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By Michele A. Shermak

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Axillary wounds are not infrequent after brachioplasty. Large caliber, absorbable barbed suture placed in the deeper subcutaneous layers in particular may aggravate and compound wound healing problems if the suture becomes exposed in the wound. It is important to remove any suture that is visible within a wound to accelerate wound healing. Postoperatively, it is dangerous to have patients wrap their arms with elastic bandages on their own: they may wrap the arm so tight that forearm lymphedema results or they may create a tourniquet that creates ischemia and skin necrosis.

Temporary caval filters are available and can be placed by colleagues in vascular surgery or interventional radiology within a day of surgery, to be removed 2–3 weeks after surgery (Figure 6-5). The filter also must be paired with low dose of aspirin each day while in place. The possibility of VTE must always be considered postoperatively. If a patient has a swollen, painful extremity, venous duplex study should be performed, and if results are positive for DVT, then anticoagulation treatment must be instituted with observation in the hospital.

The wounds are then closed. The deep fascia is approximated with interrupted #2-0 braided absorbable suture, and a deep bite of the subcutaneous tissue in the axilla is important to secure the wound closure. The dermis is approximated with buried #3-0 absorbable monofilament suture, followed by a running #4-0 monofilament absorbable intracuticular suture (Figures 10-5 and 10-6). Barbed suture may be considered for the deep and/or superficial closure. The arms are dressed with petrolatum gauze and absorbent pads and then gently wrapped with 4- to 6-inch elastic bandages.

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