Recently released results of a British study suggest that certain breast reconstruction patients can benefit from having their post-operative drains removed earlier rather than later.
The research team, led by B.H. Miranda, M.D., of the plastic and reconstructive surgery department of the Royal Free Hospital in London, has presented and published data for the duration of donor-site back-drain use in latissimus dorsi (LD) flap breast reconstruction in response to insufficient evidence and a requirement for further investigation to be added to the literature. Similar evidence, however, was lacking for deep inferior epigastric perforator (DIEP) flap reconstruction.
According to the study, the DIEP flap is a preferred technique for breast reconstruction as it allows for autologous reconstruction with less donor-site morbidity, as compared with transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. The authors write that for this study, their aim was “to compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction abdominal drain removal by post-operative day (POD) three regardless of output — the early group — with removal after POD 3 where instructions were by drainage-volume output consistency — the late group — in post-mastectomy DIEP reconstruction donor sites.”
A Retrospective Review
In order to facilitate one-year minimum follow-up per patient, the researchers undertook a retrospective review of DIEP breast reconstructions that were carried out between January 2011 and July 2012. They found that of 74 patients who underwent DIEP reconstruction and for whom there were complete hospital records, 41 were in the late drain-removal group, 33 in the early-removal group. Both groups were matched for age and number of donor-site drains (two per patient).
The researchers found that mean number of drain-removal days (4.32 vs. 2.87 days), total drainage (518.90 ml vs. 283.79 ml) and hospital inpatient stays were greater for patients in the late group. There were no differences in rates of complications, seroma, dehiscence or hematoma between the two groups.
“These data suggest significant advantages for patients who have abdominal drains removed early by POD 3, without increased post-operative complications including seroma rates,” the authors conclude. “These data are in keeping with our LD data. We recommend drain removal and patient discharge by POD 3.”
The study was published online Feb. 19 in the Journal of Plastic, Reconstructive and Aesthetic Surgery (JPRAS).