Archives of Plastic Surgery

  • 제49권4호
  • /
  • Pages.494-500
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  • 2022
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction

  • Merchant, Alisha (Faculty of Medicine, University of Zurich) ;
  • Speck, Nicole E. (Plastic Surgery Group) ;
  • Michalak, Michal (Department of Computer Science and Statistics, Poznan University of Medical Sciences) ;
  • Schaefer, Dirk J. (Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel) ;
  • Farhadi, Jian (Plastic Surgery Group)
  • 발행 : 2022.07.15
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초록

Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites. Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites. Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group. Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.

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참고문헌

  1. Jeevan R, Cromwell DA, Browne JP, et al. Findings of a national comparative audit ofmastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg 2014;67(10):1333-1344 https://doi.org/10.1016/j.bjps.2014.04.022
  2. Chow WTH, Oni G, Ramakrishnan VV, Griffiths M. The use of plasmakinetic cautery compared to conventional electrocautery for dissection of abdominal free flap for breast reconstruction: single-centre, randomized controlled study. Gland Surg 2019;8(03):242-248 https://doi.org/10.21037/gs.2018.12.04
  3. Andrades P, Prado A. Composition of postabdominoplasty seroma. Aesthetic Plast Surg 2007;31(05):514-518 https://doi.org/10.1007/s00266-007-0078-3
  4. Bae SH, Lee YW, Nam SB, et al. Recurrent late seroma after immediate breast reconstruction with latissimus dorsi musculocutaneous flap. Arch Plast Surg 2020;47(03):267-271 https://doi.org/10.5999/aps.2019.00402
  5. Nedomansky J, Nickl S, Radtke C, Haslik W, Schroegendorfer KF. Venous superdrainage in DIEP flap breast reconstruction: the impact of superficial inferior epigastric vein dissection on abdominal seroma formation. Plast Reconstr Surg 2018;141(02):206e-212e https://doi.org/10.1097/PRS.0000000000004017
  6. Zoccali G, Molina A, Farhadi J. Is long-term post-operative monitoring of microsurgical flaps still necessary? J Plast Reconstr Aesthet Surg 2017;70(08):996-1000 https://doi.org/10.1016/j.bjps.2017.05.041
  7. Lindenblatt N, Gruenherz L, Farhadi J. A systematic review of donor site aesthetic and complications after deep inferior epigastric perforator flap breast reconstruction. Gland Surg 2019;8(04):389-398 https://doi.org/10.21037/gs.2019.06.05
  8. Xu H, Dong J, Wang T. Bipedicle deep inferior epigastric perforator flap for unilateral breast reconstruction: seven years' experience. Plast Reconstr Surg 2009;124(06):1797-1807 https://doi.org/10.1097/PRS.0b013e3181bf81cf
  9. Lakhiani C, DeFazio MV, Han K, Falola R, Evans K. Donor-site morbidity following free tissue harvest from the thigh: a systematic review and pooled analysis of complications. J Reconstr Microsurg 2016;32(05):342-357 https://doi.org/10.1055/s-0036-1583301
  10. Blondeel PN. The sensate free superior gluteal artery perforator (S-GAP) flap: a valuable alternative in autologous breast reconstruction. Br J Plast Surg 1999;52(03):185-193 https://doi.org/10.1054/bjps.1998.3032
  11. Guerra AB, Metzinger SE, Bidros RS, Gill PS, Dupin CL, Allen RJ. Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases. Ann Plast Surg 2004;52(02):118-125 https://doi.org/10.1097/01.sap.0000095437.43805.d1
  12. von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs 2005;9(Suppl 2):S35-S38 https://doi.org/10.1016/j.ejon.2005.09.001
  13. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 2010;9:69 https://doi.org/10.1186/1475-2891-9-69
  14. Klink CD, Binnebosel M, Lucas AH, et al. Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair. Hernia 2011;15(01):69-73 https://doi.org/10.1007/s10029-010-0746-0
