Daltrey I, Thomson H, Hussien M, Krishna K, Rayter Z, Winters Z E
Department of Clinical Sciences at South Bristol and Bristol Breast Unit, Level 7, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK.
Br J Surg. 2006 Jul;93(7):825-30. doi: 10.1002/bjs.5434.
Latissimus dorsi (LD) flap breast reconstruction is associated with a high incidence of donor site seromas, despite the use of surgical drains. The aim of this study was to evaluate the use of donor site quilting sutures, as well as drains, on the incidence, volume and frequency of seroma aspiration.
The trial randomized 108 women undergoing LD breast reconstruction to quilting procedures (54) or control group (52) for intention-to-treat analysis; two were excluded. Outcome measures were the incidence and volume of postoperative seroma. Secondary outcome measures included postoperative back pain, analgesic consumption, shoulder movement and duration of hospital stay.
Quilting significantly reduced the overall incidence of seroma from 46 of 48 (96 per cent) to 43 of 52 (83 per cent) (P = 0.036), including the 38 women who had extended LD flap (with or without implants). There were further significant reductions in seroma volume (P = 0.004), frequency of aspiration (P = 0.001) and overall seroma volumes, including surgical drainage and symptomatic seromas (P = 0.013). Subset analyses for LD-implant (60 women) and extended LD (with or without implant) showed similar significance. Quilting did not affect back pain or compromise shoulder mobility.
Quilting significantly reduced overall seroma volumes after LD breast reconstruction including extended LD, and is recommended in combination with surgical drains.
尽管使用了手术引流管，但背阔肌（LD）皮瓣乳房重建术后供区血清肿的发生率仍很高。本研究的目的是评估供区褥式缝合以及引流管对血清肿抽吸的发生率、量和频率的影响。
该试验将108例行LD乳房重建术的女性随机分为褥式缝合组（54例）和对照组（52例）进行意向性分析；2例被排除。观察指标为术后血清肿的发生率和量。次要观察指标包括术后背痛、镇痛药物用量、肩部活动度和住院时间。
褥式缝合显著降低了血清肿的总体发生率，从48例中的46例（96%）降至52例中的43例（83%）（P = 0.036），包括38例行扩大背阔肌皮瓣（带或不带植入物）的女性。血清肿的量（P = 0.004）、抽吸频率（P = 0.001）以及总体血清肿量（包括手术引流和有症状的血清肿）（P = 0.013）均有进一步显著降低。对背阔肌皮瓣-植入物组（60例女性）和扩大背阔肌皮瓣组（带或不带植入物）的亚组分析显示了相似的显著性。褥式缝合不影响背痛或损害肩部活动度。
褥式缝合显著降低了LD乳房重建术后包括扩大背阔肌皮瓣术后的总体血清肿量，建议与手术引流管联合使用。
