What is the best tummy tuck incision closure method? Does your method vary by patient and/or skin removal amounts?

Question

I've read really good things about suturing done under high power magnification, as well as insorb staples with eXofin tape. What do you prefer?

Michele A. Shermak, MD · Answer

Hello!I go "old school" which I think is best. Insorb staples I think are optimal for closures that are less cosmetically important. Other items that are new add expense and are not necessarily improving upon results - some are gimmicks. I think a layered closure is best - a layer within the fat to smooth contours and 2 layers in the skin to optimize scar. Postoperative care beyond 1 month should be almost entirely focused on conservative measures to optimize scar and contour outcome.And be sure to see a board certified plastic surgeon whom you have researched and feel comfortable with.

Gregory T. Lynam, MD · Answer

We love insorb staples! I also agree that closure of scarpa's fascia and deep dermal closure is important. Thus, A 3 layer closure. We also use internal Quilting sutures to reduce drain usage.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  In most cases closures are done the same for all patients and involve a tension-free repair with a multilayer closure typically using sutures.  Hope this helps.

Robert M. Wald, Jr., MD · Answer

Thank you for your question. The best scars form when there is lack of tension on the wound closure. This is best achieved with a lot of deep sutures placed in the subcutaneous fat and dermis. I don't use any skin sutures or staples in order to avoid any suture marks.

Praful Ramineni, MD · Answer

Each surgeon has a slightly different preference, but the most important things to consider are minimizing tension with a 3 layer closure, the utilization of the smallest diameter sutures time minimize inflammatory reaction, meticulous soft tissue handling to avoid trauma to the skin edges and taping the skin post op to offload tension from the wound edge.   This needs to be combined with good post op scar care.   I personally find that the insorb staples tend to “spit” and leave a suboptimal scar compared to suturing all layers.

Andrew Gear, MD · Answer

That's a very good question.  The final scar of an abdominoplasty is a combinations of tensionless, atraumatic, multi-layered close and patient biology.  Don't be fooled by self-serving pitches about specific technologies as patient biology drives the bus in a lot of this.  In my practice, I close the superficial fascial system with PDS suture followed by Insorb staples in the deep dermis followed by Prineo which is a messed tape + superglue similar to Exofin.  People can have allergic reactions to the glue so you have to be careful with that one.  Simple paper tape and Skinmedica wound gel also works very well.

Camille Cash, MD · Answer

Suturing techniques vary by surgeon. I encourage you to visit a few board certified plastic surgeons for consultations.  During that time you can ask questions, including closure techniques and rationale.  You can decide which best matches your goals for surgery.

What is the best tummy tuck incision closure method? Does your method vary by patient and/or skin removal amounts?

Answers (7)

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