A Prospective Randomized Trial of the Efficacy of Fibrin Glue, Triamcinolone Acetonide, and Quilting Sutures in Seroma Prevention after Latissimus Dorsi Breast Reconstruction

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We would like to congratulate the authors on their work on prevention of seromas in latissimus dorsi flap reconstruction.1 This randomized controlled trial to determine the impact of fibrin and triamcinolone application and the use of quilting sutures to prevent seroma formation found a significant reduction of donor-site seromas and a shorter period until drainage removal in the quilting suture group. These findings provide valuable information for consideration by plastic surgeons active in reconstructive surgery.
In the Introduction section, the authors discuss studies covering the issue of compression dressings for seroma prevention. We would like to emphasize the importance of this aspect, which has not been mentioned any further by the authors. Review of the pertinent literature revealed that evidence on the use of compression dressings, particularly at latissimus dorsi muscle harvesting sites, is scarce.
Several authors found no significant reduction of seroma formation applying compression therapy.2 However, our clinical experience contradicts this finding. We have experienced that the use of external wound compression prevents seroma formation by means of impeding the drainage of lymph and wound secretion into the wound cavity. Thus, in our clinical practice, compression dressings and, after discharge, individually fitted compression garments are routinely applied and are of significant importance. From our point of view, this regimen of compression therapy is the basis for enabling short hospitalization and early drainage removal and ambulation. In contrast to this rather inexpensive strategy of compression therapy, the use of fibrin glue, from an economic perspective, can barely be justified, and thus should not be implemented in daily routine. Moreover, the use of fibrin glue alone has been described to be ineffective for seroma prevention in closure of dead space and larger wound areas.3
Furthermore, as a minor issue, we would like to mention that in the presented study, patients were instructed to document their drainage parameters after discharge. Despite providing meticulous instruction, we believe that relying on information gathered solely by patients adds a potential factor of inaccuracy to the study. The duration until drain removal by up to 4 weeks appears rather long. This differs significantly from our own experience. At our department, patients are generally not discharged until drain removal. Drains usually are removed when the output is less than 30 cc/24 hours. In addition, patients rigorously receive compression therapy postoperatively to minimize the risk of seroma formation. We fully agree, as mentioned by the authors, that long drainage duration causes patients additional discomfort and adds the risk of infection. In our opinion, patients should not be discharged with drains in situ.
In summary, we agree with the authors that the use of drains is of great importance in the reduction of seroma formation. In addition, we would like to emphasize strongly the role of compression therapy as an integral part of postoperative care.

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