МЕТОДЫ ПРОФИЛАКТИКИ РАЗВИТИЯ СЕРОМЫ ПОСЛЕ АБДОМИНОПЛАСТИКИ

To demonstrate the associated use of progressive tension sutures (PTS) with negative pressure wound therapy (NPWT) in large torso degloving wounds. This is a case report of two patients with large torso degloving wounds caused by trauma, both of whom were treated with combined PTS and NPWT. Statistics related to wound treatment responses are presented. Initial wound area for Patient 1 was 2400cm2 and 900cm2 for Patient 2. Within 21 and 12 days, respectively, using the combined method, the following data were observed: wound reduction of 94% and 99%, respectively; a closing speed rate of 98cm2/day and 75cm2/day, respectively; and a closing percentage of 4.45% per day and 8.25% per day, respectively. The use of combined PTS and NPWT techniques may be useful in the treatment of traumatic degloving injuries, reducing the wound area and facilitating reconstruction.

Seroma formation has become the most reported complication after abdominoplasties. In 2000, progressive tension sutures (PTS) were described and reported to be associated with a seroma rate of 0.1%. Surgeons worldwide use PTS to prevent seroma; however, there are discrepancies in the number of PTS commonly used, starting from five up to 35 sutures. The absence of standardization may cause a lack of seroma prevention, increased surgical time, and general hesitation to perform the technique. To determine whether 11 PTS are sufficient to prevent seroma in abdominoplasties. We performed a single-blind, prospective, comparative, randomized clinical trial of 63 healthy patients from January to December 2017. Patients were divided into groups: group 1, classic abdominoplasty without the use of PTS and drains; group 2, abdominoplasty with the use of 11 PTS and drains; and group 3, abdominoplasty with the use of 22 PTS and drains. The duration of the surgical technique, presence of clinical seroma, number of aspirations, and days to drain removal were evaluated. The Cochran-Armitage, Fisher exact, Kruskal-Wallis, and t tests were used in the statistical analyses. PTS reduced the rate of seroma formation to 3.5%. Results showed that there is a benefit in using 11 PTS instead of 22 PTS because using more sutures led to an increased surgical time (30min vs. 13min) and possible complications. Compared to patients with PTS, those without PTS underwent more seroma aspirations and delayed drain removal. Eleven PTS should be used in classic abdominoplasties. 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 .

BACKGROUND: The abdomen is the most common location from which tissue is harvested for autologous breast reconstruction.1 The evolution from musculocutaneous flaps to muscle-sparring perforators flaps has decreased donor site complications such as abdominal bulge and hernia; however, complications remain. The development of progressive tension suture placement for donor site closure has the potential to decrease complications and increase the esthetics of the abdomen after breast reconstruction.2 PURPOSE: To present our institutional experience using progressive tension sutures for a tensionless closure of the donor site to improve outcomes and optimize abdominal donor site esthetics. METHODS: A retrospective cohort study was conducted over a 2-year period. Sixty-six consecutive patients who underwent abdominally based autologous breast reconstruction were divided into an experimental group (36 patients), in which the donor site was closed using progressive tension sutures, and a control group (31 patients), in which the donor site was closed without the use of this technique. A comparison between both groups was conducted in terms of demographic characteristics, perioperative variables, and donor site–related postoperative complications. RESULTS: No significant differences were found between the 2 groups in terms of demographic characteristics including age, body mass index, smoking status, comorbidities, and previous abdominal surgery (P > 0.05). No significant differences were noted with respect to unilateral versus bilateral donor sites, operative times, and length of hospital stay (P > 0.05). With regard to donor site complications, the wound dehiscence rate was significantly higher for the control group (27.8% versus 6.5; P = 0.023). No differences were noted in terms of infection, seroma formation, hematoma formation, abdominal bulge, or abdominal hernia rates between the 2 groups. CONCLUSION: In the cohorts of patients analyzed, the use of a tensionless technique for the closure of the donor site after an abdominally based autologous breast reconstruction decreased the rates of donor site wound dehiscence. Seroma and hematoma formation rates remained the same across both groups. REFERENCES: 1. Agarwal J, Tatro E, Kwok A, et al. Immediate unilateral breast reconstruction using abdominally based flaps: analysis of 3,310 cases. J Reconstr Microsurg. 2018. 2. Lee BT, Agarwal JP, Ascherman JA, et al. Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg. 2017;140:651e–664e.

