Artikel
Serous fluid drainage after abdominal flap surgery: a multicentric evaluation
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Autoren
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D. Müller
- Division for Plastic Surgery and Handsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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U. Ziegler
- Division for Plastic and Aesthetic Surgery, Robert Bosch Krankenhaus, Stuttgart, Germany
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Z. Z. Kalash
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
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C Heitmann
- Praxis für Plastische Chirurgie, München, Germany
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K. Walgenbach
- Division of Plastic and Aesthetic Surgery, University Hospital Bonn, Bonn, Germany
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Y. Harder
- Division for Plastic Surgery and Handsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| Veröffentlicht: | 27. September 2011 |
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Gliederung
Text
Introduction: Post operative serous fluid drainage and seroma formation remain of concern in surgical procedures that need wide dissection such as flap elevation, abdominoplasty and belt lipectomy in body contouring surgery, with regard to revisional surgery, length of hospital stay and time of working inability. Data on these outcome measures in the literature is inconsistent and does not provide a useful base case on which to evaluate the impact of possible changes in technique.
Materials and methods: Multi-center (5 centers) retrospective chart review using a standardized data collection protocol for consecutive cases undergoing large flap surgery procedures including abdominoplasty (both cosmetic and medically indicated, i.e. reimbursed by the health insurance), belt lipectomy, and TRAM/ DIEP-flaps. Patient demographics, risk factors, concomitant procedures, wound drainage, time to drain removal, total length of hospital stay and post-operative complications by type (palpable fluid accumulation and intervention: puncture, surgery) were recorded.
Results: A total of 148 cases were deemed complete and met the inclusion criteria: Cosmetic abdominoplasty (CA): n=41; Medically indicated abdominoplasty (MIA): n=24; Circumferential belt lipectomy (CBL): N=19; DIEP/TRAM flaps (D/T): N=64. Mean total drain volumes were: CA: 302ml; MIA: 563ml; CBL: 910ml; D/T 386ml. Days to drain removal were: CA: 2.7; MIA: 3.8; CBL: 4.6; D/T: 4.4. Rate of seroma formation were: CA: 9.8%; MIA: 41.7%; CBL: 42.1%; D/T 9.4%.
Conclusions: Serous fluid accumulation and its management have significant clinical and economic impact in flap procedures that create wide dissection surfaces. Rates of post operative interventions to manage fluid accumulation, ranging from needle aspiration to drain reinsertion and revisional surgery remain high. Techniques or technologies which can reduce fluid accumulation will be likely to have a positive impact both clinically and economically on outcomes.
