A systematic review of flap fixation techniques in reducing seroma formation and its sequelae after mastectomy

Bastelaar, James van; Roozendaal, L. van; Granzier, R.; Beets, Geerard L.; Vissers, Yvonne L. J.

doi:10.1007/s10549-017-4540-x

Cited by 45 publications

(47 citation statements)

References 31 publications

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“…Many factors are held responsible (surgical technique, instruments used for dissection, obliterating the dead space, use of drains) causing seroma formation. The key to reducing seroma formation and its sequelae seems to lie in reduction of the dead space [ 9 ]. Previous retrospective studies have proven that reduction of the dead space after mastectomy is beneficial in seroma formation and that it furthermore reduces complications associated with seroma formation.…”

Section: Discussionmentioning

confidence: 99%

Surgical removal of fibrous axillary seroma pocket and closing of dead space using a lattisimus dorsi flap

Bastelaar

Roozendaal

Meesters-Caberg

2018

Journal of Surgical Case Reports

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Seroma formation after axillary dissection is a common problem in breast cancer surgery. We report the case of a 68-year-old female with breast cancer who underwent a wide local excision and axillary clearance due to stage III breast cancer. Patient received post-operative whole breast irradiation therapy and developed a painful, infected seroma one month after surgery. This was treated with antibiotic therapy after which the infection subsided. One year after surgery patient presented with a painful persisting seroma in the left axilla. We decided to surgically treat the seroma by removing the fibrous seroma capsula and closing of the dead space with a latissimus dorsi flap. Six weeks after surgery, patient was pain and seroma free and was happy with the surgical result. Latissimus dorsi flap harvesting is an ideal way to treat persisting fibrous encapsulated seroma pockets after axillary clearance in the treatment of breast cancer.

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Section: Discussionmentioning

confidence: 99%

Surgical removal of fibrous axillary seroma pocket and closing of dead space using a lattisimus dorsi flap

Bastelaar

Roozendaal

Meesters-Caberg

2018

Journal of Surgical Case Reports

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“…An alternative approach is to reduce the dead space of the cavity. Flap fixation using sutures (quilting) after mastectomy to reduce dead space has been found by some to be beneficial, leading to a decreased volume of seroma . More recently, surgical adhesives such as fibrin sealants have proved effective in promoting hemostasis and tissue sealing .…”

Section: Introductionmentioning

confidence: 99%

“…Flap fixation using sutures (quilting) after mastectomy to reduce dead space has been found by some to be beneficial, leading to a decreased volume of seroma. 5 More recently, surgical adhesives such as fibrin sealants have proved effective in promoting hemostasis and tissue sealing. 6 Animal models have shown that the use of fibrin sealants reduced seroma formation, [7][8][9] and in human studies, fibrin sealants reduced the amount of drainage following mastectomy when used with a drain.…”

Section: Introductionmentioning

confidence: 99%

Increasing the incidence of drain‐free day‐case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom

et al. 2019

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Day‐case mastectomy surgery provides benefits to both patients and hospitals. Key barriers are the use of a drain and the risk of postoperative seroma formation. We introduced the use of a tissue sealant (Artiss) into the surgical site (post‐mastectomy without immediate reconstruction and postaxillary clearance) and evaluated its effect on our practice, particularly day‐case rates. A prospective audit of 177 patients who underwent a simple mastectomy with or without axillary surgery, or axillary node clearance with or without breast‐conserving surgery was conducted at a single surgical center in the UK between November 2015 and November 2016. Artiss was used in all operations and, where appropriate, the drain was omitted to facilitate day‐case surgery. The clinical outcomes were compared between patients undergoing different operations and duration of hospital stay. There was no statistically significant difference between day‐case patients and inpatients in seroma aspiration rates (24.5% and 21.7%, respectively; P = 0.381) or other complications (22.4% and 16.1%, respectively; P = 0.106). The day‐case mastectomy rate increased from 3.9% in the first quarter to 45.5% in the final quarter, which was a significant increase reaching well beyond the national target. The use of Artiss enabled us to increase the drain‐free day‐case surgery rates over a 1‐year period, exceeding the 30% target recommended by the British Association of Day Surgery. We did not observe any increase in patient morbidity, and the change was cost‐effective. We have now implemented the routine use of Artiss in women undergoing simple mastectomy with or without axillary surgery and stand‐alone axillary node clearances as part of enhanced recovery clinical pathways.

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“…Various attempts have been proposed in order to reduce seroma formation, such as external compression dressing [37], drainage placement [38][39][40][41], usage of fibrin glue [42,43], flap fixation and obliteration of the dead space [44], unfortunately with inconsistent results.…”

Section: Discussionmentioning

confidence: 99%

Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation

et al. 2019

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Background: Breast cancer is the most frequent neoplasm in women. Axillary lymph nodes dissection represents the treatment of choice in locally advanced breast cancer for prognostic and curative purposes. Seroma formation, an abnormal collection of fluid in the dead space of the axilla, is described in Literature with a wide range of incidence (3-85%). It is a source of significant morbidity and discomfort. The aim of the study is to compare the different haemostasis devices used in breast surgery, investigating the eventual superiority of an instrument among the others in terms of intraoperative and postoperative outcome, especially of seroma formation. Methods: Clinical cases of female patients undergone axillary lymph nodes dissection for local advanced breast cancer between January 2013 and July 2017 at the Surgery Unit of University of Campania "Luigi Vanvitelli" were retrospectively reviewed. Patients were divided into four groups, according to device utilized during surgery: Electrocautery, Harmonic Scalpel, LigaSure and Thunderbeat. All patients underwent II level axillary lymph nodes dissection associated to radical mastectomy or quadrantectomy. Results: One hundred consecutives patients were enrolled in the study. Intra-operative blood loss resulted statistically significant different (P < 0,01) between the Electrocautery group (94,7 ml) and the Thunderbeat group (57,2 ml), while the Harmonic Scalpel group and the Ligasure group, despite presented a lower amount of blood loss, did not differ significantly. Drainage volume resulted significantly lower (P = 0,002) in the comparison between the Electrocautery group and the Thunderbeat group; the Ligasure group and Harmonic Scapel group showed no difference between them and Electrocautery group. About the seroma formation, the Electrocautery group resulted affected by the highest seroma formation rate (64%). Seroma incidence in Harmonic Scalpel group was 24%, in Ligasure group was 44%, while Thunderbeat group showed the lowest presentation of seroma with 16%. Conclusions: In patients affected by breast cancer requiring axillary lymphnodes dissection, the use of advanced hemostasis devices is highly desirable. Among the non-traditional tools, Thunderbeat resulted to be superior in terms of reduction of intra-operative blood loss and post-operative drainage output, moreover associated to a substantial reduction of postoperative seroma incidence.

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A systematic review of flap fixation techniques in reducing seroma formation and its sequelae after mastectomy

Cited by 45 publications

References 31 publications

Surgical removal of fibrous axillary seroma pocket and closing of dead space using a lattisimus dorsi flap

Surgical removal of fibrous axillary seroma pocket and closing of dead space using a lattisimus dorsi flap

Increasing the incidence of drain‐free day‐case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom

Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation

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