TPT 4.16 The Parachute and Pico: A Technique of Barbed Quilting that Enables Ergonomic, Accurate, Aesthetic and Efficient Abdominal Closure for DIEP Breast Reconstruction

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ID: 323920
2026
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Abstract
Abstract Aims Barbed sutures, progressive tension and abdominal quilting are established techniques for optimising donor-site closure in deep inferior epigastric perforator (DIEP) breast reconstruction. Quilting may reduce seroma formation and the need for drains, while negative pressure therapy has been associated with reduced wound complications. This study describes and evaluates a novel modification combining barbed quilting with negative pressure dressings, termed the “Parachute and Pico” technique. Methods A modification of barbed quilting was developed that allows the abdominal apron to be temporarily suspended using skin staples, enabling a single surgeon to perform controlled, progressive-tension quilting without an assistant. Two barbed sutures are passed between corresponding points on the rectus fascia and abdominal flap, creating a “parachute” effect prior to closure. Following closure, negative pressure dressings are applied. Outcomes from 31 consecutive patients were compared with 31 sequential patients operated on immediately prior to its introduction. Results Median age was similar between groups (54 vs 53.5 years). Mean operative duration was reduced from 6 hours 49 minutes to 6 hours 2 minutes. Mean length of hospital stay decreased from 3.6 days to 3.1 days. No complications were attributed to the technique. Conclusions The Parachute and Pico technique provides a simple, reproducible method for ergonomic and accurate abdominal closure that can be performed by a single surgeon without disrupting concurrent microsurgery. It improves efficiency and may reduce operative time and hospital stay.
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Authors Omar Abdelmohsin, Bruno Alcocer, Say Teoh, James Coelho, John Dickson
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.213
URL
https://doi.org/10.1093/bjs/znag087.213
Keywords Keywords not found

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