Superior pedicle breast reduction techniques increase the risk of postoperative drainage.

BACKGROUND: The most frequent complication after bilateral reduction mammoplasty (BRM) is the formation of seromas and hematomas. If a group of patients who are at increased risk of seroma and hematoma are identified, the use of drains in this group would be beneficial. We hypothesized that superior pedicle reductions would have increased postoperative drainage. METHODS: A prospective observational study was conducted to identify independent risk factors for increased drainage after BRM. Blinded research nurses were employed to record the amount of drainage during the postoperative period. Univariate and multivariate regression analyses were used to identify risk factors for increased postoperative drainage. RESULTS: The study included a total of 111 patients. Univariate analysis identified the amount of preoperative infiltration (P < 0.001), the amount of liposuction (P < 0.001), the amount of surgically resected tissue (P = 0.001), the type of reduction (P < 0.001), the patient's chest circumference (P = 0.035), and the patient's body mass index (BMI) (P = 0.015) as significant predictors of postoperative drainage. Multivariate regression analysis identified the amount of tissue resected and the type of reduction as the only 2 independent predictors of postoperative drainage. The use of superior pedicle technique predicted 43% of the variability in postoperative wound drainage. CONCLUSIONS: The use of the superior pedicle technique for BRM is associated with a significant increase in postoperative drainage. Surgeons using this technique should consider the routine use of drains to avoid possible complications of seroma, infection, and poor wound healing.

Completely autologous platelet gel in breast reduction surgery: a blinded, randomized, controlled trial.

BACKGROUND: The objective of this study was to assess the effectiveness of topical application of completely autologous platelet gel during breast surgery to reduce postoperative wound drainage. An increasing number of surgical centers are using tissue sealants to reduce postoperative drainage and improve surgical outcomes. However, there is a paucity of randomized, double-blind, controlled trials assessing the efficacy of these agents. METHODS: The authors conducted a within-patient, randomized, patient- and assessor-blinded, controlled trial assessing the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammaplasty. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. The primary outcome was the difference in wound drainage over 24 hours. Secondary outcomes included subjective and objective assessments of pain and wound healing. RESULTS: No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. CONCLUSION: The authors' results do not support the use of completely autologous platelet gel to improve outcomes after reduction mammaplasty.

Coronary artery bypass surgery with heparin-coated perfusion circuits and low-dose heparinization.

OBJECTIVE: To evaluate the safety and efficacy of heparin-coated perfusion circuits with low-dose heparinization and centrifugal pumping compared with the standard method during coronary artery bypass grafting. DESIGN: Prospective, randomized, single-blind clinical trial. SETTING: A primary care institution. PATIENTS: Ninety patients who underwent first-time elective coronary artery bypass grafting were eligible for the study. After giving informed consent, they were randomly assigned to 1 of 3 groups (30/group). INTERVENTIONS: Perfusion on regular uncoated bypass equipment with a roller pump and full-dose heparinization (300 IU/kg bolus, activated clotting time [ACT] > 400 s) (group 1), on a heparin-coated oxygenator with a centrifugal pump and full-dose heparinization (group 2) and on fully heparin-coated bypass equipment with a centrifugal pump and low-dose heparinization (100 IU/kg bolus, ACT of 180-400 s) (group 3). Standard coronary artery bypass grafting was performed. OUTCOME MEASURES: Postoperative bleeding, transfusion requirements and clinical outcomes. RESULTS: There were no complications related to the study protocol. Study groups were similar in terms of postoperative bleeding, transfusion requirements and clinical outcomes. CONCLUSIONS: Heparin-coated cardiopulmonary bypass with low-dose heparinization and centrifugal pumping is a safe practice but showed no advantages over the use of regular uncoated bypass circuits for coronary bypass surgery.

The effect of epsilon aminocaproic acid on blood loss in patients who undergo primary total hip replacement: a pilot study.

OBJECTIVE: To determine if the use of an antifibrinolytic agent (epsilon aminocaproic acid [EACA]) decreased perioperative and postoperative blood loss in patients who underwent total hip arthroplasty (THA). DESIGN: A prospective, double-blind, randomized, controlled clinical trial. SETTING: A university-affiliated tertiary care hospital with a large joint arthroplasty population. PARTICIPANTS: Fifty-five patients who were scheduled for a primary THA. METHOD: Patients were randomly assigned to 2 groups to receive either EACA or saline placebo perioperatively. Preoperatively, the groups were similar with respect to gender, mean age, mean hemoglobin level, operative time and prosthesis type. OUTCOME MEASURES: Blood loss from the start of surgery until the Hemovac drain was removed, and the transfusion rate and hemoglobin levels. RESULTS: Mean (and standard error) total blood loss for patients receiving EACA was 867 (207) mL and for patients receiving placebo was 1198 (544) mL (p < 0.025). Four patients in the EACA group received 7 units of packed red blood cells and 7 patients in the saline group required 12 units. CONCLUSIONS: Patients receiving the placebo sustained greater total blood loss than EACA patients and were more likely to require blood transfusion. In the current climate of concern over blood transfusions during surgery, EACA administration can reduce blood loss and consequently transfusion and transfusion-related risk.