Excellent Tummy Tuck Scar Quality and Healing Demonstrated with Two Layer High Lateral Tension Technique
A major objective of abdominoplasty is to have fine-line scar healing. This requires that tension be minimized at the skin level. Otherwise the skin will react to this tension by stretching or becoming raised or hypertrophic. This scar is very hard to improve once it has become established.
The scar seen here is the result of completely closing off the space created by flap elevation with progressive tension and quilting sutures. This takes all the tension off the incision closure because these multiple sutures that advance and secure the flap to the abdominal wall, the edges are very close to each other. By doing this, in addition to the benefit to the scar, no drains are needed. The deeper layer of the subcutaneous tissue of the abdomen is called the superficial fascia and it has a network of fibrous tissue that can securely hold sutures closed under tension. But this tension is below the skin and when it gathers the two edges together it takes all the tension off the skin layer where the visible scar forms. The final layer is rapidly dissolving quill suture just under the surface of the skin (subcuticular layer). This final layer evens out any irregularities and perfectly matches the skin edges, so the incision can heal as a fine line. This closure allows optimal scar healing without tension, and the final result will then depend on the patient’s individual biological healing tendencies. The variable of tension is greatly reduced. This type of closure takes longer. Since the scar is for life, and scar quality is very important, taking the time to set up the conditions for optimal healing is well worth the time and effort involved.