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

I think it is great you are doing your research, and learning all that you can about your surgery.  I personally feel the most secure type of rectus fascia plication (often referred to as "muscle repair") is a double layer technique. I do the first layer in multiple "single" figure-of-8 stitches (also referred to as "interrupted" figure-of-8 stitches), and do a second layer on top that is a running continuous layer. Theoretically if a single stitch is used and it breaks for any reason (such as a sudden forceful cough), or doesn't break but tears through muscle in a portion, then you could lose strength along the entire length of your repair. If the same running stitch breaks in a patient with a second row of multiple single stitches, you maintain the repair. Also, if just one of the single stitches breaks, you still have your single running stitch and all of the rest of the single stitches to hold the repair. An argument against the double layer repair is that is takes more time, and there is more suture material in the abdomen (only a problem in the face of infection). Please keep in mind that there are many other factors involved in the success of a tummy tuck, and you should be able to trust your surgeon with the details such as how many stitches he or she uses. I would recommend researching the credentials of your surgeon, and looking at his or her before-and-after photos before making your final decision. I recommend going with a board certified (or board eligible) plastic surgeon for this type of surgery. Good luck!

This is up to personal opinion and experience. There are advantages and disadvantages to both. The repair in a running stitch depends on a single suture but there are less knots and potential for bacterial colonization. An interuppted repair has multiple points of reinforcement but multiple sites for colonization. A double layer repair, which I do, has the advantages but also the disadvantages of both.  SEE VIDEO

Interesting technique question but the bottom line is that you felt most comfortable with that board certified plastic surgeon.  That's who you should go with because other issues can come up and you'll have wished you did.  Best wishes

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

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.

I would not get bogged down with how many sutures are placed and how many layers are placed.  A good repair is a good repair.

While many surgeons use a running suture technique, it does potentially cause a problem in the unlikely event that the suture breaks before healing is complete. A combination of 10 to 20 individual sutures may be better, sometimes in combination with a running suture. Fifty sutures can be done but seems a bit excessive. The single running sutures saves time (about 5 to 10 minutes compared to 10 to 20 individual sutures) but the individual sutures may provide more strength in the first few weeks after surgery.

I am of the belief that it does not matter one bit how the fascia is repaired.  You need to use strong suture and good technique.  Personally, I have always used one layer of a running suture and have never to my knowledge had one break or tear.  This is completely a personal preference issue and should not really come into play when you are choosing your surgeon.  This is a decision with no one correct way to address it. 

Everybody has their own way of doing this, running or interrupted, permanent or absorbable.  There is no absolutely right way.  Ask the doctor whom you like and see if they have ever had to re-repair the muscle and there will be the answer for you.