Effect of quilting suture interval on donor site seroma after latissimus dorsi muscle flap
Abstractdebilitating complication. Many methods were implemented but quilting sutures remains the excellent option to counter this issue. But distance between quilting sutures still remain under debate, so to address this issue current study was devised to analyse and gather date regarding post-operative seroma rates at different intervals of quilting sutures. Methods: This study was done in Jinnah burn and reconstructive centre, Lahore from January 2016 to September 2017.In accordance to quilting distance, all patients were assigned randomly into three groups: 6-cm quilting (n=12), and 3-cm quilting (n=12), non- quilting (n=10). Primary outcome measures were the drainage volume, removal time, seroma formation, frequency of aspiration and recovery time. Results: No significant difference were found in quilting group. Drain removal time is shorter in the 6-cm quilting and 3-cm quilting groups as compared to non-quilting as well as drain output which was significantly decreased in quilting group. The rate of seroma formation and frequency of aspiration was much higher in non-quilting group as compared to 6-cm quilting and 3-cm quilting groups. Conclusion: Quilting is a reliable way in prevention of seroma formation and reducing its volume. Our findings indicate the 6-cm suture interval is enough to avoid these complications. Keywords: Seroma; Latissimus dorsi flap; Quilting sutures
Quillen, C. G., Shearin, J. C., Jr., and Georgiade, N. G. Use of the latissimus dorsi myocutaneous island flap for reconstruction in the head and neck area. Plast. Reconstr. Surg. 62: 113, 1978.
Quillen, C. G. Latissimus dorsi myocutaneous flaps in head and neck reconstruction. Plast. Reconstr. Surg. 63: 664, 1979.
Barton, F. E., Jr., Spicer, T. E., and Byrd, H. S. Head and neck reconstruction with the latissimus dorsi myocu- taneous flap: Anatomic observations and report of 60 cases. Plast. Reconstr. Surg. 71: 199, 1983.
Watson, J. S., Robertson, G. A., Lendrum, J., Stranc, M. F., and Pohl, M. J. Pharyngeal reconstruction using the latissimus dorsi myocutaneous flap. Br. J. Plast. Surg. 35: 401, 1982.
Sabatier, R. E., and Bakamijan, V. Y. Transaxillary latissimus dorsi flap reconstruction in head and neck cancer. Am. J. Surg. 150: 247, 1985.
Davis, J. P., Nield, D. V., Garth, R. J., and Breach, N. M. The latissimus dorsi flap in head and neck reconstruc- tive surgery: A review of 121 procedures. Clin. Otolar- yngol. 17: 487, 1992.
Schneider, W. J., Hill, H. L., and Brown, R. G. Latissi- mus dorsi myocutaneous flap for breast reconstruc- tion. Br. J. Plast. Surg. 30: 277, 1977.
Muhlbauer, W., and Olbrisch, R. The latissimus dorsi myocutaneous flap for breast reconstruction. Chir. Plast. 4: 27, 1977.
Bostwick, J., III, and Scheflan, M. The latissimus dorsi musculocutaneous flap: A one-stage breast reconstruc- tion. Clin. Plast. Surg. 7: 71, 1980.
Maxwell, G. P. Latissimus dorsi breast reconstruction: An aesthetic assessment. Clin. Plast. Surg. 8: 373, 1981. 11. Khouri, R. K., and Shaw, W. W. Reconstruction of the lower extremity with microvascular free flaps: A 10- year experience with 304 consecutive cases. J. Trauma 29: 1086, 1989.
May, J. W., Jr., Gallico, G. G., III, Jupiter, J., and Savage, R. C. Free latissimus dorsi muscle flap with skin graft for treatment of traumatic chronic bony wounds. Plast. Reconstr. Surg. 73: 641, 1984.
May, J. W., Holls, M. J., and Simons, S. R. Free micro- vascular muscle flaps with skin graft reconstruction of extensive defects of the foot: A clinical and gait anal- ysis study. Plast. Reconstr. Surg. 75: 627, 1985.
May, J. W., and Rohrich, R. J. Foot reconstruction using free microvascular muscle flaps with skin grafts. Clin. Plast. Surg. 13: 681, 1986.
Banic, A., and Wulff, K. Latissimus dorsi free flaps for total repair of extensive lower leg injuries in children. Plast. Reconstr. Surg. 79: 769, 1987.
Dabb, R. W., and Davis, R. M. Latissimus dorsi free flaps in the elderly: An alternative to below-knee amputa- tion. Plast. Reconstr. Surg. 73: 633, 1984.
McGraw, J. B., Penix, J. O., and Baker, J. W. Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap. Plast. Reconstr. Surg. 62: 197, 1978.
Hirase, Y., Kojima, T., Kinoshita, Y., Bang, H. H., Sak- aguchi, T., and Kijima, M. Composite reconstruc- tion for chest wall and scalp using multiple ribs-latis- simus dorsi osteomyocutaneous flaps as pedicled and free flaps. Plast. Reconstr. Surg. 87: 555, 1991.
