Suture or not?
Assessing the cosmetic outcome of liposuction incision sites.

The goals of post-liposuction care are to keep edema, bruising and pain to a minimum while achieving the best possible aesthetic outcome. One of the many controversies surrounding post-liposuction care is the decision as to whether or not liposuction incision sites should be sutured or left open. Before tumescent liposuction, which allows for optimal intra-operative vasoconstriction, liposuction incision sites were routinely sutured because liposuction led to extensive blood loss. The lack of proper hemostasis led to post-operative hematomas and seromas, providing a medium for infection. Leaving incision sites open left a potential portal of entry for infection. Also, liposuction cannulas were much larger, requiring larger incisions, which needed sutures placed for proper healing. The Tumescent Technique Since the advent of the tumescent technique, and the use of microcannulas, liposuction incision sites don’t need to be sutured. Many surgeons prefer to leave liposuction incision sites open during the acute, peri-operative stage to facilitate drainage of the remaining tumescent fluid and decrease edema. The tumescent technique allows for decreased blood loss due to improved intra-operative vasoconstriction, thereby reducing the incidence of hematomas and seromas. One of the most significant benefits of eliminating sutures and allowing for open drainage is the dramatic reduction of post liposuction edema, which leads to less tenderness and bruising. Additionally, microincisions can heal better because there’s less foreign body reaction and inflammation than with sutures. Some surgeons have advocated the use of adits, which are small holes made by a 2mm to 3mm biopsy punch instrument and left open to promote drainage of residual blood-tinged anesthetic solution. You must use proper post-liposuction compression when allowing for open drainage, in order to achieve optimal results. Survey Says Even though post-liposuction care is improved with the use of open drainage and compression, there still remains the question of the final aesthetic outcome of the incision sites themselves. In order to determine if suturing liposuction incision sites influences post-op healing and cosmetic outcome, we evaluated 20 patients (10 male and 10 female) who underwent liposuction at various body sites, including the buttocks, abdomen, thighs and neck. On one side of body the incision site was sutured while the other side was left open. The liposuction incision sites from symmetric body sites were assigned randomly, created with #11 scalpel blades, undermined with gradel scissors, and ranged from 5mm to 8 mm in length. Two 5.0 nylon simple sutures were placed at the selected sites and the open and closed sites were cleansed and dressed daily. All patients received post-operative oral antibiotics, and sutures were removed at 2-weeks post-op. The incision sites underwent objective and subjective evaluation at post-op weeks 1, 2, 4, 16 and 24. The objective rating criteria included: erythema, induration, textural change, post-inflammatory pigment alteration and infection. The subjective rating criteria included: pain, pruritus, and overall appearance (graduated scale). Results showed at post-op weeks 2 and 4, the sutured sites were significantly more erythematous and indurated than the non-sutured sites. At week 8, however, there was no subjective or objective difference in wound appearance. These results continued through the 6-month follow-up period. This was simply a pilot study, and further investigation in this area is needed. In Summary Placing sutures didn’t appear to affect the long-term aesthetic appearance of the liposuction incision sites. Sites allowed to heal by secondary intention do not have an increased risk of scarring, dyspigmentation or infection. Micro-incisions heal well without sutures, leading to less foreign body reaction and decreased inflammation. Patients can expect to experience less discomfort in the peri-operative period when incision sites are left open. The fact that these non-sutured incisions healed as well as those that received sutures is reassuring to the surgeon who is attempting to achieve the best aesthetic result.