Predictors of Donor Site Seroma in Latissimus Dorsi Flap
Prakasit Chirappapha MD*, Chayanoot Rattadilok MD*, Panuwat Lertsithichai MD, MSc*, Monchai Leesombutpaiboon MD*, Thongchai Sukarayothin MD*, Youwanush Kongdan MD*, Panya Thaweepworadech MD*
Affiliation : * Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Donor site seroma occurring after latissimus dorsi (LD) reconstruction of the breast is a common complication.
The aim of the present study was to identify predictors of donor site seroma requiring aspiration in breast cancer patients
undergoing mastectomy with breast reconstruction using either ELD flap, or LD flap with prosthesis, and to compare the
frequency of donor site seroma between the two operations.
Objective : To identify predictors of donor site seroma in breast cancer patients undergoing mastectomy with breast
reconstruction using either ELD flap, or LD flap with prosthesis, and to compare the frequency of donor site seroma between
the two operations.
Material and Method: Medical records of breast cancer patients treated between January 2013 and September 2015 were
reviewed. Univariable and backward stepwise multivariable logistic regression analyses were used to identify predictors of
donor site seroma.
Results : Fifty-nine breasts in 58 cancer patients underwent breast reconstruction using the LD flap. Forty-five patients (76%)
had donor site seroma. There was no significant difference in the frequency of donor site seroma between two operations.
Multivariable analysis showed that total donor site drainage volume greater than 340 mL on postoperative days 1 to 3 (OR
= 19.2, 95% CI: 1.8 to 204.5), and duration of donor site drain retention of at most 17 days (OR = 12.5, 95% CI: 1.4 to 100)
were significant predictor of seroma. Of the 45 patients who had seroma, those with concurrent chemotherapy, whose
operative time was more than 250 minutes, and undergoing nipple sparing mastectomy had significantly longer duration of
donor site seroma.
Conclusion : Significant predictors of donor site seroma included total donor site drainage greater than 340 mL on postoperative
days 1 to 3, and duration of donor site drain retention of 17 days or less. There was no significant difference in the frequency
of donor site seroma between ELD and LD with prosthesis procedures. To avoid donor site seroma, donor site drain
retention of more than 17 days, especially in patients who have total donor site drainage volume greater than 340 mL on days
1 to 3, is recommended.
Keywords : Extended latissimus dorsi flap, Latissimus dorsi flap with prosthesis, Flap complication, Breast reconstruction, Donor site seroma
