How to prevent stitches from opening around muscle repair?

I just had a revision on tt because the fasia was to thin and all stitches opened around muscle repair. How can this be prevented this time

Doctor Answers 6

#Tummytuck #plasticsurgery #abdominoplasty

Hi angelbaby54, thank you for your excellent question. Congratulations on your recent surgery.  Without the benefit of knowing your full health history and an in person exam it's impossible to say for certain. Your concerns are important to discuss directly with your board certified plastic surgeon.  He or she will appreciate the open communication and will want to help you. If you decide to seek a second opinion, consult with a Board Certified Plastic Surgeon in person, preferably one who has these credentials: *Board Certified by the American Board of Plastic Surgery - the gold star symbol
*A member of the ASPS (American Society of Plastic Surgeons) - the circle symbol
*A member of the ASAPS (American Society of Aesthetic Plastic Surgeons) - the Queen Nefertiti symbol with a Triangle.   Hope this is helpful and wish you all the very best. Kind regards, Brian Coan, MD, FACS  CARE Plastic Surgery


Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 56 reviews

Watch your physical activity

After tummy tuck surgery, I advise the patients to take two weeks off from work. The patients may return to work, but may not engage in any strenuous activity. At two months, the patients start low impact cardio. At three months they can engage in more strenuous physical activity. If anything hurts or causes swelling, we ask them to back off somewhat. If you exercise or do some particular activity that results in pain or swelling you are doing too much for your personal recovery at that time.  Not everyone heals the same.  You need to make sure that you don’t cause more swelling.  Fighting the swelling or working through the pain will certainly backfire. I prefer the patients to stay in town for two weeks if they from more than 2-3 hours away.  I do not allow patients to fly before 2 to 3 weeks at the very minimum.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 133 reviews

Prevention of weakening or disruption of your muscle repair following tummy tuck involves several factors

