Efficacité du capitonnage dans la prévention du sérome après lambeau de grand dorsal. La technique de « Chippendale »

Latissimus dorsi seroma prevention with running quilting suture using barbed suture

Dorsal seroma is a common complication of autologous latissimus dorsi flap (ALDF) in breast reconstruction, and has limited the use of this technique, despite its aesthetic success. It is important to find a right technique to limit the incidence of seroma formation after ALDF. The aim of this study was to evaluate the effectiveness and tolerance of a dorsal quilting technique called "running quilting" using barbed resorbable suture in seroma prevention. Three hundred patients who underwent ALDF breast reconstruction in the period between 2004 and 2014 were included in this study. The population was divided in 3 groups; without quilting, with simple quilting suture, and with running quilting using barbed suture. The incidence of small seromas (requiring 1 or 2 aspirations during routine postoperative visits without adding additional appointments to the follow-up routine) was not significantly decreased: it was 54% in the non-quilted group, 47% in group 2 Quilting, and 34% in group 3 running quilting. However, quilting reduced the duration of drainage, and the rate of late seromas (from 8% to 0%), and chronic sero-hematomas completely disappeared in our experience. Running quilting using barbed suture is highly effective in preventing late and refractory donor-site seromas. Its effectiveness is expected to increase the use of ALDF in breast reconstruction, which we consider currently as one of the best autologous reconstruction techniques.

Dorsal Lipomodeling to Treat Donor Site After Latissimus Dorsi Flap: Safety and Effectiveness

BACKGROUND

The latissimus dorsi flap (LDF) is a classic and efficient technique for breast reconstruction. However, its use has recently diminished in surgical practice due to dorsal disadvantages and to the increased use of microsurgical techniques for breast reconstruction, such as the deep inferior epigastric artery perforator flap.

OBJECTIVES

The aim of this study was to evaluate the safety and efficacy of managing dorsal problems such as asymmetry, irregularities, and dysesthesia by lipomodeling the back region during the associated surgery for breast reconstruction.

METHODS

A series of 300 patients operated by the last author for dorsal lipomodeling to correct sequelae after harvesting the total LDF, between November 2012 and March 2019, was analyzed.

RESULTS

The results show a very good improvement in the dorsal region in 6.7% of cases, good improvement in 86.7% cases, and fair improvement in 6.7% of cases. There was a good improvement in dorsal comfort in 90% of cases, a very good improvement in 6.66% of cases, and a fair improvement in 6.66% of cases. In 5% of cases 2 sessions were required to obtain a satisfactory result. No major complications were registered, and the only complication encountered were oil cysts in 2.6% of cases that were treated during consultation with percutaneous puncture.

CONCLUSIONS

This study showed that lipomodeling in the back area after LDF harvesting is an efficient and safe technique that corrects secondary dorsal sequelae such as irregularities, asymmetry, sensitivity, and dysesthesia. This technique should increase the indications for LDF because it decreases donor site sequelae, which are some of the main drawbacks of the LDF approach.

LEVEL OF EVIDENCE: 3

Short-Scar Latissimus Dorsi With a Lateral Approach: A Game Changer in Breast Reconstruction?

BACKGROUND

In delayed breast reconstruction, the thoraco-mammary cutaneous tissue often shows residual damage from radiotherapy. The fragility of this tissue is associated with a risk of skin necroses of approximately 8% when dissection is performed by reopening of the mastectomy scar.

OBJECTIVES

The objective of this study was to adapt the technique of short-scar latissimus dorsi flap surgery with an abdominal advancement flap employing a lateral approach only avoiding re-incision of the mastectomy scar.

METHODS

In this retrospective study, the authors performed 150 reconstructions in 146 patients to assess the safety and effectiveness of the short-scar latissimus dorsi technique with lateral approach. The primary outcome was the occurrence of postoperative skin necrosis of the thoraco-mammary area.

