The drain game: Abdominal drains for transverse rectus abdominis myocutaneous breast reconstruction.
BACKGROUND
We recently published data for the duration of donor site drain use in latissimus dorsi and deep inferior epigastric perforator breast reconstruction, due to a reported requirement in the literature; evidence is still required for transverse rectus abdominis myocutaneous (TRAM) 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), versus after POD 3 where instructions were by drainage volume/24 h ± output consistency (late group), in post-mastectomy TRAM breast reconstruction.


METHODS
A retrospective review of TRAM breast reconstructions, between June 2008-2013, was undertaken with a minimum 1 year follow-up per patient.


RESULTS
Of 65 patients who underwent TRAM breast reconstruction, 56 hospital records contained complete documentation. Both the late (n = 35) and early (n = 21) drain removal group were matched for age and number of donor site drains (2 per patient). Mean drain removal day (5.34 ± 0.20 days vs. 2.67 ± 0.14 days; p < 0.0001), total drainage (797.86 ± 77.15 mls vs. 295.71 ± 29.72 mls; p < 0.0001) and hospital inpatient stay (7.46 ± 0.29 days vs. 6.09 ± 0.32 days; p = 0.003) were greater for patients in the late versus early group. There were no differences in total complications (5.71% (2/35) vs. 14.29% (3/21); p = 0.28), including seroma (2.86% (1/35) vs. 4.76% (1/21); p = 0.71) 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 by POD 3.
Plastic & Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK. Electronic address: DrBMiranda@googlemail.com.
B H
BH
Miranda
Plastic & Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
R B L
RB
Wilson
Plastic & Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
K
K
Amin
Plastic & Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK.
J S
JS
Chana
D057785:Catheters; D020878:Device Removal / Q000009:adverse effects; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty; D008875:Middle Aged; D064827:Myocutaneous Flap; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D016038:Skin Transplantation / Q000009:adverse effects; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods; D060053:Transplant Donor Site / Q000601:surgery*
Breast; Complications; Drain; Flap; Seroma; TRAM