Commentary on: Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty?

See the Original Article here.

Plastic surgeons often consider themselves to be innovators; however, many of us remain tied to dogmatic practices regarding some of the most basic tenets of patient care. I would like to commend the authors for challenging one of the most basic assumptions in plastic surgery, namely, that there is a benefit to placing patients in compressive garments after body contouring surgery.

The authors performed a prospective, randomized controlled trial of abdominal binder use after abdominoplasty.¹ Thirty-four women were randomized into 2 groups who either wore a binder or nothing after surgery. Ultrasound evaluation at 1 and 2 weeks as well as 6 months postoperatively was used to assess for seromas and recurrence of a diastasis recti. The authors found no difference in postoperative outcomes between the 2 groups.

A variety of techniques have been utilized over the last several decades to improve outcomes after abdominoplasty. Probably the most widely accepted is the use of progressive tension sutures—originally described by Pollock and Pollock²—which has been shown in numerous studies to improve complication rates, particularly postoperative seroma.^3-7 A significant number of quilting sutures were used in all patients included in this study. Although the results from this study may not be generalizable to procedures performed without progressive tension sutures, the authors’ data are quite compelling: binders do not reduce seroma rates if progressive tension sutures are employed.

The other measured outcome from this study was the incidence of recurrent diastasis recti. In both groups, ultrasound analysis revealed recurrence in approximately 10% of cases. I agree with the authors’ conclusion that a binder is ineffective in reducing the rate of recurrent diastasis recti, particularly when we consider the relatively short length of time that most patients wear a binder postoperatively.

This study is not without its limitations. The sample size is relatively small, and I wonder if a larger sample size would have demonstrated a difference in complication rates. Another major limitation of the study is the relative homogeneity of the patients included. The fact that no postbariatric or patients with previous abdominal surgery were included makes the results less generalizable.

This is the first study in plastic surgery to investigate whether abdominal binders reduce complications. Even outside of plastic surgery, there are essentially no data that abdominal binders improve outcomes.^8-11 In fact, a study published in 2015 indicates that the use of postoperative compression may actually increase venous stasis, and therefore the risk of venous thromboembolism.¹² Given this potential risk, much larger studies are needed to assess the safety and potential benefits of any kind of postoperative compression garments in general. The additional cost and inconvenience of wearing postoperative garments may prove to be much higher than any potential benefit.

I again want to thank the authors for providing us with the first step towards an evidence-based approach to postoperative compressive garments and I look forward to the results of future studies to help further define the utility of these devices.

Disclosures

The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes