title: New risk factors for donor site seroma formation after latissimus dorsi flap breast reconstruction: 10-year period outcome analysis.
abstract: BACKGROUND
  Latissimus dorsi flap breast reconstruction is associated with a high incidence of donor site seromas. After using several preventive operative techniques, we were able to reduce postoperative complications in a standard operation procedure. The aim of this study was to evaluate the effect of various risk factors related to incidence, volume and frequency of seroma aspiration.
  
  
  METHODS
  A retrospective review of 87 latissimus dorsi breast reconstructions over a 10-year period was carried out. Associations between potential risk factors and outcome (total drainage volume, number of aspirations and total seroma volume) were investigated on a descriptive level by means of correlation analysis and on an analytical level by multiple linear regression analysis.
  
  
  RESULTS
  Correlation analysis showed that co-morbidity and higher body mass index (BMI, in kilograms per square metre) were associated with larger seroma volumes. BMI remained a significant risk factor also after adjustment for other co-variates (p<0.001, linear regression). Moreover, patients receiving selective serotonin reuptake inhibitors (SSRIs) presented significantly higher seroma volumes (p=0.047, linear regression). At a trend level (p<0.1), post-operative hypertension, lower Ca ± - levels and a reduction in haemoglobin levels (before vs. after operation) were also associated with larger seroma volumes.
  
  
  CONCLUSIONS
  This study, besides observing the effects of well-established risk factors such as age, BMI and surgical operation techniques, identified new risk factors, in particular the perioperative use of SSRIs and the calcium balance, which should be considered in patients in pre- and postoperative care.
authors.affiliation: Hospital of Barmherzige Brüder, Salzburg, Austria. gruber.sabine1@gmail.com
authors.forename: Sabine
authors.initials: S
authors.lastname: Gruber
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Whitworth
authors.forename: Georg
authors.initials: G
authors.lastname: Kemmler
authors.forename: Christoph
authors.initials: C
authors.lastname: Papp
mesh_terms: D000328:Adult; D017677:Age Distribution; D001943:Breast Neoplasms / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000601:surgery; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000098:blood supply / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D049291:Seroma / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply / Q000706:statistics & numerical data; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult