Randomized clinical trial of the effect of quilting latissimus dorsi flap donor site on seroma formation

Background: Latissimus dorsi (LD) flap breast reconstruction is associated with a high incidence of donor site seromas, despite the use of surgical drains. The aim of this study was to evaluate the use of donor site quilting sutures, as well as drains, on the incidence. volume and frequency of seroma aspiration. Methods: The trial randomized 108 women undergoing LD breast reconstruction to quilting procedures (54) or control group (52) for intention-to-treat analysis; two were excluded. Outcome measures were the incidence and volume of postoperative seroma. Secondary outcome measures included postoperative back pain, analgesic consumption, shoulder movement and duration of hospital stay. Results: Quilting significantly reduced the overall incidence of seroma from 46 of 48 (96 per cent) to 43 of 52 (83 per cent) (P = 0.036), including the 38 women who had extended LD flap (with or without implants). There were further significant reductions in seroma volume (P = 0.004), frequency of aspiration (P = 0.001) and overall seroma volumes, including surgical drainage and symptomatic seromas (P = 0.013). Subset analyses for LD-implant (60 women) and extended LD (with or without implant) showed similar significance. Quilting did not affect back pain or compromise shoulder mobility. Conclusion: Quilting significantly reduced overall seroma volumes after LD breast reconstruction including extended LD, and is recommended in combination with surgical drains.