Ligating perforators in abdominoplasty reduces the risk of seroma.
BACKGROUND
Seroma formation, a common complication of abdominoplasty, can cause patient discomfort and inconvenience. This study aimed to compare seroma rates after ligation and diathermy of large abdominal perforating vessels during abdominoplasty.


METHODS
Consecutive patients undergoing abdominoplasty with epigastric undermining between 2004 and 2011 were studied. Body mass index (BMI), age at operation, smoking history, preoperative weight loss, operative details, perioperative fluid infiltration, concomitant abdominal liposuction, ligation of perforators by clips, suture or diathermy, use of quilting sutures, weight of tissue removed, postoperative drainage, inpatient stay, and seroma rates were recorded. Statistical analysis was undertaken using the unpaired t test, Fisher's exact test, the Mann-Whitney U test, and Kendall's tau-b test.


RESULTS
The study included 90 patients. The incidence of seroma was significantly lower among the patients who had perforators ligated (4/60, 6.7%) than among those who had diathermy (10/30, 33%) (p=0.002, Fisher's exact test). Seroma formation was significantly associated with a higher BMI, (27.45 vs. 25.16 kg/m2; p=0.025, t test) but not with preoperative weight loss. Postoperative fluid drainage did not differ significantly between ligated and diathermied perforators (p=0.716 Mann-Whitney U test).


CONCLUSIONS
Use of ligation by clip or suture rather than by diathermy to ablate large abdominal perforators significantly reduced the incidence of seroma among abdominoplasty patients.


METHODS
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 .
Plastic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK, joskillman@doctors.org.uk.
J M
JM
Skillman
M R
MR
Venus
P
P
Nightingale
O G
OG
Titley
A
A
Park
D000009:Abdominal Muscles / Q000601:surgery; D061645:Abdominoplasty / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016208:Databases, Factual; D003972:Diathermy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D015187:Lipectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D049291:Seroma / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult