Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay

Thacoor, Amitabh; Kanapathy, Muholan; Torres-Grau, Jana; Chana, Jagdeep S.

doi:10.1016/j.bjps.2018.04.019

Cited by 18 publications

(22 citation statements)

References 19 publications

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“…Our search strategy retrieved 19 studies and, after thorough screening, we identified four studies that met the eligibility criteria (Figure 2). Thacoor et al: They undertook a single-centre retrospective review of patients undergoing DIEP flap reconstruction [4]. Patients were divided into groups based on the method of abdominal closure.…”

Section: Literature Searchmentioning

confidence: 99%

“…Although used by 90% of plastic surgeons, the use of abdominal drains during donor site closure in breast reconstruction with abdominal flaps is widely debated across the surgical literature [ 1 ]. Inserting a drain is based on the premise that it has a role in reducing dead space by preventing fluid accumulation, thereby minimising subsequent complications such as seroma formation and wound dehiscence [ 4 ]. Drain use, however, does carry caveats to patient care, including an increased risk of infection, pain, reduced mobility, greater nursing requirements, as well as prolonged hospital admission [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Initially described by Pollock, and shown in Figure 1 below, PTS have demonstrated encouraging results with comparable complication rates to standard closure with drains [ 8 - 11 ]. Several recent reports in the literature have compared the two modalities, yet there is no study to amalgamate outcomes and provide the best available evidence to guide surgeons [ 4 - 5 ]. The authors, therefore, report the first systematic review and meta-analysis assessing the outcomes of drain-free closure of abdominal wounds in breast reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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The Drain Dilemma: A Systematic Review and Meta-Analysis of Drain-Free Abdominal Closure With Progressive Tension Sutures Against Drain-Assisted Closure for Abdominal Flaps in Breast Reconstruction

Khan¹,

Wood²,

Abdul³

et al. 2021

Cureus

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The use of abdominal drains in donor site closure following breast reconstruction with abdominal flaps is widespread. Our review aimed to compare the outcomes of donor site closure with and without the use of abdominal drains following breast reconstruction with abdominal flaps.Randomized, non-randomized, and observational studies that compared the use of drains vs. no drain in breast reconstruction were included by searching MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL).Four studies enrolling 327 participants were identified. A statistically significant difference was found in terms of duration of hospital stay favouring abdominal closure without the use of drains (MD = -1.15, 95% CI = -1.88 tom-0.42, P=0.002), with a similar difference found in terms of overall complication rate (OR = 0.44, 95% CI = 0.23 to 0.83, p=0.01). Likewise, a statistically significant difference was found favouring abdominal closure without the use of drains for the secondary outcome of operative time (MD = -55.95, 95% CI = -107.19 to -4.74, p=0.03).Abdominal closure without drains following breast reconstructions with abdominal flaps is superior to closure with drains.

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Section: Literature Searchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Drain Dilemma: A Systematic Review and Meta-Analysis of Drain-Free Abdominal Closure With Progressive Tension Sutures Against Drain-Assisted Closure for Abdominal Flaps in Breast Reconstruction

Khan¹,

Wood²,

Abdul³

et al. 2021

Cureus

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“…Big subcutaneous space formed during surgery of the abdominal wall, is also one of the most common sites for postoperative seroma. After a breast reconstruction using DIEP free flap, where fat and skin with their vasculature are harvested from the lower abdomen, micro surgically connected to vessels in the chest and repositioned instead of the former breast tissue, a prevalence of 2.8%-4% is reported for seroma formation in the abdominal wall [9]. Abdominoplasties are commonly performed by plastic surgeons as a part of body contouring surgeries after Open Access Journal of Surgery massive weight loss.…”

Section: Introductionmentioning

confidence: 99%

Preventing Postoperative Seroma formation in Abdominal wall Hernia by Intraoperative Hypertonic Saline Irrigation, early Report

