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Are Surgical Drains Needed in DIEP Flap Surgery? The Drain-Free DIEP Flap Concept
Evgenios Evgeniou1, Julian Liew2, Geoffrey Lee2
1From the Departments of Plastic Surgery.
Background:
Studies support an inherent morbidity associated with the use of surgical drains-such as postoperative pain, infection, reduction in mobility, and delay in patient discharge-and they do not prevent seroma or hematoma. The authors' series aims to evaluate the feasibility, benefits, and safety of performing drainless deep inferior epigastric perforator (DIEP) flap surgery and to formulate an algorithm for when this can be used.
Methods:
A retrospective review of DIEP reconstruction outcomes of two surgeons was performed. Over the course of 24 months, consecutive DIEP flap patients were included from the Royal Marsden Hospital in London and Austin Hospital in Melbourne, and drain use, drain output, length of stay (LOS), and complications were analyzed.
Results:
A total of 107 DIEP flap reconstructions were performed by two surgeons. Thirty-five patients had abdominal drainless DIEP flaps, and 12 patients had totally drainless DIEP flaps. Mean age was 52 years (range, 34 to 73 years) and mean body mass index was 26.8 kg/m 2 (range, 19.0 to 41.3 kg/m 2 ). Abdominal drainless patients showed a potential trend toward shorter hospital stays as compared with the ones with drains (mean LOS, 3.74 days versus 4.05 days; P = 0.154). Totally drainless patients had an even shorter, statistically significant, mean LOS of 3.10 days, as compared with patients with drains (4.05 days, P = 0.002), with no increase in complications.
Conclusions:
The avoidance of abdominal drains in DIEP flaps reduces hospital stay without increasing complications, and this has become our standard practice for patients with a body mass index of less than 30 kg/m 2 . It is our opinion that the totally drainless DIEP flap procedure is safe in selected patients.
Clinical Question/Level Of Evidence:
Therapeutic, III.
Insights
Drainless deep inferior epigastric perforator (DIEP) flap surgery reduces hospital stays without increasing complications. This approach is safe and effective for selected patients, particularly those with a body mass index under 30.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
Background:
- Surgical drains are associated with complications like pain, infection, and delayed discharge.
- Drains do not effectively prevent seroma or hematoma formation.
- There is a need to evaluate alternative surgical techniques to minimize drain-related morbidity.
Purpose of the Study:
- To assess the feasibility, benefits, and safety of performing drainless deep inferior epigastric perforator (DIEP) flap surgery.
- To develop an algorithm for patient selection for drainless DIEP flap procedures.
- To compare outcomes of drainless DIEP flaps versus those with drains.
Main Methods:
- Retrospective review of 107 DIEP flap reconstructions over 24 months.
- Analysis of drain use, drain output, length of stay (LOS), and complications.
- Inclusion of patients from two major hospitals (Royal Marsden Hospital and Austin Hospital).
Main Results:
- Totally drainless DIEP flaps resulted in a statistically significant shorter mean LOS (3.10 days) compared to flaps with drains (4.05 days).
- Abdominal drainless flaps showed a trend toward shorter LOS (3.74 days) versus those with drains (4.05 days).
- No increase in complications was observed in drainless DIEP flap patients.
Conclusions:
- Avoiding drains in DIEP flap surgery shortens hospital stays without increasing complications.
- Drainless DIEP flap surgery has become standard practice for patients with a BMI < 30 kg/m².
- The totally drainless DIEP flap procedure is considered safe in carefully selected patients.
