Ligating perforators in abdominoplasty reduces the risk of seroma.

BACKGROUND: Seroma formation, a common complication of abdominoplasty, can cause patient discomfort and inconvenience. This study aimed to compare seroma rates after ligation and diathermy of large abdominal perforating vessels during abdominoplasty. METHODS: Consecutive patients undergoing abdominoplasty with epigastric undermining between 2004 and 2011 were studied. Body mass index (BMI), age at operation, smoking history, preoperative weight loss, operative details, perioperative fluid infiltration, concomitant abdominal liposuction, ligation of perforators by clips, suture or diathermy, use of quilting sutures, weight of tissue removed, postoperative drainage, inpatient stay, and seroma rates were recorded. Statistical analysis was undertaken using the unpaired t test, Fisher's exact test, the Mann-Whitney U test, and Kendall's tau-b test. RESULTS: The study included 90 patients. The incidence of seroma was significantly lower among the patients who had perforators ligated (4/60, 6.7%) than among those who had diathermy (10/30, 33%) (p=0.002, Fisher's exact test). Seroma formation was significantly associated with a higher BMI, (27.45 vs. 25.16 kg/m2; p=0.025, t test) but not with preoperative weight loss. Postoperative fluid drainage did not differ significantly between ligated and diathermied perforators (p=0.716 Mann-Whitney U test). CONCLUSIONS: Use of ligation by clip or suture rather than by diathermy to ablate large abdominal perforators significantly reduced the incidence of seroma among abdominoplasty patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Outcomes in the repair of pilonidal sinus disease excision wounds using a parasacral perforator flap.

INTRODUCTION: The ideal treatment for pilonidal sinus disease has yet to be defined. There are many approaches described in the literature. METHODS: Thirty-five consecutive patients who underwent wide excision of pilonidal sinus disease had the wound repaired using a parasacral perforator flap. Outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires. RESULTS: There were ten minor complications including six minor wound edge dehiscences. There were two ischaemic complications, with one flap loss. There were 3 recurrences of pilonidal disease at a mean follow-up of 33 months, giving a 5-year recurrence free rate of 86%. Of the patients questioned, all would recommend the procedure to someone else despite 69% being dissatisfied with the cosmetic outcome. CONCLUSIONS: This series indicates that the parasacral perforator flap technique is able to repair pilonidal sinus excision wounds successfully with minimal morbidity and a low recurrence rate at a mean of follow-up of 33 months. The study suggests that it may be a technique best reserved for recurrent cases of pilonidal sinus disease. Patients feel the procedure is successful despite reservations regarding the cosmetic outcome.

Immediate breast reconstruction with latissimus dorsi flap and implant: audit of outcomes and patient satisfaction survey.

METHODS: A retrospective case-note study of immediate breast reconstruction using the pedicled latissimus dorsi flap with a silicone implant and a patient-satisfaction survey were carried out. RESULTS: Fifty-four reconstructions were performed in 52 patients between March 2001 and October 2006. Major complications included capsular contracture requiring capsulotomy (7.4%); minor complications included donor-site seroma (20.4%) and superficial wound problems (13%). The average score out of 10 for the appearance of the reconstructed breast whilst wearing a bra was 8.35; score for appearance whilst out of a bra was 7.0 and overall symmetry was 6.6. On the basis of the scores, 16 patients were grouped as excellent; 15 as good; seven as fair and two as poor. Significantly, more of the patients without a contralateral matching procedure graded their reconstruction as good or excellent (p=0.024). CONCLUSIONS: The pedicled latissimus dorsi flap with a silicone implant gives the majority of patients a satisfying reconstruction, without necessarily requiring a contralateral matching procedure, whilst minimising postoperative complications.

Just another sebaceous cyst?

Two cases are presented where an incorrect diagnosis of a sebaceous cyst delayed the treatment of a more serious underlying problem. The history and examination findings pointed to the diagnosis in both cases. Although not rare entities in themselves, these cases illustrate the importance of formulating a differential diagnosis even when confronted with an apparently straightforward condition.