Running barbed suture quilting reduces abdominal drainage in perforator-based breast reconstruction.

Prolonged abdominal drainage after perforator-based breast reconstruction is a common problem that can result in seroma formation, patient morbidity, and increased duration of hospital stay. Abdominal quilting with progressive tension sutures has been effective in reducing abdominal drainage in abdominoplasty patients prompting a change of practice in our unit. We studied consecutive unilateral mastectomy patients undergoing breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap. The initial 27 patients underwent breast reconstruction without any form of abdominal flap plication. The subsequent 26 patients underwent an identical DIEP flap raise procedure after which the abdominal flap was progressively tensioned using a running barbed suture quilting technique. All patients had closed suction drains inserted bilaterally until daily drain output was <40 ml in 2 consecutive days. Primary outcome measures were total volume of abdominal drainage and length of hospital stay. Independent statistical analyses were performed using Welch's t-test. There were no demographic differences between the two groups. A statistically significant decrease in the mean total abdominal drainage was found after quilting (238 ml vs. 528 ml; p = 0.0005). Patients in the quilting group also showed a reduction in mean duration of hospital stay. Quilting of the abdominal flap helps to reduce abdominal drainage not only in abdominoplasty patients but also in patients undergoing breast reconstruction with DIEP flap.

Unrecognized ligamentous instability due to high-energy, low-velocity mechanism of injury.

We report a unique mechanism of injury and illustrate the difficulties of diagnosing purely ligamentous injuries to the cervical spine. To our knowledge, there have been no previous reports of this type of high-energy, low-velocity mechanism of injury. The pattern of injury is also unusual, consisting of anterolisthesis of L4 on L5 with bilateral perched facet joints, atlantoaxial instability and bilateral lower limb fractures. We present a 49-year-old man who experienced a high-energy, low-velocity crush injury that led to extreme hyperflexion of his spine. Standard trauma protocols were carried out, yet atlantoaxial instability was not diagnosed until 3 days post-operatively, when the patient went into respiratory failure due to high spinal cord compression. We fused the C1/2 vertebral bodies using Harm's technique; the patient exhibited no long-term spinal cord dysfunction. Although uncommon, if left undiagnosed or not considered, purely ligamentous injuries to the cervical spine can result in catastrophic complications. Such injuries are an important subgroup to be considered at the time of initial assessment. Furthermore, when managing the multi-trauma patient, clinicians must remember not to overlook the atlantoaxial joint, as high-energy, low-velocity injury to the cervical spine may lead to silent, life-threatening instability that may not be apparent on routine imaging.