Latissimus dorsi donor-site morbidity: the combination of quilting and fibrin sealant reduce length of drain placement and seroma rate

Abstract

Seroma formation has been shown to be a multifactorial process in part due to dead space and the formation of raw surfaces, which produce large quantities of serous exudate. The purpose of this study is to evaluate the effect of quilting/progressive tension sutures (to reduce dead space) and fibrin sealant (to seal the raw surface) in combination on the seroma rate and length of drain placement in patients undergoing latissimus dorsi breast reconstruction. A retrospective review of 43 patients undergoing latissimus dorsi flap breast reconstruction was performed. The patients were divided into 2 groups: quilting sutures alone versus those with quilting sutures and fibrin sealant. Data regarding age, body mass index, smoking history, timing of reconstruction, type of breast surgery, radiation history, complications, length of drain placement, use of fibrin glue, and use of quilting/progressive tension sutures were collected for each patient. Results were analyzed statistically using unpaired t tests (P < 0.05). The quilting group included 19 patients with 24 donor sites. The mean drain placement duration was 21.5 days (range, 9-69 days). One patient in 19 developed a seroma, which was treated and resolved with aspiration. The seroma rate for the quilting only group was 5%. The quilting and sealant group included 23 patients with 26 donor sites. The quilting and sealant group had a mean duration of drain placement of 13.9 days (range, 6-38 days). This was a statistically reduced length of drainage (P = 0.04) compared with quilting only. The quilting and sealant group had 1 patient in 23 develop a seroma with a rate of 4% which compared with quilting only was not statistically significant (P = 0.4). The combination of quilting sutures and fibrin sealant directed at the 2 main mechanisms of seroma formation, (dead space and serous exudate, respectively) can decrease the duration of postoperative drain placement and does maintain low seroma rates.