Sowa Yoshihiro, Inafuku Naoki, Kodama Takuya, Morita Daiki, Numajiri Toshiaki
Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences.
Plast Reconstr Surg Glob Open. 2018 Dec 17;6(12):e2035. doi: 10.1097/GOX.0000000000002035. eCollection 2018 Dec.
Postoperative seroma is still the main complication after a latissimus dorsi (LD) flap procedure. The etiology of seroma is currently thought to comprise tissue fluids resulting from inflammatory reactions in affected tissue caused by the use of monopolar electrocautery (EC). It is possible that seroma formation can be reduced by using alternative devices such as the PEAK PlasmaBlade (PPB), which provides atraumatic scalpel-like cutting precision while the blade temperature remains close to body temperature. The subjects were 44 patients who underwent breast reconstruction with LD flaps from August 2015 to April 2017. They were retrospectively split into groups treated with a PPB (n = 21) and with conventional EC (n = 23). Outcomes such as rate of seroma formation, total drain discharge volume, indwelling period of drainage at the donor site, length of hospital stay, and operation time were compared between the 2 groups. The incidence of seroma was significantly lower in the PPB group (19.0%) than in the EC group (47.8%). The total drain discharge volume was significantly lower and the indwelling period of drainage and length of hospital stay were significantly shorter in the PPB group. In summary, use of PPB in an LD flap procedure can reduce seroma formation and the lengths of the drainage period and the hospital stay.
术后血清肿仍是背阔肌（LD）皮瓣手术后的主要并发症。目前认为血清肿的病因包括因使用单极电灼（EC）导致受影响组织发生炎症反应而产生的组织液。使用诸如PEAK等离子刀（PPB）等替代设备有可能减少血清肿的形成，该设备可提供类似手术刀的无创伤切割精度，同时刀片温度接近体温。研究对象为2015年8月至2017年4月期间接受LD皮瓣乳房重建手术的44例患者。他们被回顾性地分为接受PPB治疗的组（n = 21）和接受传统EC治疗的组（n = 23）。比较了两组之间血清肿形成率、总引流量、供区引流留置时间、住院时间和手术时间等结果。PPB组血清肿的发生率（19.0%）显著低于EC组（47.8%）。PPB组的总引流量显著更低，引流留置时间和住院时间也显著更短。总之，在LD皮瓣手术中使用PPB可减少血清肿的形成以及引流期和住院时间。
