title: The Effect of Progressive-Tension Closure on Donor Site Seroma Formation in Delayed Latissimus Dorsi Flaps for Breast Reconstruction.
abstract: BACKGROUND
  Autologous tissue flaps play an integral part in breast reconstruction. The latissimus dorsi myocutaneous flap is an effective and aesthetic method of immediate breast reconstruction, although a high rate of donor site seroma formation has plagued this procedure. Many techniques to reduce donor site seromas have been undertaken. This study evaluates the effect of progressive-tension closure (PTC) on postoperative seroma.
  
  
  METHODS
  This is a retrospective cohort study of 100 breasts reconstructed using a traditional closure versus PTC of the donor site. Outcomes collected include patient age, date of surgery, side of surgery, body mass index (BMI), smoking status, diabetes diagnosis, number of days the initial operative drain was present, seroma occurrence, seroma aspirations, seroma catheters placed, and operative interventions.
  
  
  RESULTS
  The PTC technique significantly decreased seroma formation, with 40% of the traditional closure sites developing seromas and only 14% in the PTC group (P = 0.0078). The mean number of days the postoperative drain remained was significantly reduced with the PTC technique, just 16.6 days compared to 27.8 days (P < 0.0001). Of the seromas which did develop, the PTC group had significantly fewer aspirations (38.9% vs 14%, P = 0.014), drains placed (15.8% vs 4.6%, P < 0.0001), and operative interventions (7% vs 0%, P < 0.0001). There was no significant difference in mean patient age (54.1, 52.4) or body mass index (28.1, 27.3) between the groups.
  
  
  CONCLUSIONS
  The PTC technique of closing latissimus dorsi donor sites significantly decreases seroma formation, number of days a drain is present, and postoperative interventions. This decreases the time and resources devoted to addressing seromas.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, University of Tennessee, Chattanooga, TN.
authors.forename: Lesley V
authors.initials: LV
authors.lastname: Landis
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brzezienski
authors.forename: Cuilan
authors.initials: C
authors.lastname: Gao
authors.forename: Tara
authors.initials: T
authors.lastname: Lee
mesh_terms: D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps / Q000637:transplantation*; D013536:Suture Techniques