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The use of surgical site drains in breast reconstruction: a literature review
Isis Scomacao, MD; Eliana Duraes, MD, PhD; Humzah Quereshy, MD; Risal Djohan, MD
Cleveland Clinic
2018-02-15
Presenter: Isis Scomacao
Affidavit:
I certify the project represents original work of the residents and authors on this project
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: To analyze the literature on the use of drain after breast reconstruction and understand its effectiveness and indications.
Methods: Using Cochrane Library, Embase, Pubmed databases, a literature review was performed. All types of study were considered. The quality of the study was graded by two independent reviewers and data was extracted according to PRISMA statement. Search terms: "breast reconstruction" and "breast flap in combination with "drain", "seroma" and "seroma prevention". The first selection was done by the tittles, followed by the abstract, and concluded by the full text evaluation. The best available papers were selected after reviewers' agreement. Study methodology, rate of complications and reoperations, length of hospital stay (LOS), criteria to remove the drain and study conclusions were analyzed. Exclusion criteria was the association of other seroma prevention method without a group with drain alone.
Results: Out of 2171 studies, 51 relevant articles were found and 22 met inclusion criteria. Seventeen studies (77.27%) were retrospective reviews, only 1 randomized controlled trial (RCT) and 1 meta-analysis. Seroma formation was available in 15(68.18%) of the studies, infection rate in 9(40.90%), dehiscence in 5(22.72%), reoperation in 3(15.63%), LOS in 5(22.72%). Criteria to remove drain was available in 18(82%) and majority of studies agreed to remove the drain with less 30ml in 24 or 48h.
Conclusion: Most of what is standard of care in terms of drain management is not scientifically evidence-based. Level 1 studies are necessary to optimize the decision-making process and establish a better drain management guideline for breast reconstruction.
