Reducing seroma formation and its sequelae after mastectomy by closure of the dead space: The interim analysis of a multi-center, double-blind randomized controlled trial (SAM trial)

Reducing seroma formation and its sequelae after mastectomy by closure of the dead space: The interim analysis of a multi-center, double-blind randomized controlled trial (SAM trial)

The Breast: August 2019 Volume 46, Pages 81–86

by Renée W.Y. Granzier, James van Bastelaar, Sander M.J. van Kuijk, Kim F.H. Hintzen, Cathelijne Heymans, Lotte L.B. Theunissen, Els R.M. van Haaren, Alfred Janssen, Geerard L. Beets, Yvonne L.J. Vissers

The main objective of this double-blind randomized controlled trial (RCT) was to assess seroma formation and its sequelae in patients undergoing mastectomy. Patients were randomized into one of three groups in which different wound closure techniques were applied: 1) conventional wound closure without flap fixation (CON) 2) flap fixation using sutures (FF–S) and 3) flap fixation using an adhesive tissue glue (FF-G).

Venous Superdrainage in DIEP Flap Breast Reconstruction: The Impact of Superficial Inferior Epigastric Vein Dissection on Abdominal Seroma Formation

Venous Superdrainage in DIEP Flap Breast Reconstruction: The Impact of Superficial Inferior Epigastric Vein Dissection on Abdominal Seroma Formation

Nedomansky, J et al
Plastic and Reconstructive Surgery: February 2018 - Volume 141 - Issue 2 - p 206e–212e

Background: Abdominal seroma formation after deep inferior epigastric perforator (DIEP) flap breast reconstruction is a common donor-site complication. Additional dissection of one or both of the superficial inferior epigastric veins (SIEVs) in DIEP flap breast reconstruction allows an additional anastomosis for venous superdrainage if venous congestion occurs. However, generally, SIEV dissection involves greater invasiveness into the inguinal region, which can traumatize lymphatic tissue and lead to lymph accumulation. The aim of this study was to evaluate the impact of SIEV dissection on the incidence of postoperative abdominal seroma. 
Methods: A series of 100 consecutive cases performed by the Department of Plastic and Reconstructive Surgery at the Medical University of Vienna from 2001 to 2016 was analyzed. Patients were divided into three groups: unilateral, bilateral, and no SIEV dissection. Abdominal seroma rates, length of hospital stay, abdominal drainage duration, and drainage fluid volumes were compared retrospectively. 
Results: Seromas were observed in 11.5 percent of patients without SIEV dissection, 17.2 percent of patients with unilateral SIEV dissection (p = 0.45 versus no SIEV), and 40 percent of patients with bilateral SIEV dissection (p = 0.02 versus no SIEV). The SIEV was anastomosed to salvage a congested DIEP flap twice. All seromas that developed could be treated with, on average, two fine-needle aspirations without any complications. 
Conclusions: Bilateral, but not unilateral, SIEV dissection increased abdominal seroma rates significantly. Venous congestion was observed rarely, but when it did occur, it endangered flap viability. Because an additional anastomosis of the SIEV can salvage a flap, unilateral SIEV dissection should be considered when raising a DIEP flap.