Hemostatic Net

Abstract

Hematoma is considered the most frequent complication following rhytidoplasties, ranging from 8% to 14.2% according to the study. It is associated with higher morbidity and a longer recovery period. Risk factors for the occurrence of hematoma include nausea and vomiting, psychomotor agitation, urinary retention, constipation, combined cervical procedures, arterial hypertension, male sex, use of acetylsalicylic acid and nonhormonal anti-inflammatory drugs, and smoking.

Many different approaches have been tried to prevent hematoma, among them are surgical drains, tissue sealants, and rigorous blood pressure control protocols. Despite these efforts, hematoma still persists as a challenging issue in face-lifts.

The hemostatic net is an efficient alternative for the prevention of hematomas. It consists of columns of transfixing sutures encompassing the skin and the superficial muscular aponeurotic system and the platysma with the objective of closing all dissected spaces, therefore eliminating the possibility of hematoma formation.

In this chapter we review and discuss the etiology of hematomas in rhytidoplasties, offering some historical background for the development of the hemostatic net, which is presented with technical details, results, and other uses in plastic surgery.

The hemostatic net, or simply the net, is a surgical technique we developed to prevent hematomas in rhytidoplasties (Auersvald et al., Rev Bras Cir Plást 27(1):22–30, 2012; Auersvald et al., Aesthet Surg J 37(1):1–11, 2017; Auersvald and Auersvald, Aesthet Plast Surg 38(1):1–9, 2014; Auersvald and Auersvald, Plast Reconstr Surg Glob Open 2(12):e274, 2014). Colleagues have also called it the A-net, as an indication of the authorship of the technique. The net consists of parallel columns of continuous nonabsorbable sutures that ensure the mechanical closure of all detached skin in a safe and consistently reliable way.

This chapter discusses the etiology of hematoma formation in rhytidoplasty and the history, techniques, and advantages of the hemostatic net in preventing its occurrence in this and other areas of plastic surgery. The focus is on hematomas of the subcutaneous space; prevention of bleeding in the subplatysmal space is not discussed.