From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University.
Department of Plastic Surgery, Osaka International Cancer Institute, Osaka, Japan.
Ann Plast Surg. 2021 Mar 1;86(3):265-267. doi: 10.1097/SAP.0000000000002545.
Latissimus dorsi myocutaneous (LD) flaps are widely used in breast reconstruction surgery. However, seromas often form postoperatively at the donor site as a complication. This study aimed to determine the impact of different electrocautery modes during flap elevation, with or without subsequent quilting sutures, on postoperative seroma formation.
Subjects were 112 patients who underwent immediate breast reconstruction with LD flaps after breast-conserving surgery between April 2015 and January 2019. Group A consisted of 21 patients who underwent LD flap elevation using the fulgurate mode, and group B consisted of 25 patients who underwent flap elevation using the lower power, pure cut mode. Group C consisted of 66 patients who underwent flap elevation with the lower power, pure cut mode combined with quilting sutures for wound closure.
Mean 1-week postoperative back drain volume and the mean number of days to drain removal in group B were significantly reduced relative to those in group A (group A, 752.3 mL and 16.9 days, respectively; group B, 552.2 mL and 10.6 days, respectively; P < 0.001 for both). Group C, which included quilting sutures, had even lower values than group B (459.7 mL and 7.4 days, respectively; group B vs group C: P = 0.03 and P < 0.001, respectively). Significant differences were observed between groups for postoperative seroma formation at the flap donor site (group A, 16 [76.2%] of 21 patients; group B, 11 [44%] 25 patients; group C, 4 [6.1%] of 66 patients; A vs B: P < 0.001, B vs C: P < 0.001).
The use of low power, pure cut mode for LD flap harvest, combined with quilting sutures, effectively shortened the time to drain removal and suppressed seroma formation. Given that specialized devices and materials are not required, this combination may reduce both patient burden and medical costs.
背阔肌肌皮瓣（LD）在乳房重建术中被广泛应用。然而，术后供区常出现血清肿等并发症。本研究旨在确定在皮瓣掀起过程中采用不同电切模式（有或无后续缝合）对术后血清肿形成的影响。
112 例患者于 2015 年 4 月至 2019 年 1 月因保乳术后行即刻乳房重建而接受 LD 皮瓣，将其分为三组：A 组 21 例采用电灼模式掀起皮瓣，B 组 25 例采用低功率、纯切模式掀起皮瓣，C 组 66 例采用低功率、纯切模式掀起皮瓣并缝合关闭伤口。
B 组术后 1 周引流总量及引流管拔除时间均明显少于 A 组（A 组分别为 752.3 mL 和 16.9 天，B 组分别为 552.2 mL 和 10.6 天；均 P＜0.001），而 C 组（缝合组）的引流总量及引流管拔除时间进一步减少（459.7 mL 和 7.4 天；B 组与 C 组比较：P=0.03 和 P＜0.001）。各组术后供区皮瓣血清肿形成发生率有显著差异（A 组 21 例中 16 例[76.2%]，B 组 25 例中 11 例[44%]，C 组 66 例中 4 例[6.1%]；A 组与 B 组比较：P＜0.001，B 组与 C 组比较：P＜0.001）。
采用低功率、纯切模式掀起 LD 皮瓣，并缝合关闭伤口，可有效缩短引流管拔除时间，减少血清肿形成。该方法无需特殊设备和材料，可减轻患者负担和医疗费用。
