The Drain Dilemma: A Systematic Review and Meta-Analysis of Drain-Free Abdominal Closure With Progressive Tension Sutures Against Drain-Assisted Closure for Abdominal Flaps in Breast Reconstruction.

Abbas Ali Khan,Zabihullah Abdul,Ammar Allouni,Shafiq Rahman,Benjamin Wood

doi:10.7759/cureus.18924

Abstract

The use of abdominal drains in donor site closure following breast reconstruction with abdominal flaps is widespread. Our review aimed to compare the outcomes of donor site closure with and without the use of abdominal drains following breast reconstruction with abdominal flaps.Randomized, non-randomized, and observational studies that compared the use of drains vs. no drain in breast reconstruction were included by searching MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL).Four studies enrolling 327 participants were identified. A statistically significant difference was found in terms of duration of hospital stay favouring abdominal closure without the use of drains (MD = -1.15, 95% CI = -1.88 tom-0.42, P=0.002), with a similar difference found in terms of overall complication rate (OR = 0.44, 95% CI = 0.23 to 0.83, p=0.01). Likewise, a statistically significant difference was found favouring abdominal closure without the use of drains for the secondary outcome of operative time (MD = -55.95, 95% CI = -107.19 to -4.74, p=0.03).Abdominal closure without drains following breast reconstructions with abdominal flaps is superior to closure with drains.

Highlights

BackgroundFree flap breast reconstruction is utilised for 14% of patients undergoing immediate breast reconstruction and 33% undergoing delayed reconstruction [1]
The analysis showed that abdominal closure following breast reconstruction using abdominal flaps without the use of a drain was superior to drain-assisted closure in terms of both primary and secondary outcome measures
The authors report the first meta-analysis within the literature comparing the use of drains in abdominalbased free-flap surgery for breast reconstruction with progressive tension sutures (PTS) closure and no drains

Summary

Introduction

BackgroundFree flap breast reconstruction is utilised for 14% of patients undergoing immediate breast reconstruction and 33% undergoing delayed reconstruction [1]. Used by 90% of plastic surgeons, the use of abdominal drains during donor site closure in breast reconstruction with abdominal flaps is widely debated across the surgical literature [1]. Does carry caveats to patient care, including an increased risk of infection, pain, reduced mobility, greater nursing requirements, as well as prolonged hospital admission [5]. Taking this into account, alternative techniques have been used to circumvent the drawbacks associated with abdominal drains, including tissue sealants, progressive tension sutures (PTS), as well as barbed sutures [6]. The authors, report the first systematic review and meta-analysis assessing the outcomes of drain-free closure of abdominal wounds in breast reconstruction

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Conclusion