Use of absorbable running barbed suture and progressive tension technique in abdominoplasty: a novel approach.

Certain general principles regarding abdominoplasty have remained constant throughout the last century, although incision patterns, fascial repair, and fatty contour techniques have varied. What has remained constant has been the use of a layered closure technique for final wound approximation, including in most cases the closure of Scarpa’s fascia, popularized by the work of Lockwood.1 Controversy, however, has continued to present itself over the types of suture material to be used for fascial plication and wound closure, as well as over the necessity for drains following these procedures. The Quill self-retaining system (Quill SRS; Angiotech Pharmaceuticals, Inc. Vancouver, Canada) is a knotless, bidirectional, barbed, self-anchoring suture that incorporates tiny barbs spaced evenly in a helical array on either side of a nonbarbed midsegment.2 Two needles are attached, one at each suture end. In contrast to standard sutures, wound tension is distributed across multiple barbs running the length of the suture line rather than at the knotted end. This suture was designed to allow for faster, more efficient, and more economical tissue approximation and wound closure. It is available in absorbable (polydioxanone; polyglycolide-polycaprolactone copolymer, Monoderm) and nonabsorbable (polypropylene, nylon) formulations. This study evaluated the operative times, closure costs, and safety outcomes associated with bidirectional barbed absorbable sutures compared with standard sutures when used for soft-tissue approximation, including fascial repair, in patients undergoing cosmetic abdominoplasty. PATIENTS AND METHODS A group of 24 patients scheduled for abdominoplasty were operated on by the same surgeon in the same facility, with the same anesthesiologist, between June of 2007 and November of 2008. All tissue approximation and wound closure procedures for the first 12 patients were performed using standard nonbarbed sutures with drains and absorbable deep dermal staples. Barbed absorbable sutures were used for the remaining 12 patients without drains or dermal staples. In all cases, a running progressive tension suture was deployed in the paramedian area, securing Scarpa’s fascia in a vertical fashion on each side from the costal margin to the lower incision (Figs. 1 and 2). All incisions were closed in three layers (Scarpa’s, deep dermal, and subcuticular). In the standard suture group, fascial plication was performed using size 0 polydiaxanone sutures (PDS II; Ethicon, Somerville, N.J.), the progressive tension suture used was a 2-0 polydiaxanone (PDS II; Ethicon), then a skin stapler (Insorb Incisive Surgical, Inc., Plymouth, Minn.) was used for deep dermal approximation, and the subcuticular closure was performed with 4-0 poliglecaprone suture (Monocryl; Ethicon). In the bidirectional barbed suture group, fascial plication was performed using sizes 2, 0, or 2-0 polydiaxanone sutures, the progressive tension suture used was 0 or 2-0 polydiaxanone, and skin closure was performed using polydioxanone and/or Monoderm sutures in various sizes (2-0 and 3-0) and combi-