By far the most annoying aspect of a tummy tuck is the use of drains. Drains are long tubes inserted under the skin to suction excess serous fluid and allowing the skin to reattach to the muscle layer. Drains are painful where they exit the skin and usually remain in place for 7-10 days and occasionally for several weeks. In spite of having these drains a significant number of patients still developed pesky fluid accumulations requiring repeated needle aspirations (15-52%).
Surgeons have used quilting sutures to decrease the use of drains and a few have been able to eliminate drains using this method, however the majority of quilted tummy tucks still had drains placed. Fibrin glue was tried as well, but proved to be ineffective and too expensive.
While drains are effective at removing fluid, they do not seal or eliminate the dead space between tissue layers following tummy tucks , or prevent shearing forces from disrupting the early healing process during movement. As a result, up to 52 % of the patients with drains will still require invasive procedures in order to manage post-operative fluid complications. Perhaps the most serious of these risks is surgical site infection associated with prolonged drain use.
A new approach was recently published in a prestigious plastic surgery journal by Dr Hunstad and others ( Aesth Plast Surg (2015) 39: 616.)
They report that a new biocompatible adhesive provides tight bonding of tissue to reduce the dead space between tissue layers and minimizes shearing forces during the healing process. The adhesive is non-toxic and has a bonding strength equivalent to cyanoacrylates. The use of the adhesive may provide an alternative to closed suction drains, reducing patient discomfort and the risks associated with indwelling drains.
In a large multi-center clinical trial 130 subjects undergoing elective abdominoplasty at five centers in the United States were enrolled in the study. They report that 87% of Control group had drains with 12% still needing aspirations while 72% of Treatment group needed no aspirations but 20% needed some aspirations and 8% needed a drain
The treatment group resumed normal activities such as showering, driving, exercising, walking up stairs, or returning to work earlier than the treatment group
The results of this large randomized, prospective study support the use of the lysine-derived urethane adhesive as a safe and effective alternative to drains in subjects undergoing abdominoplasty. Subjects treated with the adhesive were able to achieve comparable outcomes compared to subjects with drains, while experiencing a decrease in the total number of invasive procedures required to manage post-surgical fluid accumulation-related issues. The cumulative number of days receiving treatment was also significantly less in the Treatment group since they did not require the placement of drains. In the Treatment group, 27 % of the subjects required invasive procedures, whereas in the Control group, 100 % required invasive procedures.
- Quicker recovery with fewer post-op visits required (great for a busy professional)
- Significantly easier with no drain care or drain removal needed
- Vast majority 72% required no subsequent treatment for seroma-s
- Expensive treatment adds $800-$1000 to the cost of surgery
- Not completely effective as a minority (18%) still required some aspirations (however, these are well tolerated).
- Lysene—-an amino acid (natural building block of proteins)
- urethane- a polymer used as an adhesive
- cyanoacrylates- a quick setting adhesive