RESULTS

Of the 150 delayed breast reconstruction procedures performed, none showed skin necrosis of the thoraco-mammary area, and a positive effect on skin trophicity of this area was observed. The resulting patient and surgical team satisfaction were very favorable.

CONCLUSIONS

In the authors' practice, this technique changed their paradigm because of good skin safety and effectiveness. It allows reconstruction without a patch-effect in patients with very poor skin quality in whom the thoraco-mammary skin would have been replaced in the past by a skin paddle. Reconstruction would have even be contraindicated. It could also be an alternative to many other more complex and longer techniques of autologous reconstruction.

LEVEL OF EVIDENCE: 4

Risk Factors Associated With Complications After Unilateral Immediate Breast Reconstruction: A French Prospective Multicenter Study

BACKGROUND/AIM

For women who have undergone a mastectomy, breast reconstruction provides psychological as well as aesthetic benefits. Thus, many patients ask for an immediate breast reconstruction (IBR). The present study focuses on risk factors assiociated with complications after IBR.

PATIENTS AND METHODS

A national prospective study (2007-2009) was conducted on 404 patients who underwent an unilateral IBR: 205 implants alone (IA) including 46 tissue expanders, 91 latissimus dorsi musculocutaneous flaps with implant (LDI), 78 autologous latissimus dorsi musculocutaneous flaps (LD), and 30 autologous transverse rectus abdominis musculocutaneous flaps (TRAM). Outcomes concerned major and minor complications, as well as early and late complications.

RESULTS

Related risks of complications were different according to the IBR technique. Major complications rate remained moderate and concerned 15% of patients. Obesity and diabetes significantly increased the incidence of major complications.

CONCLUSION

To reduce complication rate, the risk factors associated with each type of IBR should be taken into account.

Retrospective Evaluation of the Effectiveness of a Synthetic Glue and a Fibrin-Based Sealant for the Prevention of Seroma Following Axillary Dissection in Breast Cancer Patients

Introduction: Seroma formation represents one of the most frequent postoperative complications of axillary dissection in breast cancer (BC) patients. We aimed to retrospectively explore the effectiveness of the intraoperative use of a synthetic cyanoacrylate glue (specifically Glubran®2) vs. the intraoperative use of a fibrin sealant (specifically Tisseel) in reducing seroma formation compared to the use of nonsealant in BC patients who underwent breast surgery and axillary dissection. Materials and Methods: We conducted a retrospective, monocentric observational study on BC patients who underwent axillary dissection associated with breast surgery. The axillary dissection was completed with the application of a closed suction drain and was preceded by the application of either Glubran®2 glue or Tisseel sealant or nonsealant. We analyzed the quantity of serum drained in the first 3 postoperative days, length of hospitalization, days of permanence of axillary drain, seroma development, and presence of postoperative infection signs. Results: Forty-one BC patients were considered. Based on the device used during the surgical treatment, the patients were divided into three groups: group A (17 patients), to whom suction axillary drain was applied; group B (7 patients), to whom Tisseel and axillary suction drain were applied; and group C (17 patients), to whom Glubran®2 and axillary suction drain were applied. Among the three groups, we did not find significant differences in terms of amount of serum drained in the first 3 postoperative days, length of hospitalization, and incidence of seroma. Group C maintained the axillary drain in a significantly lower number of days compared to the other two groups (p = 0.02); it also had a lower incidence of postoperative infections (6%) compared to group A (23%) and group B (57%) (p = 0.02). Conclusions: We did not find any evidence that the use of surgical glues may reduce the formation of seroma following axillary dissection in BC patients. Nevertheless, the use of cyanoacrylate glue in association with closed suction axillary drain seems to contribute to the reduction in days of axillary drain permanence and of postoperative infections, which are known factors delaying the schedule of any adjuvant oncological therapies.

Reducing the seroma volume by quilting suture after breast reconstruction with a latissimus dorsi flap: Single institutional experience

INTRODUCTION

After breast reconstruction (BR) with latissimus dorsi flap (LDF) postoperative seroma is a frequent source of functional discomfort. The aim of this study was to evaluate the quilting suture on reducing the seroma volume by reducing the dead space created by LDF harvest for BR.

