Abstract：
OBJECTIVE: Previous studies have identified the added value of flap fixation in reducing seroma formation and its sequelae after mastectomy. The seroma reduction after mastectomy (SAM)-trial proved that sutures were superior to tissue glue. In this article, we will elaborate on the results of the SAM-trial to provide a clear surgical guideline.
METHODS: All patients in the suture flap fixation cohort from the SAM-trial were analyzed if details regarding flap fixation were available. The most optimal number of sutures was determined using a receiving operator characteristics curve. The incidence of seroma formation between patients receiving the most optimal number of sutures and patients receiving fewer sutures was compared.
RESULTS: The most optimal number of sutures proved to be 15. Patients with ≥15 sutures had a lower incidence of seroma formation at every time frame during follow-up. There was a significant difference at 6 weeks (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.09-8.56), 3 months (OR: 4.62, 95% CI: 1.34-12.92), and 1 year postoperatively (OR: 20.48, 95% CI: 2.18-192.22). Ten days and 6 months postoperatively did not differ significantly.
CONCLUSIONS: Flap fixation in general, but also the surgical technique influences the incidence of seroma formation after mastectomy. Results suggest a minimum of 15 sutures, spaced approximately 3.7 cm apart.
METHODS: All patients in the suture flap fixation cohort from the SAM-trial were analyzed if details regarding flap fixation were available. The most optimal number of sutures was determined using a receiving operator characteristics curve. The incidence of seroma formation between patients receiving the most optimal number of sutures and patients receiving fewer sutures was compared.
RESULTS: The most optimal number of sutures proved to be 15. Patients with ≥15 sutures had a lower incidence of seroma formation at every time frame during follow-up. There was a significant difference at 6 weeks (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.09-8.56), 3 months (OR: 4.62, 95% CI: 1.34-12.92), and 1 year postoperatively (OR: 20.48, 95% CI: 2.18-192.22). Ten days and 6 months postoperatively did not differ significantly.
CONCLUSIONS: Flap fixation in general, but also the surgical technique influences the incidence of seroma formation after mastectomy. Results suggest a minimum of 15 sutures, spaced approximately 3.7 cm apart.
摘要：
目的：先前的研究已经确定了皮瓣固定在减少乳房切除术后血清肿形成及其后遗症方面的附加价值。乳房切除术（SAM）后血清肿减少试验证明，缝线优于组织胶。在这篇文章中,我们将详细阐述SAM试验的结果,以提供明确的手术指南.
方法：分析了SAM试验中缝合皮瓣固定队列中的所有患者是否有关于皮瓣固定的详细信息。使用接收操作员特征曲线确定最佳的缝合线数量。比较了接受最佳数量缝线的患者与接受较少缝线的患者之间血清肿形成的发生率。
结果：被证明的最佳缝合线数量为15。在随访期间，≥15条缝线的患者在每个时间范围内血清肿形成的发生率较低。6周时有显著差异(比值比[OR]:3.05,95%置信区间[CI]:1.09-8.56),3个月（OR：4.62，95%CI：1.34-12.92），术后1年（OR：20.48，95%CI：2.18-192.22）。术后10天和6个月无明显差异。
结论：一般皮瓣固定，而且手术技术也会影响乳房切除术后血清肿形成的发生率。结果表明，至少有15条缝线，间隔约3.7厘米。
方法：分析了SAM试验中缝合皮瓣固定队列中的所有患者是否有关于皮瓣固定的详细信息。使用接收操作员特征曲线确定最佳的缝合线数量。比较了接受最佳数量缝线的患者与接受较少缝线的患者之间血清肿形成的发生率。
结果：被证明的最佳缝合线数量为15。在随访期间，≥15条缝线的患者在每个时间范围内血清肿形成的发生率较低。6周时有显著差异(比值比[OR]:3.05,95%置信区间[CI]:1.09-8.56),3个月（OR：4.62，95%CI：1.34-12.92），术后1年（OR：20.48，95%CI：2.18-192.22）。术后10天和6个月无明显差异。
结论：一般皮瓣固定，而且手术技术也会影响乳房切除术后血清肿形成的发生率。结果表明，至少有15条缝线，间隔约3.7厘米。
