When I began performing abdominoplasty in 1990, we used sutures in the skin that don’t dissolve, so we had to remove them in a couple of weeks. We used bulky gauze dressings to absorb the drainage from the wound. A wide, tight elastic binder was applied (for reasons that never made sense to me) to reduce swelling or help the skin flap to stick down to the abdominal wall or for who knows what reason! We put two silicone rubber drains inside the wound to collect and remove all the fluid that accumulated under the skin flap and evacuate it to a collecting reservoir. Patients were admitted to the hospital for one or two days because there was a lot of pain and this needed to be controlled.
What We Are Really Doing …
Now, lets look at what we we are really doing by all this. First of all, removing the sutures from the skin was uncomfortable for the patient. The wounds were long, typically over twelve inches, so pulling out the sutures was not pleasant. Bulky gauze dressings need to be changed at least daily. Lots of tape to stick to the skin which got irritating after a few days. Some patients had to wait a couple of days to shower before they removed the dressings for the first time. That’s when things began to get a little bit “fragrant”! Now, the dreaded abdominal binder. What a pain that was! It is about ten inches wide and had velcro on each end. You wrap it around your body and secure the velcro in the front. One manufacturer put a cute little pink rose in the front to show you how to put it on. The problem is that the binder is a flat sheet and when it wraps in a circle it forms a cylinder. Whose body is cylindrical? Certainly not after an abdominoplasty.
Following abdominoplasty, the patient usually returns to the hourglass shape they had in their distant memories. So the binder would not conform well. It slid up the abdomen. Sometimes it would compress the abdominal skin flap and cause creases or grooving into the skin. That didn’t look good. Now for the drains. As I have looked on the patient forums such as www.realself.com and www.makemeheal.com, abdominoplasty patients hate nothing more than their drains. Drains are kind of like unwanted relatives who overstay their welcome. They are with you in the beginning when you don’t really mind them. Like your relatives, you need to entertain them. They don’t just sit there quietly. You need to empty them, strip them of blood clots, clean the exit holes where they come out from the skin with antiseptic and apply antibiotic ointment, cut those funny little slits in gauze pads so you can place a dressing over them and record the drainage on a chart. You get to do all this several times a day as if you don’t already have enough to do! Then you anxiously go to your appointment with your plastic surgeon and hope and pray he says the amount is now low enough so he can remove the drains. And, when he says he will remove them you think “Oh, my G-d!, how much will it hurt to get that tube out of my body!!!” And you have not one but two of them!!! Now lets talk about the pain medicine (have I convinced you not to have an abdominoplasty at this point???
Read on, it actually gets better, let me just finish my discourse on the past here, bear with me for another moment. You get to be admitted after surgery for “pain control” another word for intravenous narcotics which do relieve pain with the trade off of causing nausea and sometimes vomiting! Then you get to go home on oral pain pills, a pill form of the same stuff that made you sick in the hospital. And a few days later you begin to realize that you are feeling a little “irregular” because you haven’t moved your bowels in five days. Another wonderful effect of narcotics. Gotta love modern pharmacology! Well, cheer up, and hang on tightly because things have certainly changed…
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