Dudai¹

2019

OAJS

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Seroma formation is a frequent post-operative complication of many operations, mainly abdominal wall Hernias and reconstructive surgeries, where extensive dissection take place. It increases overall morbidity and can be challenging to manage. Drains, aspirations and sclerotherapy are established for treating postoperative seromas and increase the risk for infections. No study has yet to describe the use of intraoperative hypertonic saline irrigation as a preventive measure for seroma formation. The purpose of this report is to describe a novel intraoperative method of hypertonic saline irrigation to abdominal wall subcutaneous surgical cavity, which prevent seroma formation and enables a shorter drainage usage due to early drain removal. Thus, reducing infections and overall morbidity, shortening hospitalization period and decreasing the annoying inconveniency of repeated aspirations and drains insertion with significant cost saving.Our experience is preventing abdominal wall seromas formation in seven patients undergone the Extended Endoscopic Hernia & Linea Alba Reconstruction Glue surgery for Ventral Hernias and Rectus Muscles Separation. A wide endoscopic dissection of the anterior Rectus fascia is followed by mesh placing over the repaired Rectus muscles which is fused to the muscles with Fibrin Glue. A developed novel preventive method includes Intraoperative Irrigation of the cavity through two 7mm Jackson-Pratt closed system drains with 20 cc of NaCl 10%, left in place for 10 minutes. We have excellent early results of seroma prevention, reduced secretions and drain removal within 20 hours. This method can be applied in other potential seroma formation surgeries. Further follow up will be needed.

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“…The timeliness of this study is compounded by recent interest in utilizing progressive barbed tension sutures for a drain free donor site closure. [8][9][10] With multiple abdominal wound closure options available, there is an even greater need for a better understanding of which patients are predisposed to increased drain use. This study aims to elucidate the factors associated with prolonged drain duration in autologous breast reconstruction.…”

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confidence: 99%

Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction

Dinis

Allam

Junn

et al. 2021

J Reconstr Microsurg

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Background Surgical drains are routinely used following autologous reconstruction, but are often cited as the leading cause of peri-operative discomfort. This study defined routine drain use duration and assessed the risk factors for prolonged breast and abdominal drain use during microvascular breast reconstruction, measures which have never previously been defined. Methods Patients who underwent an abdominal microvascular free flap were included. Demographics, comorbidities, and operation-related characteristics were retrospectively collected in a prospectively maintained database. Statistical analysis utilized chi-square independent t-test, and linear regression analyses. Results One hundred forty-nine patients comprising 233 breast flaps were included. Average breast and abdominal drain duration were 12.9 ± 3.9 and 17.7 ± 8.2 days, respectively. Prolonged breast and abdominal drain duration were defined as drain use beyond the 75th percentile at 14 and 19 days, respectively. Multivariable regression revealed hypertension was associated with an increased breast drain duration by 1.4 days (p = 0.024), axillary dissection with 1.7 days (p = 0.026), African-American race with 3.1 days (p < 0.001), Hispanic race with 1.6 days (p = 0.029), return to the OR with 3.2 days (p = 0.004), and each point increase in BMI with 0.1 days (p = 0.028). For abdominal drains, each point increase in BMI was associated with an increased abdominal drain duration by 0.3 days (p = 0.011), infection with 14.4 days (p < 0.001), and return to the OR with 5.7 days (p = 0.007). Conclusion Elevated BMI, hypertension, and axillary dissection increase risk for prolonged breast drain requirement in autologous reconstruction. African-American and Hispanic populations experience prolonged breast drain requirement after controlling for other factors, warranting further study.

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Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay

Abstract: Our data suggests that drain-free abdominal closure in DIEP reconstruction can be safely achieved without increased postoperative complications. These conclusions support existing evidence on the use of a drain-free approach in cosmetic abdominoplasty.

Cited by 18 publications

References 19 publications

The Drain Dilemma: A Systematic Review and Meta-Analysis of Drain-Free Abdominal Closure With Progressive Tension Sutures Against Drain-Assisted Closure for Abdominal Flaps in Breast Reconstruction

The Drain Dilemma: A Systematic Review and Meta-Analysis of Drain-Free Abdominal Closure With Progressive Tension Sutures Against Drain-Assisted Closure for Abdominal Flaps in Breast Reconstruction

Preventing Postoperative Seroma formation in Abdominal wall Hernia by Intraoperative Hypertonic Saline Irrigation, early Report

Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction

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