Drains are still commonly inserted during abdominoplasties despite extensive evidence documenting the benefits of drainless procedures. Continued improvements in progressive tension suturing (PTS) techniques and suture technologies have consistently shown a reduced seroma risk profile that outperforms procedures involving surgical drains. The aim of this report was to assess the authors' combined patient series, which represents the largest and longest-running, retrospective, multicenter set of abdominoplasty patients treated with a PTS technique involving running barbed sutures. Two surgical groups, each at different surgical centers, have for the past decade performed drainless abdominoplasties in which running barbed sutures were used. The results for all 445 patients in this series are reported by surgical center and pooled across centers. The majority of the 445 patients underwent drainless abdominoplasty alone (n = 368; 82.7%); most of the remaining patients did so as part of a circumferential body lift (n = 55; 12.4%). Overall, 33 (7.4%) patients experienced a postoperative complication. The overall seroma rate was 4.7% (21 of 445 patients), but this dropped to 2.3% after surgical technique modifications were made to decrease upper abdominal dead space. The seroma incidence in this series is markedly lower than the 13% seroma rate with drains reported during the same time period and comparable to those seen in drainless abdominoplasties with interrupted suture techniques. Drainless abdominoplasty involving PTS with running barbed sutures shows long-term reproducibility in lowering seroma risk compared to techniques in which drains are inserted, supporting results from published series of drainless abdominoplasty procedures that use interrupted suture techniques.

Progressive tension sutures (PTS) are commonly utilized to reduce postoperative seroma in abdominoplasty. However, current evidence regarding PTS in abdominoplasty is limited to small series and the findings of single institutions. The authors reviewed the available literature concerning the effects of PTS and drains on seroma formation following abdominoplasty, and summarized the different techniques that have been described to date. We conducted a systematic review of the Medline, Embase, and Cochrane databases. We identified randomized controlled trials (RCTs) and observational studies in which the numbers of patients who had postoperative seroma were indicated. We applied the Cochrane Collaboration's tool for assessing the risk of bias. Seven studies were included (three RCTs and four retrospective studies). Patients who had PTS and drains following abdominoplasty had a significantly lower rate of postoperative seroma than those who had drains only. The mean surgical time difference between the two groups was 23 minutes. There was no difference in postoperative seroma rate in patients who had PTS and drains placed following abdominoplasty compared to those who had PTS only. Addition of PTS to drains reduces the risk of postoperative seroma in standard abdominoplasty. More RCTs with larger sample sizes and better comparability are warranted to confirm with more confidence the impact of PTS in abdominoplasty.

Abdominoplasty is a widely performed cosmetic procedure aimed at improving abdominal contour and function. Seroma formation, with an incidence of approximately 10.9%, remains a common and challenging complication. Traditional preventive measures like suction drains and progressive tension sutures (PTS) are effective but can increase operative time and patient discomfort. To address these limitations, the Absorbable Running Barbed Arch Suture (ARBAS) technique was introduced, aiming to simplify wound closure while preventing fluid accumulation. To evaluate the safety and effectiveness of the ARBAS technique in preventing seroma formation and its impact on operative time and recovery. A retrospective observational study was conducted on 74 patients who underwent abdominoplasty with or without rectus diastasis repair between April 2021 and May 2023. All surgeries were performed by a single senior surgeon using the ARBAS technique. The primary endpoint was seroma incidence; secondary endpoints included drainage volume, duration of drainage, and total operative time. No postoperative seromas were observed. Average drainage volume decreased from 36ml on day one to 19ml on day two, allowing early drain removal within 48hours for most patients. The ARBAS technique added only 8minutes to the operative time-significantly less than PTS. No major complications, such as infection, hematoma, or flap necrosis, were reported. The ARBAS technique is a safe and efficient method for seroma prevention in abdominoplasty. It shortens operative time compared to traditional methods, supports faster recovery, and enhances patient comfort. Further multicenter studies are recommended to validate these results and promote its widespread adoption. 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 .

