Single Multiple Stitches or Double Running Stitch to Plicate the Facia?

I assume you are referring to rectus plication of an abdominoplasty to correct for diastasis recti and tightening the abdominal muscles. I prefer indivual figure of 8 sutureswith buried knots that are non-absorbable some surgeons before running single long sutures like a baseball stitch. The theory is that if you use a single long suture and it pulls through or breaks the whole repair will fall apart. If you use mutiple sutures and one loosens or breaks the whole repair does not come apart however you can get more unsightly bulges where the individual sutures were. That is more of personal philosophy of the surgeon than standard of practice. It should not be the major criteria for choosing a surgeon.

Regarding: "Single Multiple Stitches or Double Running Stitch to Plicate the Facia?
Most of the doctors I went to for consults do the running stitch. However, the doc I felt most comfortable with does about 50 single stitches to plicate the muscles. Are there advantages or disadvantages with this method?"

The muscle repair IF done well and IF it remains together is the foundation of the flat tummy and narrow waist that is the goal of every Tummy Tuck. If you read through the comments posted here and elsewhere you will hear a recurrent theme of a new bulge which appears weeks or months AFTER a flat tummy tuck was achieved.

It is NOT enough to bring the separated muscles together but they must stay together despite bouts of coughing, vomiting or straining. How do we buy that "stay together" insurance? Every surgeon has his own thinking.

In MY opinion, the muscle repair is too important to entrust to luck, chance, a single running stitch or even a dissolving stitch.

I therefore perform a 2 layer muscle repair; both in permanent stitches which will keep the muscles together no matter what. A deep layer of interrupted locking sutures which will not break or cut through the muscle lining on top of which I run and lock a double stand of Prolene (a smooth (less apt to become infected). If both strands of the prolene for any reason break (never saw it in all my years as a surgeon), the muscles will still be held by the multiple underlying stitches which will remain intact and in place.

Excessive? I don't think so. None of my patients ever came back complaining of a recurrent midline fullness or worse returning to the before the tummy tuck pooch.

Pick the surgeon you believe in the most and you will do well.

Dr. Peter Aldea