Thekkinkattil Dinesh Kumar, Hussain Tasadooq, Mahapatra Tapan Kumar, McManus Penelope Louise, Kneeshaw Peter John
Department of Oncoplastic Breast Surgery, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire, UK.
Arch Plast Surg. 2013 Mar;40(2):117-22. doi: 10.5999/aps.2013.40.2.117. Epub 2013 Mar 11.
Latissimus dorsi (LD) myocutaneous flap is a popular method of breast reconstruction which can be associated with high incidence of seroma formation. Quilting sutures at the harvest site are used to reduce this. Barbed sutures are self anchoring sutures which avoid multiple knotting and can be useful in quilting.
A retrospective analysis of prospectively maintained database of patients who underwent LD flap breast reconstruction between January 2009 and January 2011 was carried out. Seroma formation at the harvest site, wound related complications, inpatient stay and duration of surgery were analysed and a comparison was made between two groups where quilting was done with barbed (V-Loc) suture and conventional polydioxanone (PDS) II sutures.
Fifty-seven patients were included of which 33 had quilting by V-Loc sutures and in 24 patients PDS II suture was used. Median age in the PDS group was 55 years (interquartile range [IQR)], 45 to 61 years) which was comparable to the V-Loc group (53 years [IQR, 48 to 59 years]; P-value 0.948). Sixteen patients (28%) had significant seroma formation and 5 (9%) patients developed superficial wound dehiscence. Incidences of seroma or wound complications were comparable (P-value 0.378 and 1.00, respectively). Secondary outcomes such as total duration of surgery, total inpatient stay, total amount of drain at the donor site were also similar in two groups.
Use of barbed sutures for quilting the donor site in LD flap reconstruction is a feasible option and the associated seroma formation and wound complications are comparable with conventional sutures.
背阔肌（LD）肌皮瓣是一种常用的乳房重建方法，但血清肿形成的发生率较高。在取材部位使用褥式缝合可减少这种情况。倒刺缝线是一种自锚式缝线，无需多次打结，可用于褥式缝合。
对2009年1月至2011年1月期间接受LD皮瓣乳房重建患者的前瞻性维护数据库进行回顾性分析。分析取材部位血清肿形成、伤口相关并发症、住院时间和手术时长，并对使用倒刺（V-Loc）缝线和传统聚二氧六环酮（PDS）II缝线进行褥式缝合的两组患者进行比较。
纳入57例患者，其中33例使用V-Loc缝线进行褥式缝合，24例使用PDS II缝线。PDS组的中位年龄为55岁（四分位间距[IQR]，45至61岁），与V-Loc组（53岁[IQR，48至59岁]；P值0.948）相当。16例患者（28%）出现明显血清肿形成，5例（9%）患者发生浅表伤口裂开。血清肿或伤口并发症的发生率相当（P值分别为0.378和1.00）。两组的手术总时长、总住院时间、供区引流总量等次要结局也相似。
在LD皮瓣重建中使用倒刺缝线对供区进行褥式缝合是一种可行的选择，其血清肿形成和伤口并发症与传统缝线相当。
