The Dallas-based father and son plastic surgeons describe the progressive tension sutures (PTS) technique as "controlled advancement of the abdominal skin flap by the placement of multiple sutures from the skin flap to the deep fascia."
Todd A. Pollock, M.D., explains, "This secure fixation closes dead space, but more important, it prevents the shearing forces caused by movement in the early postoperative period, thereby preventing disruption of early healing."Calling their technique "a simple modification," the senior physician, Harlan Pollock, M.D., says PTS eliminates the need for drains and permits the patient to ambulate in an upright posture as early as comfortable.
Excisional abdominoplasty issues
While excisional abdominoplasty continues to grow in popularity — especially as the incidence of gastric bypass surgery increases — it remains associated with worrisome complications, the most common of which are seroma formation and skin flap necrosis.
"Although these complications are usually easily managed," Dr. Todd Pollock says, "They can be distressing to the patient and physician, increase the risk of infection and contour irregularity and in some cases, be persistent and difficult."
Because the PTS procedure circumvents many of the causes of complications associated with the conventional procedure, the surgeons stress that there is no need to subject patients to preventive efforts such as post-op drains, bent posture and limited ambulation.
With PTS, the progressive tension sutures are placed from the skin flap to the deep fascia as the abdominal flap is advanced. This distal advancement is maintained as each suture is placed and tied. In this manner, tension is redistributed over a broad area of the abdominal flap, as opposed to the conventional procedure in which all the tension is concentrated at the level of the incision.
Because the PTS technique allows closure of the incision with virtually no tension, it improves the quality of resulting scars and prevents healing problems. With minimal tension on the skin closure, no superior migration of the transverse scar has been observed, according to the surgeons.
Dr. Harlan Pollock mentions another advantage of PTS — a better-looking navel.
"By using the sutures, the umbilicus can be easily inset in continuity with the closure as the PTS closure reaches the appropriate level. By insetting the umbilicus from beneath the flap and under direct vision, the closure can be inverted deep into the umbilicus. The umbilical scar is hidden and has a more natural appearance."
Not quilting sutures
Dr. Harlan Pollock makes a point of differentiating his and his son's method from so-called "quilting" techniques.
"Others have described 'quilting' techniques to close two tissue layers together to reduce the dead space created in abdominoplasty. While these methods are similar, our progressive tension sutures are placed under tension to precisely advance a skin flap distally, as well as to eliminate dead space and prevent shear forces on the healing wound. We find, with our method, patients have an easier convalescence and experience fewer complications."