Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Efficacy of Quilting Sutures and Fibrin Sealant Together for Prevention of Seroma in Extended Latissimus Dorsi Flap Donor Sites

  • Shin, In Soo (Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Lee, Dong Won (Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine)
  • Received : 2012.05.02
  • Accepted : 2012.07.11
  • Published : 2012.09.15
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Abstract

Background The extended latissimus dorsi flap is important for breast reconstruction. Unfortunately, donor site seroma is the most common complication of extended latissimus dorsi flap for breast reconstruction. Although using fibrin sealant in the donor site reduces the rate of seroma formation, donor site seroma remains a troublesome complication. The purpose of this study was to analyze the effectiveness of the combination of quilting sutures and fibrin sealant in the latissimus dorsi donor site for the prevention of seroma. Methods Forty-six patients who underwent breast reconstruction with extended latissimus flap were enrolled in the study. The patients received either fibrin sealant (group 1, n=25) or a combination of fibrin sealant and quilting sutures (group 2, n=21) in the extended latissimus dorsi donor site. Outcome measures were obtained from the incidence, volume of postoperative seroma, total drainage amount, indwelling period of drainage, and duration of hospital stay. Results The incidence of seroma was 76% in group 1 and 42.9% in group 2 (P=0.022). We also found significant reductions in seroma volume (P=0.043), total drainage amount (P=0.002), indwelling period of drainage (P=0.01), and frequency of aspiration (P=0.043). The quilting sutures did not affect the rate of drainage, tube reinsertion, or hospital stay. Conclusions The use of quilting sutures combined with fibrin sealant on the latissimus dorsi flap donor site is helpful for reducing the overall seroma volume, frequency of aspiration, and total drainage amount.

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References

  1. Hokin JA. Mastectomy reconstruction without a prosthetic implant. Plast Reconstr Surg 1983;72:810-8. https://doi.org/10.1097/00006534-198312000-00012
  2. Min SY, Kim HY, Jung SY, et al. Oncological safety and quality of life associated with mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap. Breast J 2010;16:356-61.
  3. Rusby JE, Paramanathan N, Laws SA, et al. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg 2008;196:512-8. https://doi.org/10.1016/j.amjsurg.2008.06.026
  4. Woodworth PA, McBoyle MF, Helmer SD, et al. Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg 2000;66:444-50.
  5. Clough KB, Louis-Sylvestre C, Fitoussi A, et al. Donor site sequelae after autologous breast reconstruction with an extended latissimus dorsi flap. Plast Reconstr Surg 2002;109: 1904-11. https://doi.org/10.1097/00006534-200205000-00020
  6. Roy MK, Shrotia S, Holcombe C, et al. Complications of latissimus dorsi myocutaneous flap breast reconstruction. Eur J Surg Oncol 1998;24:162-5. https://doi.org/10.1016/S0748-7983(98)92810-4
  7. Schwabegger A, Ninkovic M, Brenner E, et al. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 1997;38:594-7. https://doi.org/10.1097/00000637-199706000-00005
  8. Aitken DR, Hunsaker R, James AG. Prevention of seromas following mastectomy and axillary dissection. Surg Gynecol Obstet 1984;158:327-30.
  9. Kulber DA, Bacilious N, Peters ED, et al. The use of fibrin sealant in the prevention of seromas. Plast Reconstr Surg 1997;99:842-9. https://doi.org/10.1097/00006534-199703000-00034
  10. Reddick LP. Seroma after latissimus dorsi myocutaneous flap for breast reconstruction. Plast Reconstr Surg 1990;85:826.
  11. Titley OG, Spyrou GE, Fatah MF. Preventing seroma in the latissimus dorsi flap donor site. Br J Plast Surg 1997;50:106-8. https://doi.org/10.1016/S0007-1226(97)91321-7
  12. Lindsey WH, Masterson TM, Spotnitz WD, et al. Seroma prevention using fibrin glue in a rat mastectomy model. Arch Surg 1990;125:305-7. https://doi.org/10.1001/archsurg.1990.01410150027005
  13. Saltz R, Sierra D, Feldman D, et al. Experimental and clinical applications of fibrin glue. Plast Reconstr Surg 1991;88:1005-15. https://doi.org/10.1097/00006534-199112000-00009
  14. McCarthy C, Lennox P, Germann E, et al. Use of abdominal quilting sutures for seroma prevention in TRAM flap reconstruction: a prospective, controlled trial. Ann Plast Surg 2005;54:361-4. https://doi.org/10.1097/01.sap.0000151465.10356.dd
  15. Gosain AK, Lyon VB; Plastic Surgery Educational Foundation DATA Committee. The current status of tissue glues: part II. For adhesion of soft tissues. Plast Reconstr Surg 2002;110:1581-4. https://doi.org/10.1097/00006534-200211000-00031
  16. Nahas FX, Ferreira LM, Ghelfond C. Does quilting suture prevent seroma in abdominoplasty? Plast Reconstr Surg 2007;119:1060-4. https://doi.org/10.1097/01.prs.0000242493.11655.68
  17. Daltrey I, Thomson H, Hussien M, et al. Randomized clinical trial of the effect of quilting latissimus dorsi flap donor site on seroma formation. Br J Surg 2006;93:825-30. https://doi.org/10.1002/bjs.5434
  18. Gisquet H, Delay E, Paradol PO, et al. Prevention of seroma by quilting suture after harvesting latissimus dorsi flap. The "Chippendale" technic. Ann Chir Plast Esthet 2010;55:97-103. https://doi.org/10.1016/j.anplas.2009.05.002
  19. Ali SN, Gill P, Oikonomou D, et al. The combination of fibrin glue and quilting reduces drainage in the extended latissimus dorsi flap donor site. Plast Reconstr Surg 2010; 125:1615-9. https://doi.org/10.1097/PRS.0b013e3181d0ab4d
  20. Dancey AL, Cheema M, Thomas SS. A prospective randomized trial of the efficacy of marginal quilting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg 2010;125:1309-17. https://doi.org/10.1097/PRS.0b013e3181d4fb68
  21. Taghizadeh R, Shoaib T, Hart AM, et al. Triamcinolone reduces seroma re-accumulation in the extended latissimus dorsi donor site. J Plast Reconstr Aesthet Surg 2008;61:636-42. https://doi.org/10.1016/j.bjps.2007.03.019
  22. Jain PK, Sowdi R, Anderson AD, et al. Randomized clinical trial investigating the use of drains and fibrin sealant following surgery for breast cancer. Br J Surg 2004;91:54-60. https://doi.org/10.1002/bjs.4435
  23. Watt-Boolsen S, Nielsen VB, Jensen J, et al. Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy. Dan Med Bull 1989;36:487-9.
  24. Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J Surg Oncol 2003;29:711-7. https://doi.org/10.1016/S0748-7983(03)00096-9

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