What Are the Advantages of Using PTS Sutures for a Tummy Tuck Procedure?

Doctor Answers 12

Progressive Tension Sutures are great in tummy tucks.

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They do several very good things.  1)  They tighten the upper abdomen.  2)  They markedly lower the risk of a seroma.  3)  They decrease the tension in the scar.  4)  They often eliminate the need for drains.

Manhattan Plastic Surgeon

Stitching techniques in tummy tucks

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Dear Alexandra

By PTS sutures, I presume you mean Progressive Tension Sutures (also known as quilting sutures). The principle behind using these internal stitches is twofold: firstly, they reduce the "deadspace" or cavity, limiting how much fluid can build up in the wound area; and secondly, because of the tension they spread over the whole of the abdominoplasty flap, they avoid all the strain being put on the area of the scar above the pubic hair (which is what happens in a traditional tummy tuck). This then minimises the risks for wound healing problems and scar breakdown, and in addition the PTS sutures can be used to sculpt a more attractive shape to the abdomen.

I hope this answers your question!


Advantages of Using PTS Sutures for a Tummy Tuck Procedure

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Over the years, surgeons have improved procedures and found ways to eliminate the need for #drains commonly used in a #tummy #tuck or #abdominoplasty, and a variety of other operations. I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty. Any extra fluid may be reabsorbed back into the body without the use of drains.  I may use drains on a case by case basis for these patients. If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. The use of tissue #glue is to adhere the abdominal #skin to the #muscle. It is a new option and alternative to sutures in a tummy tuck.
If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Progressive tension sutures

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The progressive tension suture technique uses absorbable sutures under the abdominal skin to stabilize the skin flap and more evenly spread the tension of the abominoplasty. The advantages are, decreased seroma (fluid collection) risk, no need for drains, and typically, a better scar because the tension at the scar area has been reduced.

The Advantages of Drainless are Many

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Fewer Seromas, Less Discomfort, Quicker Healing, Quicker Return to Activities of Daily Living, Less Anxiety for You and Your Caregiver, No Additional Scars, Fewer Follow-up Visits Needed, Fewer Infections, and Less Messy Drainage are some of the advantages of the Drainless tummy tuck.

Advantages of no drain tummy tuck

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1) no drainsl! 2) I use them to shape and contour the abdomen 3) lower rate of fluid collections (seroma) 4) can take out more skin, thus more likely to not have a vertical component to the scar (where the belly button used to be), 5) less pain from drain site, 6) no drain output log 7) no drain to pull out by accident  8) reports of less overall pain 9) reports of earlier return to activity 10) possibly leads to better scar as less tension on incision.

Extra 23 min (on average from published studies) of operating time (without any added risk, just more time for the surgeon and staff, so a little more cost for you)

PTS or drainless tummy tuck

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Progressive tension sutures use absorbable sutures that close any cavities inside your body that are created after tissue removal, minimizing the risk of seroma/hematoma and making drains unnecessary. It can reduce the risk of infection and your recovery tends to be faster than if drains were used. However, thinner patients may require drains. That's why you have to get a consultation to see which technique would be best for you.

Drains and Tummy Tucks

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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
4.9 out of 5 stars 42 reviews

Progressive Tension Sutures for Tummy Tuck

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This is a technique I commonly use for my tummy tuck patients and DIEP flap breast reconstruction patients, where abdominal tissue is harvested to recreate a breast.  


It helps remove the drains more quickly by carefully placing sutures to approximate the abdominal soft tissue to the underlying muscle.   The key is placing the suture such that they do not result in skin dimpling or contour deformities.


With proper use, I have been able to remove my drains in about half the time compared to without Progressive Tension Sutures.


I hope this helps.


Dr. Gill 

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Sutures in Tummy Tucks

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PTS sutures can mean Progressive Tension Sutures which are placed between the skin/fat layer and the deep fascia layer progressively as the excess skin/fat is pulled inferiorly and are designed to prevent space between the two layers, thus reducing the risk of fluid accumulation. Drains, when used properly, and other methods also do this. There is another similar sounding suture, the PDS suture that is frequently used in Tummy Tucks and other procedures to improve the eventual scar. These sutures dissolve very slowly and maintain their strength for many months, thus supplying strength to the wound until the body builds enough strong scar to keep that scar from spreading and looking ugly. The reasons for using both these sutures are what we are all striving to improve. If your surgeon does not use either, you might ask how he/she accomplishes the goal of each.


Robert T. Buchanan, MD
Highlands Plastic Surgeon

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.