Muscle Plication Suture Failure Causes, Symptoms, and Treatment

Introduction:

Muscle plication is a surgical technique commonly used in abdominoplasty procedures to tighten the underlying muscles of the abdominal wall. While this procedure is generally effective in achieving a flatter and more toned abdomen, there is a possibility of suture failure, which can lead to postoperative complications. This article aims to discuss muscle plication suture failure from both the perspective of the patient and the plastic surgeon, covering its causes, symptoms, and treatment options.

Causes of Muscle Plication Suture Failure:

1. Tension on sutures: Excessive tension on the sutures during the initial surgery can result in the gradual loosening or breakage of the sutures over time. 2. Inadequate tissue support: Insufficient tissue support, especially in individuals with weak abdominal muscles or significant weight fluctuations, can contribute to suture failure. 3. Poor suture material: The choice of suture material can influence the risk of failure. Using low-quality or biologically incompatible sutures may increase the chances of suture breakage or tissue reaction. 4. Surgical technique: Improper surgical technique, including incorrect suture placement or inadequate knot tying, can compromise the integrity of the muscle plication and lead to suture failure.

Symptoms of Muscle Plication Suture Failure:

1. Recurrence of abdominal bulge: One of the most common symptoms of suture failure is the reappearance of an abdominal bulge, despite initially achieving a flat abdomen post-surgery. 2. Visible or palpable sutures: In some cases, patients may notice the presence of sutures protruding through the skin or feel them under the surface, indicating suture failure. 3. Muscle weakness or pain: Failed muscle plication sutures can result in weakened or painful abdominal muscles, possibly limiting mobility and affecting daily activities.

Treatment Options:

1. Suture revision: In cases where the suture failure is identified early, a surgical revision can be performed to repair or replace the failed sutures. 2. Mesh reinforcement: For individuals with recurrent or severe suture failure, the use of synthetic mesh may be considered to provide additional support and strengthen the abdominal wall. 3. Muscle reinforcement techniques: In some instances, alternative muscle reinforcement techniques, such as the use of acellular dermal matrix or tissue flaps, may be employed to improve the durability of the muscle plication.

Conclusion:

Muscle plication suture failure can be a frustrating complication for both patients and plastic surgeons. Understanding the causes, recognizing the symptoms, and considering appropriate treatment options are essential for addressing this issue effectively. By ensuring meticulous surgical technique, appropriate suture materials, and proper patient selection, the risk of suture failure can be minimized, leading to better long-term outcomes for abdominal contouring procedures.

References:

1. Mendelson BC, Rajka T. Complexities and challenges of abdominal wall reconstruction. Plast Reconstr Surg Glob Open. 2016 Jun;4(6):e709. doi: 10.1097/GOX.0000000000000671. 2. Cánovas-Manzano JL, Gacto-Sánchez P, Franco-Verduras C, Magaña-Sevilla FJ. Abdominoplasty with polypropylene mesh reinforcement: Analysis of 215 consecutive surgeries. Cir Esp. 2021 Jan 21;S0009-739X(21)00002-2. doi: 10.1016/j.ciresp.2020.11.001. [Epub ahead of print].