Our Experience of Tie Over bolster and Quilting Sutures Versus Stapler fixation for Split thickness skin graft in post burn neck contracture – A Comparative study

Background:Traditional method to fix Split thickness skin graft in post burn neck contracture is Tie over Bolster dressing and Quilting sutures. We used staplers to fix split thickness skin graft. Methodology:Acomparative study conducted in 30 patients with post burn neck contracture at tertiary care hospital, Nashik over a period of 6 years. Time required for fixation of split thickness skin graft, outcome in terms of graft uptake and patients comfort level while removing sutures and stapler recorded. Results: Total 30 Patients were included in our study. Mean time required for Tie over and quilting suture was 10.53 ± 0.88 min, significantly higher than the mean time in stapler fixation 4.87 ± 0.81 min. (p<0.001). Graft take was 95% in stapler and 93% in Tie over and quilting suture. Conclusion:Fixation of Split thickness skin graft with stapler is more rapid, less time consuming also results in decreased surgical and anaesthesia time. More patient friendly while removing staplers with comparable skin graft uptake

Total quilting suture at latissimus dorsi muscle donor site: Drain tube is no longer needed

PURPOSE: The purpose of this study was to assess the effect of quilting suture extent on the latissimus dorsi myocutaneous flap (LDMCF) donor site and the necessity of drainage.METHODS: Clinical data of 136 breast cancer patients, who underwent breast reconstruction using LDMCF between May 2014 and December 2015, were retrospectively reviewed. Patients were divided into three groups. Group A: quilting sutures were performed on half of the LDMCF donor site and a closed suction drain was inserted. Group B: quilting sutures were performed for the entire LDMCF donor site and a closed suction drain was inserted. Group C: quilting sutures were performed for the entire LDMCF donor site and no drain was inserted. The duration of drainage, total drainage, length of hospital stay, number of postoperative aspirations for seroma removal, and total aspirated volume were compared.RESULTS: In the comparison of groups A and B, group B showed better results including the total amount of drained seroma, drain maintenance period, number of aspirations for seroma removal after drainage tube removal, total aspirated seroma, and hospitalization period with statistical significance (P<0.05). In the comparison of groups B and C, group C without drain showed no difference in all other variables except mean total drained seroma volume. Therefore, group C was superior to group A and there was no difference compared to group B with drain, even though the drain was not inserted.CONCLUSION: Total quilting suture at LDMCF donor site can reduce seroma formation and eliminate the need for a drain tube.

Feasibility of Use of a Barbed Suture (V-Loc 180) for Quilting the Donor Site in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction

BACKGROUND: Latissimus dorsi (LD) myocutaneous flap is a popular method of breast reconstruction which can be associated with high incidence of seroma formation. Quilting sutures at the harvest site are used to reduce this. Barbed sutures are self anchoring sutures which avoid multiple knotting and can be useful in quilting. METHODS: A retrospective analysis of prospectively maintained database of patients who underwent LD flap breast reconstruction between January 2009 and January 2011 was carried out. Seroma formation at the harvest site, wound related complications, inpatient stay and duration of surgery were analysed and a comparison was made between two groups where quilting was done with barbed (V-Loc) suture and conventional polydioxanone (PDS) II sutures. RESULTS: Fifty-seven patients were included of which 33 had quilting by V-Loc sutures and in 24 patients PDS II suture was used. Median age in the PDS group was 55 years (interquartile range [IQR)], 45 to 61 years) which was comparable to the V-Loc group (53 years [IQR, 48 to 59 years]; P-value 0.948). Sixteen patients (28%) had significant seroma formation and 5 (9%) patients developed superficial wound dehiscence. Incidences of seroma or wound complications were comparable (P-value 0.378 and 1.00, respectively). Secondary outcomes such as total duration of surgery, total inpatient stay, total amount of drain at the donor site were also similar in two groups. CONCLUSIONS: Use of barbed sutures for quilting the donor site in LD flap reconstruction is a feasible option and the associated seroma formation and wound complications are comparable with conventional sutures.

Does Abdominal Quilting Suture Prevent Seroma in TRAM Flap Breast Reconstruction?

