Bolsters in Plastic Surgery Practice

A bolster places to promote adherence of lateral chest flaps following gynecomastia surgery

Bolsters are specialized dressings that provide compression at surgical sites, playing a crucial role in optimizing outcomes across various plastic surgery procedures. Their gentle yet sustained pressure offers several key benefits.
Benefits of BolstersBolsters help by:

• Allowing flaps to adhere properly to underlying raw areas
• Reducing the incidence of seromas and fluid collections
• Simplifying postoperative dressings in the initial recovery period

Application TechniqueBolsters are typically made from sterile open-pore sponges, cut into finger-sized shapes. The application process involves:
The sponge is secured to the external skin surface using sutures that traverse through the bolster, pass through the skin, attach to underlying fascia, and exit back through the skin and bolster. This creates a secure compression system where pressure can be adjusted by modifying suture tension. Standard pad dressings can be placed over the bolster for additional protection.
Common ApplicationsBolsters are extensively used in numerous procedures, including:

• Gynecomastia surgery (securing lateral chest flaps)
• Otoplasty (preventing hematomas)
• Rhinoplasty (closing dead space in the nasal tip)
• Axillary breast surgery (promoting flap adherence)
• Skin graft stabilization, particularly on concave surfaces

Duration and RemovalBolsters are typically retained for 3-5 days before removal. The process is straightforward—the retaining suture is cut at the bedside, causing minimal discomfort to the patient. If necessary, they can be reapplied.
AlternativesWhile bolsters are preferred in many cases, alternatives include:
Quilting Sutures: These sutures are placed across a cavity to obliterate dead space as they are tightened. However, they are more technically challenging to apply than bolsters and may leave more persistent dimpling at superficial entry points.
Compression Bandaging: This technique can be effective but may not be feasible in mobile areas or regions prone to becoming soaked with fluid.
ConclusionBolsters represent a cost-effective, reliable method for providing gentle compression at surgical sites. Their ability to reduce seroma formation, promote flap adherence, and simplify postoperative care makes them invaluable in plastic surgery practice, with few comparable alternatives.