Drains are Not Needed in Body Contouring Procedures. Karol A Gutowski, MD, FACS
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1 Drains are Not Needed in Body Contouring Procedures Karol A Gutowski, MD, FACS
2 Drains are Not Needed in Body Contouring Procedures Karol A Gutowski, MD, FACS
3 Disclosures The Doctors Company - Advisory Board Angiotech/Quill - Advisory Board Suneva Medical - Instructor Viora - Speaker Will not discuss off-label uses
4 Objectives Rethink the use of routine subcutaneous drains in body contouring procedures Make a change in your practice Improve your patient s experience
5 Breast Reduction Mastopexy Augmentation Trunk Abdominoplasty Body lift Extremity Arm lift Thigh lift Common Drain Sites
6 Drains Standard of care but no supporting evidence Do not prevent hematomas No evidence in reducing seromas (non-lymphatic cases) Risks Entry point for pathogens Patient discomfort & anxiety at removal More home care & less patient mobility Additional scarring
7 Drains in Breast Reduction
8 Drains in Breast Augmentation No evidence to support drains in primary breast augmentation Drains may increase risk of capsular contracture 4x No guidelines for secondary cases with capsulectomy or with biological products
9 Patient s Perception of Drains
10 Patient s Perception of Drains
11 Drains in Abdominoplasty
12 Drains in Abdominoplasty PRS 2010 ASJ 2009
13 Barbed Progressive Tension Sutures
14 Barbed Progressive Tension Sutures Finish lower abdominal PTS Address the umbilical transposition
15 Barbed Progressive Tension Sutures Use Non-Dominant Hand for Traction Toward Incision
16 Body Lift Deep 3-point interrupted sutures Superficial fascia - deep tissue - superficial fascia or Running barbed suture in superficial fascia Either method closes the posterior dead space Abdominal binder or compression garment
17 Arm Lift Medial or posterior incision 3-point interrupted suture Running barbed suture in superficial fascia or Moderate compression (ACE wrap or garment)
18 Thigh Lift Upper incision with or without medial incision Running barbed suture in superficial fascia Consider drain (remove next day if low output) Moderate compression (ACE wrap or garment)
19 Seroma Treatment Amount, location & timing Seroma treatment Aspirate Percutaneous drain (SeromaCath) Sclerosing agent Doxycycline 500 mg in 50 cc NS Ethanol 95% Seroma capsule excision
20 Breast Reduction (No Drains) Breast Reductions (481 patients, 910 breasts) Tumescent infiltration (500 to 1000cc per breast) 93% inferior pedicle with Wise pattern 71% with lateral chest liposuction 4 hematomas (0.4%) 1 abscess (0.1%) 0 seroma
21 Abdominoplasty (No Drains) 177 Abdominoplasties + 34 Body lifts (211 patients) Tumescent infiltration (1000 to 2000cc) 78% with lateral truck liposuction Anterior barbed progressive tension sutures Posterior barbed running sutures Compression garments or binders Early ambulation
22 Abdominoplasty (No Drains) Seroma 6 (3%) Drained by single needle aspiration 4 Drained by two needle aspirations 2 Wound dehiscence (> 1 cm) 5 (2%) Anterior & superficial (skin only) 2 Posterior & superficial (skin only) 2 Lateral & deep (Scarpa s fascia) 1 Hematoma 0 (0%)
23 Arm & Thigh Lift (No Drains) Arm lift (51 patients, 102 arms) Tumescent infiltration (100 to 300cc per arm) 21% with posterior arm liposuction 3 seromas (2 aspirated, 1 excised) Thigh lift (19 patients, 38 thighs) Tumescent infiltration (400 to 800cc per thigh) 44% with thigh liposuction 7 no drain, 12 drain removed next day 2 seromas (1 aspirated, 1 excised)
24 No Drain Body Contouring Patient Arm lift Mastopexy with lateral autoaugmentation Body lift Thigh lift
25 No Drain Body Contouring Patient No undermining = no PTS Undermining = PTS
26 No Drain Body Contouring Patient
27 No Drain Body Contouring Patient After 2 weeks
28 No Drain Body Contouring Patient After 4 weeks
29 No Drain Body Contouring Patient After 3 months
30 Summary Little evidence for drains in body contouring Surgical technique can eliminate need for drains Low seroma incidence when drains not used Personal experience No patient every asked for a drain to be used All patients were happy that drains weren t used
31 Not Using Drains is an Uplifting Experience!
32 Drains are Not Needed in Body Contouring Procedures Karol A Gutowski, MD, FACS Karol@DrGutowski.com
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36 BS-PTS Abdominoplasty (1 year)
37 BS-PTS Abdominoplasty (1 year)
38 BS-PTS Abdominoplasty (5 months)
39 BS-PTS Abdominoplasty (5 months)
40 BS-PTS Abdominoplasty (5 months)
41 BS-PTS Abdominoplasty (7 weeks) Exposed #2 PDO Suture
42 BS-PTS Abdominoplasty (7 weeks)
43 MWL BS-PTS Abdominoplasty & liposuction (4 months)
44 MWL BS-PTS Abdominoplasty & liposuction (4 months)
45 MWL BS-PTS Abdominoplasty & liposuction (4 months)
46 MWL BS-PTS Abdominoplasty & liposuction (4 months)
47 Video Presentation
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Breast reduction surgery reduction mammaplasty Is it right for me? What to expect during your consultation Be prepared to discuss:
This guide is for women who are considering having an operation to lift their breasts. We advise that you talk to a plastic surgeon and only use this information as a guide to the procedure. Breast reduction
Strattice Reconstructive Tissue Matrix used in the repair of rippling
Clinical case study Strattice Tissue Matrix Strattice Reconstructive Tissue Matrix used in the repair of rippling Steven Teitelbaum, MD* Santa Monica, CA Case summary A 48-year-old woman with a history
The evolution of lipoplasty technique1 has in turn
Full bdominoplasty With Circumferential Lipoplasty Lázaro Cárdenas-Camarena, MD; and Victor Laguna-arraza, MD Dr. Cárdenas-Camarena is from the Instituto Jalisciense de Cirugía Reconstructiva in Guadalajara,
Clinical Policy Title: Body contouring surgery after massive weight loss
Clinical Policy Title: Body contouring surgery after massive weight loss Clinical Policy Number: 18.03.03 Effective Date: July 1, 2016 Initial Review Date: April 27, 2016 Most Recent Review Date: April
CONSENT FOR LIPOSUCTION SURGERY
CONSENT FOR LIPOSUCTION SURGERY Liposuction is a surgical technique to remove unwanted deposits of fat from specific areas of the body, including the face and neck, upper arms, trunk, abdomen, buttocks,