It is always unfortunate when this type of thing happens, and I'm very sorry to hear that you have had to undergo a second tummy repair procedure; one is tough enough!  I think of the ways that we can actively do something to prevent weakening of the muscle repair as being lumped into  2 categories:  those things that you can do as the patient and those things that your surgeon can do.  At this point for you, as you are now postop from your revision, I know it's a bit late to consider things along the planning and surgical execution line, but I'm going to mention them just for completeness' sake, and because I think sometimes having this kind of information helps people understand better what this surgery is all about and just how complex each little detail can be.  There are 5 basic things I can think of right off the top of my head that a surgeon can consider doing to help decrease the chances that a muscle plication, or repair, will weaken.  This doesn't mean that your particular surgeon did or didn't use any of these ideas, or that he or she should or shouldn’t have, rather these are just things that I have gathered over the years that have helped me ensure the reliability of my own muscle repairs.  The first is to use the right kind of suture material.  There are lots of different kinds of sutures out there, and I have seen surgeons use just about all of them for tummy tucks.  The thing is though, that some are absorbable and some are permanent, and of those that are absorbable, some absorb more rapidly than others.  Without going into all the boring details about all of the different suture materials, suffice it to say that in general a surgeon should use a suture that is both large enough in caliber to hold the necessary strength for the repair, and stays around long enough for the tissues to heal and develop their own strength before the suture absorbs.  If a surgeon uses a suture that is too small and weak, or one that absorbs, and thus weakens too soon, the repair is at risk of failure.  Additionally, in some instances in which the tissues are thin and weak (which often happens when we do tummy tucks, as those who require that operation have had their tissues stretched by pregnancy and/or weight gain), smaller caliber sutures can act like a "cheese cutter" and actually slice through thin tissues, causing failure and disruption of the repair.  This is a big reason, in addition to simple consideration of strength, to select a suture of large enough caliber for the muscle repair.  The second thing that a surgeon can do to ensure that a muscle repair holds is to use the proper suture technique; in other words, put the sutures in the "right way."  The truth of the matter is that there are may ways to put sutures in - continuous, interrupted (individual), locking, simple, mattress, and so forth.  Some are mechanically stronger than others, especially in weaker tissues.  It follows that there are really lots of "right ways" to use sutures to repair the muscles, or at least a number of ways that will "work" and get the job done.  I also think though, that there are a lot of ways that won't work, or that are less likely to work, and it is up to the surgeon to gain the experience to know what those are and to use the right technique for the right situation.  Third, a surgeon needs to use enough sutures to ensure that the repair remains intact.  This means both that the sutures are close enough together, or there are enough of them, to distribute the force of the repair adequately and lessen the likelihood of failure, and that there are enough layers for the type of suture being used, the technique of suturing, and the quality of the tissues to ensure that a repair won't fail.  I frequently see surgeons using only one layer of sutures in their plications, and this is OK, as long as all of the factors are considered, and the end result is something that is done with maximum integrity of the repair in mind for that particular patient (and her or his tissues) and not just as a "cookbook" approach done the same way on all people.  Personally, more often than not, I use 2 overlapping layers of sutures to repair the muscle, which on the one hand takes a bit longer, but on the other hand, I have very few weakened repairs, so I keep doing it this way.  It also allows me to more gradually and accurately set the tension on the muscle layer, because any excess laxity left from my first layer can be accurately adjusted for in my second.  This leads to the fourth surgical trick to prevent disruption of the muscle repair.  The surgeon has to set the proper tension on the tissues in the first place.  As you have already alluded to, your fascia was "too thin," and this may have contributed to the failure of your first repair.  When tissues are too thin or weak, and they are subjected to forces that they cannot bear, as one might expect, they will give way and fail.  Thus, we have to be sure that we aren’t exceeding the capabilities of the tissues, while at the same time tightening them adequately to accomplish our goal.  The way to do this properly is not to arbitrarily mark the muscles for plication based upon anatomical landmarks, length or width measurements, or other things which don’t really give us an indication of the tissue strength.  Rather, the surgeon needs to use special clamps which allow a “testing” of the tightening force being applied to the tissues before doing the actual suturing so that an accurate assessment can be made of how much force can safely be applied before the tissues tear or fail, and it allows for visualization of the contour of the abdomen and waistline with a specific amount of force applied.  Then the repair can be marked and completed much more accurately, and I think reliably as well.  If this isn’t done, there is a chance that either excessive force, or not enough force, will be used to repair the muscles, and both of those could lead to inadequate results.  Again, this paired with more than one layer of reinforcement typically adds to the reliability of the procedure, especially when tissues are visibly thin or weak.  The last thing that a surgeon can do to enhance the strength of the muscle repair is to use a material like prosthetic mesh or ADM (Acellular Dermal Matrix, like Strattice or Alloderm) to reinforce the tissues.  