title: Quantity-guided drain management reduces seroma formation and wound infections after radical lymph node dissection: results of a comparative observational study of 374 melanoma patients.
abstract: BACKGROUND
  Lymphatic fistulas are common complications after lymph node dissections in melanoma patients. We investigated whether drain management could improve the patient's outcome.
  
  
  METHODS
  Patients who underwent axillary or inguinal lymph node dissection (RALND or RILND) for malignant melanoma were recorded in a prospective database. Two different methods of drain management were compared. Either the drain was removed no later than the eighth postoperative day (period I, 2003-2007) or it was left in place until fluid flow was below 50 ml in 24 h for two consecutive days (period II, 2008-2011). The main outcome criterion was the incidence of seroma punctures after drain removal.
  
  
  RESULTS
  374 patients were analysed. The incidence of seroma punctures significantly decreased in period II. The number of patients with elevated lymphatic secretions rose by 41.3% (RALND) and 38.1% (RILND). With the exception of lymphatic fistulas, we observed significantly more local complications with need for treatment in period I (n = 104, 52%) than in period II (n = 31, 18%). In period II, the hospital stays after both procedures were significantly reduced.
  
  
  CONCLUSIONS
  We conclude that quantity-guided drain management leads to a prolonged interval of drainage but is associated with a lower incidence of seroma formation and shorter hospital stay.
authors.affiliation: a Department of Surgery , Charité ? University Medicine Berlin, Campus Mitte/Campus Virchow-Klinikum , Berlin , Germany.
authors.forename: Gerold
authors.identifier: http://orcid.org/0000-0002-6649-0001
authors.initials: G
authors.lastname: Koplin
authors.affiliation: b Department of General, Visceral, Vascular and Bariatric Surgery , KRH-Klinikum Nordstadt, Klinikum Region Hannover GmbH , Hannover , Germany.
authors.forename: Julian W
authors.initials: JW
authors.lastname: Mall
authors.affiliation: a Department of Surgery , Charité ? University Medicine Berlin, Campus Mitte/Campus Virchow-Klinikum , Berlin , Germany.
authors.forename: Wieland
authors.initials: W
authors.lastname: Raue
authors.affiliation: a Department of Surgery , Charité ? University Medicine Berlin, Campus Mitte/Campus Virchow-Klinikum , Berlin , Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Böhm
authors.affiliation: c Department of Radiation Oncology , Charité - Universitätsmedizin Berlin, Campus Mitte , Berlin , Germany.
authors.forename: Ulrike
authors.identifier: http://orcid.org/0000-0002-3485-4632
authors.initials: U
authors.lastname: Hoeller
authors.affiliation: a Department of Surgery , Charité ? University Medicine Berlin, Campus Mitte/Campus Virchow-Klinikum , Berlin , Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Haase
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care; D049291:Seroma / Q000453:epidemiology / Q000517:prevention & control*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
keywords: Melanoma; dissection; drain; lymph node; lymphatic fistula; metastasis; morbidity