MATERIAL AND METHODS

This retrospective monocenter study was designed to compare patients who underwent BR using LDF with or without quilting suture. The primary endpoint was the seroma volume drained during hospitalization and percutaneous puncture. Complications and painful or functional sequelae were also evaluated in both groups.

RESULTS

One hundred eight patients were included in the study. The mean (standard deviation, SD) age of our population was 49.7 years (9.3) and the mean body mass index (BMI) 26.9kg/m² (4.1). Sixty-nine patients (63%) underwent quilting suturing in the latissimus dorsi compartment, 41% with overedge and 59% with simple stitches. The mean total volume of fluid drainage was 1238mL (1111). In multivariate analysis, the use of quilting suture was associated with a significant reduction in the total volume of drainage (-502mL, P=0.03); reduction was greater using overedge stitches than simple stitches (P=0.02). The beneficial effect of quilting suture appears to be more important in patients with a BMI greater than 30kg/m2 (interaction test, P=0.01).

CONCLUSION

This study shows the efficacy of quilting suture in reducing postoperative seroma formation in BR using LDF. Efficacy was greater when overedge stitches were used. Obese patients benefited more from quilting suture than patients with BMI<25.

[Breast reconstruction with the autologous latissimus dorsi flap]

Amongst various techniques of breast reconstruction, Autologous Latissimus Dorsi (ALD) flap without breast implant is the newest technique that took advantage of recent improvement during the last decade. Surgical procedure is well standardized, and allows to harvest various fat areas attached to the muscle, to obtain an autologous reconstruction. Thoracodorsal pedicle is steady and makes ALD the most reliable flap that can be used in several indications, especially when DIEP or TRAM flap are inappropriate. Lipomodeling of the cleavage is performed during the first surgery. Additionnal lipomodeling is performed in the whole reconstructed breast area at 2 months to get the expected volume. In some cases, two lipomodelings may be required. Advantages of ALD flap are numerous such as its reliability, its trophicity, and a very low complications rate. After a learning curve, drawbacks are well controlled, since quilting suture of the donor site helped to reduce drastically seroma rate. Finally, ALD flap became the best technique, and the most used in our team for autologous breast reconstruction, and surpassed abdominal flaps such as TRAM flap or DIEP flap.

Tolerance of latissimus dorsi in immediate breast reconstruction without implant to radiotherapy

INTRODUCTION

Immediate breast reconstruction (IBR) improves the quality of life of patients who undergo mastectomy. The latissimus dorsi flap (LDF) method provides particularly good aesthetic results, but its tolerance to subsequent radiotherapy remains unclear. We thus sought to assess tolerance and esthetic results and satisfaction, as reported by patients who underwent IBR by LDF with or without subsequent radiotherapy.

MATERIALS AND METHODS

We performed a retrospective case-control study in a population of women who were diagnosed with breast cancer between January 1999 and January 2014 and who had mastectomies with IBR by LDF without prostheses. We paired 29 patients who needed postoperative radiotherapy to 58 control patients who did not. These patients responded to a questionnaire to evaluate tolerance and their satisfaction with the aesthetic results of the reconstruction.

RESULTS

In total, 86.2% of all patients reported "very good" or "good" overall aesthetic satisfaction. Consistency was judged as "very good" or "good" by 82.7% of control patients and by 93.1% of case patients. No statistically significant differences were identified between the two groups with regard to reconstruction results. The number of surgical procedures needed did not differ significantly between the two groups.

CONCLUSION

In our study, IBR by LDF appeared to have excellent tolerance to subsequent radiotherapy, the latter having no impact on patient aesthetic satisfaction. Our results suggest that the possibility of postoperative radiotherapy should not prevent physicians from proposing this method to women who are candidates for it.

