Use of Abdominal Quilting Sutures for Seroma Prevention in TRAM Flap Reconstruction:

Abstract

This study is designed to evaluate the effect of abdominal quilting sutures on the incidence of abdominal seroma formation in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. It is theorized that the use of such sutures during closure of abdominal flaps will collapse dead space, thus preventing abdominal seroma formation. A total of 71 consecutive patients undergoing pedicled TRAM flap breast reconstruction were randomly assigned to receive abdominal quilting sutures or to undergo a standard abdominal closure. Primary outcome measures included: daily drain output for the first 3 postoperative days, time to drain removal, and seroma formation. Drain output per day decreased with the use of abdominal quilting sutures; however, the time to drain removal was not significantly affected. Most importantly, there was no significant decrease in the incidence of seroma formation with the use of abdominal quilting sutures in this series.

Reconstruction of the chestwall and thorax

“…Efforts to reduce seromas with quilting sutures have produced mixed results [21,22], but the use of fibrin tissue sealants to reduce seroma rates appears promising [23].…”

The drain game: Abdominal drains for transverse rectus abdominis myocutaneous breast reconstruction

“…double polypropylene mesh fold over, acellular dermal matrix insertion and the use of quilting sutures. 12,13,16,17 As…”

“…3e11 In contrast, a study of 200 consecutive free/muscle-sparing TRAM and DIEP flaps found complications to be identical in both groups; these included total/partial flap loss, infection, haematoma, minor wound healing problems, fat necrosis, mastectomy flap necrosis and systemic complications, with seroma rates reported as 7.5% and 4.9% in the TRAM and DIEP groups respectively (p Z 0.74). 12 Of interest, reported clinically-detectable seroma rates during TRAM breast reconstruction range in the literature between 2.1% and 52.6%, with increased rates detectable on ultrasound. 4,12e18 As seroma management is labour-intensive, often involving multiple outpatient visits for drainage AE compressive dressings, the lack of data pertaining to its development in TRAM flap breast reconstruction is surprising.…”

Retalho TRAM com dissecção mínima para reconstrução mamária

“…As cirurgias abdominais comumente evoluem com formação de seroma devido ao espaço morto resultante do descolamento 9 , com incidência variando de 2,1% a 9,4% [10][11][12] . Os seromas são frequentemente detectados durante a segunda semana de pós-operatório, e são necessárias aspirações com agulha que tornam a área com aspecto de casca de laranja 9 .…”