In general, abdominoplasty is a conceptually simple procedure with consistent aesthetic improvement of the abdomen from its preoperative appearance. However, until recently, abdominoplasty has been plagued with an unacceptably high complication rate, with seromas reported in a consistently high percentage of cases. This has been accepted because it was generally easy to treat, reasonably well tolerated by the patient, and had only uncommon long-term sequelae. Drains, compression, and immobilization were the mainstays of prevention. These techniques alone are clearly inadequate in seroma prevention, and there are significant negatives of the preventative measures themselves. Immobilization slows recovery and places the patient at risk of a far worse complication: venous thrombosis. Compression places the vulnerable flap at risk of vascular compromise and can be restrictive to patient mobility. Drains are uncomfortable, poorly tolerated, and dreaded by the patient. More recently, several techniques for decreasing the incidence of seromas have been described, including quilting or progressive tension sutures, avoiding lymphatic disruption by altering the plane of dissection, and lipoabdominoplasty using discontinuous undermining through liposuction, as in this study. All have been shown to be successful at decreasing seroma rates and allowing drains to be safely eliminated. Regardless of which technique is used, inclusion of a seroma reduction technique should be included in the current-day abdominoplasty. The specific method selected by the …

Surgical Management of Primary Thumb Carpometacarpal Osteoarthritis: A Systematic Review

After the first report of laparoscopic incisional and ventral hernia repair (LIVHR) in 1993, several studies have proven its efficacy over open method. Among the technical issues, the technique of mesh fixation to the abdominal wall is still an area of debate. This prospective randomized study was done to compare two techniques of mesh fixation, i.e., tacker with four corner transfascial sutures versus transfascial sutures alone. 68 patients admitted for LIVHR repair (defect size less than 25 cm2) were randomized in two groups: group I, tacker fixation (36 patients) and group II, suture fixation (32 patients). Various intraoperative variables and postoperative outcomes were recorded and analyzed. The patients in the two groups were well matched in terms of age, sex, body mass index (BMI), and hernia characteristics. Mean BMI was 29.0 kg/m2. Operative time was found to be significantly higher in group II (77.5 versus 52.6 min, p=0.000). Patients in group I were found to have significantly higher pain scores at 1 h, 6 h, 24 h, 1 week, 1 month, and 3 months postoperatively. At follow-up, incidence of seromas was higher in group II but the difference was not significant (7 versus 4, p=0.219). During long-term follow-up, patients in group II were satisfied cosmetically. Suture fixation is a cost-effective alternative to tacker fixation, for small and medium-sized defects in anatomically accessible areas. However, suture fixation requires significantly longer operation time, but patients have statistically significantly less postoperative pain.

What's New in Spine Surgery.

Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to localised immunosuppression. Sometimes, it causes superadded Non tuberculous mycobacterial infections that require radical surgeries. After an extensive literature search, no Indian case report on this rare topic could be found, and this case report aims to fill up the void. A 28-yearold female presented with recurrent ulcers over her left axilla, which were refractory to medical treatments and surgeries for the last 5 years. Earlier, she had received a 6 month course of antitubercular drugs after Acid-Fast Bacilli (AFB) were found on pus examination. When the ulcers recurred afterward, she was empirically diagnosed as Non tuberculous mycobacterial infection in Thailand and treated with appropriate antibiotics for 3 months. However, multiple ulcers in new areas recurred over her axilla about a month after her treatment schedule was completed. To achieve complete surgical cure, radical excision of all the tracts, fistulae, and sinuses over her axilla was performed under ultrasound guidance. Wide excision resulted in a significant axillary defect that was reconstructed with large advancement flaps aided by progressive tension sutures. Postoperatively, a 7 year follow-up period of the patient was disease-free with the patient taking all necessary precautions. After 7 years, the affected axilla appeared nearnormal with some areas of stretched scars that did not bother the patient. To conclude, HS with Non tuberculous mycobacteria is rare, and a proper antimicrobial therapy with early en bloc excision under ultrasound guidance produced a complete cure.

The achilles heel of minimally invasive inguinal lymph node dissection: Seroma formation

Commentary regarding the publication “Fractures of the mandibular condyle—A review of 466 cases. Literature review, reflections on treatment and proposals” by N. ZACHARIADES et al.

Topical agents are widely used in the care of burn patients; however the efficacy to prevent local infections and/or sepsis has not been clearly established in studies with a high level of evidence. This systematic review was conducted to assess the comparative efficacy among different topical agents. Material and Methods. The literature search was performed using the Medline database. Key MESH terms were: (burn* or scald*) AND (antibacterial or antibiotic*) AND (topic*) AND (therap* or prophylax*). Only randomized or quasi-randomized clinical trials, with a primary endpoint of local infection and/or sepsis were included. Studies were scored and classified regarding methodological key issues according to their level of evidence. Results. The initial search identified 457 studies of which 14 were eligible for final evaluation, and full text was available for 11 of them. Conclusions. The evidence found in our review does not support differences in efficacy of topical agents to reduce sepsis and/or local infections in burn patients.

Aspects médicolégaux des douleurs pelvipérinéales chroniques