Zolper Elizabeth G, Bekeny Jenna C, Fan Kenneth L, Del Corral Gabriel A
From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
Plastic and Reconstructive Surgery, MedStar Franklin Square Medical Center, Baltimore, MD.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S37-S40. doi: 10.1097/SAP.0000000000002328.
Seroma is a common complication after breast surgery such as mastectomy and immediate reconstruction. However, there is a lack of evidence for the utility of drains in the recipient site in delayed autologous breast reconstruction. We reviewed our experience with delayed abdominal-based flap breast reconstruction with a drainless recipient site.
A single-surgeon retrospective case review was performed for delayed abdominal-based flap breast reconstruction using drainless recipient sites from May 2018 to June 2019. Primary outcomes were recipient-site complications.
Thirty-one delayed abdominal-based flap breast reconstructions that did not use drains in the recipient site were identified in 22 patients. Mean age was 52.8 years (SD, 9.7 years). Mean body mass index was 30.1 kg/m (interquartile range [IQR], 28.2-35.0 kg/m). Common comorbidities were obesity (45.4%), prior tobacco use (31.8%), and diabetes (10.0%). Median time to abdominal-based flap reconstruction was 27.5 months (IQR, 9.9-105.2 months). There were 22 muscle-sparing transverse rectus abdominis musculocutaneous flaps and 9 deep inferior epigastric artery perforator flaps performed. Ten patients (45.4%) underwent bilateral reconstruction. Mean operative time was 302 minutes (SD, 85 minutes). Flap take back occurred in 1 case (3.2%). Mean length of stay was 4 days (SD, 0.8 days). Recipient-site complications were healing complications (32.3%), seroma (3.2%), hematoma (3.2%), and fat necrosis (19.4%). Median follow-up was 4.2 months (IQR, 2.5-11.5).
In this case series, our data indicate that delayed autologous reconstruction without drain placement at the recipient site has been proven to be safe and successful and did not increase the rate of seroma or other complications. Adopting a drainless approach may also improve patient comfort and satisfaction.
血清肿是乳房切除术和即刻乳房重建等乳房手术后的常见并发症。然而，在延迟自体乳房重建中，受体部位放置引流管的效用缺乏证据。我们回顾了我们在受体部位不放置引流管的延迟腹直肌肌皮瓣乳房重建方面的经验。
对2018年5月至2019年6月使用无引流受体部位的延迟腹直肌肌皮瓣乳房重建进行单术者回顾性病例分析。主要结局是受体部位并发症。
在22例患者中确定了31例受体部位未放置引流管的延迟腹直肌肌皮瓣乳房重建。平均年龄为52.8岁（标准差，9.7岁）。平均体重指数为30.1kg/m²（四分位间距[IQR]，28.2-35.0kg/m²）。常见合并症为肥胖（45.4%）、既往吸烟史（31.8%）和糖尿病（10.0%）。延迟腹直肌肌皮瓣重建的中位时间为27.5个月（IQR，9.9-105.2个月）。共进行了22例保留肌肉的腹直肌肌皮瓣和9例腹壁下动脉穿支皮瓣手术。10例患者（45.4%）接受了双侧重建。平均手术时间为302分钟（标准差，85分钟）。1例（3.2%）出现皮瓣回植。平均住院时间为4天（标准差，0.8天）。受体部位并发症包括愈合并发症（32.3%）、血清肿（3.2%）、血肿（3.2%）和脂肪坏死（19.4%）。中位随访时间为4.2个月（IQR，2.5-11.5个月）。
在本病例系列中，我们的数据表明，受体部位不放置引流管的延迟自体乳房重建已被证明是安全且成功的，且未增加血清肿或其他并发症的发生率。采用无引流方法还可提高患者的舒适度和满意度。
