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Progressive Tension Suture Technique Canadian Surgeons? (photo)

After years research I am eager to finally go ahead with an abdominoplasty. Having four kids I have loose skin and alot of stretch marks as I am quite small (just under 110lbs and 5'5"). I have recently learned about the progressive tension suture method which I am interested in as the scars seem to heal very nicely. Are their any Plastic Surgeons in Canada that specialize in this technique? Does it differ from the "quilting" method? I’ve read conflicting info. Any guidance is appreciated.

Doctor Answers (8)

Progressive Tension Sutures and Abdominoplasty- Canadian Style


Our practice in Toronto has featured this technique for over 10 years.  The terms 'progressive tension' vs. 'quilting' are used interchangeably, but effective use of PTS requires a comprehensive understanding of what the sutures can do to improve abdominoplasty. PTS distribute tension across the abdominal wall fascia, so that there is less tendency for the flap edge to drift upwards creating a high scar location. There is also less tension on the scar, so it heals better with less spread or thickening.  Secondly, PTS close space between the skin and the muscle so that there is less opportunity for fluid collection.  This in turn means no drains, and no tight belts, each of which can cause problems in the post-operative period.  PTS can also be used to shape the abdominal contour and get the most from your abdominoplasty. 

Toronto Plastic Surgeon
5.0 out of 5 stars 7 reviews

Progressive Tension Suturing vs. Quilting Sutures


The difference between progressive tension sutures and quilting sutures is a technical one.  Progressive tension sutures are a type of quilting sutures.  Advocates of progressive tension sutures will tell you that they are placed in such a way as to pull on and advance the flap of skin while regular quilting sutures just tie the skin down to the underlying muscle.  I live and work in Texas and cannot make a recommendation in Canada for you.

Sacha Obaid, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 21 reviews

In abdominoplasty progressive tension suturing and "quilting" are the same thing.


Selective suturing of the skin and fat flap to the abdominal wall is intended to obliterate dead  space and remove tension from skin closure.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

Quilting vs Progressive Tension Suture Techniques


   Quilting sutures were designed to reduce the likelihood of fluid collection in tummy tuck and to help eliminate the need for drains.  The progressive tension suture implies that tension is taken off of the closure by placing interrupted sutures above the level of closure.  Stitches can be placed that serve both purposes.  However, people are probably splitting hairs about them being markedly different.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 218 reviews

PTS or drainless tummy tuck

PTS has helped resolve one of the lingering problems associated with recovery: the use of surgical drains. After the traditional form of abdominoplasty is complete, patients are typically fitted with small, thin tubes that pass through the skin. For about one to two weeks following surgery, these tubes are used to drain any of the excess fluid that accumulates in the potential space between the skin / fat and the muscle left behind by the surgery and ensures a safe, speedy recovery. Without drains, the fluid that naturally collects in the wound can stop the underlying fat and muscle tissues from coming together and properly healing.

When using PTS, the first part of surgery remains the same: creating a horizontal abdominal incision, strengthening the weakened or separated internal muscles, removing excess skin, liposuction and repositioning the remaining tissue. Then, PTS bypasses what would usually be the next step: placing drainage tubes. At this point in the procedure, I instead administer a series of carefully placed stitches that close the cavity usually left open and tended with drains. These tissues are then able to heal without any significant amount of fluid accumulation interfering with the process.

While using PTS to create a drainless tummy tuck may take the surgeon slightly longer to perform, the benefits of the approach are well worth it. Not having drains in place makes the recovery process more comfortable, cost effective, and less painful. There is also a greatly lessened risk of infection, additional scarring, and healing complications. When PTS is used, the tummy tuck heals more quickly and recovery isn't as difficult for the patient. My patients have achieved highly satisfying results with this technique.

However, not everyone is a candidate for this type of surgery. For example, thinner patients may benefit more from the use of drains than others. When PTS is used, thinner patients are at a higher risk for developing permanently dimpled skin due to the stitching technique inherent to the no drain approach. Consequently, it is necessary for every patient to be carefully assessed during their consultation.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 63 reviews

Drains and Tummy Tucks

Thank you for your post. Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'. This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space. In a tummy tuck, the space is in between the skin/fat layer and the muscle layer. Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer. At that point, no more fluid is secreted into the area, because there is no more space for fluid. The length of time that this takes varies from patient to patient. Some patients heal much faster, thus the layers seal together much faster. Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other. The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow. This is because it takes just a little bit of blood to make the fluid dark red. Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days. Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.
More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision. This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains. However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue. This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 28 reviews

Progressive Tension Sutures


The progressive tension method and quilting sutures are the same technique.  It minimizes the tension on the wound which can improve the scar quality.  You have some excess skin and weakness of your abdominal muscles.  You don't have a ton of excess skin so you might end up with a small inverted "T" incision.  I would recommend going to the ASPS website to find a BC in Canada.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Quilting and progressive sutures are the same thing


they are two different names for the same thing.  the idea is to use sutures to help take the tension off of the incision and to help to eliminate the dead space and decrease the rate of seroma.  some use drains with it.  some eliminate the use of drains altogether.

Eric Chang, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 8 reviews

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