采用无引流渐进性张力缝合后血清肿发生率降低：一家外科中心7年451例腹壁成形术的经验
Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years.
作者信息
Macias Luis H, Kwon Edwin, Gould Daniel J, Spring Michelle A, Stevens W Grant
机构信息
Dr Macias is an Associate Clinical Professor of Surgery, Dr Gould is a Resident, and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA. Dr Kwon is a Fellow, USC Aesthetic Surgery Fellowship, Los Angeles, CA. Dr Spring is a plastic surgeon in private practice in Kalispell, MT.
出版信息
Aesthet Surg J. 2016 Oct;36(9):1029-35. doi: 10.1093/asj/sjw040. Epub 2016 Mar 14.
BACKGROUND
Abdominoplasty is a common aesthetic procedure in the United States. Pollock and Pollock described their progressive tension technique in 2000 and published a series of 597 patients in 2012 of their experience. The reported seroma rate in the literature ranges from 2% to 26% with drains and 0.1% to 4% with progressive tension sutures (PTS) without drains.
OBJECTIVES
Given these data, we decided to use PTS and forego drains in abdominoplasty. Here we present our experience with the transition.
METHODS
This is a retrospective chart review of 451 abdominoplasties performed at our outpatient surgery center over a 7-year period (2009-2015). We gathered data on patient demographics, concomitant liposuction, and complications and length of follow up.
RESULTS
Five main differences were examined in PTS vs traditional abdominoplasty using drains groups. These included rate of seroma, wound complication, scar revision, hematoma, and follow up. We found a decreased rate of seroma in the PTS group, 2% vs 9%. Wound complications were similar. Scar revision was slightly higher in the PTS group at 17% vs 10% in traditional abdominoplasty, this association had a P value of .048. The rates of hematoma were similar (0% vs 1%). The mean follow up was 6 months in PTS and 9 months in traditional abdominoplasty. Addition of liposuction did not increase the rate of seroma.
CONCLUSIONS
PTS without drains significantly decreased the seroma rate in our practice. Our experience adds to the mounting evidence that surgeons should consider using the PTS technique and abandon the use of drains in abdominoplasty. A well powered, multicenter, randomized controlled study is needed in order to definitively lay this question to rest.
LEVEL OF EVIDENCE
4 Therapeutic.
背景
腹壁成形术在美国是一种常见的美容手术。波洛克和波洛克在2000年描述了他们的渐进性张力技术，并于2012年发表了一系列597例患者的经验。文献报道的使用引流管时血清肿发生率为2%至26%，使用渐进性张力缝合（PTS）且不使用引流管时为0.1%至4%。
目的
鉴于这些数据，我们决定在腹壁成形术中使用PTS并放弃引流管。在此我们介绍我们在这一转变过程中的经验。
方法
这是一项对我们门诊手术中心在7年期间（2009 - 2015年）进行的451例腹壁成形术的回顾性病历审查。我们收集了患者人口统计学资料、同期吸脂情况、并发症以及随访时间的数据。
结果
对使用PTS组与使用引流管的传统腹壁成形术组进行了五项主要差异检查。这些差异包括血清肿发生率、伤口并发症、瘢痕修复、血肿以及随访情况。我们发现PTS组血清肿发生率降低，分别为2%和9%。伤口并发症情况相似。PTS组瘢痕修复率略高，为17%，而传统腹壁成形术组为10%，这种关联的P值为0.048。血肿发生率相似（0%和1%）。PTS组的平均随访时间为6个月，传统腹壁成形术组为9个月。吸脂术的增加并未提高血清肿发生率。
结论
不使用引流管的PTS在我们的实践中显著降低了血清肿发生率。我们的经验进一步证明，外科医生在腹壁成形术中应考虑使用PTS技术并放弃使用引流管。需要进行一项样本量充足、多中心、随机对照研究，以便最终解决这个问题。
证据级别
4 治疗性。
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