Improved Perioperative Seroma and Complication Rates Following the Application of a 2-Layer Negative Pressure Wound Ther
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ORIGINAL ARTICLE – MELANOMA
Improved Perioperative Seroma and Complication Rates Following the Application of a 2-Layer Negative Pressure Wound Therapy System After Inguinal Lymphadenectomy for Metastatic Cutaneous Melanoma Marc D. Moncrieff, MD FRCS(Plast.)1,2 Martin J. Heaton, MD FRCS(Plast.)1
, Riti A. Sharma, MBBS1,2, Esther Gathura, FRCS(Plast.)1, and
1
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; 2Norwich Medical School (University of East Anglia), Norwich, UK
ABSTRACT Background. Perioperative complications following inguinal lymphadenectomy, including seroma formation, are frequent. We have employed a 2-layer negative pressure wound therapy (2-LNPWT) as a method to reduce seroma rate and perioperative complications. We present the outcome of our initial experience with 2-LNPWT and compare the outcomes of its use with traditional closed suction drains (CSDs). Materials and methods. A non-randomised retrospective case–control series was analysed. Surgeons performing inguinal lymphadenectomy for metastatic cutaneous melanoma utilised either the 2-LNPWT therapy or traditional CSDs according to their practice preference. Results. The study included 111 patients. The cohorts were well matched for gender, disease burden, body mass index and comorbidities. The 2-LNPWT technique was associated with significantly better postoperative outcomes than CSD, in terms of incidence of seroma formation (26.9% vs 49.4%; p \ 0.03), period of drainage (15 days vs 20 days; p = 0.005) and return to theatre rate (0% vs 15.3%; p = 0.03). The overall seroma rate was 44.1%. The only significant association with seroma initiation was the type of drainage system used (2-LNPWT 31.2% vs CSD 58.3%; p \ 0.03; OR 3.0). The method of drainage did not
The Author(s) 2020 First Received: 27 January 2020 M. D. Moncrieff, MD FRCS(Plast.) e-mail: [email protected]
alter the course of an established seroma. There was no significant difference in overall or disease-specific survival detected between the 2 groups. Conclusion. This retrospective non-randomised case control study has demonstrated the safe use of a novel application of negative pressure wound therapy that significantly reduced the incidence of seroma formation and postoperative complication rate for inguinal lymphadenectomy for melanoma.
Inguinal lymphadenectomy is the current standard of care in the management of macroscopic lymph node metastasis. Postoperative complications following inguinal dissection commonly include seromas, wound infection, impaired wound healing, cellulitis and skin necrosis.1,2 Seroma formation accounts for 32–80% of presentations postoperatively.2 These patients routinely return to outpatient clinics for aspiration and resolution of the problem is often protracted. As a direct result of the repeated seroma aspirations and drainage, subsequent complications such as infection may follow. This often leads to unscheduled returns to theatre for a further surgical proc
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