In their article in “No-Drain Abdominoplasty with Progressive Tension Sutures” for this issue of Clinics in Plastic Surgery , Drs Todd Alan Pollock and Harlan Pollock write about a technique that they have employed for a very long time with excellent success. It is interesting to note that despite their success there is little increase in the adaptation of their technique in the United States. I have taken several informal surveys in multiple plastic surgery meetings and discovered that US plastic surgeons feel that it takes too long to place the progressive tension sutures (PTS), and despite the Pollocks’ findings, most feel that the sutures are ineffective in reducing seromas. On the other hand, almost always after I conduct these informal surveys, many surgeons convey that they have adopted the technique, and it has revolutionized their abdominoplasty practice. It is interesting that many plastic surgery colleagues in South America utilize quilting or Baroudi-type sutures on a regular basis. As in many aspects of plastic surgery, there are regional practice differences that are based on exposure, training, and recommendations of influential plastic surgeons. The use of quilting or PTS certainly seems to fit this pattern.

I would like to share my practice’s experience with quilting sutures since mine is a typical representative practice that has tried to adopt them. My colleagues and I have been utilizing quilting sutures for a few years now, and it is my empirical impression that the practice has had a decrease in its seroma rate. However, other parameters have been changed that may influence seroma formation, so it is hard for me to determine what the actual cause of the decrease is. Of note, my practice’s patient population is probably different from the Pollocks’ patient population, and thus I am hesitant to completely abandon drains. That, however, is something that time and experience may lead me to change. For plastic surgeons who are new to PTS and want to try them, it is probably wise to get comfortable with them while continuing to use drains and then eventually graduate to not using drains. This has been the sequence followed by many surgeons who use PTS, and it is what I hope to do in the future.