P007 COMPLETE FASCIAL CLOSURE IN LARGE HERNIAS AFTER LIVER TRANSPLANT USING BOTOX

Aim Hernias after liver transplant (HaLT), being transverse, preclude mechanical muscle release for fascial advancement. However, even with large HaLT, complete fascial closure is possible following Botox muscle release. Material and Methods A retrospective review included 31 consecutive large primary HaLT repairs between 2017 and 2021. Patients were immunosuppressed, with BMI=33+/-5. Fascial defects were 13+/-5cm (range 7.5-28cm) transversely and 11+/-3cm (range 5-17cm) vertically. Botox was administered 29+/-3days preoperatively. After extensive myofascial mobilization, mesh was inserted intraperitoneally and covered with omental flap alone or with posterior components, followed by fascial closure, progressive tension sutures and drains. Results Operative time was 235+/-69min (range 111-418min), with no enterotomy or blood transfusion. Complete fascial closure was achieved in all. No mortality or abdominal compartment syndrome occurred. Two patients had long ICU stays (135 and 75days, aspiration and caecal necrosis), but were discharged with intact repairs, off dialysis and sound mentally. Other patients had a postoperative hospital stay of 5.8+/-2.2days (range 3-13days). Mean follow-up was 48+/-28.3 months (range 1-84 months). One patient with a mainly left sided repair developed a hernia on the right, beyond the mesh edge. No other recurrence or mesh infection occurred. One wound required open abscess drainage. Two seromas were aspirated. Conclusions Abdominal wall reconstruction with complete fascial closure is possible following abdominal muscle release with Botox, even in large HaLT. However, these immunosuppressed patients with multiple comorbidities may develop significant medical complications. One recurrence along the mesh edge suggests the need for complete incision mesh coverage, not just hernia coverage.

Expanding the Progressive Tension Suture Concept: A Study of its Utility in Body Contouring Procedures

Background Seroma is one of the most common complications following body contouring. Progressive tension sutures have been shown to decrease the seroma rate following abdominoplasty, component separation, facelifts and following latissimus flap and DIEP flap harvest. Objectives The objective of our study was to look at the effects of progressive tension suture techniques and their role on the seroma rate in body contouring flap procedures. Methods A retrospective review was performed of all patients undergoing a flap procedure (defined as any procedure that produces a dead space and subsequent susceptibility to seroma) by a single surgeon at a single institution over 3 years. All patients/procedures utilized progressive tension techniques, as is routine in the surgeon’s practice. No drains were used. Patient demographics and complications, including seroma, were tracked. Results A total of 441 flap procedures were performed in 351 patients over the 3-year study period. There were 305 abdominoplasties, 68 lower body lifts, 17 medial thigh lifts, 36 brachioplasties and 15 torsoplasties. Progressive tension sutures were used in all procedures. No drains were utilized. Complications occurred in 72 procedures (16.3%), with the most common complication being minor wound dehiscence without infection. There were no cases of seroma. Conclusions Progressive tension sutures represent an effective technique for reducing the seroma rate, eliminating the potential space and promoting tissue adherence in flap procedures for body contouring. This is the first study of its kind demonstrating the use and role of this technique in body contouring procedures beyond the scope of abdominoplasty.

Fibrin Sealant Artiss Compared to Progressive Tension Sutures With Stratafix in the Management of Wound Drainage Following Post-Bariatric Body-Contouring Surgery

Background: Post-bariatric body-contouring surgery is one of the most rapidly growing areas in plastic surgery. One of the most common complications following post-bariatric body-contouring surgery is seroma. There are a number of approaches to reducing wound drainage and seroma formation. A promising strategy to reduce these complications is to develop effective methods for reducing dead space between the tissue layers. Methods: We conducted a retrospective trial assessing the use of human fibrin sealant Artiss in comparison to progressive tension sutures (PTS) with Stratafix, a bidirectional barbed suture device in patients undergoing post-bariatric body-contouring surgery. Thirty-six patients for abdominoplasty or lower-body-lift were evaluated. Treatment patients underwent procedure with fibrin sealant applied to adapt the tissue layers. Control patients underwent an identical procedure but with PTS. Primary outcome measures included total wound drainage and time to drain removal. Results: The use of Artiss in abdominoplasty was associated with a mean drain volume that was significantly higher and more days that were needed to remove all drains compared to the PTS group. In body-lift, the mean drain volume and number of days needed to remove all drains tended to be higher when using Artiss compared to the PTS group. Conclusion: The use of Artiss in post-bariatric body-contouring surgery did not decrease the rate of seromas and the length of time required for post-surgical drains when compared to PTS.