From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Plast Reconstr Surg. 2019 Jul;144(1):9e-17e. doi: 10.1097/PRS.0000000000005697.
A closed-suction drain is usually inserted during tissue expander-based breast reconstruction. Prolonged duration of drain retention can disturb patients' daily lives and affect overall sociomedical costs. This study aimed to investigate factors that may influence the drainage and to identify predictors of unusually prolonged drain duration.
Patients who underwent delayed-immediate, two-stage breast reconstruction using a tissue expander between January of 2013 and July of 2017 were reviewed. Prolonged drain duration was defined as drain duration for longer than the 75th percentile of that for the entire cohort. Effects of patient- and operation-related variables on drainage and prolonged drain duration were evaluated.
A total of 1056 cases (1002 patients) were analyzed. The median drain duration was 10 days. Drain placement for more than 12 postoperative days was observed in 256 cases (24.2 percent), classified as prolonged drain duration. Multivariate analyses demonstrated that old age, high body mass index, neoadjuvant chemotherapy, insertion of large Siltex textured tissue expanders, and greater volume of initial inflation were independent risk factors of prolonged drain duration. The size and texture of the tissue expanders and initial inflation volume retained their influence, regardless of mastectomy specimen weight. Use of acellular dermal matrix had contradictory effects according to breast size, being protective against prolonged drain duration in cases with mastectomy specimen weight greater than 400 g, and being a significant predictor for it in cases with mastectomy specimen weight less than or equal to 400 g.
Several factors, including reconstructive operation-related factors, might influence drain duration following tissue expander-based breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
组织扩张器乳房重建术通常会插入负压引流管。引流管留置时间过长会干扰患者的日常生活并影响整体社会医疗费用。本研究旨在探讨可能影响引流的因素，并确定引流时间异常延长的预测因素。
回顾了 2013 年 1 月至 2017 年 7 月期间接受延迟即刻、两阶段组织扩张器乳房重建术的患者。将引流时间长于整个队列中位数 75%的患者定义为引流时间延长。评估了患者和手术相关变量对引流和延长引流时间的影响。
共分析了 1056 例（1002 例患者）。引流时间的中位数为 10 天。256 例（24.2%）患者的引流管放置时间超过 12 天，被归类为引流时间延长。多变量分析表明，年龄较大、体质量指数较高、新辅助化疗、大尺寸 Siltex 纹理组织扩张器的插入和初始充气量较大是延长引流时间的独立危险因素。组织扩张器的大小和纹理以及初始充气量保留了它们的影响，与乳房切除术标本重量无关。脱细胞真皮基质的使用根据乳房大小具有相反的效果，在乳房切除术标本重量大于 400 g 的情况下，对延长引流时间具有保护作用，而在乳房切除术标本重量小于或等于 400 g 的情况下，则是延长引流时间的重要预测因素。
几个因素，包括与重建手术相关的因素，可能会影响组织扩张器乳房重建术后的引流时间。
临床问题/证据水平：风险，III。