The Role of Negative-Pressure Wound Therapy in Latissimus Dorsi Flap Donor Site Seroma Prevention: A Cohort Study

Background

Donor site seroma is the most common complication after latissimus dorsi (LD) flap harvest. This study aimed to evaluate the efficacy of negative-pressure wound therapy (NPWT) in preventing donor site seroma formation after the harvest of an LD flap for breast reconstruction.

Methods

In this prospective matched-pair study, 40 patients in whom an LD flap was harvested for breast reconstruction were enrolled. NPWT was used in 20 patients, and in a control group composed of another 20 patients, the conventional donor site dressing technique was used. Information was collected regarding postoperative complications, the incidence of seroma, total drainage volume, the number of percutaneous seroma aspirations, and the volume aspirated.

Results

In the NPWT group, the incidence of seroma formation after drain removal was significantly lower than in the control group (15% vs. 70%; odds ratio=0.07; relative risk, 0.24). Both the mean percutaneous aspirated volume (P=0.004) and the number of percutaneous aspirations (P=0.001) were also significantly lower in the NPWT group. There were no significant differences in the total drainage volume or the duration of wound drainage between the NPWT dressing group and the control group (P>0.05).

Conclusions

This study showed that NPWT is a promising tool for reducing the incidence of seroma formation after removing the drain at the donor site after LD flap harvesting. It is a simple and safe technique.

Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures

BACKGROUND

In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate.

OBJECTIVES

We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF.

METHODS

Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed.

RESULTS

Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001).

CONCLUSIONS

The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts.

LEVEL OF EVIDENCE 4

Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial

INTRODUCTION

Postoperative wound seroma is common after mastectomy. This complication is associated with significant impact on patient outcomes and healthcare costs. The optimal closure approach for seroma prevention remains unknown but some evidence suggests that quilting suture of the dead space could lower the incidence of seroma. The aim of this trial is to compare seroma formation using quilting suture versus conventional closure with drainage in patients undergoing mastectomy.

METHODS AND ANALYSIS

This is a multicentre, superiority, randomised controlled trial in women undergoing mastectomy with or without axillary involvement. Exclusion criteria include indication of bilateral mastectomy or immediate reconstruction and any physical or psychiatric condition that could impair patient's ability to cooperate with postoperative data collection or that do not allow an informed consent. 320 participants will be randomised in a 1:1 ratio to receive either quilting suture or conventional wound closure with drain. The primary outcome is seroma requiring either aspiration or surgical intervention within 21 days following mastectomy. Secondary outcomes include seroma regardless of whether or not it requires an intervention, surgical site infection, pain score, cosmetic result, patient's quality of life, costs and cost-effectiveness. The primary analysis will be an intention-to treat analysis performed with a χ(2) test (or Fisher's exact test).

ETHICS AND DISSEMINATION

Written informed consent will be obtained from all participants. This study was approved by Tours Research ethics committee (CPP TOURS-Region Centre-Ouest 1, 2014-R20, 16 December 2014). Study findings will be published in peer-reviewed journals and presented at relevant national and international breast cancer conferences.

TRIAL REGISTRATION NUMBER

NCT02263651.

Fibrin Sealants and Quilting Suture for Prevention of Seroma Formation Following Latissimus Dorsi Muscle Harvest: A Systematic Review and Meta-analysis

PURPOSE

Despite popular use of fibrin sealants and quilting sutures for prevention of seroma formation at the donor site of the latissimus dorsi (LD) muscle flap, there is still no consensus regarding their efficacy. The present review estimates the potential benefits of fibrin and quilting suture for reducing seroma-related morbidity following LD muscle harvest.

METHODS

Using Medline, Ovid, and Cochrane databases, two-arm studies evaluating the efficacy of fibrin sealants, quilting suture, or their combination for prevention of seroma formation following LD muscle transfer were searched. The outcome measure was the incidence of seroma, total drainage volume from the back, periods of drainage in situ, volume of seroma, and frequency of aspiration for treatment of seroma. The efficacy on reducing the seroma-related morbidity for each procedure was estimated by meta-analytic methodology.

