Decrease Wound Dehiscence with Closed-Suction Drains: A Single Facilities Experience in An Overweight Patient Population

Author(s):
Chandler Hinson; Hayden Alford; Wilson Huett; Melody Zeidan; Ronald Brooks

Background:

With trends of obesity increasing within the United States, plastic surgeons are being challenged at resecting larger weights from larger patients. Published literature has demonstrated the association between BMI and resection weight to post-surgical complications; however, these relationships are unclear in a population that is primarily overweight or obese. The purpose of this study is to determine if closed-suction drains decrease the rate of wound dehiscence after breast reduction in a patient population with a high body mass index.

Methods:

We reviewed electronic medical records to identify a cohort of 182 patients who received bilateral reduction mammoplasties at our single institution over a 4-year period. A multivariable analysis was conducted to assess the association between closed-suction drains and wound dehiscence.

 

Results:

Within the study cohort, 95% of the patients were either overweight or obese. Wound dehiscence was the most common complication, occurring in 36.36% of the patients. No patients developed hematomas and only one patient developed a seroma. Results from the multivariable analysis are shown in Table 1.

The results from our analysis challenge current recommendations by demonstrating a protective association in using closed-suction drains in preventing wound dehiscence. In our facility, some surgeons consistently use drains while others are more selective in their use of drains. Decisions to use drains are based on resection volumes and nipple elevation. A possible explanation for the protective factor in using drains in preventing wound dehiscence is the reduction in postoperative edema immediately after surgery. While our facility operates on a patient population with a high prevalence of obesity, the larger reductions require greater resections, leaving larger dead spaces for filling by postoperative edema. Larger resections require longer operative times, increasing the inflammatory response leading to postoperative swelling.

Conclusions:

As the prevalence of obesity rises, plastic surgeons will be resecting larger weights from larger patients. The results of this studies challenge the current literature about the use of closed-suction drains after surgery, suggesting that drains can be a protective factor in preventing wound dehiscence by allowing drainage of the postoperative edema. We believe this finding can help provide guidance to plastic surgeons about limiting common postoperative complications in larger patients receiving a breast reduction.