A prospective audit of the use of a buttress suture to reduce seroma formation following axillary node dissection without drains

Schuijtvlot, M.; Sahu, A.; Cawthorn, S.

doi:10.1054/brst.2001.0366

Cited by 41 publications

(26 citation statements)

References 10 publications

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“…As such, tissue ligation around the axillary vessels during dissection may decrease the amount of postoperative discharge compared with transection with a knife or diathermy (23). The number of lymph nodes remains a controversial factor because some authors declared obvious seroma formation, whereas others did not observe a significant relation (10,11,(24)(25)(26)(27)(28)(29). However, the number of lymph nodes removed during axillary dissection was found to be an independent risk factor for the duration of draining in the present study.…”

Section: Discussioncontrasting

confidence: 72%

“…We think that the consensus should begin by finding factors that affect DIT. Age, remains a controversial factor because some studies revealed apparent seroma formation, whereas others did not show a significant link, like in our study (10,11,(24)(25)(26)(27)(28)(29). In our clinical practice, we used closed suction drainage systems that are removed from skin flaps following from axilla.…”

Section: Discussionmentioning

confidence: 63%

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Factors that Affect Drain Indwelling Time after Breast Cancer Surgery

et al. 2016

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Objective:The most common procedure to prevent seroma formation, a common complication after breast and axillary surgery, is to use prophylactic surgical drains. Ongoing discussions continue regarding the ideal time for removing drains after surgical procedures. In this study, we aimed to investigate factors that affect drain indwelling time (DIT). Materials and Methods: From 2014 to 2015, a total of 91 consecutive patients with breast cancer were included in the study. The demographic characteristics of the patients, treatment methods, histopathologic features of the tumor, size of removed breast tissue (BS), tumor size (TS), number of totally removed lymph nodes (TLN), and metastatic lymph nodes (MLN), whether they had neoadjuvant chemotherapy, and the DIT were retrospectively recorded from the hospital database. Results: The mean age of the patients was 48.9 years, and the mean DIT was 4.8 days. The mean size of breast removed was 17.3 cm and tumor size was 4.7 cm, and the mean number of metastatic lymph nodes was 3.3, and mean total number of lymph nodes was 14.1. Patients who had neoadjuvant chemotherahpy had longer DIT. There was a positive correlation between the BS, TS, TLN, MLN, length of hospital stay, and DIT. Linear regresion analysis revealed that the BS, TLN, and history of neoadjuvant chemotherahpy were independent risk factors for DIT. Conclusion: DIT primarily depends on BS, TLN, and history of neoadjuvant chemotherahpy. A policy for the management of removing drains to prevent seroma formation should thus be individualized.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 63%

Factors that Affect Drain Indwelling Time after Breast Cancer Surgery

et al. 2016

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“…Zavotsky et al practiced drain insertion vs no drain for reducing seroma formation [14], Use of electrocautery vs scalpel was advocated by Porter et al [1], Immediate reconstruction vs radical mastectomy alone and Buttress suture vs non-buttress suture were some techniques practiced earlier to reduce the axillary drainage [15,16]. None of these studies showed any significant reduction in cumulative drainage after axillary dissection for breast surgery.…”

Section: Discussionmentioning

confidence: 99%

Use of Ultrasonic Shears in Patients with Breast Cancer Undergoing Axillary Dissection—A Pilot Study

Ramesh

Manjunath

Shivakumar

et al. 2011

Indian J Surg Oncol

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Patients with breast cancer and positive sentinel node biopsy usually require axillary dissection. Different instruments are used for axillary dissection like regular scalpel,monopolar cautery, bipolar cautery etc. All these instruments are having its advantages and disadvantages. Our dept did a pilot study to know the efficacy of ultrasonic shears over cautery for axillary dissection. Parameters considered were cumulative drain amount, number of days with the drain and number of lymphnodes harvested. Ultrasonic shear machine delivers precisely directed mechanical energy with an ultrasonic vibrating blade.A single device dissects, cuts, grasps, spot coagulates. This machine was used for doing axillary dissection in one group and regular cautery in the other group. Study period was from April 2011 to June 2011 at Dept of Surgical Oncology, St Johns Hospital, Bangalore. Nine people in the ultrasonic shear group and 11 people in the cautery group were included in the pilot study. No significant difference were noticed in the cumulative drain amount, number of days with the drain, and number of lymphnodes harvested in both the groups. Axillary dissection using ultrasonic shears do not show any significant difference in the cumulative drain amount, number of days with the drain, and number of lymphnodes harvested. These are the findings of the pilot study, further prospective randomized studies are required for substantiating the findings.

