Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients.
BACKGROUND
Hematoma is the most common postoperative complication of rhytidoplasty, resulting in higher morbidity and longer recovery. Quilting suture for closure of the undermined area in abdominoplasty avoids the occurrence of seroma. Based on this principle and with the objective of reducing the number of patients with hematomas in rhytidoplasty, a similar surgical tactic was developed in which a hemostatic net is created with a running transfixing suture of 5-0 nylon encompassing the skin and the superficial musculoaponeurotic system-platysma.


METHODS
The study enrolled 525 consecutive patients who underwent rhytidoplasty between July 2009 and February 2013. The first 120 patients (group A) were evaluated retrospectively and considered control subjects. The remaining 405 patients (group B) had application of the described tactic, with data collected prospectively. The occurrence of hematoma, ischemia, and necrosis was observed during the first 72 h after surgery.


RESULTS
Control group A included 17 patients with hematoma (14.2 %) during the first 72 h, whereas no patient in group B experienced such a complication (p < 0.001). The surgical tactic did not significantly increase the occurrence of ischemia. This complication was experienced by 11 patients in group A (9.2 %) and 26 patients in group B (6.4 %) (p = 0.408). The tactic also did not change the incidence of necrosis, which was present in three group A patients (2.5 %) and six group B patients (1.5 %) (p = 0.723).


CONCLUSIONS
The hemostatic net is an efficient and safe method for preventing early hematomas in rhytidoplasties. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
, Alameda Presidente Taunay, 1756, Curitiba, Paraná, 80430-000, Brazil.
André
A
Auersvald
, Alameda Presidente Taunay, 1756, Curitiba, Paraná, 80430-000, Brazil. luizauersvald@uol.com.br.
Luiz A
LA
Auersvald
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects* / Q000379:methods*; D013536:Suture Techniques