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Use of Progressive Tension Sutures in Components Separation: Merging Cosmetic Surgery Techniques with Reconstructive Surgery Outcomes

Janis, Jeffrey E. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 851–855
doi: 10.1097/PRS.0b013e318262f1fd
Reconstructive: Trunk: Ideas and Innovations

Summary: Components separation is a widely used technique for defect size reduction in abdominal wall reconstruction, and ultimately helps achieve gold standard primary fascial reapproximation in many cases. Even with perforator-sparing techniques, oftentimes there are undermined skin flaps to varying degrees that can lead to complications such as seromas. In this article, the author describes the previously published technique of “progressive tension sutures” reported in the cosmetic literature and extrapolates it to reconstructive abdominal surgery with statistically significant decreases in drain output. This technique also enables recruitment of skin to the midline to afford tension-free reapproximation and excision of redundancy, thereby discarding the most random portion of the skin flaps.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication April 8, 2011; accepted April 17, 2012.

Disclosure:The author is a consultant for LifeCell Corporation.

Jeffrey E. Janis, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75309-9132 E-mail

©2012American Society of Plastic Surgeons