Lee, G. W., and Hines, G. L. Chest wall reconstruction using a latissimus dorsi myocutaneous flap. N. Y. State J. Med. 83: 727, 1983.
Matsuo, K., Hirose, T., Hayashi, R., and Senga, O. Chest wall reconstruction by contralateral latissimus dorsi musculocutaneous flap. Plast. Reconstr. Surg. 82: 994, 1988.
Salmon, R. J., Razaboni, R., and Soussaline, M. The use of the latissimus dorsi musculocutaneous flap follow- ing recurrence of cancer in irradiated breasts. Br. J. Plast. Surg. 41: 41, 1988.
Sharma, R. K., Verma, G. R., and Biswas, G. Recon- struction of a major abdominal and chest wall defect using latissimus dorsi and extended deep inferior epi- gastric artery flap. Ann. Plast. Surg. 28: 366, 1992.
Moelleken, B. R. W., Mathes, S., and Chang, N. Latis- simus dorsi muscle: Musculocutaneous flap in chest wall reconstruction. Surg. Clin. North Am. 69: 977, 1989.
Schwabegger A, Ninkovic M, Brenner E, et al. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg. 1997;38:594Y597.
Tomita K, Yano K, Masuoka T, et al. Postoperative seroma formation in breast reconstruction with latissimus dorsi flaps: a retrospective study of 174 con- secutive cases. Ann Plast Surg. 2007;59:149Y151.
Delay E, Gounot N, Bouillot A, et al. Autologous latissimus breast recon- struction: a 3-year clinical experience with 100 patients. Plast Reconstr Surg. 1998;102:1461Y1478.
Menke H, Erkens M, Olbrisch RR. Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg. 2001;47:107Y114.
Jeon BJ, Lee TS, Lim SY, et al. Risk factors for donor-site seroma formation after immediate breast reconstruction with the extended latissimus dorsi ap: A statistical analysis of 120 consecutive cases. Ann Plast Surg. 2012;69:145–147.
Tomita K, Yano K, Masuoka T, Matsuda K, Takada A, Hosokawa K. Postoperative seroma formation in breast reconstruction with latissimus dorsi aps: A retrospective study of 174 con- secutive cases. Ann Plast Surg. 2007;59:149–151.
Slavin, S. A. Seroma after latissimus dorsi myocutane-ous flap for breast reconstruction: Reply (Letter). Plast. Reconstr. Surg. 85: 826, 1990. .
Kulber, D. A. The use of fibrin sealant in the prevention of seromas. Plast. Reconstr. Surg. 99: 842, 1997.
Daltrey I, Thomson H, Hussien M, et al. Randomized clinical trial of the effect of quilting latissimus dorsi flap donor site on seroma formation. Br J Surg 2006; 93: 825-30.
Benditte-Klepetko HC, Lutgendorff F, Kästenbauer T, et al. Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction. Scand J Surg 2014; 103:249-55.
Rios JL, Pollock T, Adams WP Jr. Progressive tension sutures to prevent seroma formation after latissimus dorsi harvest. Plast Reconstr Surg 2003; 112:1779-83.
Titley OG, Spyrou GE, Fatah MF. Preventing seroma in the latissimus dorsi flap donor site. J Plast Surg 1997; 50:106-8.
Roy MK, Shrotia S, Holcombe C, et al. Complications of latissimus dorsi myocutaneous flap breast reconstruction. Eur J Surg Oncol 1998; 24:162-5.
Schwabegger A, Ninkovi c M, Brenner E, et al. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 1997; 38:594-7.
Gruber S, Whitworth AB, Kemmler G, et al. New risk factors for donor site seroma formation after latissimus dorsi flap breast reconstruction: 10-year period outcome analysis. J Plast Reconstr Aesthet Surg 2011; 64:69-74.
Lee S, Seo H, Bae Y. Quilting prevents seroma formation following imme- diate LDMCF reconstruction after quadrantectomy. J Korean Surg Soc 2008; 74:177-81.
Thekkinkattil DK, Hussain T, Mahapatra TK, et al. Feasibility of use of a barbed suture (V-Loc 180) for quilting the donor site in latissimus dorsi myocutaneous flap breast reconstruction. Arch Plast Surg 2013; 40:117-22.
Menke H, Erkens M, Olbrisch RR. Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg 2001; 47:107-14.
Jain PK, Sowdi R, Anderson AD, et al. Randomized clinical trial investigating the use of drains and fibrin sealant following surgery for breast cancer. Br J Surg 2004; 91:54-60.
Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J Surg Oncol 2003; 29:711-7.
Schwabegger A, Ninkovic M, Brenner E, Anderl H. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 1997; 38: 594–597.
RiosJL,PollockT,AdamsWPJr.Progressivetensionsuturestopreventseroma formation after latissimus dorsi harvest. Plast Reconstr Surg. 2003;112: 1779Y1783.
Mannu GS, Qurihi K, Carey F, et al. Quilting after mastectomy significantly re- duces seroma formation. S Afr J Surg 2015; 53:50-4.