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“…In 1953, Keyes et al [31] used through and through sutures to attach the skin flaps to the chest wall. Besides these techniques, suturing of flaps with subcutaneous tissue, [32] avoiding use of axillary drains following breast conservation therapy, [33] and obliterating axillary dead space by muscle approximation have all been tried for reducing seroma formation. Coveney et al compared suturing skin flaps to underlying muscle with conventional skin closure and observed a lower incidence of seroma formation in the flap suture group, although flap suturing did add to total operating time.…”

Section: Management Of Dead Spacementioning

confidence: 99%

Seroma Formation in Cancer Breast Surgery

Sitaram¹,

Hemanthi²

2015

jemds

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Post-operative breast surgery for malignancy has a common side effect of seromas, whose formation and drainage requires a special attention to prevent as much as possible and as early as possible to avoid morbidity. How best we can prevent the dead space is the problem. In this study a review of various methods adopted all over the world is reviewed including early discharge of the patient with drain. It is always preferable to remove the drain when the collection of serum is less than 25ml in 24 hours the chance of re accumulation of fluid is less likely. INTRODUCTION: Carcinoma breast has remained the second leading cause of cancer death among women worldwide over the past three decades [1] and contributes significantly to cancer surgical load. Surgical treatment for breast cancer includes breast conservation therapy and mastectomy with or without axillary dissection depending on disease stage. Seroma formation is the most frequent postoperative Side effect seen after mastectomy and axillary surgery with an incidence of 3% to 85%. OBSERVATIONS: TYPE OF SURGERY: Surgical treatment for breast cancer has undergone a paradigm shift from Halstead's radical mastectomy to breast conservation. It has been demonstrated that radical mastectomy increases seroma formation compared with that of simple mastectomy, but the association is inconclusive when radical mastectomy is compared with modified radical mastectomy (MRM). SURGICAL DEVICES: Various electro-mechanical devices are used during surgery to reduce blood loss and operating time. These include electrocautery, laser scalpel, argon diathermy, ultrasonic scalpel, ultrasonic scissors, and vessel sealing systems. All of these devices have been investigated in an effort to reduce seroma formation. Randomized trials have shown that the use of electrocautery for dissecting flaps is significantly associated with increased seroma formation when compared to that of scalpel dissection. However, no individual study has shown a significant effect on seroma formation with or without the use of a laser scalpel, argon diathermy, or an ultrasonic scalpel. Ultrasonic scissors resulted in reduced seroma formation in a randomized controlled trial comparing level I and II axillary dissection using either ultrasound scissors or surgical scissors with ligation. MANAGEMENT OF DEAD SPACE: MECHANICAL DEVICES: Different techniques have been employed to obliterate the dead space (under flaps and the axilla) to reduce seroma formation. CHEMICAL: Fibrin glue.light activated fibrin sealant, and transdermal photo-polymerized adhesive reduce seroma formation after mastectomy in animal models. Use of a fibrinolysis inhibitor was based on the hypothesis that fibrinolytic activity in serum and lymph might contribute to fluid accumulation. SHOULDER MOVEMENT: Shoulder dysfunction is a common complication of mastectomy,and it is necessary to mobilize the shoulder early to prevent this complication. It was thought that early shoulder mobilization led to increased seroma formation and this hypot...

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A prospective audit of the use of a buttress suture to reduce seroma formation following axillary node dissection without drains

Cited by 41 publications

References 10 publications

Factors that Affect Drain Indwelling Time after Breast Cancer Surgery

Factors that Affect Drain Indwelling Time after Breast Cancer Surgery

Use of Ultrasonic Shears in Patients with Breast Cancer Undergoing Axillary Dissection—A Pilot Study

Seroma Formation in Cancer Breast Surgery

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