Serial Tacking Sutures to Reduce Seroma Formation in Dermatologic Surgery

As persistent and contained collections of fluid, seromas and hematomas are usually found within subcutaneous pockets that are iatrogenically created by wide undermining above or below the fascia. For dermatologic surgeons, the formation of a seroma or hematoma can dramatically alter the postoperative course of surgery, making an otherwise normal wound healing process prolonged or complicated. 

One of the most common preventive techniques used to reduce seroma formation is the placement of a negative-pressure or Penrose drain to evacuate and minimize the buildup of postoperative fluid collections. The placement of a drain is usually paired with a compression dressing to coapt the widely undermined subcutaneous pocket. 

Although simple to perform, the decision to place a drain is often met with some resistance by patients who may perceive the drain as a cumbersome and often uncomfortable surgical appliance. As such, the authors advocate for the use of an alternate surgical strategy to minimize seroma or hematoma formation after wide surgical undermining and dissection. 

The specific technique involves serial tacking sutures to effect coaptation of the superior-most and inferior-most tissue layers of the surgical pocket. This technique is described in the plastic surgery literature and is widely used to reduce the surgical pocket after wide dissection of the abdominal fascia during an abdominoplasty. It is reliable and can be used in dermatologic procedures where surgical drains may be prohibitive or inconvenient. 

In this technique, the surgeon utilizes absorbable braided sutures to approximate the roof and floor of the surgical pocket to serially close the surgical pocket from the periphery toward the central incision line. The sutures should be tied firmly to prevent expansion of the surgical pocket. In addition, upon closure of the incision line, the subcutaneous sutures may incorporate a 3-layer surgical “bite,” which includes the right and left subcutaneous tissue and the deep pocket tissue simultaneously. 

Of course, the reduction in seroma and hematoma formation relies heavily on precise surgical dissection, hemostasis, proper wound closure, and compliance with postoperative instructions. The added benefit of serial tacking sutures is that the sutures may act as further tension destressors postoperatively, thus theoretically aiding in proper wound healing, tension abatement, and scar minimization.