Seroma Reduction: Using Barbed Sutures (V-Loc) to Close Latissimus Dorsi Donor Sites

787 Dear Editor, We note with interest the recent article by Thekkinkattil et al. [1] studying the feasibility of the barbed suture (BS) (V-Loc) to close latissimus dorsi donor sites (LDD). Their seroma rates were fairly high (33% in the BS group) compared with the recently published literature [2,3], although they did not demonstrate any statistical difference with traditional interrupted quilting. The higher than expected seroma rates may well reflect the fact that a significant number of their patients underwent complete autologous breast reconstruction (29 out of 30) in the immediate reconstruction group; however, this was not clearly elucidated. As for the delayed reconstruction patients, this same critical point was again not clearly highlighted and no firm conclusions can be made. Complete autologous breast reconstruction with latissimus dorsi flaps (LD) tends to be reserved for patients with smaller natural breasts, if harvested in a non-extended manner. Extended LD flaps, on the other hand, require a much more extensive dissection by virtue of the technique, in order to increase the flap size. Hence, it is unsurprising that the seroma rates were increased with this technique [4]. Despite this omission of relevant information, Thekkinkattil et al. [1] have commendably demonstrated that the barbed suture is a very viable alternative to traditional quilting methods when used to close LDD. We recently reviewed our own LDD data in our unit from January 2005 till the present, having started using the V-Loc suture since January 2010. Before 2010, 31 patients underwent conventional closure of LDD with interrupted quilting sutures using 2.0 polyglactin (Vicryl) sutures (Ethicon, Johnston & Johnston, Livingston, Scotland) LETTER