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A New Technique of External Quilting Sutures

2012; Lippincott Williams & Wilkins; Volume: 131; Issue: 1 Linguagem: Inglês

10.1097/prs.0b013e318272a1cc

1529-4242

João Cabas Neto, Dario Ernesto Rodriguez Fernandez, Murilo Muniz Boles,

Dermatologic Treatments and Research

Sir:FigureHematomas in rhytidectomies were common despite the use of many preventive measures such as different types of suction drains, careful hemostasis, Valsalva maneuvers, and fibrin glue1,2; the absence of epinephrine in the local anesthetic solution1; and the use of different types of compressive dressings. None of these seemed to be completely effective in avoiding hematomas, thus leaving the surgical team uncertain as to whether a return to the operating table would be necessary. Between October of 2010 and March of 2012, the first author (J.C.N.) operated on 100 patients, performing a new method of preventing hematomas by using external quilting sutures of the undermined skin to the superficial musculoaponeurotic system/platysma in the midface and neck. The external quilting sutures had the same advantages as the internal quilting sutures3 (used in the temporal region) but without the problem of skin dimples. Their functions were to reduce the dead spaces and prevent the expansion of hematomas, reduce the formation of seromas, decrease tension at the rhytidectomy suture lines, and restrain the skin release and its movement back over the underlying tissue.4 The technique adopted tor carrying out the external sutures is as follows. The suture is started externally in the skin, going deep to grab the platysma and superficial musculoaponeurotic system and returning to the skin again, tied without tension, forming a knot. The knot can be tied directly above the skin (this was done only twice) or performed (as in all other cases) above an Adaptic nonadhering dressing (Johnson & Johnson, New Brunswick, N.J.), further improving the aspect of the temporary marks on the skin. The external quilting sutures follow the direction of the flap traction, and one should try to keep all the sutures parallel to each other, keeping at least 2 cm of skin flap near its borders without stitches to control and preserve its vascularization. The average number of sutures per side was approximately 27 knots. The sutures are kept in place for only 2 days, and they left no permanent marks on the skin. In cases where some flap ischemia had been observed, it was easy to remove such sutures and to relocate them in a more convenient position. Hematomas did not occur even in cases where the patient was woken up before the dressings had been completed or had suffered several episodes of vomiting in the immediate postoperative period. It is now clear that despite their initial strange appearance, the use of internal and external quilting sutures is the most important and effective single measure with which to avoid the occurrence of hematomas. In our view, all the other preventive measures are of secondary importance by comparison. João Cabas Neto, M.D. Dario Ernesto Rodriguez Fernandez, M.D. Murilo Muniz Boles, M.D. Brazilian Society of Plastic Surgery, Vitória, Espírito Santo, Brazil DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.