RESULTS

Fourteen studies were analyzed. Fibrin alone failed to reduce seroma-related morbidities compared with no intervention, while fibrin instillation combined with quilting suture halved the risk of seroma formation (relative risk (RR): 0.51, 95 % CI 0.12-2.16) and significantly reduced total drainage volume (mean difference (MD); -320.80, 95 % CI -389.92 to -251.68) and drain indwelling periods (MD -1.62, 95 % CI -2.91 to -0.33) compared with quilting suture alone. Quilting suture had significant protective effects on reducing the risk of seroma formation (RR 0.38, 95 % CI 0.19-0.75), total drainage volume (MD -284.10, 95 % CI -474.61 to -93.60), and drain indwelling periods (MD -3.65, 95 % CI -5.43 to -1.87), and its efficacy was enhanced by combining with fibrin.

CONCLUSIONS

According to this review, both fibrin and quilting sutures contributed in varying degrees to reducing seroma-related morbidity following LD muscle transfer, and their combination can have a synergistic effect. Although large-scaled, randomized studies are needed, the combination of both procedures may be considered an effective option for minimizing the risk of seroma.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quilting Suture of Mastectomy Dead Space Compared with Conventional Closure with Drain

PURPOSE

This study was designed to compare conventional closure with a drain and quilting suture of mastectomy dead space for preventing wound seroma.

METHODS

Consecutive patients undergoing mastectomy for breast cancer were included in this retrospective observational study. Patients received conventional closure with drainage or quilting suture for wound closure. Propensity score (PS) matching was performed based on potential confounders to minimize selection bias. The primary outcome was the rate of type 2 or 3 wound seroma according to the common terminology criteria for adverse events (CTCAE) definition.

RESULTS

A total of 119 patients were included (quilting suture n = 59; conventional closure n = 60). Type 2 or 3 seroma was observed in 6.8 % of the quilting suture group and 21.7 % of the conventional closure group (crude odds ratio 0.26; 95 % confidence interval 0.08-0.86; p = 0.03). The overall seroma rate was 15.2 % in the quilting suture group and 51.7 % in the conventional closure group (p < 0.001). Persistent pain at days 15-21 was significantly less frequent in the quilting suture group than in the conventional suture group. PS matched analysis confirmed these findings, in particular the lower rate of type 2 or 3 seroma in the quilting suture group than in the conventional closure group (PS-matched odds ratio 0.16; 95 % confidence interval 0.04-0.72; p = 0.02).

CONCLUSIONS

Quilting suture of the mastectomy dead space is associated with significantly less frequent seroma than conventional closure with drain.

[Quilting suture after mastectomy in prevention of postoperative seroma: a prospective observational study]

OBJECTIVES

The occurrence of a postoperative seroma is the main complication of mastectomy. In 2011, Ouldamer et al. adapted a quilting technique used in reconstructive surgery in mastectomy closure. The aim of this study is to evaluate the impact of quilting in the prevention of postoperative seroma.

PATIENTS AND METHODS

This is an observational prospective study to the Centre Hospital-University of Tours. Hundred and forty-four patients who underwent a mastectomy between January 1st, 2011 and October 1st, 2012 were included. Patients were divided into 2 groups, one with a classic wound closure with drainage and the second with quilting suture of skin flaps to the underlying musculature after mastectomy without drainage.

RESULTS

Quilting suture significantly reduces the postoperative seroma appearance (OR=0.15; CI95% [0.06-0.39]; P<0.001). Operative time is increased by 20minutes in the quilted group (P<0.001). Postoperative pain is not changed by quilting. The duration of hospitalization is significantly shorter (5.09±1.46 days versus 6.49±2.77 days; P<0.001). Quality of the healing and appearance of the scar, rated by patients, are identical in both groups.

CONCLUSION

Quilting is an effective method not only for prevention of seroma, but also for reducing of hospitalization duration, without increasing of postoperative pain and complications.

