title: Modified aesthetic abdominoplasty approach in perforator free-flap breast reconstruction: Impact of drain free donor site on patient outcomes.
abstract: BACKGROUND
  The use of progressive tension sutures alone has been shown to be comparable to using abdominal drains in aesthetic abdominoplasty. This study reviews outcomes with the use of barbed progressive tension suture technique without drains in DIEP donor site closure compared to standard closure with drains.
  
  
  METHODS
  A two year retrospective review was conducted of DIEP flap reconstructions in the enhanced recovery program at Mayo Clinic, Rochester (USA). Donor site closure was divided into barbed progressive tension sutures (B-PTS) without drains, and standard abdominal closure with drains(S-AD). Demographics, perioperative data and donor site complications were documented.
  
  
  RESULTS
  93 patients were included in the study, 42 in the B-PTS no drain group and 51 in the S-AD with drains. 81% of all procedures were bilateral and 39% were immediate. Patients were discharged faster to the ward postoperatively and total hospital admission was reduced in the B-PTS group, 3.7 (SD = 1.4) days versus 4.7 (SD = 2.1) days in the standard group (P = 0 < 0.001 and 0.004 respectively). Less morphine was required postoperative day (POD) 1, 2 and 3 (P = 0.04, 0.03, 0.02 respectively), and time to mobilize was quicker but not statistically significant (P = 0.09) in the B-PTS group. Overall there were 18 patients in the S-AD group who had complications versus 9 in the B-PTS group (P = 0.14). The incidence of complications occurring within 30 days were lower in the B-PTS group (P = 0.05). The overall seroma rate was 5.4% and rates in the B-PTS group was 2.4% versus 7.8% in the S-AD group, P = 0.37.
  
  
  CONCLUSIONS
  Use of barbed progressive tension sutures for abdominal closure after DIEP flap harvest can obviate the need for abdominal drains, reduce postoperative pain and encourage early discharge from the hospital without an increased risk in complications.
  
  
  METHODS
  III.
authors.affiliation: Department of Plastic Surgery, Mayo Clinic, Rochester, MN, United States; Restoration of Appearance and Function Charitable Trust (RAFT) Surgical Research Fellow, United Kingdom.
authors.forename: Anita T
authors.initials: AT
authors.lastname: Mohan
authors.affiliation: Department of Plastic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Charalambos K
authors.initials: CK
authors.lastname: Rammos
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, MN, United States.
authors.forename: Prakriti
authors.initials: P
authors.lastname: Gaba
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, MN, United States.
authors.forename: John
authors.initials: J
authors.lastname: Schupbach
authors.affiliation: Pharmacy Services, Rochester Methodist Hospital, Mayo Clinic, Rochester, MN, United States.
authors.forename: Whitney J
authors.initials: WJ
authors.lastname: Goede
authors.affiliation: Department of Biomedical Statistics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Karla
authors.initials: K
authors.lastname: Ballman
authors.affiliation: Department of Plastic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Niles
authors.initials: N
authors.lastname: Batdorf
authors.affiliation: Department of Plastic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Angela
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Department of Plastic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*; D061645:Abdominoplasty / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004322:Drainage / Q000009:adverse effects; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D061525:Perforator Flap; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013536:Suture Techniques / Q000295:instrumentation; D013537:Sutures; D020858:Tissue and Organ Harvesting / Q000379:methods; D060053:Transplant Donor Site / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Abdominal free tissue transfer; Abdominoplasty; Autologous breast reconstruction; DIEP; Deep inferior epigastric artery perforator flap; Donor site complications