Byline: Medha. Bhave
Context: Seroma formation is a common complication after lipoabdominoplasty. Conventionally, drains have been placed to prevent seroma; however, there are problems with drains, namely, pain, compromised mobilisation, breakage, tissue irritation and infection. Strategies to prevent seroma, such as the use of glue or quilting sutures have all been attempted with variable and unpredictable benefit. Aims: The author extrapolated the experience with own liposuction protocols to lipoabdominoplasty and began doing away with drains from the year 2006 onwards unless absolutely indicated. Incidence of complications is evaluated here. Settings and Design: This retrospective study is the report of our experience with 204 lipoabdominoplasties performed since 2006 upto December 2016. Subjects and Methods: Consecutive abdominoplasty patients were evaluated for seroma formation, wound dehiscence till suture removal. Nuances of operative details that helped avoid drains were contemplated. Results: Only one patient who had drainless abdominoplasty had seroma formation and wound dehiscence. Conclusions: We found that (a) 'toilet liposuction', (a term the author would like to introduce) (b) multilayer wound closure without tension, (c) avoidance of gliding surfaces d) continuous use of pressure garment for 4 days post-operative and (e) reducing the amount of infiltration are the key factors in avoidance of collections and thus seroma formation. If such a technique is diligently followed, desired results are obtained; yet there is no need to insert drains in most patients. Reducing the need of drains permits early ambulation and better patient comfort without seroma and other complications.
It is routine practice to use drains in lipoabdominoplasty operations. It can be safely assumed that only closed; suction drains are being used. Open drains are obsolete due to inconvenience, soakage, soiling of surrounding skin and inability to calculate exact amount of effluent. Closed drains are less messy and facilitate measurement of the drainage fluid. Active drains are preferred over passive.
The function of negative suction drain is purported to be evacuation of accumulated fluids - blood, serum and pus if any. Suction is expected to improve approximation of raw areas by better apposition of the surfaces. However, problematic issues with drains are ineffectiveness, discomfort, difficulty in mobilisation, breakage or premature extrusion, bacterial colonisation and increased the duration of hospitalisation.
Our earlier experience with liposuction patients showed that seromas could be avoided by uninterrupted use of elastic garment for initial 4 days post-operatively. This prompted us to adopt the same protocol for our lipoabdominoplasty patients. Once drains were done away with, we could implement uninterrupted garment support for initial 4 days with early mobilisation after abdominoplasty.
The objective of our retrospective study is to evaluate the results of lipoabdominoplasty, wherein drains were avoided and to define a protocol to avoid seromas after drainless abdominoplasty.
Subjects and Methods
Clinical records of 204 consecutive abdominoplasty patients operated in the last 11 years (2006-2017) by a single surgeon were reviewed retrospectively. Parameters observed were (1) method of abdominal closure (2) occurrence of seroma, haematoma, pus collection, skin necrosis and wound discharge or dehiscence till the time of suture...