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Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) xx, 1e5

The drain game: Abdominal drains for deep inferior epigastric perforator breast reconstruction B.H. Miranda*, K. Amin, J.S. Chana Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK Received 7 November 2013; accepted 16 March 2014

KEYWORDS Breast; DIEP; Flap; Drain; Complications; Seroma

Summary Introduction: The deep inferior epigastric perforator (DIEP) flap is often preferred for breast reconstruction as it allows for autologous reconstruction with less donor site morbidity versus transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Our group has presented and published data for the duration of donor site back drain use in latissimus dorsi (LD) flap breast reconstruction due to insufficient evidence and a requirement for further investigation in the literature; this evidence is still lacking for DIEP reconstruction. Aim: To compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction abdominal drain removal by post-operative day (POD) 3 regardless of output (early group), with removal after POD 3 where instructions were by drainage volume/24 h  output consistency (late group), in post-mastectomy DIEP reconstruction donor sites. Method: A retrospective review of DIEP breast reconstructions, between January 2011 and July 2012, was undertaken to facilitate 1 year minimum follow-up per patient. Results: Of 78 patients who underwent DIEP breast reconstructions, 74 hospital records contained complete documentation. There were 41 patients in the late, and 33 in the early removal group; both groups were matched for age and number of donor site drains (2 per patient). Mean drain removal day (4.32  0.10 days vs. 2.87  0.06 days, p < 0.0001), total drainage (518.90  41.53 mls vs. 283.79  18.06 mls; p < 0.0001) and hospital inpatient stay were greater for patients in the late versus early group. There were no differences in total complications (21.95% (9/41) vs. 12.12% (5/33); p Z 0.46), seroma (4.88% (2/41) vs. 0% (0/ 33); p Z 0.20), dehiscence (4.88% (2/41) vs. 9.09% (3/33); p Z 0.47) or haematoma (7.32% (3/41) vs. 3.0% (1/33); p Z 0.42) rates between the late and early groups. Discussion: These data suggest significant advantages for patients who have abdominal drains

* Corresponding author. Tel.: þ44 (0) 7961 996 229. E-mail address: [email protected] (B.H. Miranda). http://dx.doi.org/10.1016/j.bjps.2014.03.020 1748-6815/Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. Please cite this article in press as: Miranda BH, et al., The drain game: Abdominal drains for deep inferior epigastric perforator breast reconstruction, Journal of Plastic, Reconstructive & Aesthetic Surgery (2014), http://dx.doi.org/10.1016/j.bjps.2014.03.020

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B.H. Miranda et al. removed early by POD 3, without increased post-operative complications including seroma rates; these data are in keeping with our LD data. We recommend drain removal and patient discharge by POD 3. Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

Introduction In 2010, 93,083 women underwent breast reconstruction in the USA, with autologous flap reconstruction procedures performed for over 18,500 patients.1 In the UK 2010 national mastectomy and breast reconstruction audit of 18,216 patients, free flaps were performed for 14% (476/ 3389) of patients who underwent immediate and 32.7% (566/1731) who underwent delayed reconstruction.2 The deep inferior epigastric perforator (DIEP) flap is often the preferred breast reconstruction option as it allows for autologous reconstruction with breast-like tissue and with less donor site morbidity compared to transverse rectus abdominis myocutaneous (TRAM) flap reconstruction.3e6 Complications of post-mastectomy DIEP flap reconstruction are highlighted by an important 10 year review of 758 patients; 6% returned to theatre for flap-related issues, 2.5% had partial and

The drain game: abdominal drains for deep inferior epigastric perforator breast reconstruction.

The deep inferior epigastric perforator (DIEP) flap is often preferred for breast reconstruction as it allows for autologous reconstruction with less ...
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