PURPOSE: Seroma formation is still major complication of abdominal donor site after TRAM flap surgery in spite of various efforts to reduce seroma formation such as closed suction drain. We performed a clinical study, that quilting suture at abdominal donor site can prevent seroma formation. METHODS: Between May 2002 and September 2008, we performed 600 breast reconstructions using a unilateral TRAM flap except patients who has smoking history or abdominal scar. We performed 300 breast reconstructions without quilting sutures(A: Experimental group) until January 06, and after then 300 reconstructions with quilting sutures (B: Control group). We compared total drain output (mL), time to drain removal(days), and donor site complications between two groups. RESULTS: There were no statistical difference at BMI (p=0.28) and time to remove suction drain between two group. (A: 8.37, B: 9.69)(p=0.40) But, total drain output was reduced with quilting suture. (A: 432.5, B: 495.2) (p=0.005) And also complication rate was decreased, such as seroma formation, epigastric bulging. (A: 1%, B: 7%) (p=0.005) CONCLUSION: Quilting suture is a simple and reliable method to reduce seroma formation and abdominal donor site complication.

Limited Dissection Face Lift with PDS Quilting Suture

PURPOSE: Facial rejuvenating surgery has become a challenge to most plastic surgeons. Patients are demanding fewer complications, a prompt recovery, and more natural results. Current trend of the face lift surgery has been developed into less invasive procedures. Every aging patient in Asia wants to look younger without obvious evidence of surgical correction. METHODS: The authors performed the limited dissection face lift with PDS quilting suture on twenty five patients. These five quilting sutures consist of sutures at 1~2 cm posterior to the prominent point of zygoma to the periosteum of the zygomatic arch, at the lateral border of Bichat's fat pad area to the zygomatic arch, at the lateral border of the orbicularis oculi muscle to the deep temporal fascia, at the upper lateral border of the platysma to the periosteum of the mastoid, and at the anterior lower margin of the earlobe to the deep temporal fascia by quilting suture technique to achieve rejuvenation. RESULTS: These procedures could produce a balanced volumetric rejuvenation. This method gave considerable benefit of stable and satisfactory results. It provides reduced operative time, well corrected nasolabial fold and neck wrinkle, and swift recovery with minimal complications. CONCLUSION: Although it could not replace the classic facelift, this technique can be recommended as an option for patients who do not present with advanced facial aging or not want a more extensive procedure.

Quilting Prevents Seroma Formation following Immediate LDMCF Reconstruction after Quadrantectomy

PURPOSE: Latissimus dorsi myocutaneous flap (LDMCF) is a commonly used technique for breast reconstruction following breast-conserving surgery. However, this technique has a high incidence of donor site seroma. The aim of this study is to evaluate the effect of donor-site quilting on seroma formation. METHODS: A retrospective review of 95 patients who underwent immediate breast reconstruction with LDMCF from May of 2006 through February of 2007 was performed. Patients were divided into Group A, in which only a closed suction drain was used, and Group B, in which quilting and a closed suction drain were used. The outcome measures were age, body mass index (BMI), mastectomy volume, duration of drain, total volume of postoperative seroma, length of hospital stay, and incidence of postoperative aspiration. RESULTS: In Group B, the total amount of seroma, duration of drain, and length of hospital stay were significantly reduced (P<0.05). However, the incidence of postoperative aspiration was not different between Group A and Group B (P=0.06). CONCLUSION: The quilting technique reduces the volume of postoperative seroma and may help prevent of seroma after LDMCF.

A Quilting Suture Technique for the Correction of Prominent Ears

A great number of operative techniques has been described about the correction of the prominent ears. The most primary deformity of the prominent ears comes from an underdeveloped or unfolded antihelix, which results in widening of the conchoscaphal angle and/or flattening of the superior crus, and which, in severe forms, involves antihelical body and inferior crus. Most authors manage the prominent ear deformity by excising, suturing, scoring, or sculpturing the auricular cartilage. We carried out a modified quilting suture technique in order to produce an antihelix. This technique provides several advantages; 1) it prevents the bowstring of the suture material during the formation of the helix; 2) the procedure is easy and time-saving; 3) the reconstructed ear shows reliable results in firmness and stability against external force or trauma; 4) the recurrence rate is not more than that of the conventional methods.