How Do You Avoid Tension on the Incision During Healing?

Question

In a tummy tuck, the external flesh is repositioned - I'm curious about closing of the incision and how tension/pulling is avoided. Is it usually closed with sutures or staples? Won't gravity (or any physical positions that either arch the spine or stretch the skin upwards) affect the scar healing? Also (similarly), what is the result if too much flesh were to be removed, causing an upright physical posture to pull too much on the sutures/staples? Hypothetically.

Jerome Edelstein, MD · Answer

You should not stand or sit straight up after your tummy tuck to prevent pulling on your incision lines. If too much skin is removed, you'll definitely feel very, very tight and the risk of wound separation would increase.Sutures are preferred over staples, as staples result in scarring that is generally more uneven and visible.

Mathew C. Mosher, MD · Answer

All Plastic Surgeons try to minimize tension on the skin closure with every procedure performed. This has a little bit of influence on the scars final appearance. We all have our preferred approach. I choose to use progressive tension sutures and place most of the tension on the deeper layers rather than the skin. 

After surgery there is always a period of tissue tension adjustment as your posture gradually straightens. The skin and incision will stretch during this time as well. In most cases, the scar will mature normally and appear like a stretch mark rather than a thin line after a year. Many of us also employ proactive strategies to manage the scar during the most important early months after surgery. Careful planning, skilled surgical technique and proactive scar management strategies have made the appearance of abdominoplasty scars much less problematic.

Good luck!

Richard Baxter, MD · Answer

Tension on a wound is one of the biggest contributors to poor scar formation, so methods like the progressive tension suture method help by placing the tension away from the wound edges. This uses a series of stitches under the flap that distribute the tension on deeper stronger layers that the skin. It also helps minimize the need for drain tubes. We also use tape on the incision for about 6 weeks which also helps reduce tension.

Scott C. Sattler, MD, FACS · Answer

The tension of a proper tummy tuck closer is placed along the superficial fascial layer - this is closed with a heavy, absorbably barbed suture in my practice. The skin itself is on no tension when the wound is closed. This technique has yielded high quality scars.

Gary Hall, MD (retired) · Answer

With a plastic surgical closure of a wound, care is usually taken to close the would in layers taking tension off of the skin closure.  This will help give you a good scar.  I also will usually place steri strips on the incision which helps remove the most superficial tension as well as put pressure on the scar which can help.

	Gary Hall,MD

How Do You Avoid Tension on the Incision During Healing?

Answers (5)