This is not typically done on primary cases, but in situations like yours in which the tissues in the center of the abdomen are just too weak on their own to maintain a repair, even with doubly reinforced sutures, it can add some additional strength to the area and also move the main focus of the tension to healthier, stronger tissues.  This type of thing is not needed very commonly at all.  It is a more advanced concept, and not something that would usually be done unless a simpler option had already been tried and failed, but I wanted to mention it, again so that you would get the full picture of how we surgeons think about this issue of muscle repair and revision of failed repairs.It is always unfortunate when this type of thing happens, and I'm very sorry to hear that you have had to undergo a second tummy repair procedure; one is tough enough!  I think of the ways that we can actively do something to prevent weakening of the muscle repair as being lumped into  2 categories:  those things that you can do as the patient and those things that your surgeon can do.  At this point for you, as you are now postop from your revision, I know it's a bit late to consider things along the planning and surgical execution line, but I'm going to mention them just for completeness' sake, and because I think sometimes having this kind of information helps people understand better what this surgery is all about and just how complex each little detail can be.  There are 5 basic things I can think of right off the top of my head that a surgeon can consider doing to help decrease the chances that a muscle plication, or repair, will weaken.  This doesn't mean that your particular surgeon did or didn't use any of these ideas, or that he or she should or shouldn’t have, rather these are just things that I have gathered over the years that have helped me ensure the reliability of my own muscle repairs.  The first is to use the right kind of suture material.  There are lots of different kinds of sutures out there, and I have seen surgeons use just about all of them for tummy tucks.  The thing is though, that some are absorbable and some are permanent, and of those that are absorbable, some absorb more rapidly than others.  Without going into all the boring details about all of the different suture materials, suffice it to say that in general a surgeon should use a suture that is both large enough in caliber to hold the necessary strength for the repair, and stays around long enough for the tissues to heal and develop their own strength before the suture absorbs.  If a surgeon uses a suture that is too small and weak, or one that absorbs, and thus weakens too soon, the repair is at risk of failure.  Additionally, in some instances in which the tissues are thin and weak (which often happens when we do tummy tucks, as those who require that operation have had their tissues stretched by pregnancy and/or weight gain), smaller caliber sutures can act like a "cheese cutter" and actually slice through thin tissues, causing failure and disruption of the repair.  This is a big reason, in addition to simple consideration of strength, to select a suture of large enough caliber for the muscle repair.  The second thing that a surgeon can do to ensure that a muscle repair holds is to use the proper suture technique; in other words, put the sutures in the "right way."  The truth of the matter is that there are may ways to put sutures in - continuous, interrupted (individual), locking, simple, mattress, and so forth.  Some are mechanically stronger than others, especially in weaker tissues.  It follows that there are really lots of "right ways" to use sutures to repair the muscles, or at least a number of ways that will "work" and get the job done.  I also think though, that there are a lot of ways that won't work, or that are less likely to work, and it is up to the surgeon to gain the experience to know what those are and to use the right technique for the right situation.  Third, a surgeon needs to use enough sutures to ensure that the repair remains intact.  This means both that the sutures are close enough together, or there are enough of them, to distribute the force of the repair adequately and lessen the likelihood of failure, and that there are enough layers for the type of suture being used, the technique of suturing, and the quality of the tissues to ensure that a repair won't fail.  I frequently see surgeons using only one layer of sutures in their plications, and this is OK, as long as all of the factors are considered, and the end result is something that is done with maximum integrity of the repair in mind for that particular patient (and her or his tissues) and not just as a "cookbook" approach done the same way on all people.  Personally, more often than not, I use 2 overlapping layers of sutures to repair the muscle, which on the one hand takes a bit longer, but on the other hand, I have very few weakened repairs, so I keep doing it this way.  It also allows me to more gradually and accurately set the tension on the muscle layer, because any excess laxity left from my first layer can be accurately adjusted for in my second.  This leads to the fourth surgical trick to prevent disruption of the muscle repair.  The surgeon has to set the proper tension on the tissues in the first place.  As you have already alluded to, your fascia was "too thin," and this may have contributed to the failure of your first repair.  When tissues are too thin or weak, and they are subjected to forces that they cannot bear, as one might expect, they will give way and fail.  Thus, we have to be sure that we aren’t exceeding the capabilities of the tissues, while at the same time tightening them adequately to accomplish our goal.  The way to do this properly is not to arbitrarily mark the muscles for plication based upon anatomical landmarks, length or width measurements, or other things which don’t really give us an indication of the tissue strength.  Rather, the surgeon needs to use special clamps which allow a “testing” of the tightening force being applied to the tissues before doing the actual suturing so that an accurate assessment can be made of how much force can safely be applied before the tissues tear or fail, and it allows for visualization of the contour of the abdomen and waistline with a specific amount of force applied.  