Commentary on: Progressive Tension Sutures in Abdominoplasty: A Review of 597 Consecutive Cases

It is uncommon to read a follow-up article by original authors on a surgical technique many years after the initial report. Drs Pollock and Pollock1 provide additional evidence that the progressive tension suture (PTS) technique they presented in 2000 can almost entirely eliminate seroma in abdominoplasty. Although other techniques to prevent seroma have been published—including tissue glues, different dissection planes, new dissection devices, and prolonged patient immobilization2,,-5—it appears that none has been supported by favorable results published by other authors who treated a large number of patients. The success of the PTS technique has been corroborated by several large series,6,-8 including reports with Level 2 and Level 3 evidence.9,10 From the available evidence, PTS appears to be the only technique that continues to be associated with low seroma rates and allows for the elimination of drains. Since their original publication,1 the authors have made minor modifications, including the use of a heavier absorbable suture (0 Vicryl instead of 3-0 Vicryl; Ethicon, Inc, Somerville, New Jersey) and placement of the PTS further apart (2 cm instead of 1 cm apart). The latter modification allows for only 18 to 20 PTS to be placed and should take no more than 15 minutes after becoming comfortable with the procedure, typically after a few cases. The authors’ current study also confirms that PTS are safe and effective when abdominoplasty is combined with liposuction, as 67% of their patients had liposuction of the abdominoplasty flap or an adjacent area without any increased risk of seroma formation.