Efficacy of Low Power, Pure Cut Mode of Monopolar Electrosurgery and Quilting Sutures for Preventing Seroma Formation After Latissimus Dorsi Myocutaneous Flap Harvest.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
entrez:
8
2
2021
pubmed:
9
2
2021
medline:
15
5
2021
Statut:
ppublish
Résumé
Latissimus dorsi myocutaneous (LD) flaps are widely used in breast reconstruction surgery. However, seromas often form postoperatively at the donor site as a complication. This study aimed to determine the impact of different electrocautery modes during flap elevation, with or without subsequent quilting sutures, on postoperative seroma formation. Subjects were 112 patients who underwent immediate breast reconstruction with LD flaps after breast-conserving surgery between April 2015 and January 2019. Group A consisted of 21 patients who underwent LD flap elevation using the fulgurate mode, and group B consisted of 25 patients who underwent flap elevation using the lower power, pure cut mode. Group C consisted of 66 patients who underwent flap elevation with the lower power, pure cut mode combined with quilting sutures for wound closure. Mean 1-week postoperative back drain volume and the mean number of days to drain removal in group B were significantly reduced relative to those in group A (group A, 752.3 mL and 16.9 days, respectively; group B, 552.2 mL and 10.6 days, respectively; P < 0.001 for both). Group C, which included quilting sutures, had even lower values than group B (459.7 mL and 7.4 days, respectively; group B vs group C: P = 0.03 and P < 0.001, respectively). Significant differences were observed between groups for postoperative seroma formation at the flap donor site (group A, 16 [76.2%] of 21 patients; group B, 11 [44%] 25 patients; group C, 4 [6.1%] of 66 patients; A vs B: P < 0.001, B vs C: P < 0.001). The use of low power, pure cut mode for LD flap harvest, combined with quilting sutures, effectively shortened the time to drain removal and suppressed seroma formation. Given that specialized devices and materials are not required, this combination may reduce both patient burden and medical costs.
Sections du résumé
BACKGROUND
Latissimus dorsi myocutaneous (LD) flaps are widely used in breast reconstruction surgery. However, seromas often form postoperatively at the donor site as a complication. This study aimed to determine the impact of different electrocautery modes during flap elevation, with or without subsequent quilting sutures, on postoperative seroma formation.
METHODS
Subjects were 112 patients who underwent immediate breast reconstruction with LD flaps after breast-conserving surgery between April 2015 and January 2019. Group A consisted of 21 patients who underwent LD flap elevation using the fulgurate mode, and group B consisted of 25 patients who underwent flap elevation using the lower power, pure cut mode. Group C consisted of 66 patients who underwent flap elevation with the lower power, pure cut mode combined with quilting sutures for wound closure.
RESULTS
Mean 1-week postoperative back drain volume and the mean number of days to drain removal in group B were significantly reduced relative to those in group A (group A, 752.3 mL and 16.9 days, respectively; group B, 552.2 mL and 10.6 days, respectively; P < 0.001 for both). Group C, which included quilting sutures, had even lower values than group B (459.7 mL and 7.4 days, respectively; group B vs group C: P = 0.03 and P < 0.001, respectively). Significant differences were observed between groups for postoperative seroma formation at the flap donor site (group A, 16 [76.2%] of 21 patients; group B, 11 [44%] 25 patients; group C, 4 [6.1%] of 66 patients; A vs B: P < 0.001, B vs C: P < 0.001).
CONCLUSIONS
The use of low power, pure cut mode for LD flap harvest, combined with quilting sutures, effectively shortened the time to drain removal and suppressed seroma formation. Given that specialized devices and materials are not required, this combination may reduce both patient burden and medical costs.
Identifiants
pubmed: 33555680
doi: 10.1097/SAP.0000000000002545
pii: 00000637-202103000-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-267Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: none declared.
Références
Schneider WJ, Hill HL Jr., Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg . 1977;30:277–281.
Mendelson BC. Latissimus dorsi breast reconstruction—refinement and results. Br J Surg . 1983;70:145–149.
Gabriel A, Gupta S, Orgill DP. Challenges and management of surgical site occurrences. Plast Reconstr Surg . 2019;143:7S–10S.
Porter KA, O'Connor S, Rimm E, et al. Electrocautery as a factor in seroma formation following mastectomy. Am J Surg . 1998;176:8–11.
Sajid MS, Betal D, Akhter N, et al. Prevention of postoperative seroma-related morbidity by quilting of latissimus dorsi flap donor site: a systematic review. Clin Breast Cancer . 2011;11:357–363.
Gruber S, Whitworth AB, Kemmler G, et al. New risk factors for donor site seroma formation after latissimus dorsi flap breast reconstruction: 10-year period outcome analysis. J Plast Reconstr Aesthet Surg . 2011;64:69–74.
Jeon BJ, Lee TS, Lim SY, et al. Risk factors for donor-site seroma formation after immediate breast reconstruction with the extended latissimus dorsi flap: a statistical analysis of 120 consecutive cases. Ann Plast Surg . 2012;69:145–147.
Tomita K, Yano K, Masuoka T, et al. Postoperative seroma formation in breast reconstruction with latissimus dorsi flaps: a retrospective study of 174 consecutive cases. Ann Plast Surg . 2007;59:149–151.
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;38:594–597.
Longo B, Grippaudo FR, Laporta R, et al. Prospective control study using fibrin sealants and harmonic(R) scalpel in latissimus dorsi flap transfer. J Plast Surg Hand Surg . 2016;50:59–62.
Sowa Y, Inafuku N, Kodama T, et al. Preventive effect on seroma of use of PEAK PlasmaBlade after latissimus dorsi breast reconstruction. Plast Reconstr Surg Glob Open . 2018;6:e2035.
Titley OG, Spyrou GE, Fatah MF. Preventing seroma in the latissimus dorsi flap donor site. Br J Plast Surg . 1997;50:106–108.
Lee KT, Mun GH. Fibrin sealants and quilting suture for prevention of seroma formation following latissimus dorsi muscle harvest: a systematic review and meta-analysis. Aesthetic Plast Surg . 2015;39:399–409.
Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg . 2012;39:509–513.
Yang Y, Chen Y, Qu J, et al. The use of OK-432 to prevent seroma in extended latissimus dorsi flap donor site after breast reconstruction. J Surg Res . 2015;193:492–496.
Angspatt A, Laopiyasakul T, Pungrasmi P, et al. The role of negative-pressure wound therapy in latissimus dorsi flap donor site seroma prevention: a cohort study. Arch Plast Surg . 2017;44:308–312.
Sowa Y, Numajiri T, Kawarazaki A, et al. Preventive effects on seroma formation with use of the harmonic focus shears after breast reconstruction with the latissimus dorsi flap. J Plast Surg Hand Surg . 2016;50:349–353.
Rousseau P, Vincent H, Potier B, et al. Diathermocoagulation in cutting mode and large flap dissection. Plast Reconstr Surg . 2011;127:2093–2098.
Llewellyn-Bennett R, Greenwood R, Benson JR, et al. Randomized clinical trial on the effect of fibrin sealant on latissimus dorsi donor-site seroma formation after breast reconstruction. Br J Surg . 2012;99:1381–1388.
Miranda BH, Amin K, Chana JS. The drain game: back drains for latissimus dorsi breast reconstruction. J Plast Reconstr Aesthet Surg . 2014;67:226–230.