and abdominoplasty: a comparative study using ultrasound

BACKGROUND

Abdominoplasty is one of the most frequently performed cosmetic procedures, and its combination with liposuction has become more common. Seroma is one of the most common complications in abdominoplasty. The aim of this study was to compare the rate of seroma formation in patients who underwent either abdominoplasty with or without the use of quilting sutures or lipoabdominoplasty.

METHODS

Fifty-eight female patients were divided into three groups and underwent one of the following procedures: group A (n=21), abdominoplasty without quilting sutures; group B (n=17), abdominoplasty with quilting sutures; and group C (n=20), lipoabdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (epigastrium, umbilical, hypogastrium, right iliac fossa, and left iliac fossa) at two postoperative periods (P1, between postoperative days 11 and 14; and P2, between postoperative days 18 and 21).

RESULTS

The rate of seroma formation at both P1 and P2 was significantly higher in group A. It was observed that in group A at P1, the regions of right iliac fossa and left iliac fossa developed larger fluid collections. In group B, there were no significant differences with respect to fluid collections among the five study regions at both P1 and P2. In group C, there were significantly larger fluid collections in the hypogastrium region at P1 and in the umbilical and hypogastrium regions at P2.

CONCLUSION

Abdominoplasty with quilting sutures and lipoabdominoplasty are effective techniques for the prevention of seromas compared with abdominoplasty without quilting sutures.

Progressive Tension Sutures in the Prevention of Postabdominoplasty Seroma: A Prospective, Randomized, Double-Blind Clinical Trial

BACKGROUND

The purpose of this study was to evaluate the seroma reduction capabilities of progressive tension sutures and compare them with the conventional use of drains.

METHODS

Sixty female patients were randomized into four groups: group 1 (control, no drains, and no progressive tension sutures), group 2 (progressive tension sutures alone), group 3 (drains alone), and group 4 (progressive tension sutures and drains). All patients underwent a classic abdominoplasty and drains were left for 7 days in the corresponding groups. Clinical and ultrasound assessments were performed 2 weeks after the operation by blinded evaluators. Punctures, volumes, nonseroma complications, and aesthetic outcome were also measured.

RESULTS

Surgical time was 50 minutes longer in groups 2 and 4. Drain outputs were higher in group 3 than in group 4. The clinical and ultrasound seroma frequency was 35 percent and 90 percent respectively, without significant differences among the groups. The control group was interrupted at 10 patients because of considerably larger seromas and an increased amount of punctures needed for treatment. No differences were found in the other groups. There were no differences with respect to complication rates and aesthetic outcome after follow-up.

CONCLUSIONS

Progressive tension sutures increase surgical time, reduce drain outputs, and have the same clinical and ultrasound seroma frequency as the use of drains alone. The combination of both methods simultaneously does not add any advantages. However, complications and interventions increase if at least one of them is not used. The mechanism of action of progressive tension sutures could be the compartmentalization of the fluid collection under the flap facilitating absorption.

Does quilting suture prevent seroma in abdominoplasty?

BACKGROUND

Seroma is the most frequent complication in abdominoplasty. Some patients are more prone to develop this complication. Ultrasound is a well-known method with which to diagnose seroma in the abdominal wall. The purpose of this study was to verify the efficacy of the use of quilting suture to prevent seroma.

METHODS

Twenty-one female patients who presented with abdominal deformity type III/A according to the authors' classification of abdominal skin and myoaponeurotic deformity had undergone abdominoplasty. The selected patients should have had at least one of the following characteristics: body mass index greater than 25 kg/m; weight loss greater than 10 kg; previous incision in the supraumbilical region; or present thinning of the subcutaneous in the area above the umbilicus. Ultrasound was performed for every patient from 15 to 18 days after the operation to search for fluid collection in the abdominal wall.

RESULTS

The average fluid collection found was 8.2 cc per patient. Only two patients underwent aspiration because ultrasound showed greater than 20 cc collected above the fascial layer. These patients did not present with recurrence of seroma after aspiration.

CONCLUSION

The quilting suture seems to be an efficient technique with which to prevent seroma formation.

Abdominal Contour Procedures: Evaluating the Options

Surgical science continues to increase the options available to an individual seeking an improved abdominal contour. Appropriately applied, abdominal-contouring procedures offer significant aesthetic improvements and result in a high level of patient satisfaction. Liposuction is one procedure in a continuum of techniques available for addressing abdominal contour, and it is the one with which patients are most familiar and most likely to request. Advising patients of the many available methods involves an understanding of the scope of each technique and an accurate assessment of individuals' anatomy and their expectations and perceptions of what a successful result represents. This article outlines the various surgical methods of abdominal contouring and fosters an understanding of how to select the appropriate procedure.