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Barbed vs. Interrupted Suture Closure of Abdominal Fasciotomies After Free Flap Harvest
Rishi Jindal, MD, Diana Zhong, BS, Vu T. Nguyen, MD
University of Pittsburgh
2014-03-14
Presenter: Rishi Jindal
Affidavit:
The above work represents 100% original work of the resident.
Director Name: Joseph E. Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Bulge formation after fasciotomy repair for msfTRAM and DIEP flap harvest is 1-5% in literature, with higher rates in bilateral harvest. This complication deters patients from choosing free-flap reconstruction when the abdomen is the only available donor site, as in thin breast reconstruction patients. We hypothesized that bulge and hernia rates would not increase with barbed suture compared to standard, interrupted fascial closure. Bulge rates were compared between patients who underwent msfTRAM or DIEP flaps from 2007-2013 by a single surgeon, who switched from interrupted (Group 1) to V-Loc (Group 2) closure in 2011. Unilateral and bilateral fasciotomy, BMI, wound complications, and smoking status were analyzed. 25 patients were included in each retrospective group. 4/25 patients developed bulge or hernia in Group 1 vs. 5/25 in the Group 2; however, 2/4 in group 1 were symptomatic, requiring surgery, vs. only 1/5 in group 2. There were no significant differences between groups for BMI, smoking status, number of fasciotomies, or wound-healing complications. In both groups, patients with bulges were more likely to be smokers than those without bulges, and only in Group 2 did BMI correlate with bulge. Overall, the only risk factor for bulge/hernia in our study was smoking status (p<0.05). We identified no increased risk for barbed suture closure of abdominal fasciotomy sites after free-flap harvest. As barbed suture closure is less technically demanding, faster, and leaves fewer knots that can create suture granulomas, it may become the new standard closure technique for abdominal fasciotomy sites in the future.
