title: The drain game: abdominal drains for deep inferior epigastric perforator breast reconstruction.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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=0.46), seroma (4.88% (2/41) vs. 0% (0/33); p=0.20), dehiscence (4.88% (2/41) vs. 9.09% (3/33); p=0.47) or haematoma (7.32% (3/41) vs. 3.0% (1/33); p=0.42) rates between the late and early groups.
  
  
  CONCLUSIONS
  These data suggest significant advantages for patients who have abdominal drains 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.
authors.affiliation: Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK. Electronic address: DrBMiranda@googlemail.com.
authors.forename: B H
authors.initials: BH
authors.lastname: Miranda
authors.affiliation: Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
authors.forename: K
authors.initials: K
authors.lastname: Amin
authors.affiliation: Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Chana
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000273:Adipose Tissue / Q000637:transplantation; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000009:adverse effects; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D016038:Skin Transplantation / Q000009:adverse effects; D013396:Suction / Q000009:adverse effects / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013997:Time Factors; D060053:Transplant Donor Site / Q000601:surgery*
keywords: Breast; Complications; DIEP; Drain; Flap; Seroma