Then the repair can be marked and completed much more accurately, and I think reliably as well.  If this isn’t done, there is a chance that either excessive force, or not enough force, will be used to repair the muscles, and both of those could lead to inadequate results.  Again, this paired with more than one layer of reinforcement typically adds to the reliability of the procedure, especially when tissues are visibly thin or weak.  The last thing that a surgeon can do to enhance the strength of the muscle repair is to use a material like prosthetic mesh or ADM (Acellular Dermal Matrix, like Strattice or Alloderm) to reinforce the tissues.  This is not typically done on primary cases, but in situations like yours in which the tissues in the center of the abdomen are just too weak on their own to maintain a repair, even with doubly reinforced sutures, it can add some additional strength to the area and also move the main focus of the tension to healthier, stronger tissues.  This type of thing is not needed very commonly at all.  It is a more advanced concept, and not something that would usually be done unless a simpler option had already been tried and failed, but I wanted to mention it, again so that you would get the full picture of how we surgeons think about this issue of muscle repair and revision of failed repairs. On the side of patients, the main things that you can do to help ensure that the muscle repair doesn’t fail are not “rocket science” as they say.  They are all more or less “common sense” things that are easily accomplished.  The first, and most important, thing is that you follow your surgeon’s instructions regarding activity and diet very closely.  Typically we have our patients refrain from any type of activities that can strain their abdominal muscles for several weeks, like lifting, pushing, pulling, getting up too quickly or in the wrong way, and things like that.  In addition, it is very important that you consider how your diet might impact the pressure in your abdomen, and thus the tension on your repair, especially in the first several weeks during which the repair is at its weakest.  You will find that eating smaller meals more frequently will help, and avoiding foods which typically cause bloating or gas production will also help greatly.  Things like carbonated beverages, legumes like beans, peas, lentils, and such, and for some people dairy products are all common examples of foods that can significantly increase abdominal pressure, and should probably be avoided until the tissues settle in a bit more.  Making sure that you aren’t going without proper nutrition, especially sufficient protein to help you heal, is also important.  The idea here isn’t to restrict caloric intake, rather to keep the size and type of the meals under control so as to not overstress the abdomen while still getting in the proper nutrition to promote healing.  In addition to this, you will want to pay strict attention to your bowel habits and do all that you can to prevent constipation.  This is easy to forget, yet taking narcotic pain medications, laying in bed more than you normally do, and changes in diet all make it very easy to become constipated.  Not only will this increase the pressure in your abdomen, but it will force you to strain to have a bowel movement, and this is very hard on an abdominal muscle repair.  Adding regular amounts of fiber to your diet, taking stool softeners, drinking lots and lots of water, and being proactive with things like Milk of Magnesia if you get a little behind the power curve are all good things to remember.  In many instances like this, surgeons will use a supportive or compressive garment, like an abdominal binder or liposuction garment, to take some stress off of the repair.  If your surgeon has recommended something like this, be sure to follow his or her instructions closely as to its wear.  Lastly, and this probably should go without saying, but I’ll say it just in case, you should avoid any sources of nicotine whatsoever while you are recovering from this type of surgery.  This includes not only smoking tobacco (and secondhand smoke), but also vaping, lozenges, gum, patches, and any other way that you might ingest nicotine.  Such exposure will significantly affect tissue healing and increase the chances of failure of the procedure.  These are the main things that I can think of that can be done on the parts of surgeons as well as patients to ensure that muscle repairs, especially revisionary or secondary repairs, succeed.  I’m sure there are others too, but this will get you started.  Be sure to discuss these things with your own surgeon as well if you have any questions or consider starting something new that he or she hasn’t recommended.  Best of luck for a successful outcome!

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

Tummy tuck revision

Hopefully the revision was done in such a way as to prevent further recurrence. Unfortunately these things happen sometimes, and surgery is the proper way to fix them. You should refrain from physical exercise for as long as your surgeon recommends. Good luck!

How to prevent stitches from opening around muscle repair?

I'm sorry to hear about the initial complication;  at this point, besides following postoperative instructions carefully, I do not think that there is anything specific that you can do to help prevent further problems.

Generally, avoiding any activity that can significantly increase intra-abdominal pressure (for example heavy lifting, straining,  coughing…) will be important during the initial postoperative period.  Common sensical  attention to good nutrition will obviously help during the healing process.
Again, careful attention to your surgeons postoperative instructions will be important. Best wishes for an oucome that you will be very pleased with.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,464 reviews

Fascia repair

Not knowing why this happened in the first place makes it difficult to say for sure. If you just had  your revision and repair, then I suggest you take it easy for several weeks. Best to follow your surgeon's instructions

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.