Plastic & Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
Plastic & Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
J Plast Reconstr Aesthet Surg. 2014 Feb;67(2):226-30. doi: 10.1016/j.bjps.2013.10.010. Epub 2013 Oct 26.
The pedicled latissimus dorsi myocutaneous (LD) flap is a popular breast reconstruction choice, representing approximately 50% of procedures undertaken in the UK. Donor site drain use may reduce complication rates, however no evidence exists regarding the duration of back drain use for LD flap breast reconstruction and calls have been made in the literature to investigate this further.
To compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction back drain removal by post-operative day (POD) 3 regardless of output (early group), with removal after POD 3 where instructions were documented by drainage volume/24 h ± output consistency (late group), in post-mastectomy LD reconstruction donor sites.
A retrospective review of LD breast reconstruction procedures, performed between January 2010 and July 2011, was undertaken to ensure 1 year minimum follow-up per patient.
There were 81 patients who underwent unilateral LD breast reconstructions; 78 hospital records contained complete documentation. There were 48 patients in the late removal group and 30 patients in the early removal group. The mean drain removal day (5.42 ± 0.17 days vs. 2.87 ± 0.06 days, p < 0.001), total drainage (907.71 ± 76.07 ml vs. 492.67 ± 35.15 ml, p < 0.0001) and hospital inpatient stay (4.60 ± 0.19 days vs. 3.63 ± 0.17 days, p < 0.001) were greater for patients in the late group, versus the early group. There were no differences in total complications (16.67%(8/48) vs. 10%(3/30), p = 0.41), seroma (6.25%(3/48) vs. 6.67%(2/30), p = 0.94), dehiscence (4.17%(2/48) vs. 3.33%(1/30), p = 0.85) or haematoma rates (10.42%(5/48) vs. 0%(0/30), p = 0.07) between patients in the late and early groups; seroma sub-analysis also indicated no differences in number of seroma aspirations, duration of drainage (months) and mean total drainage (ml) prior to resolution.
These data suggest significant advantages for patients who have back drains removed by POD 3, without increased post-operative complications including seroma rates, and we recommend drain removal and patient discharge by POD 3.
带蒂背阔肌肌皮瓣是一种常用的乳房重建选择，约占英国所有手术的 50%。使用引流管可能会降低并发症的发生率，但目前尚缺乏关于背阔肌皮瓣乳房重建中引流管使用时间的证据，因此有文献呼吁对此进行进一步研究。
比较经皮术后第 3 天（POD3）拔除封闭负压引流（closedsuctionbackdrain）的住院时间、引流参数和供区并发症，无论引流量/24h±输出量是否一致（早期组），与 POD3 后根据引流体积/24h±输出量的一致性（晚期组）记录的引流管拔出时间，以评估这两种方式在乳房切除术后背阔肌皮瓣重建供区的效果。
回顾性分析 2010 年 1 月至 2011 年 7 月期间行单侧背阔肌皮瓣乳房重建术患者的病历，以确保每位患者至少随访 1 年。
共有 81 例患者行单侧背阔肌皮瓣乳房重建术，78 例患者的住院病历中有完整的记录。晚期组 48 例，早期组 30 例。晚期组患者引流管拔除日（5.42±0.17 天 vs. 2.87±0.06 天，p<0.001）、总引流量（907.71±76.07ml vs. 492.67±35.15ml，p<0.0001）和住院时间（4.60±0.19 天 vs. 3.63±0.17 天，p<0.001）均大于早期组。晚期组和早期组的总并发症发生率（16.67%（8/48）vs. 10%（3/30），p=0.41）、血清肿发生率（6.25%（3/48）vs. 6.67%（2/30），p=0.94）、切口裂开发生率（4.17%（2/48）vs. 3.33%（1/30），p=0.85）和血肿发生率（10.42%（5/48）vs. 0%（0/30），p=0.07）无差异；血清肿亚组分析也表明，两组患者的血清肿抽吸次数、引流时间（月）和平均总引流量（ml）在得到解决前无差异。
这些数据表明，对于术后第 3 天就拔管的患者来说，具有显著的优势，不会增加术后并发症，包括血清肿的发生率，我们建议术后第 3 天就拔除引流管并让患者出院。