Techniques in the prevention and management of seromas after breast surgery

Seromas are the most frequent complications following breast surgery, resulting in significant discomfort and morbidity with possible delays in commencing adjuvant therapies. Varied clinical practices exist in the techniques employed to prevent and manage seromata. This article assesses published literature on the techniques employed in prevention of seroma formation following breast surgery, evaluating the different methodologies used. Although prevention is the best strategy, seromata remain problematic and we consider their management. The principle findings were that prevention is key to the management of seromata. Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants and innovative measures of managing the axilla, among others. The evidence demonstrated that a combination of quilting and drains significantly reduces the incidence and volumes of seromata. These effects are sustained by minimizing use of electrocautery, alongside increasing frequencies of axillary sentinel lymph node biopsies and node sampling. The efficacy data on fibrin sealants is inconclusive and consequently should not be routinely used alone or accompanied by quilting sutures. Clinically significant seromas deemed 'symptomatic' by patients and complicating infected seromas should be aspirated. There are limited data on the recommended treatment of established seromas with a paucity of high-quality studies and further research involving randomized trials are indicated.

[Prevention of seroma post-mastectomy by surgical padding technique]

INTRODUCTION

Every year, 20,000 mastectomy are realized. The most common complication of these surgical procedure is seroma, occurring in a range of 10 to 85% of the cases, which may be responsible for an increased morbidity by complications: disunity of surgical flap, infection, and delay in administrating adjuvant therapies.

OBJECTIVE

We focused on a post-mastectomy padding technique, aiming at decreasing incidence of postoperative seromas.

PATIENTS AND METHODS

We conducted a retrospective study of patients treated with mastectomy from January 2012 to March 2014 in Amiens University Hospital. Forty-two patients were included: 20 to the "padding's" group and 22 to the "control's" group.

RESULTS

Drainage flow was significantly decreased at Day 1, Day 2, Day 3 and throughout hospitalization after padding (358.5mL versus 685mL; P=0.02). Hospital stays were significantly shortened by 2 days (5.3 versus 7.3 days; P<0.05) for patients receiving padding surgery.

DISCUSSION AND CONCLUSION

Our results show a benefit in the mastectomy padding flap. However, the retrospective character of our study and its strength character imply bias and data not available such as complications in type of wound dehiscence, pain, necrosis, the period from the establishment of the adjuvant therapies and aesthetic evaluation of technique. As such, we initiated a prospective randomized multicenter study late 2013, named PRELYMCA, which should be able to answer the pending questions.

Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites

BACKGROUND

The extended latissimus dorsi flap is important for breast reconstruction. Unfortunately, donor site seroma is the most common complication of extended latissimus dorsi flap for breast reconstruction. Although using fibrin sealant in the donor site reduces the rate of seroma formation, donor site seroma remains a troublesome complication. The purpose of this study was to analyze the effectiveness of the combination of quilting sutures and fibrin sealant in the latissimus dorsi donor site for the prevention of seroma.

METHODS

Forty-six patients who underwent breast reconstruction with extended latissimus flap were enrolled in the study. The patients received either fibrin sealant (group 1, n=25) or a combination of fibrin sealant and quilting sutures (group 2, n=21) in the extended latissimus dorsi donor site. Outcome measures were obtained from the incidence, volume of postoperative seroma, total drainage amount, indwelling period of drainage, and duration of hospital stay.

RESULTS

The incidence of seroma was 76% in group 1 and 42.9% in group 2 (P=0.022). We also found significant reductions in seroma volume (P=0.043), total drainage amount (P=0.002), indwelling period of drainage (P=0.01), and frequency of aspiration (P=0.043). The quilting sutures did not affect the rate of drainage, tube reinsertion, or hospital stay.

CONCLUSIONS

The use of quilting sutures combined with fibrin sealant on the latissimus dorsi flap donor site is helpful for reducing the overall seroma volume, frequency of aspiration, and total drainage amount.