  15. Modarressi A, Muller CT, Montet X, Ruegg EM, Pittet-Cuenod B. DIEP flap for breast reconstruction: is abdominal fat thickness associated with post-operative complications? J Plast Reconstr Aesthet Surg 2017;70(08):1068-1075 https://doi.org/10.1016/j.bjps.2017.05.002
  16. Seidenstuecker K, Munder B, Mahajan AL, Richrath P, Behrendt P, Andree C. Morbidity of microsurgical breast reconstruction in patients with comorbid conditions. Plast Reconstr Surg 2011;127(03):1086-1092 https://doi.org/10.1097/PRS.0b013e318205f255
  17. Guerra AB, Metzinger SE, Bidros RS, et al. Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: an experience with 280 flaps. Ann Plast Surg 2004;52(03):246-252 https://doi.org/10.1097/01.sap.0000110529.37143.96
  18. Fischer JP, Nelson JA, Sieber B, et al. Free tissue transfer in the obese patient: an outcome and cost analysis in 1258 consecutive abdominally based reconstructions. Plast Reconstr Surg 2013;131(05):681e-692e https://doi.org/10.1097/PRS.0b013e31828e2159
  19. Sadeghi A, Malata C. CASE REPORT persistent seromas in abdominal free flap donor sites after postmastectomy breast reconstruction surgery: case reports and literature review. Eplasty 2013;13:e24
  20. Gill PS, Hunt JP, Guerra AB, et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 2004;113(04):1153-1160 https://doi.org/10.1097/01.PRS.0000110328.47206.50
  21. Munder B, Andree C, Witzel C, et al. The DIEP flap as well-established method of choice for autologous breast reconstruction with a low complication rate - retrospective single-centre 10-year experience. Geburtshilfe Frauenheilkd 2020;80(06):628-638 https://doi.org/10.1055/a-1116-2102
  22. Kontos M, Petrou A, Prassas E, et al. Pressure dressing in breast surgery: is this the solution for seroma formation? J BUON 2008;13(01):65-67
  23. Rousseau P, Vincent H, Potier B, Arnaud D, Darsonval V. Diather-mocoagulation in cutting mode and large flap dissection. Plast Reconstr Surg 2011;127(05):2093-2098 https://doi.org/10.1097/PRS.0b013e31820cf46e
  24. Marsh DJ, Fox A, Grobbelaar AO, Chana JS. Abdominoplasty and seroma: a prospective randomised study comparing scalpel and handheld electrocautery dissection. J Plast Reconstr Aesthet Surg 2015;68(02):192-196 https://doi.org/10.1016/j.bjps.2014.10.004
  25. Lee D, Jung BK, Roh TS, Kim YS. Ultrasonic dissection versus electrocautery for immediate prosthetic breast reconstruction. Arch Plast Surg 2020;47(01):20-25 https://doi.org/10.5999/aps.2019.00759
  26. Janis JE, Khansa L, Khansa I. Strategies for postoperative seroma prevention: a systematic review. Plast Reconstr Surg 2016;138(01):240-252 https://doi.org/10.1097/PRS.0000000000002245
  27. Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg 2000;105(07):2583-2586 https://doi.org/10.1097/00006534-200006000-00047
  28. Sforza M, Husein R, Andjelkov K, Rozental-Fernandes PC, Zaccheddu R, Jovanovic M. Use of quilting sutures during abdominoplasty to prevent seroma formation: are they really effective? Aesthet Surg J 2015;35(05):574-580 https://doi.org/10.1093/asj/sju103
  29. Warner JP, Gutowski KA. Abdominoplasty with progressive tension closure using a barbed suture technique. Aesthet Surg J 2009;29(03):221-225 https://doi.org/10.1016/j.asj.2009.01.009
  30. Nagarkar P, Lakhiani C, Cheng A, Lee M, Teotia S, Saint-Cyr M. Nodrain DIEP flap donor-site closure using barbed progressive tension sutures. Plast Reconstr Surg Glob Open 2016;4(04):e672 https://doi.org/10.1097/GOX.0000000000000049
  31. Liang DG, Dusseldorp JR, van Schalkwyk C, et al. Running barbed suture quilting reduces abdominal drainage in perforator-based breast reconstruction. J Plast Reconstr Aesthet Surg 2016;69(01):42-47 https://doi.org/10.1016/j.bjps.2015.09.009
  32. Salgarello M, Tambasco D, Farallo E. DIEP flap donor site versus elective abdominoplasty short-term complication rates: a meta-analysis. Aesthetic Plast Surg 2012;36(02):363-369 https://doi.org/10.1007/s00266-011-9804-y