Gisquet H, Delay E, Paradol P-O, Toussoun G, Delaporte T, Perol D
Unité de chirurgie plastique et reconstructrice, département de chirurgie, centre Léon-Bérard, université Lyon1, 28, rue Laënnec, 69373 Lyon cedex 08, France.
Ann Chir Plast Esthet. 2010 Apr;55(2):97-103. doi: 10.1016/j.anplas.2009.05.002. Epub 2009 Aug 12.
Seroma is the most frequent minor complication after harvesting latissimus dorsi flap for breast reconstruction. It induces patient's discomfort and multiple consultations for punctions. The dead space resulting from the harvest has to be closed by the "quilting suture" in order to prevent the seroma. Our aim is to evaluate the efficiency and the tolerance of the quilting suture by comparing two groups of 100 patients who had a breast reconstruction by the same technic of extended latissimus dorsi flap, performed by the same surgeon, from 2004 to 2007. Half of patients had the classic way of dorsal closure, and the other half of patients had the dorsal quilting suture.
In order to compare the two groups we have collected data concerning age, body mass index (BMI), tobacco use, postoperative complications, number and volume of punctions, draining time and postoperative pain. The efficiency of the quilting suture lies on a rigorous repartition of at least six sutures on the upper skin flap, 12 on the lower skin flap and under the skin suture line. The suture model is based on the one used for the Chippendale-designed sofa. We suture the skin flap while pushing down the shoulder, in order to split the skin tension and avoid traction on the final skin suture line. The procedure takes 15 minutes.
The "Chippendale" technic allows to reduce draining time from 12 days to 6 days. The incidence of chronic seroma is reduced by 50%. The dorsal wound healing seems also better thanks to tension reduction resulting from the quilting suture.
The "Chippendale" technic is a quick, cheap and easy learned procedure, efficient for preventing chronic seroma after the latissimus dorsi flap. The postoperative recovery is eased and the patients comforted.
血清肿是背阔肌皮瓣用于乳房重建术后最常见的轻微并发症。它会引起患者不适，并需要多次穿刺引流。为防止血清肿形成，取材造成的死腔必须通过“褥式缝合”来封闭。我们的目的是通过比较两组各100例患者来评估褥式缝合的有效性和耐受性，这些患者均在2004年至2007年间由同一位外科医生采用相同的扩大背阔肌皮瓣技术进行乳房重建。其中一半患者采用经典的背部闭合方式，另一半患者采用背部褥式缝合。
为比较两组患者，我们收集了有关年龄、体重指数（BMI）、吸烟情况、术后并发症、穿刺次数和量、引流时间以及术后疼痛的数据。褥式缝合的有效性在于在上部皮瓣至少严格缝合六针，下部皮瓣和皮下缝合线处缝合12针。缝合模式基于齐本德尔式沙发的缝合方式。我们在向下推肩部的同时缝合皮瓣，以分散皮肤张力，避免对最终皮肤缝合线产生牵拉。该操作耗时15分钟。
“齐本德尔”技术可使引流时间从12天缩短至6天。慢性血清肿的发生率降低了50%。由于褥式缝合减少了张力，背部伤口愈合情况似乎也更好。
“齐本德尔”技术是一种快速、廉价且易于掌握的操作方法，对预防背阔肌皮瓣术后慢性血清肿有效。它减轻了术后恢复过程，让患者感到舒适。
