title: A Prospective Randomized Trial of the Efficacy of Fibrin Glue, Triamcinolone Acetonide, and Quilting Sutures in Seroma Prevention after Latissimus Dorsi Breast Reconstruction.
abstract: BACKGROUND
  Donor-site seroma is the most common complication following latissimus dorsi flap breast reconstruction. Various agents and techniques have attempted to minimize seroma formation. The purpose of this study was to compare the efficacy of different products and quilting sutures at seroma prevention.
  
  
  METHODS
  This is a single-center, double-blinded, randomized, controlled trial of a consecutive series of breast cancer patients (n = 96) undergoing latissimus dorsi flap reconstruction performed by a single surgeon. Patients were randomized to receive (1) fibrin glue (Tisseel) (n = 23), (2) triamcinolone acetonide (n = 26), or (3) normal saline (control) (n = 27) sprayed into the donor site. The fourth arm included donor-site quilting sutures (n = 20). Outcomes included seroma, drain output, and days to last drain removal. Drain removal was standardized at less than 30 cc/day.
  
  
  RESULTS
  All groups were matched evenly without differences in risk, procedures, or complications. The overall seroma rate was 31.3 percent (n = 30). The quilting group had significantly less drainage for weeks 1 (p = 0.006) and 2 (p = 0.050) postoperatively. Quilting statistically reduced the incidence of seromas to 5.0 percent (n = 1; p = 0.038) compared with other groups (control, 34.5 percent; fibrin, 27.6 percent; and triamcinolone, 37.6 percent). Drains were removed 10 days earlier with quilting (control, 35.5 days; fibrin, 39.5 days; triamcinolone, 37.4 days; and quilting, 25.8 days; p = 0.001). The incidence of all other complications was similar between groups.
  
  
  CONCLUSIONS
  The use of quilting donor sites significantly decreases the incidence of donor-site seromas and leads to earlier drain removal following latissimus dorsi flap reconstruction and maintains a low complication profile.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Atlanta, Ga.|From the Division of Plastic Surgery, Emory University School of Medicine.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Hart
authors.affiliation: Atlanta, Ga.|From the Division of Plastic Surgery, Emory University School of Medicine.
authors.forename: Clarie
authors.initials: C
authors.lastname: Duggal
authors.affiliation: Atlanta, Ga.|From the Division of Plastic Surgery, Emory University School of Medicine.
authors.forename: Ximena
authors.initials: X
authors.lastname: Pinell-White
authors.affiliation: Atlanta, Ga.|From the Division of Plastic Surgery, Emory University School of Medicine.
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004322:Drainage; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D049291:Seroma / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D064171:Superficial Back Muscles / Q000637:transplantation*; D013536:Suture Techniques; D014014:Tissue Adhesives; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D014222:Triamcinolone Acetonide