Effect of different quilting techniques on seroma formation after breast surgery: retrospective study

• Published in: BJS open Vol. 7; no. 2
• Main Authors: van Zeelst, Lotte J, van der Waal, Dagmar C, Keemers-Gels, Mariël E, van den Wildenberg, Frits J H, Schlooz-Vries, Margrethe S, Wijers, Charlotte H W, de Wilt, Johannes H W, Strobbe, Luc J A
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 07.03.2023
• Subjects: Breast Neoplasms - surgery; Drainage - adverse effects; Drainage - methods; Female; Humans; Mastectomy - adverse effects; Mastectomy - methods; Original; Polyglactin 910; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Seroma - epidemiology; Seroma - etiology; Seroma - prevention & control; Suture Techniques - adverse effects
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1093/bjsopen/zrac171

Abstract Background Quilting, a technique in which skin flaps are sutured to the underlying muscle, reduces seroma after mastectomy and/or axillary lymph node dissection. The aim of this study was to assess the effect of different quilting techniques on the formation of clinically significant seroma. Methods This was a retrospective study including patients undergoing mastectomy and/or axillary lymph node dissection. Four breast surgeons applied the quilting technique based on their own discretion. Technique 1 was performed using Stratafix in 5–7 rows placed at 2–3 cm distance. Technique 2 was performed using Vicryl 2–0 in 4–8 rows placed at 1.5–2 cm distance. Technique 3 was performed using Vicryl 0/1 in 3 rows placed at 3–4 cm distance. Technique 4 was performed using Vicryl 0 in 4–5 rows placed at 1.5 cm distance. The primary outcome was clinically significant seroma. Results A total of 445 patients were included. Clinically significant seroma incidence was 4.1 per cent (six of 147) for technique 1, which was significantly lower than that for the other techniques (25.0 per cent (29 of 116), 29.4 per cent (32 of 109), and 33 per cent (24 of 73) for techniques 2, 3, and 4 (P < 0.001) respectively). The duration of surgery was not significantly longer for technique 1 compared with the other three techniques. The length of hospital stay, number of additional visits to the outpatient clinic, and reoperations did not differ significantly between the four techniques. Conclusion Quilting using Stratafix and placing 5–7 rows with 2–3 cm distance between the stitches associates with low clinically significant seroma incidence without adverse effects. Clinically significant seroma (CSS) incidence differs significantly depending on which quilting technique is used. Quilting using Stratafix and placing 5–7 rows with 2–3 cm distance between the stitches results in the lowest CSS incidence without an increase in healthcare consumption.